Pathologies related to the Thorax Flashcards
(120 cards)
1
Q
What causes chicken pox and shingles?
A
varicella - zoster virus
2
Q
What are risk factors for varicella?
A
Hx of chicken pox
increased risk around 50 years of age
3
Q
Why has varicella declined in prevalence?
A
Vaccines :)
4
Q
What is necessary for someone to develop shingles?
A
History of chicken pox
5
Q
How is varicella transmitted?
A
Airborne or direct contact
6
Q
Hold long should someone isolate with varicella?
A
Crusted lesions dry
7
Q
Who is varicella highly contagious to?
A
Those who’ve not had chicken pox and 2-3 days prior to symptoms
8
Q
If you’re exposed to varicella and you haven’t had chicken pox, what will you get?
A
Chicken pox, not shingles
9
Q
How does the virus of varicella travel through the body?
A
From lymph through blood
10
Q
What does varicella eventually target?
A
Nerve endings
11
Q
Where can varicella persist in the body?
A
latent in dorsal root
12
Q
Why are subsequent infections triggered with varicella - zoster virus?
A
Lowered immunity/ stress
13
Q
What are PT implications of varicella?
A
- Pain and itching
- dewdrop on a rose petal vesicle on a red base that erupt
- shingles skin lesions and paresthesias occur in a dermatomal pattern
(typically T3-L3)
14
Q
When is varicella - zoster virus an emergency referral?
A
When it is close to the eye
15
Q
What kind of referral is varicella - zoster virus typically?
A
urgent referral
16
Q
What is the risk of developing postherpetic neuralgia with varicella?
(pain more than 90 days after onset)
A
low
17
Q
What is the incidence of spinal malignancy?
A
Multiple myeloma
- primary malignant tumor in bone marrow
- typically in older individuals
18
Q
What is the most common tumor of the spine?
A
spinal metastases
19
Q
Spinal metastases are the ___ most common serious spinal pathology
A
2nd
20
Q
What are 30% of spinal metastases from?
A
Breast, lung, prostate, kidney, GI and thyroid tumors
21
Q
What is the 3rd most common area of metastasis from?
A
Bone, behind lung and liver
22
Q
What is the most common structure of bone involved with spinal malignancy?
A
Vertebral body, mostly in anterior portion leading to wedging
23
Q
What is rarely involved with spinal malignancy?
A
Discs
24
Q
What is the most common region of the spine for spinal malignancy?
A
Thoracic (70%)
25
Where are spinal malignancies rarely?
Cervical region
26
What percentage of spinal metastases create cord compression or myelopathy?
20%
27
What is a risk factor for spinal malignancy?
history of cancer
28
What is the pathogenesis of spinal malignancy?
Healthy bone replaced by tumor
29
What is the gold standard for imaging with spinal malignancies?
MRI
30
What are some clinical manifestations / S&S of spinal malignancy?
* Cancer S&S
* Spinal pain
* Unfamiliar and severe pain that may become progressive and constant
* possible myelopathy S&S
* Possible bony alterations including fxs and joint instability
* unable to lie flat due to pain
* likely mechanical pain for bone involvement
* Stress tests positive for bone involvement
31
What is the most common initial symptom of spinal malignancy?
spinal pain
32
What are the first type of S&S in 25% of spinal malignancy cases?
myelopathy S&S
33
What is the referral type of spinal malignancy?
urgent referral to MD unless cord S&S - then immobilize for emergency referral
34
What is thoracic spinal cord myelopathy?
Slow, gradual, and often progressive compression on cord
35
What is the incidence of thoracic spinal cord myelopathy?
Most common region of spine for myelopathy due to smaller ration of canal to cord than in other regions
36
What is thoracic spinal cord myelopathy most commonly due to?
Degenerative spinal changes
37
What percentage of the time is there a malignancy with thoracic spinal cord myelopathy?
20% of the time
38
What is the only validated red flag for malignancy with thoracic spinal cord myelopathy?
Hx of cancer
39
What can rarely happen with thoracic spinal cord myelopathy?
Rare central disc herniation
40
What is the pathogenesis for thoracic spinal cord myelopathy?
Slow, gradual, and often progressive compression causing ischemia
41
What are some clinical manifestations and S&S for thoracic spinal cord myelopathy?
-Level of injury determines specific S&S
- extreme spinal pain
- mechanical reproduction with thoracolumbar scan
- multi-segmental numbness and weakness/paralysis of extremities and trunk below level of injury leading to impaired balance
- spastic or retentive bowel and bladder
- hyperactive DTRs
- UMN tests positive
- Superficial reflexes - hypoactive
42
What is the referral type with thoracic spinal cord myelopathy?
