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Name: Class: Date:
Chapter 01 - Basic Mathematics
DATE CREATED: 2/4/2019 12:50 AM

DATE MODIFIED: 2/5/2019 2:31 AM
4. 46.3 + 29.87 =
a. 245
b. 2,450
c. 76.17
d. 7.617
ANSWER: c
POINTS: 1
DIFFICULTY: Easy
QUESTION TYPE: Multiple Choice
HAS VARIABLES: False
5. 16.3 1.2 =
a. 19.56
b. 195.6
c. 17.5
d. 1.75
ANSWER: a
POINTS: 1
DIFFICULTY: Easy
6. 1,800 0.30 =
a. 0.0001
b. 540
c. 6,000
d. 60,000
ANSWER: c
POINTS: 1
DIFFICULTY: Easy
DATE CREATED: 2/4/2019 9:48 PM
7. Convert 7/12 to a decimal.

Copyright Cengage Learning. Powered by Cognero. Page 2
Name: Class: Date:
a. 0.583
b. 1.714
c. 19.83
d. 84.00
ANSWER: a
POINTS: 1
DIFFICULTY: Medium
8. Convert 87.3% to a decimal.

a. 0.0873
b. 0.873
c. 8.73
d. 87.3
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
9. Change 23.46 to a percent.

a. 0.2346%
b. 23.46%
c. 2.346%
d. 2,346%
ANSWER: d
POINTS: 1
DIFFICULTY: Medium
DATE MODIFIED: 2/28/2019 4:01 PM
10. The number of significant digits in 3.75 104 is

a. two.
b. three.
c. four.

Name: Class: Date:
d. five.
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
11. The inverse of 0.137 is approximately

a. 1.37.
b. 7.30.
c. 73.
d. 137.
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
12. Convert 540.7 to scientific notation.

a. 5.407 102
b. 5.407 10−2
c. 5.407 103
d. 5.407 10−3
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
13. 2.63 10−2 =

a. 0.00263
b. 0.0263
c. 26.3
d. 263
ANSWER: b
POINTS: 1
Name: Class: Date:
DIFFICULTY: Medium
14. If you purchase four (4) twelve-packs of soda as a fundraiser for $10.00 and sell each can of soda for 50 cents, your
profit is
a. $9.74.
b. $14.00.
c. $24.00.
d. $34.00.
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
15. Mercury (Hg), a metal, is liquid at room temperature. Its density is 13.6 g/cm3. If you have 100 mL of Hg, how many
grams do you have?
a. 0.136
b. 1.36 10−3
c. 136
d. 1.36 103
ANSWER: d
POINTS: 1
DIFFICULTY: Difficult
16. Convert 113°F to °C.

a. 20.3°C
b. 62.8°C
c. 81°C
d. 235°C
ANSWER: b
POINTS: 1
DIFFICULTY: Medium

Name: Class: Date:

17. The equation x2 + 2xy + y2 can be expressed as:

a. (x + y)2
b. 2x + 2y
c. x + 2xy + y2
d. x2 + y2 + xy
ANSWER: a
POINTS: 1
DIFFICULTY: Medium
18. Consider the following proportional relationship: x = ay/bd. Assuming all other quantities remain constant, what
happens to the value of x when b increases?
a. increases
b. decreases
c. remains the same
d. cannot be determined
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
happens to the value of x when d decreases?
a. increases
b. decreases
c. remains the same
ANSWER: a
POINTS: 1
DIFFICULTY: Medium
Name: Class: Date:

happens to the value of x when the product of bd increases?
a. increases
b. decreases
c. remains the same
ANSWER: b
POINTS: 1
DIFFICULTY: Medium
Completion
21. 74 kV is equal to ____________________ volts.

ANSWER: 74,000
POINTS: 1
DIFFICULTY: Easy
QUESTION TYPE: Completion
STUDENT ENTRY MODE: Basic
22. 400 mA is equal to ____________________ amperes.

ANSWER: 0.40
POINTS: 1
DIFFICULTY: Easy
23. 120,000 V is equal to ____________________ kVp.

