Apuntes del torax en ingles (preguntas) PDF

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Apuntes para practicar vocabulario de anatomia y casos clinicos en ingles ,sobre el Torax y región toracica, anatomia humana, minni netter de anatomia...

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SECTION 3 Thorax Question 1 A 2-year-old girl is suspected of aspirating the eye from one of her small stuffed animals and she is seen in the emergency department. Her mother reports consistent coughing but no displays of distress or pain. In which area of the airway would you expect to hear diminished breath sounds? A. B. C. D. E.

Both the left and right lobe The carina The left inferior lobe The right inferior lobe The right superior lobe

Answer: D A. Both the left and right lobe Explanation: The eye does not seem to be causing severe distress to the child, pointing to the fact that the airway is not completely occluded. The eye is more likely lodged somewhere after the bifurcation of the primary bronchi. B. The carina Explanation: The carina is the structure at the division of the primary bronchi. Since the child does not seem to be in respiratory distress, it is more likely that the eye has lodged further down the airway into a bronchus of one lung. C. The left inferior lobe Explanation: The left mainstem bronchus is anatomically more horizontal than the right mainstem bronchus because of the presence of the heart on the left side of the thorax. The angle of the left bronchus makes it less likely for aspirated objects to lodge in the left lung. D. The right inferior lobe Explanation: The right inferior lobe is the most likely location of diminished breath sounds because the right mainstem bronchus is more vertical compared to the left, allowing gravity to take effect and lodge the object in the lowest division of the bronchi. E. The right superior lobe Explanation: Although the right lung is more prone to aspirating objects than the left, the superior lobe would be less likely to be the location of diminished breath sounds because

2 the vertical drop of the right mainstem bronchus allows gravity to more often lodge the object in the lower lobe.

Question 2 A 35-year-old man goes to his family doctor due to tingling in the fingers of his left hand and he complains that his left hand seems to frequently feel cooler than his right. He is a sheet-rock worker and he frequently works with his arms overhead for long periods of time. He tells his doctor that his left hand gets much worse after many hours of overhead work. You suspect thoracic outlet syndrome and hypothesize that an artery is being compressed as it exits the thorax. Therefore, the overhead work coupled with reduced vascular supply could cause the tingling in the hand and a reduction in skin temperature of the left hand. Which of the following is most likely compressed and therefore causing the symptoms in this patient? A. B. C. D. E.

Subclavian artery Radial artery Superior vena cava Celiac trunk Lateral thoracic artery

Answer: A A. Subclavian artery Explanation: The subclavian artery exits the superior thoracic outlet and passes between the anterior and middle scalene muscles as it continues out to supply blood to the arm. It is easily compressed in the scalene hiatus, which can cause the vascular symptoms experienced in this patient. B. Radial artery Explanation: The radial artery branches from the brachial artery near the antecubital fossa and therefore does not pass through the thoracic outlet and is not directly affected by the compression or injury that causes this syndrome. C. Superior vena cava Explanation: The superior vena cava is formed by the left and right brachiocephalic veins, which subsequently drain the subclavian veins that pass into the thorax through the thoracic outlet. The superior vena cava is located within the thoracic cavity and does not pass through the outlet. D. Celiac trunk Explanation: The celiac trunk is a branch off the abdominal descending aorta that has already exited the thoracic cavity inferiorly through the aortic hiatus. It does not supply blood to the upper limbs, nor does it exit the superior thoracic outlet.

3 E. Lateral thoracic artery Explanation: The lateral thoracic artery branches off the axillary artery, which has already exited the thoracic outlet as the subclavian artery.

Question 3 A 37-year-old woman is diagnosed with a lobular carcinoma of her right breast located in the superomedial aspect, close to the midline. Based on the staging and aggressiveness of her cancer, a lymph node biopsy has been indicated. Which of the following draining lymph nodes is located closest to the cancer and therefore needs to be biopsied? A. B. C. D. E.

