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CLIN MED EXAM 2 > Pathologies related to the Thorax > Flashcards

Pathologies related to the Thorax Flashcards

1
Q

What causes chicken pox and shingles?

A

varicella - zoster virus

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2
Q

What are risk factors for varicella?

A

Hx of chicken pox
increased risk around 50 years of age

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3
Q

Why has varicella declined in prevalence?

A

Vaccines :)

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4
Q

What is necessary for someone to develop shingles?

A

History of chicken pox

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5
Q

How is varicella transmitted?

A

Airborne or direct contact

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6
Q

Hold long should someone isolate with varicella?

A

Crusted lesions dry

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7
Q

Who is varicella highly contagious to?

A

Those who’ve not had chicken pox and 2-3 days prior to symptoms

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8
Q

If you’re exposed to varicella and you haven’t had chicken pox, what will you get?

A

Chicken pox, not shingles

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9
Q

How does the virus of varicella travel through the body?

A

From lymph through blood

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10
Q

What does varicella eventually target?

A

Nerve endings

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11
Q

Where can varicella persist in the body?

A

latent in dorsal root

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12
Q

Why are subsequent infections triggered with varicella - zoster virus?

A

Lowered immunity/ stress

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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)
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14
Q

When is varicella - zoster virus an emergency referral?

A

When it is close to the eye

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15
Q

What kind of referral is varicella - zoster virus typically?

A

urgent referral

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16
Q

What is the risk of developing postherpetic neuralgia with varicella?

(pain more than 90 days after onset)

A

low

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17
Q

What is the incidence of spinal malignancy?

A

Multiple myeloma
- primary malignant tumor in bone marrow
- typically in older individuals

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18
Q

What is the most common tumor of the spine?

A

spinal metastases

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19
Q

Spinal metastases are the ___ most common serious spinal pathology

A

2nd

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20
Q

What are 30% of spinal metastases from?

A

Breast, lung, prostate, kidney, GI and thyroid tumors

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21
Q

What is the 3rd most common area of metastasis from?

A

Bone, behind lung and liver

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22
Q

What is the most common structure of bone involved with spinal malignancy?

A

Vertebral body, mostly in anterior portion leading to wedging

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23
Q

What is rarely involved with spinal malignancy?

A

Discs

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24
Q

What is the most common region of the spine for spinal malignancy?

A

Thoracic (70%)

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25
Q

Where are spinal malignancies rarely?

A

Cervical region

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26
Q

What percentage of spinal metastases create cord compression or myelopathy?

A

20%

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27
Q

What is a risk factor for spinal malignancy?

A

history of cancer

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28
Q

What is the pathogenesis of spinal malignancy?

A

Healthy bone replaced by tumor

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29
Q

What is the gold standard for imaging with spinal malignancies?

A

MRI

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30
Q

What are some clinical manifestations / S&S of spinal malignancy?

A
  • 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
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31
Q

What is the most common initial symptom of spinal malignancy?

A

spinal pain

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32
Q

What are the first type of S&S in 25% of spinal malignancy cases?

A

myelopathy S&S

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33
Q

What is the referral type of spinal malignancy?

A

urgent referral to MD unless cord S&S - then immobilize for emergency referral

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34
Q

What is thoracic spinal cord myelopathy?

A

Slow, gradual, and often progressive compression on cord

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35
Q

What is the incidence of thoracic spinal cord myelopathy?

A

Most common region of spine for myelopathy due to smaller ration of canal to cord than in other regions

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36
Q

What is thoracic spinal cord myelopathy most commonly due to?

A

Degenerative spinal changes

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37
Q

What percentage of the time is there a malignancy with thoracic spinal cord myelopathy?

A

20% of the time

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38
Q

What is the only validated red flag for malignancy with thoracic spinal cord myelopathy?

A

Hx of cancer

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39
Q

What can rarely happen with thoracic spinal cord myelopathy?

A

Rare central disc herniation

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40
Q

What is the pathogenesis for thoracic spinal cord myelopathy?

A

Slow, gradual, and often progressive compression causing ischemia

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41
Q

What are some clinical manifestations and S&S for thoracic spinal cord myelopathy?

A

-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

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42
Q

What is the referral type with thoracic spinal cord myelopathy?

A
  • immobilize with emergency referral
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43
Q

What is the most common serious spinal pathology?

A

Non-traumatic spinal fractures

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44
Q

Where do 70% of non traumatic spinal fractures occur?