ANSWER: 120
POINTS: 1
DIFFICULTY: Easy
Name: Class: Date:

24. 3.7 m are equal to ____________________ cm.

ANSWER: 370
POINTS: 1
DIFFICULTY: Easy
Problem
25. 1/R = 1/R1 + 1/R2; solve for R2.

ANSWER: RR1/R1 − R
POINTS: 1
QUESTION TYPE: Numeric Response
26. F = Gm1m2/r2; solve for m1.

ANSWER: Fr2/Gm2
POINTS: 1
27. PV = nRT; solve for T.

ANSWER: PV/nR
POINTS: 1

Name: Class: Date:

28. I = E/R + r; solve for r.

ANSWER: E − IR/I
POINTS: 1
29. P = 2L + 2W; solve for L.

ANSWER: (P − 2W)/2
POINTS: 1
30. V = 1/3 r2h; solve for .

ANSWER: 3V/r2h
POINTS: 1
31. P1V1/T1 = P2V2/T2; solve for V2.

ANSWER: P2V2T1/P1V1
POINTS: 1

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bursæ often develop Fig. 135
on the outer sides of
club-feet, on the ends
of amputation
stumps, and
wherever there is
prolonged irritation of
mild degree.[21]
[21] A bunion is in
many instances due to
flat-foot, causing the
great toe to turn out.
This condition should
be remedied by the
usual arch, or raising
the inner border of the
shoes. Four out of the
five tendons attached to
the great toe tend also
to draw it outward. If the
tripod of the foot can be
restored without
operation this should be
done.
The treatment of
acute bursitis is that
of threatening
phlegmon in any
other part of the body.
As soon as the
presence of pus can
be determined, or
even before, a free
incision should be
made. Such an Hygroma of a prepatellar bursa (“housemaid’s knee”).
incision should not be (Lexer.)
entirely closed after
evacuation of the sac, but should be permitted to heal by
granulation.
Chronic bursitis, whether with or without formation of granuloma, is
best treated by excision, when the sac has become thickened and a
new formation has practically occurred. Housemaid’s knee, for
instance, like bunion, is more satisfactorily treated by a clean
excision of all diseased tissue than by any other less radical method.
Every tuberculous lesion of this kind should be rigorously extirpated,
and every syphilitic lesion should be treated by constitutional as well
as by local measures, the former being, save in exceptional
instances, the more important of the two.[22]
[22] The Radical Cure of Bunions.—The term bunion is generally used
to indicate a painful swelling over the inner aspect of the ball of the great
toe; it is never seen on the feet of those who go barefooted, but is the result
of badly fitting shoes, almost all of which crowd the great toe outward, thus
making its base more prominent and exposing it to irritation and pressure.
The inner border of the foot is nearly a straight line, but shoes are rarely
made to conform to this. The result of the consequent partial dislocation of
the toe, and of the pressure made at its base, is chronic periostitis, and the
development of a bursa. It becomes greatly thickened and forms a small
tumor, usually sensitive and painful. The dislocation often proceeds to such
a degree that the great toe lies across the others, either over them or under
them, in such a position as to receive and deserve the name hallux valgus,
which is generally given it when this is pronounced. There is nothing to do
but to exsect the head of the first metatarsal bone, and at the same time
excise the bursa and some of the overlying and thickened skin.
CHAPTER XXIX.
SURGICAL DISEASES OF THE HEART AND
VASCULAR SYSTEM.
A generation ago a chapter on the surgery of the heart would have
been regarded as a surgical fantasy. Today the subject is not only a
live one, but experience is constantly accumulating as to the value of
surgical intervention in diseases of the heart and pericardium.
MALPOSITIONS OF THE HEART.