Axillary lymph nodes Subscapular lymph nodes Apical axillary lymph nodes Humeral (lateral) lymph nodes Parasternal lymph nodes

Answer: E A. Axillary lymph nodes Explanation: The axillary lymph nodes drain more than 75% of the breast, including the humeral (lateral), central, subscapular (posterior), pectoral (anterior), and apical lymph nodes. However, the medial aspect of the breast is drained by the parasternal lymph nodes and would be most near to the cancer in this patient. B. Subscapular lymph nodes Explanation: The subscapular (posterior) lymph nodes are a part of the axillary lymph node group but they receive little direct lymph flow from the breast. C. Apical axillary lymph nodes Explanation: All flow from the axillary lymph nodes eventually travel through the apical axillary nodes. Considering these nodes are upstream from the other axillary lymph nodes, this would not be a good node to biopsy unless the ones closer to the breast were already shown to contain cancerous cells. D. Humeral (lateral) lymph nodes Explanation: The humeral (lateral) lymph nodes are a part of the axillary lymph nodes and they drain the majority of lymph from the upper limb and only a small portion of the lateral aspect of the breast. This would not be a good choice to biopsy first. E. Parasternal lymph nodes Explanation: The parasternal lymph nodes drain lymph from the medial breast. These nodes should certainly be biopsied in this patient.

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Question 4 A 56-year-old man with congestive heart failure presents to the emergency department because of a rusty red–colored hemoptysis, or blood in the sputum. The color is caused by the phagocytosis of leaked erythrocytes by alveolar macrophages, and the hemoptysis associated with congestive heart failure is often attributed to increased intravascular pressure. Which of the following vessels are most likely responsible for the leakage of erythrocytes, causing blood in the sputum of this patient? A. B. C. D. E.

Pulmonary veins Pulmonary capillaries Pulmonary trunk Pulmonary arteries Pulmonary lymphatics

Answer: B A. Pulmonary veins Explanation: The pulmonary veins are large vessels that drain the newly oxygenated blood from the pulmonary venules and pulmonary capillaries and return that blood directly to the left atrium. These vessels are not normally situated near the alveolar surface, are not as leaky as pulmonary capillaries, and are not likely to be the ones responsible for the leakage in hemoptysis. B. Pulmonary capillaries Explanation: The pulmonary capillaries are located near the alveolar surface of the lung, as they are the location of gas exchange. Increased intravascular pressure due to congestive heart failure would cause these normally leaky vessels to leak erythrocytes near the surface of the airway, which can easily be coughed up. C. Pulmonary trunk Explanation: The pulmonary trunk branches directly from the heart and does not enter the lungs; thus it cannot be causing the hemoptysis. D. Pulmonary arteries Explanation: The pulmonary arteries are large vessels that carry deoxygenated blood away from the heart into the lungs. Once in the lung tissue, they branch extensively into the pulmonary arterioles and capillaries, which are closer to the airway surface and more delicate than the arteries themselves. E. Pulmonary lymphatics Explanation: The lymphatic system of the lungs does not normally contain any erythrocytes.

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Question 5 A 62-year-old man with mitral valve insufficiency is taken in for an echocardiogram to image his heart. Flow sensors on the echocardiogram equipment can pick up the acceleration of flow past the insufficient mitral valve. Which of the following chambers of the heart will the regurgitating blood reenter? A. B. C. D. E.

Right atrium during systole Right atrium during diastole Left atrium during systole Left atrium during diastole Left ventricle during diastole

Answer: C A. Right atrium during systole Explanation: The right atrium and right ventricle are connected by the tricuspid valve, not the bicuspid (mitral) valve. B. Right atrium during diastole Explanation: The right atrium and right ventricle are connected by the tricuspid valve, not the bicuspid (mitral) valve. C. Left atrium during systole Explanation: During systole, the left ventricle contracts, the mitral valve closes, and blood is pushed into one of the outflow tracts of the heart. If the mitral valve is insufficient, the high pressure of blood during systole will leak through the weakly closed mitral valve into the left atrium from which it came. D. Left atrium during diastole Explanation: The mitral valve lies between the left atrium and left ventricle; however, insufficiency of the valve would be evident only during systole, when the mitral valve is supposed to be closed. During diastole, the mitral valve is open, allowing blood to exit the left atrium and fill the left ventricle. E. Left ventricle during diastole Explanation: During diastole, the left ventricle is being filled with blood from the left atrium that comes through the open mitral valve. Mitral valve insufficiency occurs during systole, when the valve does not close properly and blood leaks from the left ventricle back into the left atrium.

