Screening for the Chest, Breast and Ribs

Question 1

What are 4 most common chest pain issues that are medical?

Answer 1

1. oncology
2. Cardiac
3. Pulmonary
4. GI

Question 2

What is important to remember about chest pain in general?

Answer 2

it is usually not a primary complaint but must figure out if it is cardiac or not

Question 3

What are three things to look for if chest pain is oncology related?

Answer 3

1. PMH- pts with previous cancer hx at greater risk like lung or breast
2. Lung- will present on shoulder pain, cough, DOE but this means its well advanced
3. Breast- recent mammogram, life long estrogen exposure

Question 4

What are the 3 P’s that are not MI related?

Answer 4

1. pleuritic- increased with deep breathing
2. pain on palpation- MS
3. pain with changes of position- MS

Question 5

What is cardiac pain patterns with males?

Answer 5

pressure, discomfort substernal, pain-jaw down to arm

Question 6

What is cardiac pain pattern with females?

Answer 6

more subtle, likely will get more DOE, fatigue than pain

Question 7

What are two risk factors for breast cancer?

Answer 7

1. genetics- 5-10% of cases

2. Estrogen exposure- biggest risk factor

Question 8

What are 4 types of estrogen exposure?

Answer 8

1. Menarche under 12- first period
2. menopause over 55
3. Nulliparous- no children
4. first birth over 35 y.o

Question 9

What are age ranges for greatest risk of breast cancer?

Answer 9

peak age 45-70

men- 60-66
women 60-61

Question 10

What are clinical signs and symptoms for breast cancer?

Answer 10

lump (breast or axilla), unusual discharge from nipple, dimpling of skin over breast

Question 11

What are two types of screens for breast cancer?

Answer 11

1. mammography- begins at 40
2. CBE- every 3 years 20-39
   annually after 40

Question 12

What are two other less common reasons for non- MI chest pain?

Answer 12

1. anxiety/panic attack

2. cocaine use

Question 13

What are signs and symptoms of a panic attack?

Answer 13

SOB, diaphoretic, chest pain very similar to MI

risk factors- extreme stress, mental health issues, OTC decongestants, caffine

Question 14

What are cardiotoxic effects of cocaine?

Answer 14

can cause MI or arrthymia, tachy, HTN

chest pain most common c/o with cocaine use

Question 15

What is PP for pts who take anabolic steroids?

Answer 15

young pt with chest pain and DOE, hypertensive

Question 16

What are side effects of anabolic steroids?

Answer 16

fractures heal slower, muscles and tendons injured faster and take longer to heal

Question 17

What are S and S of anabolic steroid use?

Answer 17

chest pain, HTN, 10-15 weight gain in 2 weeks, acne, swollen face, stretch marks, male baldness, mood changes

Question 18

What are differences between costochondritis and Tietze’s?

Answer 18

C- more common, no swelling, folks over 40, more women, 2-5th joints

T- less common, more swelling, younger folks, single level

both have pain with DB and cough

Question 19

What is slipping rib syndrome?

Answer 19

clicking ribs, hyper mobility of lower ribs (7-9), pain worse with slumped posture or side bend towards

rib mob with decrease sx

Question 20

What is intercostal neuritis?

Answer 20

herpes zoster or shingles,

affects college age kids or over 70, must have had chicken poxs

triggered by stress or immune triggered

Question 21

What are symptoms of shingles?

Answer 21

follows cranial nerve or spinal nerve pattern bc it hides in nerves

extreme pain for 4-6 weeks, contagious skin rash lasts about 2 weeks

Question 22

What is dorsal root irritation?

Answer 22

lateral/anterior chest pain, hx of back pain, similar to spinal stenosis, LE mvmt will not increase pain

make sure to r/o cardiac by asking how stairs are