* immobilize with emergency referral
43
What is the most common serious spinal pathology?
Non-traumatic spinal fractures
44
Where do 70% of non traumatic spinal fractures occur?
thoracic spine
45
What population predominately experiences non-traumatic spinal fractures?
Older biological females with osteoporosis
46
What levels are non-traumatic spinal fractures most common at?
T8 and L4 levels
** kyphotic posture increases pressure on vertebral bodies
47
What is the etiology of non traumatic spinal fractures?
Malignancy
Osteoporosis
48
What are risk factors for non-traumatic spinal fractures?
Prior osteoporotic or low impact spinal fx
more than 3 months of corticosteroid use
biological female
- late onset menarche, early onset menopause
older age
- women older than 65, men older than 75
49
What is a low evidence risk factor for non traumatic spinal fractures?
hx of cancer
50
What is the pathogenesis of non-traumatic spinal fractures?
Weakening and eventual failing of bone due to disease
51
What are high evidence clinical manifestations / S&S of non traumatic spinal fractures?
thoracic pain with history of malignancy and/or osteoporosis
52
What are low evidence S&S of non traumatic spinal fractures?
* Unfamiliar and severe pain and possibly worsening
* likely mechanical pain for bone involvement
* sudden change in spinal posture/ shape such as increased kyphosis
* rare neurological S&S in LEs including coordination and bowel/bladder dysfunction
53
What type of referral are non-traumatic spinal fractures?
urgent referral unless cord S&S than immobilize with emergency referral
54
What is the first choice for imaging with non-traumatic spinal fractures?
x ray
55
When would we use an MRI with non-traumatic spinal fractures?
multiple fxs on x-ray
determine age of fx
56
What is a spinal infection?
Infectious disease of spinal structures
57
What is the incidence of spinal infection?
* Uncommon in wealthier countries, resurgence with longevity and IV drug use
* skeletal tuberculosis aka Potts disease more common in thoracic spine
58
What is the etiology of spinal infections?
Primarily from mycobacterium TB,
staph and brucella also involved at times
59
What are low evidence risk factors for spinal infection?
* Immunosuppression
* surgery, of spine and repeated procedures
* IV drug use
* social deprivation
* Hx of TB or other recent infection
60
How long does it take for a spinal infection to develop after initial air droplet infection enters lungs?
2-3 YEARS
61
how does a spinal infection spread within the body?
Through lymph and blood
62
Where does the infection begin and progress to with spinal infections?
Begins in lung (pulmonary TB), progresses to vertebral body (osteomyelitis), and eventually to the disc (discitis) and adjacent vertebrae (skeletal TB)
63
What happens as the abscess grows with spinal infections?
Nerve root irritation
Vertebral body collapse/fx
and cord compression
all may develop
64
What will we see on x ray with spinal infections?
body destruction
TB abscess
loss of height
sclerotic end plates
diminished disc space
65
What are EARLY clinical manifestations and S&S of skeletal TB?
Arthritic like back pain stiffness is most common
66
What are low evidence clinical manifestations and S&S of skeletal TB?
* Localized and progressive pain that limits motion
* likely mechanical pain for vertebral body and possibly disc involvement
* stress tests positive for vertebral body and possibly disc involvement
* infections S&S
* Unexplained weight loss of more than 5-10% over a 3-6 month period
* Possible tenderness with palpation, percussion and or vibration at SPs
67
What S&S can we see with skeletal TB if untreated?
Neuro S&S influence LE coordination, bowel and bladder function
Increased thoracic kyphosis
68
What kind of referral is skeletal TB?
Urgent referral unless cord S&S
69
What is angina?
Chest pain
70
What are the two types of angina?
Stable and unstable
71
What is stable angina?
Occurs with stress, physical activity and/or emotion
72
What is unstable angina?
Occurs at rest
73
Is angina a disease?
No
74
What is angina a symptom of?
Underlying problem such as a coronary artery disease (CAD)
75
What is a myocardial infarction?
heart attack
76
What is angina and myocardial infarction most common in?
Males 65 years and older
77
What are risk factors for angina and myocardial infarction?
Smoking
Metabolic syndrome
- high cholesterol
- HTN
- Diabetes
- Obesity
- high triglycerides
Psychosocial disorders
SAD
78
What is the etiology of angina and myocardial infarction?
CAD
79
What is the general theme with risk factors for angina and myocardial infarction?
any condition that limits blood supply to or increases demand of the heart
80
What is the pathophysiology for angina and myocardial infarction?
Ischemia or limited circulation with imbalance between supply and demand for the heart with possible complete occlusion and myocardial tissue death
81
What are typical clinical manifestations and S&S of angina and myocardial infarction?