The heart may be displaced by congenital or acquired causes.
Malpositions of the former type may vary from dextrocardia, where
the heart is placed upon the right side, and may be accompanied by
a general or partial transposition of the viscera, to those cases where
there are defects in the diaphragm or the chest wall, through which
the heart protrudes. Dextrocardia has an interest for the surgeon, as,
for example, in the following case under the writer’s observation:
Disease on the left side which simulated appendicitis, in which the
diagnosis was confirmed by finding the heart upon the right side, and
later by operation. It was a case of complete transposition.
The acquired malpositions may be due to intrinsic or extrinsic
causes. They are pressure effects, usually found in connection with
intrathoracic aneurysms and other tumors or collections of fluid, or
may be due to change in the shape of the spine in pronounced
curvatures. Occasionally the heart is hindered in its action by
pressure from beneath the diaphragm. These cardiac displacements
are surgically interesting when the cause can be removed by
operative measures.
WOUNDS OF THE HEART.

Wounds of the heart are mainly of the punctured or gunshot type. It
was formerly considered that injuries of the heart were essentially
fatal. This has been disproved by human and comparative
observations. As far back as 1855, Carnochan reported a case of
gunshot wound of the heart where the bullet was found in the heart
substance after the patient had lived eleven days. The museums
contain many illustrations of penetrating wounds of the heart or of
foreign bodies in it, some of which had remained embedded for many
years. Nevertheless the fact remains that the majority of wounds of
the heart are fatal, either by arrest of its activity, by shock, by the
outpour of blood between it and the pericardium or outside the latter,
or later by processes which consume at least a few days, either
infective or degenerative. Other things being equal the larger the
wound the more dangerous, while an injury to the heart muscle which
has not opened one of its cavities is less dangerous than one which
perforates them. A punctured wound made by a small stiletto or
knife-blade, or even by a needle used for homicidal purposes, may
leave but small trace and not prove fatal, save through injury to one
of the cardiac vessels, especially a coronary artery.[23]
[23] Illustrating the surgery of foreign bodies in the heart, Jordan has
reported the case of a young woman who stated that she had received a
blow on the front of the chest the previous day, and showed on examination
a small projecting point in the lower part of the third left intercostal space
about half an inch from the sternum, which was tender to the touch and
seemed to move or pulsate with the heart. It gave to the finger the sensation
of a hard substance beneath the skin without any external marking. Upon
making an incision and dissecting partly through the muscle the broken end
of a black steel pin came into view. After removal with forceps it proved to be
a shawl pin, one and one half inches long, with its glass head broken off.
The patient remembered having had such a pin in her bosom at the time of
the accident. On the following day she had pericarditis. She apparently
recovered, but had a relapse, and died on the twenty-fourth day, the autopsy
showing pericarditis.
In practically all of these injuries there will be evidence of some

