Screening Chest, Breast, and Ribs Flashcards
what should your 2 initial thought processes when screening
cardiac vs non cardiac
systemic vs NMS
what about clinical presentation are we specifically looking for? why?
pain patterns
- inc chance of NM if tenderness w movement (esp resisted) or TTP
what are 2 associated sx with screening chest and ribs
constitutional sx
changes w food ingestion
what pain patterns are we more or less concerned with
more: radiating chest pain
- to shoulders and arms
- worse w exertion, esp if exertion only w LE
less: chest pain changes w positional changes or can be reproduces mechanically
what is a consideration if we do a screen of chest and ribs
rarely the primary complaint
- usually an additional sx randomly brought up
what are 8 potential causes of chest, breast, and rib pain
oncologic
cardiovascular
pleuropulmonary
GI
breast conditions (ie CA)
anxiety
drug use
neuromuscular
what PMH is especially significant with oncologic causes of chest/rib pain
any cancer
- esp lung, breast
what are 4 clinical sx of an oncologic cause
- mets to pulm system
- mets to bone or primary CA
- skin changes
- palpable mass
what are sx of mets to pulmonary system leading to an oncologic cause (3)
pleural pain
dyspnea
persistent cough
what are sx of mets to bone or primary CA leading to an oncologic cause (1)
costochondritis sx
what skin changes are seen in an oncologic cause (2)
met carcinoma on chest wall from lung CA
liver CA/impairment -> spider angiomas on chest wall
describe characteristics of a palpable mass of an oncologic cause
usually metastatic from distant primary site: lymph, multiple myel, or carcinoma of breast, kidney, or thyroid
how do sx of a palpable mass of oncologic cause present
asymptomatic until compressing other structures:
- pain or paresthesias that are diffuse or along dermatomal/intercostal nerve pattern
triage a suspected oncologic cause of chest/rib pain
ask follow up questions related to cancer
- relay to referring provider
what are 6 cardiovascular things chest/breast/rib pain may be related to
angina
MI
pericarditis
endocarditis
mitral valve prolapse
aortic aneurysm
what demographic are at inc risk for cardiovascular cause (3)
older age
menopausal women
african-american women
what are 5 general risk factors for a cardiovascular cause
hx of HTN
elevated cholesterol
smoking
diabetes
general CV risk factors
what are 4 clinical sx presentation of a cardiovascular cause
- cardiac arrest
- 3 P’s - not MI related
- chest pain w activity = red flag
- higher risk for heart attacks
what are 3 sx of a cardiac arrest
loss of responsiveness
no breathing
no circulation
what are 3 P’s that mean the CV sx aren’t MI related
- Pleuritic pain = pulm
- pain w Palpation = MSK
- pain w change in Position -= MSK
triage chest pain w activity
red flag - 5-10min after activity begins (“lag time”), screening tool for cardiac involvement
MSK cause will have sx onset w activity
sx of heart attack
pain w/o exertion, lasts >10min, not relieved w rest or NTG
immediate red flag referral duh
how do cardiac patterns present in men
uncomfortable pressure, squeezing, fullness or pain in substernal/mid chest/entire upper chest
jaw, upper neck, mid-back, or down arm w/o chest pain
how do cardiac patterns present in women
sx more subtle or atypical
prodromal sx: pain in shoulder, chest, back, radiating in UEs, dyspnea, fatigue 12mo prior and up to 1mo before MI
