Chest & Thoracic Spine Differential Diagnosis & Screening Flashcards
When fluid builds up in the small space between the two layers of tissue it is called _____ ______.
pleural effusion
When a large amount of fluid in the pleural space can create pressure, compressing your lung to the point that it partially or completely collapses, leading to dyspnea and coughing, it is called ________.
atelectasis
When extra fluid in the pleural space also becomes infected, resulting in an accumulation of pus and a fever, it is called _______.
empyema
A procedure when your doctor injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor inserts a needle through your chest wall between your ribs to remove fluid for lab analysis and to help you breathe better. This is called _______.
thoracentesis
________ is inflammation of the pericardium, the thin two-layered membrane that covers and protects the outer surfaces of the heart. Sometimes this membrane is called the pericardial sac.
pericarditis
_______ ________ occurs when fluid collects between the layers of the pericardium.
pericardial effusion
___ ________ is right sided heart failure due to high blood pressure in arteries of lung and right ventricle of the heart, pulmonary hypertension is a culprit.
cor pulmonale
______ is inflammation of pleura, caused by viral infection, injury or tumor. It is associated with sharp pain with breathing, spontaneous, age 20-40 without trauma, cough, and hoarseness.
pleurisy
What are some questions to ask for differential diagnosis of chest pain related to the cardiac system? (5)
- Do you ever have discomfort or tightness in your chest?
- Have you ever had a crushing sensation in your chest with or without pain down your left arm?
- Do you have pain in your jaw, either alone or in combination with chest pain?
- If you climb a few flights of stairs fairly rapidly, do you have tightness or pressing pain in your chest?
- Have you ever had pain or pressure or a squeezing feeling in the chest that occurred during exercise, walking, or any other physical or sexual activity?
What are some questions to ask for differential diagnosis of chest pain related to the pulmonary system? (6)
- Do you ever have shortness of breath, breathlessness, or can’t quite catch your breath?
- How far can you walk before you feel breathless?
- What symptom stops your walking (e.g., shortness of breath, heart pounding, or weak legs)?
- Do you have any breathing aids (e.g., oxygen, nebulizer, humidifier, or ventilation devices)?
- Do you have a cough?
- Are you a smoker?
What are some questions to ask for differential diagnosis of chest pain related to the epigastric system? (2.5)
- Have you ever been told that you have an ulcer?
- Does the pain under your breastbone radiate (travel) around to your back, or do you ever have back pain at the same time that your chest hurts?
- Have you ever had heartburn or acid indigestion?
- If yes, how is this pain different?
- If no, have you noticed any association between when you eat and when this pain starts?
What are some questions to ask for differential diagnosis of chest pain related to the neurologic system? (3.5)
- Do you have any trouble taking a deep breath?
- Do you have feelings of weakness?
- Does your chest pain ever travel into your armpit, arm, neck, or shoulder blade?
- If yes, do you ever feel burning, prickling, numbness, or any other unusual sensation in any of these areas?
What are some questions to ask for differential diagnosis of chest pain related to the MSK system? (5)
- Have you strained a muscle from (repeated, forceful) coughing?
- Have you ever injured your chest?
- Does it hurt to touch your chest or to take a deep breath (e.g., coughing, sneezing, sighing, or laughing)?
- Do you have frequent attacks of heartburn, or do you take antacids to relieve heartburn or acid indigestion?
- Does chest movement or body/arm position make the pain better or worse?
What are some differential diagnosis in various systems for chest pain? (8)
Aortic dissection, Pulmonary Embolism, Esophageal Rupture, Pneumothorax, Pneumonia, Pericarditis, GI causes, MSK Causes
What are the 3 “P’s” to screen for cardiac pain?
- Pleuritic pain (exacerbation by deep breathing is likely pulmonary in nature).
- Pain during palpation (musculoskeletal cause).
- Pain with changes in position (musculoskeletal cause).
What are various MSK causes of chest pain?
Costochondritis/Tietze’s Syndrome
Muscle strains/Trigger points (thoracic paraspinals, pec major, scalenes, intercostals, etc)
Rib fractures (intense, well localized)
Lower rib pain syndromes
Cervical Spine Disorders
Thoracic Outlet Syndrome
Sternoclavicular subluxation/osteoarthritis
Intercostal Neuritis (Shingles)
Xiphoidalgia
Dorsal Nerve Root Irritation
Thoracic Dysfunction/Radiculopathy
Shoulder strain (biceps tendinopathy, pectoralis, etc)
[Costochondritis/Tietze’s Syndrome] is an inflammation of the cartilage that connects a rib to the breastbone (sternum). 3rd, 4th, & 5th CC joints. It causes sharp pain in the costosternal joint. Irritation without swelling.
costochondritis
[Costochondritis/Tietze’s Syndrome] is an inflammation of the costochondral cartilages of the upper front of the chest. Pain & swelling of costochondral articulation, most common 2nd or 3rd, aggravated by cough sneeze, breathing, twisting, shoulder motions, generally resolves in 12 weeks, though can be chronic.
