Chest 1-2 Flashcards
Noncardiac chest pain can be due to?
visceral musculoskeletal skin psychogenic referred local
what do you do with someone with noncardiac chest pain?
auscultate, obtain a screening ECG, consider chest radiography incorporate a mechanical challenge (stretch, compression, palpation in an attemmpt to reproduce the complaint
where should someone with cardiac caused pain go?
emergent care
how is angina described?
gripping squeezing pressure
history of someone with pleural/pulmonary chest pain
history: pneumonia, pneumothorax, TB, bronchogenic carcinoma
provocation of pleural/pulmonary chest pain
deep breathing bending toward the same side may aggarvate complaint auscultation/radiographs
history of someone with esophageal pain
may or may not have dysphasia substernal pain or radiates to central back
provocation/examination of someone with esophageal chest pain
hot or cold food barium study may be needed
history of someone with herpes zoster
often unilateral dermatomal hypersensitivity followed by vesicle formation, burning, sharp pain, recurrent
provocation of herpes zoster
hypersensitivity to palpation
history of someone with intercostal neuritis
similar to herpes presentation without vesicles may have osteophytes or be diabetic
provocation/examination of intercostal neuritis
may reproduce on rib separation or compression of intercostal space
history of someone with a rib fracture
usally history of trauma
provocation/examination of rib fracture
reproduce on compression A-P tuning fork xray
history of someone with pain in the costochondral junction
Tietze’s syndrome found in older women unilateral sharp pain
provocation/examination of costochondral junction pain
direct pressure of junction or between ribs
costovertebral/costotransverse pain history
may or may not be traumatic pain radiates along
provocation/examination of costovertebral/costotransverse pain
pressure over affected joint causes radiation
history of someone with pain in the chest from the cervical region
referral from osteophyte involvement
provocation/examination of chest pain from cervical spine
compression/distration test
history of someone with chest pain from anxiety
anxious or depressed pain is often over heart and is often either quick/stabbing or heavy/constant
provocation/examination of someone with chest pain from anxiety
psychological evaluation may be necessary, may be aggravated by deep breathing
history of someone with chest pain from a sprain
overuse or trauma usually pectoralis, serratus anterior or intercostals
provocation/examination of someone with chest pain from a sprain?
stretch, contract, combination
history of someone with chest pain from trigger pain
no neurological changes SCM, pectoralis, SCM, scalens
provocaiton/examination of someone with chest pain from trigger point
sustained pressure on trigger points
CAD
chest pain described as pressure sensation, fullness or squeezing in the mid portion of the thorax
where might the pain radiate in CAD?
jaw or teeth, shoulder, arm and/or back
other symptoms of someone with CAD
dyspnea/shorteness of breath epigastric discomfort with or without nausea and vomiting diaphoresis (sweateing) syncope or near syncope without other cause
angina
squeezing or pressure senation in the chest lasting for several minutes to 30 minutes with possible ratiation to arm or jaw
angina typically follows…?
exertion
how is angina relieved
resting for several minutes
what is angina due to?
atherosclerosis (a variation of angina is related to vasospasm)
unstable angina
extensive atherosclerosis chest pain without provocation tend to warn of an impending MI
people with angina may have?
HTN valve abnormalities
what does someone with angina have?
valve abnormalities ECG findings nonspecific scintigraphy or electrocardiographic studies may need coronary angiography
nitroglycerin
used for symptomatic management of angina decreases contraction of heart and causes vasodilation
myocardial infarction is often preceded by a history of?
angina substernal pain is more severe and often bulds up over minutes pain may be diffuse and radiate to medial left arm or jaw
does nitroglycerin help with an MI?
no
MIs are usually due to?
coronary thrombus or vasospasm
elevated cardiac enzymes during an MI
creatine kinase aspartate aminotransferase/serum glutamate oxaloacetic transaminase lactate dehydrogenase troponin
Tietze’s syndrome
females over 50 moderate to severe pain in upper part of chest one one side unknown etiology
tietze’s syndrome appears to be?
an inflammtory reaction, overexertion and prolonged coughing or exertion
how do you deal with tietze syndrome
benign and self resolving
GERD demographics
30-60 year women stress, diet, caffeine, smoking or alcohol may provoke symptoms diagnosis usually based on hisotry and physical and trial of empiric therapy
heartburn
senation of discomfort or burning behind sternum rising up to neck, worse after meals or in reclining position, eased by antacids
regurgitation
perception of flow of refluxed gastric contents into mouth or hypopharynx
pulmonary embolism demographics
middle aged male sudden onset of chest pain after having calf apin may have been immoblilzed
signs and symptoms of pulmonary embolism
low grade fever may be present, more commonly with an infartion chest pain is pleuritic with dyspnea
signs/symptoms of pleurisy
sharp pains in the chest that seem related to coughing, sneezing, or position such as bending to the side or lying on the involved side recent history of respiratory infection pleural friction rub decreased fremitus dullness to percussion increase or decrease in breath sounds
when might you take chest films?
chronic cough, hemoptysis, expectoration, shortness of breath cyanosis clubbing of fingers pain in chest thoracic spine upper extremities
when is a CT useful for chest complaints?
additional procedure especially for chest wall, pleural, lung, hilum or mediastinal and used to delineate and assess neoplastic disease
MRI for chest complaints
distinguish pathology in hilar and medistinal lymph nodes from adjacent vascular anatomy
ventilation and perfusion scans valuable in diagnosis of?