Pain
- sudden onset of chest pain, pressure, tightness, and / or heaviness
- additional pain into the jaw or left arm
- referred pain could be anywhere with C4 to T4 dermatomal pattern
SOB
Sweating
Nausea
Fatigue
Syncope
82
What are some atypical clinical manifestations with females only with myocardial infarction?
Intrascapular and right arm pain
50% don't have angina
83
people with ________ have less pain with neuropathy
diabetes
84
What is the most common S&S in older adults with myocardial infarction?
SOB due to impaired ANS response and central pain processing
85
What are PT implications of stable angina?
if less than 20 mins then urgent referral
if more than 20 minutes emergency referral
86
What are PT implications with Unstable angina?
Emergency referral
87
What is a pulmonary embolism?
A blockage of the pulmonary artery
88
What are pulmonary embolisms associated with?
High morbidity and high mortality
89
How many pulmonary embolisms go undiagnosed? Why?
around half
Non-specific signs and symptoms
90
What percentage of patients with an untreated pulmonary embolism die?
1/3
91
What percentage of patients with a a diagnosed pulmonary embolism die?
Only 8%
92
What sex and age are pulmonary embolisms more common in ?
Biological females over the age of 50
93
What are risk factors for a pulmonary embolism?
* Prior PE or DVT
* Immobility
* Hx of abdominal or pelvic surgery / malignancy
* LE Joint replacement
* Late-stage pregnancy
* LE fractures
94
What is the etiology of a pulmonary embolism?
Most often a DVT or clot, especially in the LE
95
What other factors can cause a blockage with a PE?
Fat (fx/jt. replacements), air bubbles (injections), amniotic fluid (pregnancy), clumps of parasites or tumors
96
How does a PE happen?
Obstruction travels through the right side of the heart and becomes lodged in the smaller pulmonary artery feeding the lungs
97
What is the result of a pulmonary embolism?
Pulmonary infarction which impairs gas exchange and leads to damage
98
What condition is called the "great masquerader"? why?
Pulmonary embolism
Silent, non specific S&S
99
What is the most common sign of a pulmonary embolism?
Pleuritic chest pain - sharp sudden and stabbing chest pain probably exacerbated by:
- deep inspiration
- coughing
- mechanical stress by fascial attachments between lungs, ribs, and vertebra
100
What may be the only non specific symptom with a PE?
SOB, wheezing, and/or rapid breathing
101
What are some other potential signs and symptoms of a pulmonary embolism?
Cough, possibly bloody
painful breathing
fainting
tachycardia and palpitations
102
What are the PT implications of a pulmonary embolism?
Timely detection critical for survival, utilize CDR and emergency referral if indicated
103
What makes up the upper GI system?
Esophagus
stomach
duodenum
104
What are the PT implications for the upper GI system?
Must differentiate from cardiopulm issues
thoughtful positioning with interventions (Keep upright)
105
What is gastroesophageal reflux disease?
Consequence from backflow of stomach contents into esophagus
106
What is one of the most common digestive disorders, especially in older people?
GERD
107
How many US adults will experience GERD S&S?
2/3
108
What is the etiology of GERD?
Foods
obesity
smoking
hiatal hernia
medications
109
What is the pathogenesis of GERD?
Dysfunctional valve between stomach and esophagus allowing backflow of stomach contents -> increased acidity and acid volume
110
What is esophagitis?
Inflammation or injury to esophagus
111
What is the most common clinical manifestation of gastroesophageal reflux disease?
Heartburn or chest pain/tightness esp after meals when reclining or lying
112
Where can GERD pain refer to?
The neck
113
What are other S&S of GERD?
Dysphagia
odynophalgia (painful swallowing)
belching
nausea
114
What is scheuermann disease?
Anterior vertebral body wedging of adjacent thoracic vertebrae in adolescents
115
What is the most common cause of adolescent hyperhykyphosis?
Scheuermann disease (kyphoscoliosis)
116
What population does sheuermann's disease happen in most often?
males
117
What is the etiology of sheuermann's disease?
Possibly inherited
possible collagen abnormality
modic changes following acute IDD
118
What is the pathogenesis of scheuermann disease?
Abnormal vertebral end plate mineralization and ossification during growth leading to:
- anterior vertebral body wedging
- schmorl's nodes (disc herniates into the vertebral body)
119
What are PT implications for Scheuermann disease?
Proceed with caution considering potential progressions with bone and/or neurological tissue
120
What are some clinical manifestations / S&S of Scheuermann disease?
Excessive and rigid thoracic kyphosis
Thoracic pain
Better with rest
Possible counter hyperlordosis in cervical/lumbar regions
