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ClinMed > Pathologies related to the throax: Test 2 > Flashcards

Pathologies related to the throax: Test 2 Flashcards

1
Q

what is a multiple myeloma

A

primary malignant tumor in bone marrow

typically in older

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2
Q

describe spinal metasteses (prevalance, incidence, etiology, etc)

A

most common tumor in spine

2nd most serious spine pathology

bone = 3rd most common metastasis behind lung and liver

vertebral body, usually anterior, is most common place

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3
Q

spinal metastases are most commonly from what other types of cancers

A

most often from breast, lung, prostate, kidney, GI, and thyroid tumors

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4
Q

most common region for spinal malignancy

A

thoracic (70%)

20% create cord compression or myelopathy

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5
Q

risk factors and pathogenesis for spinal malignancy

A

history of cancer

healthy bone replaced by tumor

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6
Q

clinical manifestations of spinal malignancy

A

cancer S&S including spine P! that is the most common initial symptom

unfamiliar and severe pain that may become progressive/constant

possibly myeopathy S&S

possible bony alterations including fx or instability

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7
Q

with spinal malignancy, how might bony alterations present

A

unable to lie flat due to pain

may make the pain mechanical

possibly tender with palpation, percussion and/or vibration at SPs if a spinal fx

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8
Q

PT referral for spinal malignancy

A

urgent referral unless cord S&S; then you would want to immobilize for an emergency referral

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9
Q

what is thoracic spinal cord myelopathy

A

slow, gradual and often progressive compression on the cord

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10
Q

incidence of thoracic spinal cord myelopathy

A

most common region of the spine for myelopathy due to smaller ratio of canal to cord then other regions

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11
Q

etiology of thoracic spinal cord myelopathy

A

most commonly due to degenerative spinal changes
-lax ligamenyum flavum/buckling
-stenosis
-ARDD with herniation
-vertebral body collapse/fx
-pathological instability

malignancy 20% of the time (red flag = hx cancer)

rare central disc herniation

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12
Q

clinical manifestations for thoracic spinal cord myelopathy

A

neuro S&S depends on level of injury

extreme spinal P!

multi segment numbers and weakness/paralysis of extremities and trunk below level of injury

spastic/retentive bladder/bowel

hyperactive DTR

+ UMN tests

hypoactive superficial reflexes

immobilize and emergency referral

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13
Q

incidence of non-traumatic spinal fractures

A

most common serious spinal pathology

70% of non traumatic spinal fx occur in thoracic spine

predominately in older females with osteoporosis

most common between T8 and L4

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14
Q

etiology of non-traumatic spinal fx

A

malignancy

osteoporosis

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15
Q

risk factors for non traumatic spinal fx

A

prior osteoporotic or low impact spinal fx

more than 3 months corticosteroid use

female (late onset menarche or early menopause)

older age (women over 65, men over 75)

low evidence for hx of cancer

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16
Q

pathogenesis of non traumatic spinal fx

A

weakening and eventual failing of bone due to disease

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17
Q

clinical S&S of non traumatic spinal fx

A

thoracic pain with hx or malignancy or osteoporosis

low evidence for:
-unfamiliar/severe P!
-tender with palpation, percussion, and/or vibration
-sudden change in spine posture/shape
-likely mechanical P!
-rare neuro S&S in LE

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18
Q

preferred imaging for non traumatic spinal fx

A

x-ray is first choice; lateral views most useful (but they can’t determine age of fracture)

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19
Q

how useful are MRIs for non traumatic spinal fx

A

can differentiate between osteoporotic and soft tissue malignant fx

can determine age of fracture by identifying bone marrow edema that x-ray cant pick up

should be performed if multiple fractures are found with an x-ray

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20
Q

incidence of spinal infection

A

uncommon in wealthier countries but resurgence with longevity and IV drug use

in lower income countries more due to HIV/AIDS and TB

skeletal tuberculosis (aka potts disease) is more common in the thoracic spine

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21
Q

etiology of spinal infection

A

primarily from mycobacterium TB

staphylococcus aureus and brucella are also involved at times

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22
Q

risk factors for spinal infection

A

imunosuppresion
surgery (particularly of the spine and repeated procedures)
IV drug use
social depravation
Hx of TB
recent infection

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23
Q

pathogenesis of spinal infection

A

develops 2-3 years after initial air droplet infection into lungs

spreads via lymph and blood

infection starts in lungs (pulmonary TB), goes to vertebral body (osteomyelitis), and eventually the disc (disci tis) and adjacent vertebrae (skeletal TB)

abcess grows

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24
Q

what happens when an abscess grows from a spinal infection

A

nerve root irritation

vertebral body collapse/fx

cord compression may develop

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25
Q

early S&S of spinal infection

A

arthritic like back pain/stiffness = most common presenting

constitutional symptoms not common initially

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26
Q

low evidence S&S of spinal infection

A

localized/progressive pain

infection S&S (especially fatigue, fever since onset of pain, and unexplained weight loss)

tenderness with palpation, percussion and vibration

27
Q

what happens if spinal infection is left untreated

A

neuro S&S influence LE coordination as well as bowel/bladder function

increased thoracic kyphosis

28
Q

what might you see in an x-ray of a pt with spinal infection

A

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

29
Q

what are the 2 types of angina

A

stable = occurring with stress; physical and/or emotional

unstable = occurs at rest

30
Q

incidence of angina and MI

A

most often in makes older than 65

31
Q

risk factors for angina and MI

A

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

smoking

metabolic syndromes
-high cholesterol
-HTN
-diabetes
-obesity
-high triglycerides

psychological disorders

SAD

32
Q

pathophysiology of angina or MI

A

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

33
Q

typical manifestations/S&S of angina or MI

A

Pain (sudden chest pain, pain in jaw/L arm, referred pain)
SOB
Sweating
nausea
fatigue
syncope

