Pbl - Week 1 Flashcards
What is Horner’s syndrome?
An uncommon condition caused by loss of sympathetic innervation to the eye.
Characterisation of Horner’s syndrome?
Miosis - unopposed action of the pupillary constrictor
Partial ptosis - paralysis of smooth muscle fibres contained in the Levator muscle of the upper eyelid
Enophthalmos - eye sunken into socket
Anhidrosis - loss of sweating
Predisposing factors for lunch cancer
Cigarette smoking
Occupational hazards - inhalation of noxious agents , radioactive dusts like uranium mining, gases from coking plants , silicates , asbestos , chromates and nickel
What is a pan coast tumour?
Special form of bronchogenic carcinoma. A bronchogenic carcinoma at the tip of the lung that penetrates the chest wall. The cancer then spreads into the brachial plexus and the cervical thoracic sympathetic nerves producing Horner’s syndrome
Most commonly a squamous cell carcinoma or adenocarcinoma .
pancoast tumours invade the brachial plexus causing c8-t1 palsy with small muscle wasting in the hand and weakness and pain radiating down arm
What is the thoracic outlet?
The narrow space between the clavicle and the first rib through which many nerves , arteries and veins run through. Notably the brachial plexus , subclavian vein and subclavian artery
Preganglionic fibres of the eye?
Originate from T1 and T2 levels of the spinal cord and ascend the sympathetic chain
Ganglion of the eyes?
Superior cervical ganglion of the sympathetic chain
Postganglionic fibres of the eye?
Emerge as the sympathetic nerves and contribute to the cephalic periarterial plexuses which supply branches to the eye.
Pan coast tumours are how rare?
5/100
How to diagnose a pan coast tumour?
An MRI SCAN - more accurate than X-ray or CT
Collection of odd symptoms
CT scan can help determine if tunoirbhas spread to the plexus , chest wall , mediastinum .
Needle biopsy - supraclavicular
TNM system
T - size and invasiveness
N - distribution of positive lymph nodes
M - the extent of distant metastases
Helps predict patients ability to be a candidate for surgery
Treatment for pancoast tumour
Depends on stage of cancer
The exact position on the lung
General health
Chemo and radiotherapy first to shrink cancer ( trimodality treatment)
Surgery involves removing too two ribs or more
May need to remove major artery behind the collar bone and replace
Or radiotherapy alone to shrink cancer if it has spread
What does a pancoast tumour invade?
Lymphatics Lower route of brachial plexus Intercostal nerves Stelate ganglion Sympathetic chain Adjacent ribs Vertebrae
What is paresthesia ?
A sensation of tingling pricking or creeping on the skin
Investigations for lower back pain?
Spinal X-rays are required only if pain - started before age of 20 or after 50
- is persistent and serious cause is suspected
- is worse at night or in morning (spinal tumour, inflammatory arthritis)
- associated with systemic illness fever or weight loss
- neurological symptoms
CT SCAN or MRI
- useful when neurological signs and symptoms
BONE SCANS
- ineffective and malignant lesions but also positive in degenerative lesions
FULL BLOOD COUNT
- when pain is likely to be due to malignancy , infection or metabolic cause
Lower back pain treatments - 6 Ps?
Preventative - back care , exercise , good acute pain control
Pathology - if found treat it
Physical therapies- maintain physical activity , physiotherapy, TENS
Pharmacotherapy - analgesia
Procedural - regional analgesia
Psychologically based - education , relaxation , distraction, mindfulness