Tietze’s Syndrome
What is the most common cause of MSK chest pain?
mysofascial trigger points
_____ _____ are specific thoracic spine pain areas that are referred from disc injuries in the cervical spine.
Cloward areas
½ of all chest wall pain in non-cardiac, what are the systemic causes of chest pain? (9)
Cardiac
Pulmonary
Epigastric/Upper GI
Breast
Spondylogenic Diseases
Metastases
Neurologic
Endocrine
Psychogenic
What are the cardiac causes of chest wall pain? (6)
Angina
Myocardial Infarction
Pericarditis
Endocarditis
Dissecting Aortic Aneurysm
Mitral Valve Prolapse
_____ is lack of O2 to heart. It results in gripping, viselike pain that may radiate to neck, jaw and shoulder/arm, toothache, burning indigestion, dyspnea, most common cause is coronary artery disease.
angina
_______ _______ is ischemia & necorsis of myocardial tissue. Results in sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom). Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue.
myocardial infarction
Risk factors for myocardial infarction include what? (10)
male, diabetes, smoking, age: men >45, female >55, high BP, high cholesterol, triglycerides, stress, alcohol
________ is inflammation of pericardium. May be primary or secondary (previous infection and results in chest pain to the neck and left shoulder.
pericarditis
_______ is inflammation of cardiac endothelium that damages the tricuspid, aortic and mitral valve, Caused by bacteria or abnormal growth of valves: post surgical patients, injection drug users at high risk. Results in arthralgias in proximal joints, warmth, tenderness, redness (Rule out RA: morning stiffness).
endocarditis
_____ _____ _____ (MVP) allows blood to flow back to upper chambers, connective tissue abnormalities in valves: palpitations, fatigue dyspnea, cold hands/feet, chest pain: 10% of population. Results in chest pain, angina on exertion, fatigue, dyspnea.
mitral valve prolapse
______ ______ involves the aortic arch or thoracic substernal and results in sharp pain in the back, neck or jaw, dyspnea, cough, and edema.
aortic aneurysm
What is the leading cause of death in the US?
cardiac disease
What are some symptoms a patient with chest pain might experience if it is cardiac related? (7)
Chest pain (angina)
Shortness of breath after moderate exertion
Unexplained pain in the upper torso, neck, jaw
Extremity pain, swelling, tingling, numbness, weakness, coldness
Extreme fatigue
Irregular heartbeat
Dizziness or fainting
What are the differences between what men and women experience with heart attacks?
Women: Subtler symptoms for 3-4 weeks before event
Chest pain, pressure, squeezing that comes and goes
Pain/discomfort in arms, back, neck, jaw, stomach
Shortness of breath
Cold sweat, nausea, light headedness
Men: Crushing weight on the chest, pressure, squeezing, or fullness
Pain/discomfort in arms, back, neck, jaw, stomach
Shortness of breath
Cold sweat, nausea, light headedness
What are the possible causes of chest and thoracic pain if it is pulmonary related? (10)
Parietal Chest Pain
Pulmonary Embolism
Pneumothorax
Pulmonary Hypertension
Cor Pulmonale
Pleurisy
Emphysema, COPD, Bronchitis
What are possible causes of chest pain that are gastrointestinal related? (5)
esophagitis, peptic ulcer, acute cholecystitis, biliary colic, and pancreatic disease
_______ results in epigastric pain (substernal, lower esophagus, radiating around thorax. Liver, gallbladder, pancreas), substernal pain, and heartburn (GERD).
esophagitis
_____ _____ results in midthoracic pain due to NSAID intake and could be associated with meals, blood in stool, and antacids.
peptic ulcer
____ _________ is gallbladder stones and results in right upper quadrant pain, nausea, vomiting, fevers, chills, and jaundice.
acute cholecystitis
____ ____ is a bile duct obstruction that results in right upper quadrant pain, fever, chills, nausea, indigestion, changes in urine, stool, and jaundice.
biliary colic
_______ _______ is hypotension with the pancreas that produces angina pain, fever, chills, nausea, indigestion, changes in urine, stool, and jaundice.
pancreatic disease
A ______ tumor is a benign or cancerous growth that forms between the area of the chest that separates the lungs. It results in cough, SOB, chest pain, hoarseness, etc.
mediastinal tumor
What two neurological conditions may cause chest and thoracic pain?
intercostal neuritis (herpes zoster) and dorsal nerve irritation
[Intercostal neuritis (herpes zoster)/dorsal nerve irritation] is a viral infection of the dorsal nerve that results in light burning or deep visceral pain that follows a dermatome. Signs and symptoms would be chills, fever, HA, malaise, skin rash, and lesions.
Intercostal neuritis (herpes zoster)
[Intercostal neuritis (herpes zoster)/dorsal nerve irritation] is an infection, inflammation, or mechanical irritation of the dorsal nerve that results in pain lateral and on the anterior chest wall that is aggravated by upper body activity. Signs and symptoms include numbness and tingling and muscle atrophy.
dorsal nerve irritation
________ (Cushing’s Syndrome) is the result of over-activity of the adrenal glands and release of cortisol. It results in kyphosis, bone pain, muscle weakness, “moon face”, protuberant abdomen, skin striae, cervicodorsal fat pad, and demineralization.
hypercorisolism
_____ may cause sharp, intermittent, stabbing chest pain that lasts minutes to days. It is not tender to palpation and doesn’t change with positioning. It is also not related to exercise or effort.
Anxiety
[Auscultation/Tactile Fremitus] is when you use the ulnar border of your hand to feel vibrations as the patient says “99”.
Tactile Fremitus