Question 6

6 A 40-year-old man with a long-term history of heavy alcohol consumption consults his physician because of persistent malaise and low-grade fever. The physician notes mild jaundice and hepatomegaly. The diagnosis is alcoholic hepatitis. To determine the presence or absence of cirrhosis, a liver biopsy is performed. Because the patient is thrombocytopenic, a transjugular biopsy procedure is used instead of percutaneous biopsy to minimize potentially dangerous bleeding. A catheter is inserted into the internal jugular vein and advanced into the heart via the superior vena cava. Through which aperture should the catheter leave the heart to reach the liver by the most direct route? A. Aortic valve B. Mitral valve C. Inferior vena cava D. Pulmonary valve E. Tricuspid valve Answer: C A. Aortic valve Explanation: It would not be possible for a catheter to pass from the superior vena cava to the aortic valve via the normal circulatory pathway because it would first have to leave the right ventricle via the pulmonary valve and would be brought to a halt in the pulmonary capillary bed before it could return to the left side of the heart and reach the aortic valve. B. Mitral valve Explanation: Blood does not leave the heart via the mitral valve. It passes from the left atrium to the left ventricle via this aperture. A catheter introduced into the right atrium via the superior vena cava could not reach the mitral valve because it would first be brought to a halt in the pulmonary capillary bed. C. Inferior vena cava (IVC) Explanation: From the superior vena cava (SVC) the catheter would reach the liver by passing through the right atrium into the IVC and then into a hepatic vein. Because the SVC, right atrium, and IVC are vertically aligned with one another, this represents a direct, uncomplicated approach to the liver. D. Pulmonary valve Explanation: Leaving the heart via the pulmonary valve would bring the catheter to a halt in the pulmonary capillary bed. E. Tricuspid valve Explanation: Blood does not leave the heart via the tricuspid valve. It passes from the right atrium to the right ventricle via this aperture. A catheter introduced into the right atrium via the superior vena cava could not reach the liver by going through the tricuspid valve because it would terminate into the right ventricle.

7 Question 7 In the course of performing an esophageal resection for carcinoma, a surgeon makes a radially oriented incision in the left diaphragm. This incision extends from the esophageal hiatus laterally to the costal margin. The incision in the diaphragm is repaired with heavy sutures at the conclusion of the operation. Postoperative examination reveals poor inspiratory effort on the left side. Radiographs taken at full inspiration and full expiration show that the left hemidiaphragm is high and is not moving with respiration. Which of the following is the most likely diagnosis? A. Injury to the left vagus nerve B. Injury to the left recurrent laryngeal nerve C. Injury to the left thoracodorsal nerve D. Injury to the left phrenic nerve E. Injury to the left long thoracic nerve Answer: D A. Injury to the left vagus nerve Explanation: The left vagus nerve passes through the esophageal hiatus and can be injured during surgery in this region. However, injury to the left vagus nerve would not cause paralysis of the left hemidiaphragm, and if the right vagus nerve were left intact, injury to the left vagus nerve would have no adverse sequelae. B. Injury to the left recurrent laryngeal nerve Explanation: This branch of the vagus nerve passes around the aorta and then ascends into the neck to innervate the larynx. It is not encountered during the dissection in the area described, and injury would result in hoarseness. C. Injury to the left thoracodorsal nerve Explanation: This nerve runs along the lateral chest wall and is not encountered during the dissection described. The injury described is characteristic of division of the left phrenic nerve. This nerve courses on the surface of the diaphragm and may be divided if an incision in the diaphragm is not created carefully so as to avoid it. Because the left phrenic nerve innervates the diaphragm, the left hemidiaphragm would be high and paralyzed. D. Injury to the left phrenic nerve Explanation: The injury described is characteristic of a division of the left phrenic nerve. The left phrenic nerve descends along the pericardium and then courses on the surface of the diaphragm. It may be divided if an incision in the diaphragm is not created carefully to avoid it. Because the left phrenic nerve innervates the diaphragm, injury would leave the left hemidiaphragm high and paralyzed (see Plate 195). E. Injury to the left long thoracic nerve