external violence. It is of advantage to ascertain the nature of the
accident and the character of the missile or instrument. If the depth of
penetration of a knife-blade, for instance, can be ascertained more
accurate conclusions can be drawn. The special indications of
cardiac injury pertain to disturbance of its own function, that is,
embarrassment and uncertainty of action, bellows sounds, enlarged
area of dulness owing to distention of the pericardium with blood,
dyspnea, and distress, and sometimes pain and syncope. These
symptoms and signs do not appear instantaneously, but increase in
severity.
Treatment.—In such an emergency everything possible should be
done to relieve the embarrassment of the heart’s action
—the head should be kept low, the body absolutely quiet, and
nervous excitement should be allayed at once with a full dose of
morphine. Heart stimulants should not be given. Ice applied over the
chest will help quiet cardiac activity. If the patient be not failing too
rapidly operation is advisable, and should be done in a well-equipped
hospital, with trained assistants. The purpose of the operation is to
expose the injured portion of the heart substance and close it with
suture; at least to remove the fluid or partially coagulated blood within
the pericardium.[24] As it is not always possible to expose the heart
without opening the pleural cavity, there should be at hand not only
the means for a tracheotomy, but an apparatus by which artificial
inflation of at least one lung can be effected. Pneumatic cabinets
have been devised for this purpose, especially by Sauerbruch, where
a difference of pressure can be maintained between the outside and
the inside of the cabinet, so that the chest may be widely opened and
the lung not collapsed; but such a cabinet is available in few places in
the United States. The improved Fell apparatus, by which a mask is
kept over the face and pressure maintained with the foot through a
bellows, has been found useful. Even in the absence of such
apparatus the surgeon should not abstain from the effort, though it
may appear less promising.
[24] Suture of Heart Wounds.—Stewart has tabulated 60 cases of suture
of the heart reported up to May, 1904, with a remarkably high recovery rate
of 38 per cent. (Amer. Jour. Med. Sci., October, 1904). Of the 60 cases 55
were stab wounds and 5 were gunshot wounds, 2 of the latter recovering. In
4 of the cases the coronary artery was injured, and only 1 of these
recovered. The injury occurred through a puncture while suturing the heart,
and an extra suture was necessary in order to control it. Of the 60 cases the
left ventricle was wounded thirty times, with 30 recoveries. The right
ventricle was wounded 21 times, with 7 recoveries. The operation has only
been practised for about ten years. The results reported certainly justify its
performance in all cases of this kind.
In the operative procedure one may feel inclined to utilize the
already existing wound, either as a part of his incision or for
exploratory purposes, or he may decide to disregard it. The operation
consists in raising an osteoplastic flap on the chest wall, by which the
pericardium and then the heart are exposed. The incision through the
skin is extended to the bone and only enough of the soft structures
separated from the ribs and cartilages to expose them sufficiently for
division. Ordinarily it would be preferable to divide the third, fourth,
and fifth costal cartilages at their rib terminations, and then to turn up
the flap with its base at the sternum, though the procedure can be
reversed to almost as good advantage. The cartilages and the ribs
may be divided with the costotome and the rest of the structures with
stout scissors. The flap, having been gently elevated at the edge, is
separated from the underlying cellular tissue and pericardium until its
sternal margin has been reached. When detached it may be sprung
upward, and thus a complete window is made in the chest wall.
When more room is desired bone and cartilage may be cut away with
a rongeur.
Fig. 136
Result after thoracotomy for heart wound. (E. J. Meyer.)
The pericardium being thus exposed may be found much

distended or altered by the imbibition of blood. It should be opened to
an extent sufficient to permit evacuation of its bloody contents and
sufficient exposure of the heart to permit not merely inspection but
suture of any wound in the heart substance. This is exceedingly
difficult on account of motions of the heart, and the insertion of
sutures will be as difficult as trying to hit a flying target. Nevertheless
it may be done in many cases. Unless imperative, a coronary artery
should not be included in the heart suture. Hemorrhage from the
heart being checked the pericardium is then to be united, preferably
with hardened catgut sutures, with or without drainage. In most
instances the former is the better plan, and the drain may be of the
cigarette type, that is, gauze wrapped in oiled silk.
Should it be found that the pericardium alone is injured and not the
heart the case may be regarded in a more favorable light.
There are sufficient cases on record where procedures analogous
to the above have been practised to justify the attempt in every case.
Hardened animal sutures may be used in the heart substance, and
the interrupted method will probably prove the better. A suture which
will hold firmly for three or four days will suffice, as has been proved
on animals.
RUPTURE OF THE HEART.

Rupture of the heart can scarcely be considered a surgical
condition, though it has frequently been one of medicolegal interest.
It may, however, afford a sudden and unexpected termination to
surgical cases. The cardiac muscle may be so softened by the
poisons of diphtheria and other acute infections as to be greatly
weakened, even though an intubation or tracheotomy has apparently
afforded security.
TUMORS OF THE HEART.