A

thoracic spine

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45
Q

What population predominately experiences non-traumatic spinal fractures?

A

Older biological females with osteoporosis

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46
Q

What levels are non-traumatic spinal fractures most common at?

A

T8 and L4 levels

** kyphotic posture increases pressure on vertebral bodies

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47
Q

What is the etiology of non traumatic spinal fractures?

A

Malignancy
Osteoporosis

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48
Q

What are risk factors for non-traumatic spinal fractures?

A

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

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49
Q

What is a low evidence risk factor for non traumatic spinal fractures?

A

hx of cancer

50
Q

What is the pathogenesis of non-traumatic spinal fractures?

A

Weakening and eventual failing of bone due to disease

51
Q

What are high evidence clinical manifestations / S&S of non traumatic spinal fractures?

A

thoracic pain with history of malignancy and/or osteoporosis

52
Q

What are low evidence S&S of non traumatic spinal fractures?

A
  • 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
Q

What type of referral are non-traumatic spinal fractures?

A

urgent referral unless cord S&S than immobilize with emergency referral

54
Q

What is the first choice for imaging with non-traumatic spinal fractures?

A

x ray

55
Q

When would we use an MRI with non-traumatic spinal fractures?

A

multiple fxs on x-ray
determine age of fx

56
Q

What is a spinal infection?

A

Infectious disease of spinal structures

57
Q

What is the incidence of spinal infection?

A
  • Uncommon in wealthier countries, resurgence with longevity and IV drug use
  • skeletal tuberculosis aka Potts disease more common in thoracic spine
58
Q

What is the etiology of spinal infections?

A

Primarily from mycobacterium TB,
staph and brucella also involved at times

59
Q

What are low evidence risk factors for spinal infection?

A
  • Immunosuppression
  • surgery, of spine and repeated procedures
  • IV drug use
  • social deprivation
  • Hx of TB or other recent infection
60
Q

How long does it take for a spinal infection to develop after initial air droplet infection enters lungs?

A

2-3 YEARS

61
Q

how does a spinal infection spread within the body?

A

Through lymph and blood

62
Q

Where does the infection begin and progress to with spinal infections?

A

Begins in lung (pulmonary TB), progresses to vertebral body (osteomyelitis), and eventually to the disc (discitis) and adjacent vertebrae (skeletal TB)

63
Q

What happens as the abscess grows with spinal infections?

A

Nerve root irritation
Vertebral body collapse/fx
and cord compression

all may develop

64
Q

What will we see on x ray with spinal infections?

A

body destruction
TB abscess
loss of height
sclerotic end plates
diminished disc space

65
Q

What are EARLY clinical manifestations and S&S of skeletal TB?

A

Arthritic like back pain stiffness is most common

66
Q

What are low evidence clinical manifestations and S&S of skeletal TB?

A
  • 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
Q

What S&S can we see with skeletal TB if untreated?

A

Neuro S&S influence LE coordination, bowel and bladder function

Increased thoracic kyphosis

68
Q

What kind of referral is skeletal TB?

A

Urgent referral unless cord S&S

69
Q

What is angina?

A

Chest pain

70
Q

What are the two types of angina?

A

Stable and unstable

71
Q

What is stable angina?

A

Occurs with stress, physical activity and/or emotion

72
Q

What is unstable angina?

A

Occurs at rest

73
Q

Is angina a disease?

A

No

74
Q

What is angina a symptom of?

A

Underlying problem such as a coronary artery disease (CAD)

75
Q

What is a myocardial infarction?

A

heart attack

76
Q

What is angina and myocardial infarction most common in?

A

Males 65 years and older

77
Q

What are risk factors for angina and myocardial infarction?

A

Smoking
Metabolic syndrome
- high cholesterol
- HTN
- Diabetes
- Obesity
- high triglycerides
Psychosocial disorders
SAD

78
Q

What is the etiology of angina and myocardial infarction?

A

CAD

79
Q

What is the general theme with risk factors for angina and myocardial infarction?

A

any condition that limits blood supply to or increases demand of the heart

80
Q

What is the pathophysiology for angina and myocardial infarction?

A

Ischemia or limited circulation with imbalance between supply and demand for the heart with possible complete occlusion and myocardial tissue death

81
Q

What are typical clinical manifestations and S&S of angina and myocardial infarction?

A

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
Q

What are some atypical clinical manifestations with females only with myocardial infarction?

