E2- Spinal Malignancy Flashcards
what is multiple myeloma
primary malignant tumor in bone marrow
where can spinal malignancy be metasized from
breast
lung
prostate
kidney
GI
what structure in the spine is spinal malignancy most commonly at
vertebral body
what is the main difference between myelopathy and spinal malignancy
myelopathy= C5-T1
malignancy= below T1
what are the S&S of spinal malignancy
spinal pain- unfamiliar/severe
bony landmark alterations - fx
unable to lay flat
mechanical pain thats random
tenderness to palpation
what is our referral for spinal malignancy
urgent
if spinal cord S&S are present then immobilize and becomes emergency
what is the most common region for myelopathy
why
thoracic
due to smaller ratio of canal to cord then other regions
what are the S&S of thoracic myelopathy
extreme spinal pain
multisegmental weakness/numbness
spastic or rententive bladder
dtr= hyperactive
UMN +
where is the most common nontraumatic spinal injury
T8-L4 levels
what is the most serious spinal injury
non traumatic spinal fx
what is the cause for non traumatic spinal fx
malignancy
osteoporosis
what are the RF for non traumatic spinal fx
osteoporotic
more than 3 months of corticosteriod use
female
older age
what are the low evidence S&S of non traumatic spinal fx
unfamiliar/severe pain
tenderness
sudden change in posture
mechanical
rare neuro S&S
what bacteria is most commonly involved with spinal infection
mycobacterium TB
Staph aureus
brucella
what is Potts disease and where is it most commonly
skeletal TB
thoracic spine
how can spinal infection happen
develops 2-3 years after initial air droplet infection into lungs
lungs to vb to disc to adjacent vb
how does a spinal infection spread
lymph nodes and blood
what can happen if an abcsess grows in a spinal infection
nerve root irritation
vb collapse/fx
cord compression
what can happen if spinal infection goes untreated
neuro S&S influence LE coordination including bowel and bladder
increased thoracic kyphosis
what are the early S&S of spinal infection
arthritic like back pain and stiffness
how can spinal infection be shown on xray
body destruction
TB abscess
loss of height
sclerotic end plate
diminished disc space
what is stable angina
occurring with stress, physical or emotional
what is unstable angina
occuring at rest
why CAD the cause of angina/MI
ischemia or limited circulation with imbalance between supply and demand for the heart
where could pain be distributed with angina/MI
chest pain, pressure, tightness, or heaviness
jaw or L arm
referred pain in C4-T4
what are atypical S&S of angina/MI especially females
intrascapular and R arm pain
why can someone with diabetes have less pain with angina/MI
decrease circulation so decreased n function
what do we do for stable angina
<20= urgent
>20= emergency
what do we do for unstable angina
emergency
what is a pulmonary embolism
blockage of the pulmonary artery due to a traveling blood clot
what are RF for pulmonary embolism
DVT
immobility
hx of abdominal/pelvic sx
LE jt replacement
late stage pregnancy
LE fractures
why could a femur fracture cause a pulmonary embolism
yellow marrow (fat) will act as a clot and could cause a PE
where does the obstruction come from for a PE
the right side of the heart
what is a pulmonary embolism labeled as
the great masqueraders
gets diagnosed as other things
what are the S&S of PE
chest pain- sudden, sharp, stabbing (T2-4)
deep inspiration
coughing
reaching
trunk motion
what do we do for a pulmonary embolism
utilize CDR
emergency referral
what are severe S&S of PE
cough that is bloody
painful breathing
palpitations
what are the factors of CDR for PE
DVT - LE pitting edema, TTP
HR >100
immobilization > 4 wks
prior DVT
bloody cough
malignancy
what is GERD
backflow of stomach contents into esophagus
what causes GERD
food
obesity
smoking
hernia
meds
what happens with GERD
dysfunctional valve between stomach and esophagus allowing backflow
increase acidity and acid volume
what is scheuermann disease
ant vb wedging of adjacent thoracic vb
what can cause scheuermann disease
persistent IDD
what can scheuermann disease do to the vb
abnormal vb end plate mineralization and ossification during growth leads to:
ant vb wedging
disc herniates into vb
what are S&S of scheuerman disease
excessive and rigid thoracic kyphosis
possible counter hyperlordosis in cervical and lumbar regions
what is varicella virus
chicken pox first time and shingles second time
how is varicella transmitted
airborne or direct contact so isolate until lesions are crusted
highly contagious
what is the referral method for varicella
urgent but emergency if close to the eye
what are the S&S of shingles
lesions in rose petal shape in dermatomal pattern
pain and itching
what are common S&S of pancoast tumors
shoulder pain (T2-4)
TOS S&S
UE swelling
paresthesias
what S&S does pancoast tumor share with horners syndrome
sucken eye
droopy eye
lack of face sweating on one side
what is the RF for psoriatic arthritis
psoriasis
what happens with persistent inflammation of psoarisis
targets the entheses and gradually thickens and erodes tissue- DIPs
what are the S&S for psoriatic arthritis
sausage digit
enthesis
how do we treat psoriatic arthritis
urgent referral
what do PsA and RA have in common
swelling and stiffness
damage tissue and organ
autoimmune disease
what differs with PsA and RA
RA- attacks synovial jt= MCP and wrist and bilateral
PsA- attacks entheses= DIP and unilateral
what structures are involved with RA
loose connective tissue
synovial membranes
what conditions of the wrist can develop due to RA
boutonniere deformities
spurring
ulnar drift at wrist
carpal tunnel syndrome
how do we treat RA
POLICED
orthotics/ergonomic
JM
MET with optimal stresses for cartilage integrity/jt mobility
what is the prognosis of RA
more management