Primary malignant tumors of the heart are very rare. Secondary
and metastatic manifestation are much more frequent. True primary
sarcoma has been repeatedly observed, and, with the exception of
endothelioma, is practically the only primary cancer that could appear
in this location. Carcinoma is found only as a secondary deposit, with
which, however, the heart may become so involved as to permit of
terminal rupture.
THE PERICARDIUM.
This closed sac is interesting to the surgeon in cases where it
becomes filled with air; with blood, as the result of injury (see above);
with fluid, as in acute pericarditis, or with pus, as a later stage of the
latter, with its consequent pyopericardium. With the introduction of
the aspirating needle it is possible to draw off collections of serum or
pus, and paracentesis of the pericardium is now a conventional minor
operation. It is managed in the same way and with the same
instruments as when the pleural cavity is involved. It is ordinarily
safe, and affords much relief.
The surgeon may go even farther than this and practise
cardicentesis, as the writer did once by accident while hospital
interne. After introducing the needle and withdrawing three or four
ounces of pus he discovered that he had given great relief, which,
however, was only temporary. The autopsy two days later revealed
that he had passed the needle point through the pericardial sac into
the heart wall and had tapped the abscess therein. This was in 1877,
and was probably the first time that the heart wall was ever thus
entered.
Now the operator goes still farther than this and practises
intentional cardicentesis in cases of engorgement of the right side of
the heart connected with lung disease which is threatening death
from dyspnea with an overstrained heart. In such cases the needle
may be introduced just above the fourth rib, from one-half to one inch
to the right of the sternum, or entrance can be effected just above the
fifth rib in an upward direction. From 100 to 250 Cc. of blood may be
withdrawn.
For ordinary tapping of the pericardium the needle is inserted two
inches to the left of the median line and in the fourth or fifth left
interspaces, pushing it carefully until resistance is no longer felt and
fluid flows through the tube. For either of these purposes the patient
should be recumbent, unless the distress in this position is too great,
in order that the heart may fall away from the chest wall. Aspiration
can be repeated in case it gives relief. Little or no harm seems to
ensue from the wound which a needle-point will make upon the heart
substance. As the sac is progressively emptied the needle-point
should be gradually withdrawn. When aspiration, exploratory or
therapeutic, reveals the presence of pus, the well-known rule will
apply, i. e., that pus left to itself will do more harm than will the
surgeon’s knife. For pyopericardium there is but one successful
treatment when aspiration fails, and that is open incision and
drainage. This is not so severe a measure as exposure of the heart,
as it may not even require the removal of one costal cartilage,
although it would probably be better to take out at least one, since
the shape of the pericardial cavity will change to such an extent after
it is emptied as to raise the opening to a higher level than is given it
at first. Open incision, then, with drainage, in these cases is no longer
an experiment but a life-saving procedure. It will prove successful in
at least half of the cases, which otherwise would certainly perish
without it.
PNEUMOPERICARDIUM.
Pneumopericardium implies the presence of air in the pericardial
sac, a condition of which there are now about 40 cases on record.
The air nearly always enters through an ulcerative perforation from
adjoining parts or through a wound, yet in 5 of these cases no
opening could be found. In these it was probably due to the presence
of a gas-forming bacillus, such as may also cause pneumothorax
under certain circumstances. The perforation was in the esophageal
wall in 7 cases, in 4 cases it was the result of softening of a lymph
node, while in other instances it has followed abscess of the left lobe
of the liver, pleuropneumonia and gastric ulcer perforating through
the diaphragm. Of the 8 cases of penetrating wound from without, I
included the small puncture made by paracentesis, while in 7 cases
there had been fracture of the ribs or the sternum, with wound or
laceration of the lung or the pericardium.
The most characteristic sign is a splashing, gurgling sound,
synchronous with the heart beats, such as the French have called the
“water-wheel bruit.” These sounds are louder than in
hydropneumothorax, and are heard distinctly over the heart. The
area of precordial dulness will change with position.
In unmistakable cases operation is indicated, the trap-door
exposure being the best, the inner end of the fifth and sixth ribs being
elevated. Irrigation and drainage will be necessary. It is encouraging
to know that 11 of the 40 cases above mentioned have recovered.
CARDIOLYSIS.
Cardiolysis refers to the operative release of the heart from
adhesions which have formed between it and the pericardium or the
chest wall. When with every contraction the heart itself is subjected to
the strain of an adhesion the work proves excessive and it will finally
succumb. It has been suggested by Delorme, Peterson, and Simon
to either temporarily resect the chest wall, open the pericardium and
break down or divide the adhesions, or else to resect those bony
portions of the chest wall, i. e., the sternum, cartilages, or ribs, which
are so inflexible as not to yield, not removing the bands but making
them harmless.[25]
[25] Those interested in the modern surgery of the heart and lungs
should consult Rickett’s recent work on this subject.
THE ARTERIES.
There are few parts of the body which adhere more closely to the
normal standard than do the larger arteries. Even here malformations
and congenital defects are met with. In calculating the chances of a
given procedure the surgeon should consider the condition of the
venous and lymphatic systems before deciding to operate on a
portion of the arterial system. This is particularly true when ligating
the femoral artery for elephantiasis of the leg.
Thrombosis and embolism have already been considered in the
chapter on the Blood. Nevertheless it may be well to remind the
student at this point that thrombus means a blood clot, while
thrombosis refers to the process of its formation; that embolus means
something which has passed into the blood current of an artery and
plugged it, the obstruction usually being a fragment of clot or tissue,
though it may be a droplet of fat or a bubble of air. Emboli, like
thrombi, may be sterile, and in this respect innocent, or it may be
composed of material loaded with septic, tuberculous, or cancerous
germs.
Fig. 137 Fig. 138 Fig. 139
Anastomosing Collateral venous circulation, Direct anastomosing