pulmonary embolism
the left hilum should___ be lower than the right hilum
never
Chest pain with tenderness suggests ?
self limiting Tietze’s syndrome (OHB pg.88)
enlargement of hili is usually due to?
lymphadenopathy or enlarged vessels tumor sarcoid
air bronchogram sign
uninvolved airways surrounded by water density pathology consistent with an airspace pathology, usually pneumonia or pulmonary edema
S sign of Golden
collapse of upper R lobe with superior migration of horizontal fissure medial portion of displaced fissure may be bulged inferiorly by a hilar mass causing the fissure to have a slanted and reversed S configuration
silhouette sign
loss of anatomic border intrathoracic lesion touching a border of the heart, aorta or diaphragm will obliterate that border on the xray intrathoracic lesion not anatomically contiguous with a border of one of these structures will not obliterate the border
general pulmonary radiology
increased densty decreased density consolidation interstitial atelectasis nodules or masses
consolidation
any pathologic process taht fills the alveoli with fluid, pus, blood cells (including tumor cells) or other substances resulting in lobar, diffuse or multifocal ill-defined opacities
interstitial
involvement of the supporting tissue of the lung parenchyma resulting in fine or coarse reticular opacities or small nodules
nodule or mass
any space occpuying lesion either solitary or multple
atelectasis
collapse of part of the lung due to a decrease in the amount of air in the alveoli resulting in volume loss and increased density
most common cause of consolidation
pneumonia
key findings on the xray for consolidation are
ill-defined homogeneous opacity obscuring vessels solhouette sign air bronchogram sign extension to pleura or fissure, but not crossing it no volume loss
what can cause consolidation?
water pus blood cells
interstitial tissue
network of CT that invests the arteries, veins, bronchi and lymphatics skeleton of the lung, providing mechanical support
4 types of interstitial lung patterns
linear reticular nodular reticulonodular
linear
septal lines (Kerley lines)
reticular
mesh like appearance, lines in all directions
nodular
discrete opacities
reticulonodular
combination of reticular and nodular
atelectasis
volume, collapse, under inflation
resorptive atelectasis
obstruction
passive atelectasis
adjacent mass or pneumothorax
adhesive atelectasis
surfactant inactivation
cicatrization atelectasis
scar tissue
what might you see on a film with atelectasis
increased density bronchovascular crowding displacement sings
solitary pulmonary noduel
single intraparenchyma lesion less than 3cm in size and not associated with atelectasis or lymphadenopathy
a lesion greater than 3cm in diameter is called?
mass
most SPNs are found to be?
granulomas lung cancers hamartomas
granuloma
small area of inflammation in tissue most often resulting from an infection
what are the different disease that can cause a granuloma?
TB histoplasmosis coccidiodomycosis sarcoidosis (non-infectious)
what is the most common cause of pneumonia?
streptococcus pneumoniae (bacteria MC)
s/s of pneumonia
cough dyspnea fever chills chest pain sputum decreased breath sounds rales increased fremitus, egophony, pectoriloquy, dullness to percussion
pneumonia caused by streptococcus pneumonia is associated with?
rusty colored sputum
pneumonia caused by____may have a currant jelly sputum
Klebsiella
hemoptysis can also occur with
TB gram negative pneumonia lung abscess acute bronchiits
s/s of bacterial pneumonai
sudden onset chills fever pain with breahing cough dyspnea sputum production dry cough becomes productuive purulent, blood streaked or rust sputum leukocytosis with a shift to the left
s/s of viral pneumonia
bronchitis bronchiolitis pneumonia interstitial pneumonia leukopenia/leukocytosis lymphocytosis
MC symptoms of TB
fatigue fever weight loss coughing hemoptysis night sweats
diagnosis of TB
skin tests chest xrays sputum analysis PCR tests
primary TB is usually?
asymptomatic
what iss seen in a chest xray of someone with TB
ranke complex ghon lesion ipsilateral calcified hilar node
common presenting symptoms of tumor
dyspnea persistent cough hemoptysis
non-small cell lung cancer (squamous cell carcinoma)
strongly associated with smoking poor prognosis
non-small cell lung cancer (adenocarcinoma)
more common in women more common in non-smokers peripheral
small cell carcinoma
strongly associated with smoking metastasizes early most common primary lung malignancy to cause paraneoplastic syndromes and SVC obstruction worst prognosis AKA oat cell carcinoma
increased density in the apex of the lung
pancoast tumor
COPD
represents a spectrum of obstructive airway diseases includes two key components which are chronic bronchitis- small ariways disease and emphysema
blue bloaters
chonic bronchitis
pink puffers
emphysema
4 types of angina:
stable, unstable, decubitus, and variant(prinzmetal’s) anginas
OHB pg. 110
pneumothorax
presence of air or gas in the pleural cavity
how can you get pneumothorax
spontaneous underlying lung disease trauama tension pneumothorax catamenial pneumothorax pleuritic chest pain and dyspnea
tension pneumothorax
caused by trauma to the lungs and/or chest cavity most serious type because it may affect the heart’s ability to pump blood
catamenial pneumothorax
caused by small holes in the diaphragm muscle occurs within 72 hours of start or end of menstrual cyctle and most often associated with endometriosis
Horner’s syndrome
miosis facial anhidrosis ptosis enophthalmos
ddx of anterior mediastinal masses
lymphoma thyroid enlargement teratoma tumors of thymus
