Term
| What are the possible areas of impingement to cause Thoracic Outlet Syndrome? |
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Definition
Supraclavicular impingement or Scalene Anticus Syndrome
Costoclavicular Impingement
Cervical Rib Syndrome
Infraclavicular Impingement |
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Term
| How can you test for Scalene Anticus Syndrome? |
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Definition
| By turning head outward and then extending neck to cause muscles to contract and cause compression |
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Term
| Where does Scalene Anticus Syndrome occur? |
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Definition
| Subclavian artery and brachial plexus pass between heads of scalenus medius and anticus |
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Term
| How do you test for costoclavicular impingement? |
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Definition
| downward traction of affected arm will cause the bundle to be pulled down further over 1st rib to cause symptoms |
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Term
| Where does costoclavicular impingement occur? |
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Definition
| the neurovascular bundle passes between the first rib and the clavicle |
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Term
| How do you test for cervical rib syndrome? |
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Definition
| turn head inward and extend neck to cause contraction |
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Term
| where does cervical rib syndrome occur? |
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Definition
| compression on brachial plexus and/or subclavian artery caused by bone growth |
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Term
| how do you test for infraclavicular impingement? |
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Definition
| passive abduction, external rotation and extension of the arm |
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Term
| Where does infraclavicular impingement occur? |
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Definition
| in the neurovascular bundle that passes under the coracoid process |
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Term
| How is the Adsons test performed? |
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Definition
| locate the radial pulse. patient rotates head toward the tested arm and lets head tilt backward while the examiner extends the arm. Positive if disappearance of pulse |
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Term
| How does the Roos stress work? |
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Definition
| patient brings their arms up and opens and closes their hands slowly for 3 minutes; positive test indicated by pain, heaviness ,or profound arm weakness |
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Term
| How does the Costoclavicular test work? |
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Definition
| locate the radial pulse and draw the patient's shoulder down and back as the patient lifts their chest; positive test is absence of pulse |
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Term
| What is the thoracic outlet? |
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Definition
| the space bounded by the first rib and clavicle below, the pectoral tendon and coracoid process above, and the anterior and middle scalene muscles medially and laterally |
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Term
| How does Thoracic Outlet Syndrome occur? |
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Definition
| narrowing of the outlet, putting compression on either the brachial plexus or the subclavian artery |
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Term
| What is common with thoracic outlet syndrome? |
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Definition
Pain: in arms and hands, sharp, burning, or aching; can involve only part of the hand; also in the side of neck
decoloration
weakness
tingling |
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Term
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Definition
| presentation is dependent on whether the compression is primarily VASCULAR, NEUROGENIC, or BOTH |
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Term
| What does a vascular presentation look like? |
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Definition
pure vascular is rare
can involve the subclavian artery or vein
young patients who perform vigorous overhead arm activity |
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Term
| With venous obstruction (thrombosis), patients may present with what? |
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Definition
| upper extremity swelling, venous distention, or diffuse arm or hand pain |
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Term
| With arterial obstruction, patients may report what? |
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Definition
| color changes of their affected upper extremity, claudication or diffuse arm or hand pain |
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Term
| Neurogenic TOS involves what? |
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Definition
| compression of the brachial plexus |
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Term
| What does a neurogenic presentation of TOS look like? |
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Definition
pure neurogenic is rare
painless atrophy of the intrinsic muscles
sensory loss or paresthesias
pain
overhead arm activities |
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Term
What is the survival rate for infants at the following ages:
22 weeks
23 weeks
24 weeks
25 weeks |
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Definition
22 weeks: 5%
23 weeks: 25%
24 weeks:56%
25 weeks:75% |
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Term
What are the survival rates by birth weight for infants:
<500g
500-750 g
750-1000g |
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Definition
<500: 17%
500-750: 56%
750-1000: 85% |
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Term
| Unless conception is through in vitro fertilization, how accurate are the survival rates? |
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Definition
+/- 1 to 2 weeks
+/- 15 to 20 % |
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Term
| What role do parents play in decisions about resuscitation? |
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Definition
| Parents are the appropriate surrogate decision makers and play the primary role in determining the goals of care delivered to the newborn |
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Term
| there is no ethical distinction between... |
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Definition
| withholding or withdrawing support |
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Term
| When may it not be ethical to initiate resuscitation? |
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Definition
confirmed ges. age <23 weeks or weigh <400g
anencephaly
confirmed Trisomy 13 or 18 syndrome |
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Term
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Definition
trisomy 13; 1/12,000 births
mean survival of 95 days
clinical triad
facial deformities
non-cyanotic heart defects
intrauterine growth retardation |
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Term
| What is patau syndrome associated with? |
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Definition
| advanced age of the parents |
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Term
| What is the clinical triad of patau syndrome? |
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Definition
| microphthalmia (eye dev. disorder), cleft lip, polydactyly |
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Term
| What is Edwards Syndrome? |
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Definition
an extra chromosome
not inherited; random events during the formation of eggs and sperm
error in cell development
80% of newborns affected are female |
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Term
| What is Mosaic trisomy 18? |
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Definition
| no inherited; random event during cell division |
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Term
| What is translocation trisomy 18? |
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Definition
| can be inherited; an unaffected person can carry a rearrangement of genetic material between chr 18 and another chromosome |
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Term
| fifty percent of infants with trisomy 18 don't survive beyond? |
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Definition
| the first week of life. some have survived to teenage years but with severe problems |
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Term
| What are the four common principles of medical ethics? |
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Definition
Autonomy
Beneficence
Nonmaleficence
Justice |
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Term
| How should you act after telling a parent their child has died? |
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Definition
Be supportive
Provide humane and compassionate care
follow up with the parents later that day, the next day, and a week later. |
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