circulation in sartorius from a woman aged forty- vessels of right
and pectineus of dog, seven, under the care of W. W. carotid of goat, five
three months after Gull, in whom the inferior vena months after
ligature of femoral. cava was completely ligature. (After
(After Porta.) obstructed from cancer. (Guy’s Porta.)
Hosp. Mus., Drawing 44⁴⁰.)
The readiness with which vessels, both arteries and veins, lend
themselves to the exigencies of extra work has long been
recognized, and the natural provision for collateral circulation is one
of which surgeons have for centuries availed themselves. On the
contrary, vessels which are no longer needed or whose function is
lost will undergo atrophy almost to obliteration; thus after amputation
of the thigh the corresponding iliac vessels become much reduced in
size (Figs. 137, 138 and 139).
ARTERITIS; ENDARTERITIS.
That arterial walls are resistant is shown by the fact that they are
usually the last tissues to yield to gangrene. Whether a primary acute
arteritis often occurs is a question of less interest in this place than
the fact that even arterial walls will succumb to infection and that
secondary hemorrhages from ulcerative processes are by no means
rare. The pathological processes which occur in the various
structures of the heart are repeated in the arterial walls; thus there
may be a periarteritis corresponding to pericarditis, a mesarteritis
which in many ways resembles myocarditis, and an endarteritis
which corresponds more or less closely to endocarditis, and all of
these in their acute or chronic forms. The acute forms which concern
the surgeon are due usually to the presence of infected emboli, which
have the same effect upon the arterial walls that infected thrombi
have upon the venous walls, i. e., they lead to occlusion, infiltration,
and suppuration.
Of the more chronic types those produced by syphilis are the most
common. Here it is usually the outer and inner coats which suffer
most. Tuberculous infection of an artery is of frequent occurrence and
pertains only to those vessels which are in intimate relation with
previous tuberculous lesions, while the syphilitic forms are diffuse
and generalized and as likely to involve one part of the body as
another. It is well known that arteritis in various degrees of intensity
may be met with in most of the infectious diseases. Whether they are
due to the living germs or to toxins generated during the process
concerns us at this point but little. It is of importance, however, to
realize that vessels so compromised may thus receive their first
impetus to degeneration and subsequently form aneurysm. The
degenerative types of greatest interest to the surgeon are fatty
degeneration, which occurs in the interior rather than the exterior,
and calcification, which is rather an involvement of peripheral vessels
and which occurs mainly in the middle and the outer coats. The latter
may be limited or may involve an entire vessel. When the radial
arteries are involved the condition may be appreciated at the wrist.
Calcification frequently follows other degenerations, especially fatty,
of the intima, and then may be seen in the interior of an artery. A true
ossification has been described, but is exceedingly rare.
ARTERIOSCLEROSIS.
Arteriosclerosis is a term generally applied to a combination of
these degenerations, with thickening and diminution of caliber. The
changes combined are comprehended in the term atheroma, which is
