EXAM #2 Pathologies Related to Thorax

Question 1

Incidence:
Multiple myeloma is primary _______ in ______
Typically in ______

Answer 1

malignant tumor in bone marrow
older adults

Question 2

Spinal malignancy; spinal metastases
-_________ common tumors of the spine
-________ common serious spinal pathology
-MOST often from ________,______,______,______,________,_________(6)

Answer 2

-MOST
-2nd MOST
-breast, lung, prostate, kidney, GI, and thyroid tumors

Question 3

1. What is the 3rd MOST common area of metastasis behind the lung and liver?
   2a. What specific area?
   2b. _______ rarely involved

Answer 3

1. bone
   2a. the vertebral body is the most common, in the anterior portion
   2b. disk

Question 4

What is the most common region for spinal malignancy and the least common region?

Answer 4

Thoracic 70% > Lumbar; least common in cervical region

Question 5

Risk factors for spinal malignancy? (1)

Answer 5

hx of cancer

Question 6

Pathogenesis of spinal malignancy:

Answer 6

healthy bone replaced by a tumor

Question 7

PT implication for spinal malignancy:
unless?

Answer 7

urgent referral to MD unless cord S&S—-> emergency referral w/immobilization

Question 8

slow, gradual and often progressive compression on cord is ________________

Answer 8

thoracic spinal cord myelopathy

Question 9

Where is the most common region for myelopathy? Why?

Answer 9

thoracic due to smaller ratio of a canal to cord than other regions

Question 10

thoracic spinal cord myelopathy is most commonly due to _____________

Answer 10

degenerative spinal changes

Question 11

What are degenerative changes that can cause thoracic spinal cord myelopathy? (5)

Answer 11

lax and bulking ligamentum flavum
stenosis
age-related disc disease w/hernation
vertebral; body collapse/ fx
pathological instability i.e. spondylothesis

Question 12

thoracic spinal cord myelopathy S&S:

Answer 12

-multi-segmental numbness and weakness/paralysis of extremities and trunk below level of injury resulting in paraplegia
-DTR= hyper UMN+
-spastic or retentive bowel and bladder

Question 13

Central disc herniation for thoracic spinal cord myelopathy is rare? T or F

Answer 13

true

Question 14

What are S&S of spinal malignancy:

Answer 14

spinal P! MOST common initial symptom
unfamiliar and severe P! that may become progressive and constant
bony landmark alteration (fxs), unable to lie flat due to P!, mechanical P!, TTP

Question 15

MOST common serious spinal pathology?

Answer 15

non-traumatic spinal fxs

Question 16

70% of non-traumatic spinal fxs occur in the _________ spine

Answer 16

thoracic

Question 17

predominantly seen in _________w/osteoporosis

Answer 17

older females

Question 18

Non traumatic spinal fxs are MOST commonly between ________ and _____ levels
common causes for non-traumatic spinal fxs_______ and _______

Answer 18

T8-L4
malignancy and osteoporosis

Question 19

Risk Factors of Non-Traumatic Spinal fxs: high evidence

Answer 19

prior osteoporotic or low spinal fx
≥ 3 months of corticosteroid use

Question 20

Risk Factors: Females
-late onset menarche
-early onset menopause
WHY?__________

Answer 20

over lifespan, peak bone density occurs in 20s

Question 21

Risk factors for Non-Traumatic Spinal Fxs
Older age:
_______> 65 yrs.
_______> 75 yrs

Answer 21

-women
-men

Question 22

What are some low evidence S&S of Thoracic Spinal Fxs: (5)

Answer 22

unfamiliar/serves P!
TTP
sudden posture changes
mechanical P!
Rare Nuro S&S

Question 23

Is MRI imagining useful for non-traumatic spinal fxs? If so what will be shown?

Answer 23

yes, 1st choice
lateral views MOST useful

Question 24

What are spinal infections primarily from?

Answer 24

mycobacterium TB

Question 25

Infectious diseases of spinal structures = spinal infection? T or F

Answer 25

True

Question 26

What are RFs of spinal infection?
Are these RFs low or high evidence?

Answer 26

-Sx, particularly of the spine and repeated procedure, IV drug use, Hx of TB
-Low evidence

Question 27

Spinal infection develop ____-____ years after initial __________ into lungs.

Answer 27

2-3 years; air droplet

Question 28

Spinal Infection: begins in the ________, progresses to __________ and eventually to the _______ and adjacent ________

Answer 28

lungs, vertebral body, disc, vertebra

Question 29

Arthritic-like back P!/stiffness is the MOST common presenting symptom of?

Answer 29

Spinal infections

Question 30

Spinal infections: if left untreated it can lead to

Answer 30

-neuro S&S, LE coordination, bowel, and bladder dysfunction
-increased thoracic kyphosis

Question 31

X-ray imagining will present what findings for spinal infections?

Answer 31

body destruction, loss of height, diminished disc space, TB abscess

Question 32

Angina aka _____

Answer 32

chest P!

Question 33

What are the 2 types of Angina?

Answer 33

stable and unstable

Question 34

Occurring with stress, physical and or emotional is what type of angina?

If < 20 min the _______ referral
If ≥ 20 min then _______ referral

Answer 34

stable

-urgenet
-emergency

Question 35

Occurring at rest is what type of angina?
referral type?

Answer 35

unstable
emergency

Question 36

Which type of Angina is worst type I or II?

Answer 36

Type II

Question 37

Myocardial infarction aka ___________

Answer 37

heart attack

Question 38

Angina is most often seen in:

Answer 38

males > 65yrs

Question 39

Any condition that limits blood supply or increases the demand of the heart is a risk factor for angina and myocardial infarction? T or F

Answer 39

True

Question 40

These are S&S of ___________

-sudden onset of chest P!, pressure, and or heaviness
-P! into jaw or left arm
-referred P1 C4-T4 dermatomal pattern

Answer 40

Angina and myocardial infraction

Question 41

Atypical S&S of angina and myocardial infarction
gender?

Answer 41

females
interscapular and right arm P!
50% don’t have angina
Less P! w/diabetes due to neuropathy/blood suuply