34
Q

atypical manifestations/S&S of angina and MI

A

females = intrascapular pain, R arm pain, and lack of angina

less pain with diabetes due to neuropathy

pericarditis with autoimmune diseases

most common S&S in older adults is SOB due to impaired ANS response and central P! mechanisms

35
Q

PT implications for angina and MI

A

don’t want to miss

for stable angina, if less than 20 min then urgent referral; if more than 20 min then emergency referral

unstable angina = emergency

36
Q

what is a pulmonary embolism

A

blockage of the pulmonary artery

37
Q

incidence of pulmonary embolism

A

associated with high morbidity/mortality

half go undiagnosed

1/3 pts with untreated die

only 8% of those who are diagnosed die

more common in females over 50

38
Q

risk factors for pulmonary embolism

A

prior PE or deep vein thrombosis
immobility
Hx of abdominal/pelvic sx or malignancy
LE joint replacement
late stage pregnancy
LE fx

39
Q

etiology of pulmonary embolism

A

most often deep vein thrombosis especially in LE

other blockages may be from fat, air bubbles, amniotic fluid, clumps of parasites, or tumors

40
Q

pathogenesis of pulmonary embolism

A

obstruction travels through the right side of the heart abd becomes lodged in smaller pulmonary artery feeding the lungs

pulmonary infection results including damage and impaired gas exchange

41
Q

clinical manifestations and S&S of pulmonary embolism

A

often non specific

pleuritic chest pain (sudden sharp/stabbing chest pain) made worse by deep breath, coughing, trunk motion, reaching, and accessory motion testing

SOB, wheezing, and/or rapid breathing

42
Q

other S&S of pulmonary embolism

A

cough, possibly with blood
painful breathing
fainting
tachycardia and palpitations

43
Q

PT implications for pulmonary embolism

A

don’t want to miss
timely detection is critical
utilize CDR and emergency referral is indicated

44
Q

PT implications for upper GI system issues

A

need to differentiate from cardiopulmonary issues

thoughtful positioning with interventions; keep more upright

45
Q

incidence of gastroesophageal reflux disease

A

one of the most common digestive disorders, especially in older

2/3 of US adults will experience GERD S&S

46
Q

etiology of gastroesophageal reflux disease

A

foods
obesity
smoking
hiatal hernia
medications

47
Q

pathogenesis of gastroesophageal reflux disease

A

dysfunctional valve between stomach and esophagus allowing back flow of stomach contents

increased acidity and acid volume

esophagitis - inflammation/injury of esophagus

48
Q

clinical manifestations and S&S of gastroesophageal reflux disease

A

heartburn or chest P!/tightness especially after meals, when reclining; may refer to the neck

regurgitation

dysphagia

odynophagia (painful swallowing)

belching

nausea

49
Q

what is a peptic ulcer

A

discontinuation of GI track lining

50
Q

incidence of peptic ulcer

A

decreasing due to better hygiene and sanitation worldwide

51
Q

etiology of peptic ulcer

A

H pyloric bacteria

non steroidal inflammatory drugs (NSAIDs)

52
Q

pathogenesis of peptic ulcer

A

imbalance of protective and destructive factors

lining becomes more susceptible to acids

not able to secrete neutralizing bicarbonate

53
Q

clinical manifestations and S&S of peptic ulcer

A

check pain, possibly in the mid thoracic or supraclavicular regions (possibly at night; may be temporarily relieved with eating and antacids)

abdominal bloating/fullness

N&V, possibly with blood

weight changes

54
Q

PT implications of peptic ulcer

A

usually a urgent referral but emergency if:

progressive dysphagia
persistent vomiting
family history of GI malignancy

55
Q

what is scheurmann disease (kyphoscoliosis)

A

anterior vertebral body wedging of adjacent thoracic vertebrae in adolescents

56
Q

incidence of scheuermann disease

A

most common cause of adolescent hyperkyphosis

more often in males

57
Q

etiology of scheuermann disease

A

possibly inherited but unknown, possible collagen abnormality

medic changed following acute IDD

58
Q

pathogenesis of scheuermann disease

A

abnormal vertebral endplate mineralization and ossification during growth that leads ro anterior vertebral wedging and schmorl’s nodes (disc herniated into vertebral body)

59
Q

clinical manifestations and S&S of scheuermann disease

A

excessive and rigid thoracic kyphosis that does not change in supine/prone positions

thoracic pain

worse with activity

better with rest

possible counter hyperlordosis in cervical/lumbar regions

60
Q

what is varicella zoster virus

A

causes chicken pox (1st occurrence and typically milder) and shingles (2nd occurrence and typically more severe)

mostly an urgent referral but an emergency referral if close to the eye

61
Q

risk factors for varicella zoster virus

A

hx of chickenpox is necessary to develop shingles

can develop shingles more than 1 time

increased risk around 50 years of age

significant decline since vaccine was developed

62
Q

transmission of varicella zoster virus

A

airborne or direct contact so you should isolate until crusted lesions dry

highly contagious to those who’ve not had chicken pox and 2-3 days prior to symptoms; you won’t get shingles but you will get chicken pox

63
Q

pathogenesis of varicella zoster virus

A

travels from lymph through blood and eventually to nerve endings

eventually suppressed but can persist in latency in dorsal root

subsequent infections are triggered with lowered immunity/stress

64
Q

clinical manifestations and S&S of shingles

A

shingles skin lesions and paresthesias occur in dermatomal patter (typically T3-L3)

“dewdrop on a rose petal” - vesicle on a red base that erupt

may affect any dorsal root or even a cranial nerve

P! and itching

low risk of developing into postherpetic neuralgia (P! > 90 days after onset)

ClinMed (10 decks)

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