seen as a localized lesion in nodules or plaques in the aorta and
larger vessels and in diffuse form in the smaller. Atheroma, as a
complex degeneration, constitutes an interesting study, as it leads to
well-marked changes in the vessel walls, which are softened at
points by fatty changes, the little mass of debris resulting being called
an atheromatous abscess (an unfortunate name), which may empty
into the vessel, leaving a small cavity and opening known as the
atheromatous ulcer. Around this occur usually the calcific changes
above described. The disturbance and the roughening thus produced
lead to the formation of fibrinous thrombi, which attach themselves
firmly at these points. When to such a weakening of the vessel wall
as is thus produced are added the elements of compensatory cardiac
hypertrophy, and the sudden changes of blood pressure produced by
certain occupations and alcoholic and other excesses, it will be seen
how atheromatous patches constitute points of least resistance,
where blood pressure may cause a vessel wall at least to bulge and
thus to afford the beginnings of an aneurysm; while, by combination
of various processes, final rupture may result.
The conditions are not so very different in the more diffuse forms,
especially in patients who have not only a tendency to vascular
disease but to increase it by the added toxemias of gout and syphilis,
of various excesses and bad habits, in which not only do arterial
coats suffer, but the heart muscle and lining as well. The relations
then of systematic toxemias to arterial disease and finally to surgical
conditions are not so circuitous as may at first appear.
ANEURYSM.
An aneurysm is a tumor communicating with an artery and
containing circulating or coagulated blood, or both. It may be formed
entirely from the wall of the vessel, or some portion of it may be
formed by surrounding tissue. Several varieties of aneurysm are
indicated by descriptive adjectives. They are divided, first, into true
and false, the former being composed of all the vascular coats and
being small and infrequent; the false aneurysms imply those in which
the entire arterial wall does not participate. Aneurysms inside the
body cavities are called internal, and those involving the limbs
external. The terms spontaneous and traumatic apply here as
elsewhere. Fusiform aneurysm implies a spindle-like dilatation of the
vessel in somewhat regular form. The sacculated aneurysm is
essentially a pouch protruding from one side of the vessel with which
it communicates. When the sac ruptures the aneurysm becomes
diffuse. If the outer coat gives way and the inner protrudes there is a
hernial aneurysm. The dissecting aneurysm is one formed by
separation between the arterial coats, so that blood coagulates or
flows between them. Such an aneurysm tends to assume a sacculate
form and to rupture. A varicose aneurysm is a sac through which an
artery and adjoining vein communicate. A cirsoid aneurysm
corresponds to a varix on the venous side of the circulation, and
implies dilatation of an artery and its branches. (See Figs. 140 to
145.)
Fig. 140 Fig. 141 Fig. 142
True aneurysm; the False aneurysm; the Traumatic aneurysm; the sac formed
sac formed by all sac formed by the outer by the tissues around the vessel.
the coats. (Holmes.) coat only. (Holmes.) (Holmes.)
Fig. 143 Fig. 144 Fig. 145
Dissecting Hernial aneurysm; the Sacculated aneurysm of ascending