A

Intrascapular and right arm pain
50% don’t have angina

83
Q

people with ________ have less pain with neuropathy

A

diabetes

84
Q

What is the most common S&S in older adults with myocardial infarction?

A

SOB due to impaired ANS response and central pain processing

85
Q

What are PT implications of stable angina?

A

if less than 20 mins then urgent referral
if more than 20 minutes emergency referral

86
Q

What are PT implications with Unstable angina?

A

Emergency referral

87
Q

What is a pulmonary embolism?

A

A blockage of the pulmonary artery

88
Q

What are pulmonary embolisms associated with?

A

High morbidity and high mortality

89
Q

How many pulmonary embolisms go undiagnosed? Why?

A

around half

Non-specific signs and symptoms

90
Q

What percentage of patients with an untreated pulmonary embolism die?

A

1/3

91
Q

What percentage of patients with a a diagnosed pulmonary embolism die?

A

Only 8%

92
Q

What sex and age are pulmonary embolisms more common in ?

A

Biological females over the age of 50

93
Q

What are risk factors for a pulmonary embolism?

A
  • Prior PE or DVT
  • Immobility
  • Hx of abdominal or pelvic surgery / malignancy
  • LE Joint replacement
  • Late-stage pregnancy
  • LE fractures
94
Q

What is the etiology of a pulmonary embolism?

A

Most often a DVT or clot, especially in the LE

95
Q

What other factors can cause a blockage with a PE?

A

Fat (fx/jt. replacements), air bubbles (injections), amniotic fluid (pregnancy), clumps of parasites or tumors

96
Q

How does a PE happen?

A

Obstruction travels through the right side of the heart and becomes lodged in the smaller pulmonary artery feeding the lungs

97
Q

What is the result of a pulmonary embolism?

A

Pulmonary infarction which impairs gas exchange and leads to damage

98
Q

What condition is called the “great masquerader”? why?

A

Pulmonary embolism

Silent, non specific S&S

99
Q

What is the most common sign of a pulmonary embolism?

A

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
Q

What may be the only non specific symptom with a PE?

A

SOB, wheezing, and/or rapid breathing

101
Q

What are some other potential signs and symptoms of a pulmonary embolism?

A

Cough, possibly bloody
painful breathing
fainting
tachycardia and palpitations

102
Q

What are the PT implications of a pulmonary embolism?

A

Timely detection critical for survival, utilize CDR and emergency referral if indicated

103
Q

What makes up the upper GI system?

A

Esophagus
stomach
duodenum

104
Q

What are the PT implications for the upper GI system?

A

Must differentiate from cardiopulm issues
thoughtful positioning with interventions (Keep upright)

105
Q

What is gastroesophageal reflux disease?

A

Consequence from backflow of stomach contents into esophagus

106
Q

What is one of the most common digestive disorders, especially in older people?

A

GERD

107
Q

How many US adults will experience GERD S&S?

A

2/3

108
Q

What is the etiology of GERD?

A

Foods
obesity
smoking
hiatal hernia
medications

109
Q

What is the pathogenesis of GERD?

A

Dysfunctional valve between stomach and esophagus allowing backflow of stomach contents -> increased acidity and acid volume

110
Q

What is esophagitis?

A

Inflammation or injury to esophagus

111
Q

What is the most common clinical manifestation of gastroesophageal reflux disease?

A

Heartburn or chest pain/tightness esp after meals when reclining or lying

112
Q

Where can GERD pain refer to?

A

The neck

113
Q

What are other S&S of GERD?

A

Dysphagia
odynophalgia (painful swallowing)
belching
nausea

114
Q

What is scheuermann disease?

A

Anterior vertebral body wedging of adjacent thoracic vertebrae in adolescents

115
Q

What is the most common cause of adolescent hyperhykyphosis?

A

Scheuermann disease (kyphoscoliosis)

116
Q

What population does sheuermann’s disease happen in most often?

A

males

117
Q

What is the etiology of sheuermann’s disease?

A

Possibly inherited
possible collagen abnormality
modic changes following acute IDD

118
Q

What is the pathogenesis of scheuermann disease?

A

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
Q

What are PT implications for Scheuermann disease?

A

Proceed with caution considering potential progressions with bone and/or neurological tissue

120
Q

What are some clinical manifestations / S&S of Scheuermann disease?

A

Excessive and rigid thoracic kyphosis
Thoracic pain
Better with rest
Possible counter hyperlordosis in cervical/lumbar regions

CLIN MED EXAM 2 (4 decks)

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