Presentations

Question 1

Pancoast Tumor

Answer 1

Tumor of the lung apex

Question 2

Symptoms of pancoast tumor

Answer 2

Symptoms often involve the C8 and T1 nerves within the brachial plexus
Symptoms are distributed in the C8, T1 and T2 dermatomes and mimic thoracic outlet syndrome

Question 3

What leads to Homer’s syndrome?

Answer 3

Extension into the paravertebral sympathetic nerves

Question 4

Signs of Homer’s syndrome?

Answer 4

Enophthalmos
Ptosis
Miosis

Question 5

Most common initial symptom of pancoast tumor?

Answer 5

sharp shoulder pain (usually posterior)
Nagging-type pain in the shoulder and along the vertebral border of the scapula.
Pain in the axilla and subscapular areas on the affected side

Question 6

Pulmonary symptoms of Pancoast tumor:

Answer 6

Cough, hemoptysis and dyspnea are uncommon until later in the disease

Question 7

Pulmonary red flags:

Answer 7

Shoulder pain
Onset of pulmonary symptoms in any patient with neck, shoulder, and/or arm pain
Homer’s syndrome
Ipsilateral flushing and hyperhydrosis (excessive sweating) of the face

Question 8

Standard of care treatment of Pancoast Tumor:

Answer 8

induction chemo-radiotherapy followed by surgical resection

Question 9

Where does Pancoast tumor usually invade?

Answer 9

chest wall, brachial plexus, and spine or subclavian vessels

Question 10

MSK differential diagnosis of Pancoast tumor:

Answer 10

thoracic outlet
trigger points of serratus anterior
cervical OA
shoulder bursitis
RTC injury

Question 11

Non MSK differential diagnosis of Pancoast tumor:

Answer 11

other tumors
infections and inflammatory lung disease
vascular lesion

Question 12

Pneumothorax

Answer 12

a collection of air in the pleural cavity resulting in collapse of the lung on the affected side

Question 13

Two common classifications of pneumothorax:

Answer 13

Tension

Spontaneous

Question 14

Tension pneumothorax:

Answer 14

Usually a consequence of trauma

Question 15

Signs oft tension pneumothorax:

Answer 15

Severe “pleuritic-type” chest wall pain, extreme SOB, tracheal deviation (away from involved side), distended neck veins, tachycardia, hypotension, hyper resonance

Question 16

Treatment of tension pneumothorax:

Answer 16

medical emergency
Chest tube
Needle thoracostomy

Question 17

Spontaneous pneumothorax:

Answer 17

Usually pathologic event associated with rupture lung wall

Air may escape into pleural space from a puncture or tear in an internal respiratory structure

Question 18

Signs of spontaneous pneumothorax:

Answer 18

Pain with deep inspiration, decreased chest expansion, hyper resonance, marked decreased breath sounds (affected side).

Question 19

Causes of spontaneous pneumothorax:

Answer 19

No precipitating event or after extreme coughing/strenuous physical activity

Question 20

Traumatic pneumothorax

Answer 20

Follows a penetrating chest trauma

Question 21

Iatrogenic pneumothorax

Answer 21

May follow a number of procedures

mechanical ventilation and interventional procedures

Question 22

Catamenial pneumothorax

Answer 22

Pneumothorax at the time of menstruation

Question 23

Ideopathic spontaneous pneumothorax

Answer 23

Result of leakage of air from the lung parenchyma through a ruptured viscera pleura into pleural cavity

Question 24

Risk factors for pneumothorax:

Answer 24

scuba diving
overexertion
surgery involving chest
MVA, Chest or thorax
pulmonary disease

Question 25

Patient presentation of pneumothorax:

Answer 25

abrupt onset of dyspnea severe pain in upper and lateral thoracic wall sudden onset of pain comfortable sitting in upright position

Question 26

Hallmark findings of pneumothorax:

Answer 26

``` dyspnea change in respiratory movement shoulder pain fall in BP weak and rapid pulse ```

Question 27

What pulse rate indicates pneumothorax?

Answer 27

above 135 bpm

Question 28

Pneumonia

Answer 28

the inflammation of the parenchymal structures of the lung.

Question 29

Bacterial pneumonia

Answer 29

typically acquired by inhaling infectious droplets that reach mucous membranes of the alveoli or aspirating into the upper respiratory airways.

Question 30

Atypical pneumonias

Answer 30

are from viral and mycoplasma infections that reside in the alveolar septum and the interstitium of the lung. These manifest milder symptoms and physical signs than bacterial pneumonia.

Question 31

Patient presentation of pnemonia:

Answer 31

``` tachypnea (ventilation rate greater than 20 BPM) fever shallow respiration fatigue muscular and abdominal pain cough pain ```

Question 32

With pneumonia, increased hospital mortality associated with

Answer 32

``` age over 65 neurological disease chronic liver disease absence of chest pain tachypnea diastole hypotension ```

Question 33

MSK differential diagnosis of pneumonia:

Answer 33

chostochondritis SC joint injury shoulder pain rib injury

Question 34

Red Flags for Abdominal/Chest Pain

Answer 34

``` Pain that changes location Pain that awakens from sleep Weight Loss Pain that persists for longer than 6 hours or worsens Pain followed by vomiting. ```