aneurysm. sac formed by the inner aorta. Death by pressure.
(Holmes.) coat only. (Holmes.) (Erichsen.)
The formation of an aneurysm implies previous disease of the

bloodvessel or traumatism, by either of which its coats must have
been weakened or divided. The previous disease which leads to this
change is either of syphilitic or other toxic origin, and usually of the
type of the endarteritis already alluded to, or its continuation into
atheroma. A so-called atheromatous ulcer may lead to giving way of
the intima and the passage of blood between the coats of the vessel.
It is in this way that most dissecting aneurysms are formed. On the
other hand, violent strain may stretch the vessels already weakened
by increasing blood pressure, or those conditions which induce
abnormally high blood pressure may produce it by slow processes.
Lastly a vessel may be partly divided, as by a bullet or stab wound, or
its adjoining supports may have been weakened by disease or by
accident to such an extent that it constitutes a weakening of the
arterial wall. The result of this will be expansion in the direction of
least resistance and the formation of a sacculated aneurysm.
As a morbid condition spontaneous aneurysm seems to be less
frequent now than in the past. Certain features pertain to all cases,
the most essential being a pulsating tumor, giving physical signs of its
presence by pressure, which causes pain, sometimes paralysis, and
nearly always absorption of surrounding tissues as the tumor
expands. Pulsation is characteristic and pathognomonic of aneurysm,
but an aneurysmal sac may have become so filled with clots as to
minimize the prominence of this symptom. The same is true of the
aneurysmal bruit or murmur which is heard on auscultation. This
sound and pulsation, especially of the expansile type, when present
will rarely deceive. They may, however, be simulated by a solid tumor
which overlies a large vessel and transmits its pulsation or even
some of its murmur. Even in this case the significant expansile
character of the pulsation will be lacking.
The progress of an aneurysm may be checked by spontaneous or
surgical processes, but no vessel involved in this way can return to
its previous condition. As the vessel expands the tendency is to
fortification of its weakened walls by coagulation of the blood around
the periphery of the sac. This process may be a continuous one or
may occur at intervals in such a way as to produce laminated coats
of blood clot, complete or incomplete, which in certain specimens can
be peeled off, one after another, much as an onion can be peeled,
the innermost portion representing the most recent coagulum. In this
way an aneurysm is strengthened and thickened, and rupture
postponed for an indefinite period. On the other hand, as the
aneurysmal tumor grows slowly but steadily it tends to make way for
itself at the expense of every other tissue in the body. The hardest
bone will disappear before the constant advance of such a growth,
and this permits aneurysms which have had their origin in the thorax
to develop into large extrathoracic tumors whose walls, lacking
resistance, become thinner and finally give way, death from
hemorrhage being the result. In fact, rupture is the natural tendency
of such lesion, the question being whether it may be averted by
spontaneous or non-operative methods, or whether it should be
subjected to operation (Fig. 146).

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Chapter 01 - Basic Mathematics

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7. Convert 7/12 to a decimal.

Chapter 01 - Basic Mathematics

8. Convert 87.3% to a decimal.

9. Change 23.46 to a percent.

10. The number of significant digits in 3.75 104 is

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Chapter 01 - Basic Mathematics

11. The inverse of 0.137 is approximately

12. Convert 540.7 to scientific notation.

13. 2.63 10−2 =

Chapter 01 - Basic Mathematics

16. Convert 113°F to °C.

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Chapter 01 - Basic Mathematics

QUESTION TYPE: Multiple Choice

17. The equation x2 + 2xy + y2 can be expressed as:

Chapter 01 - Basic Mathematics

HAS VARIABLES: False

21. 74 kV is equal to ____________________ volts.

22. 400 mA is equal to ____________________ amperes.

23. 120,000 V is equal to ____________________ kVp.

Chapter 01 - Basic Mathematics

QUESTION TYPE: Completion

24. 3.7 m are equal to ____________________ cm.

25. 1/R = 1/R1 + 1/R2; solve for R2.

26. F = Gm1m2/r2; solve for m1.

27. PV = nRT; solve for T.

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Chapter 01 - Basic Mathematics

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28. I = E/R + r; solve for r.

29. P = 2L + 2W; solve for L.

30. V = 1/3 r2h; solve for .

31. P1V1/T1 = P2V2/T2; solve for V2.

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MALPOSITIONS OF THE HEART.

WOUNDS OF THE HEART.

In practically all of these injuries there will be evidence of some

The pericardium being thus exposed may be found much

RUPTURE OF THE HEART.

TUMORS OF THE HEART.

Anastomosing Collateral venous circulation, Direct anastomosing

Dissecting Hernial aneurysm; the Sacculated aneurysm of ascending

The formation of an aneurysm implies previous disease of the

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