8 Explanation: This nerve runs along the chest wall. Injury results in weakness of the shoulder muscles with a characteristic winged scapula deformity. The nerve is not at risk during surgery in this region.

Question 8 You are asked to place a chest tube (tube thoracostomy) to drain a traumatic hemopneumothorax in a 45-year-old man. You decide to pass the tube into the chest through the fifth intercostal space in the anterior axillary line. To minimize the risk of damage to the intercostal neurovascular bundle, care must be taken when inserting the trocar before passing the tube. What is the most favorable position to pass the trocar for this procedure? A. As far laterally as possible B. Just over the sixth rib C. Just under the fifth rib D. Through the fourth rather than the fifth interspace E. Through the sixth rather than the fifth interspace Answer: B A. As far laterally as possible Explanation: The neurovascular bundle runs in a groove along the inferior aspect of each rib. Entering the chest just above a rib minimizes the chance of injury to the neurovascular bundle by maximizing the distance between the entry site and the structures of concern. There is no advantage to entering the chest more laterally than the site described. B. Just over the sixth rib Explanation: The neurovascular bundle runs in a groove along the inferior aspect of each rib. Entering the chest just above a rib minimizes the chance of injury to the neurovascular bundle by maximizing the distance between the entry site and the structures of concern. C. Just under the fifth rib Explanation: The neurovascular bundle runs in a groove along the inferior aspect of each rib. Entering the chest just over, rather than under, a rib minimizes the chance of injury to the neurovascular bundle by maximizing the distance between the entry site and the structures of concern. D. Through the fourth rather than the fifth interspace Explanation: The neurovascular bundle runs in a groove along the inferior aspect of each rib. Entering the chest just above a rib minimizes the chance of injury to the neurovascular bundle by maximizing the distance between the entry site and the structures of concern. This is no different between fourth and fifth interspaces. E. Through the sixth rather than the fifth interspace

9 Explanation: The neurovascular bundle runs in a groove along the inferior aspect of each rib. Entering the chest just above a rib minimizes the chance of injury to the neurovascular bundle by maximizing the distance between the entry site and the structures of concern. This is no different between fifth and sixth interspaces.

Question 9 A 22-year-old woman consults her obstetrics and gynecology physician about a suspected pregnancy. She has noticed some swelling of her breasts that has caused some slight discomfort. Her breasts are bilaterally enlarged with no masses, and some darkening of the areolas is noted. She has also performed a home pregnancy test, which she reports as positive. A test at the office confirms this result, and she is estimated to be 5 weeks pregnant by the patient’s self-reported last menstrual period. What is the most likely reason for the swelling in her breasts? A. Duct hypertrophy B. Gland hyperplasia C. Infiltrating ductal carcinoma D. Mastitis E. Phyllodes tumor Answer: B A. Duct hypertrophy Explanation: Hypertrophy and hyperplasia of the ducts may occur in males, in whom it is known as gynecomastia, but this is not usually a feature of female lactational change, which mainly involves the acini. B. Gland hyperplasia Explanation: Prolactin and estrogen cause profound and prolonged hyperplasia of the breast acini. C. Infiltrating ductal carcinoma Explanation: Breast cancer does grow rapidly in pregnant women, but it usually forms a distinct mass and would rarely cause bilateral, symmetric enlargement. D. Mastitis Explanation: While common in pregnancy, mastitis is usually seen postpartum. E. Phyllodes tumor Explanation: A phyllodes tumor may cause rapid breast enlargement, but it is usually a distinct mass that involves only one breast and is most common in women in their 60s....