SPE #2 S&S

Question 1

Thoracic Spinal Cord Myelopathy S&S:

Answer 1

-slow gradual, and often progressive compression on the cord
-extreme spinal P!
-multi-segmental numbness and weakness/paralysis of extremities and trunk below the level of injury resulting in paraplegia
-spastic or retentive bowel and bladder

Question 2

Thoracic Spinal Cord Myelopathy Etiology:

Answer 2

-MOST commonly due to degenerative spinal changes
-20% of the time with the only well-validated RED FLAG being hx of cancer

Question 3

Thoracic Spinal Myelopathy
-PT Plan:

Answer 3

-emergency referral

Question 4

What is the MOST common area of metastasis?

Risk factors: (1)

Answer 4

-lungs; it is the first organ to filter malignant cells in the vena cava

-long term smokers

Question 5

Lung Cancer S&S:

Answer 5

Cough is the MOST common symptom along with other respiratory S&S (rare - apical region)

**May have shoulder P! (T2-4 shared innervation) associated with Pancoast Tumor

Question 6

PT plan for lung cancer:

Answer 6

urgent referral

Question 7

Male >50 yrs. of age and has a hx of smoking can you suspect a Pancoast tumor?

Answer 7

yes

Question 8

Pancoast tumor S&S:

Answer 8

-lung cancer S&S
- Shoulder P! 90% of case

Growth may lead to compression on:
-subclavian vv. so TOS S&S or UE swelling with decreased venous return
-ribs, vertebrae which possibly mechanical P!
-brachial plexus, spinal nn. so parathesis along C8, T1 spinal n and/or medial/ulnar nn.

-may lead to horners syndrome

Question 9

PT plan for Pancoast tumor:

Answer 9

urgent referral

Question 10

The mean age is 60 yrs.
2nd MOST common primary tumor in children
MOST common intracranial metastatic tumor in adults

Answer 10

Brain Tumor

Question 11

Brain tumor etiology:

Answer 11

compression of cerebral tissue
at times erosion of bone with tumor growth
leads to edema and increased intracranial pressure

Question 12

Brain tumor S&S:

Answer 12

-Cancer S&S plus specific S&S related to are of brain
-HA that is increased with activities further increasing ICP, looking straining exercise, coughing
-UMN S&S including ataxia if cerebellum involved
-Cranial N. VI (abducens) susceptible to ICP - diplopia and painful eye motion may develop
-Seizures
-Speech Impairment

Question 13

PT plan for Brain Tumor

Answer 13

urgent referral

Question 14

Non traumatic spinal fracture S&S

Answer 14

-Thoracic P! w/ history of malignancy and/or osteoporosis
-Unfamiliar and severe P! possibly worsening
-TTP at fx
-Sudden change in spinal posture/shape
-Mechanical P!
-Coordination and bowel/bladder dysfunction

Question 15

What levels are non traumatic spinal fractures most commonly between?

Answer 15

T8-L4 (lower thoracic, upper lumbar)

Question 16

Non traumatic spinal fracture etiology:

Answer 16

Malignancy
Osteoporosis

Question 17

Non traumatic spinal fracture involved system and objective
- PT Plan

Answer 17

Skeletal system

TTP
Test for possible fracture by performing percussion test
Test for possible fracture by performing vibration at SPs

• emergency referral

Question 18

Non traumatic spinal fracture risk factors:

Answer 18

Prior osteoporotic or low impact spinal fx
>3 month corticosteroid use
Female – late menarche, early menopause
Older age – women >65, men >75
History of cancer

Question 19

Non traumatic spinal fracture 1st choice for imaging:

Answer 19

x ray

Question 20

angina:
myocardial infarction:

Answer 20

Angina: chest P!
—– stable – occurring with stress, physical, and/or emotional
—Unstable – occurring at rest

Myocardial infarction: heart attack

Question 21

Angina/myocardial infarction risk factors:

Answer 21

Males 65 or older
Any condition that limits blood supply to or increases demand of the heart
o Smoking
o Metabolic syndrome: high cholesterol, HTN, diabetes, obesity
o Psychosocial disorders
o Standard American diet

Question 22

Angina/myocardial infarction etiology:

Answer 22

Coronary artery disease (CAD)

Question 23

Angina/myocardial infarction S&S:

Answer 23

• P!
  o Sudden onset of chest pain, pressure, tightness, heaviness
  o Additional pain in the jaw or left arm
  —females: interscapular and right arm pain
  o Referred pain C4-T4 dermatomal pattern due to shared innervation
• SOB
• Sweating
• Nausea
• Fatigue
• Syncope

Atypical S&S:
- Less pain with diabetes due to neuropathy
- Pericarditis with autoimmune disease
- Most common in adults is SOB due to impaired ANS response and central P!

Question 24

Angina/myocardial infarction
- PT Plan

Answer 24

Stable angina:
- < 20 minutes urgent
- > 20 minutes emergency
Unstable angina:
- Emergency referral

Question 25

Thoracic metastasis S&S:

Answer 25

cancer S&S
spinal P! - most common
unfamiliar and severe P!, may be progressive
possible myelopathy S&S
bony alterations, including fractures and subsequent joint instability
may be unable to lie flat due to P!
mechanical P!

Question 26

Thoracic metastasis risk factor:

Answer 26

history of cancer

Question 27

thoracic metastasis
- PT Plan

Answer 27

urgent referral unless cord S&S - emergency referral

Question 28

PT objective: Thoracic Myelopathy

Answer 28

1. Test for postitive UMN
2. Test for hyperactive DTRs
3. Check vitals due to compression causing ischemia

Question 29

PT objective: Lung Cancer With Pancoast Tumor

Answer 29

1. Check ULTT in media/ulnar N.
2. Check myotomes for fatiguing weakness @ C8 and T1
3. Observe pupils for ptosis or mitosis
4. Observe ipsilateral fascial flushing and sweating
5. Perform Gillards cluster for TOS S&S

Plus cancer s&s

Question 30

PT objective: Brain Tumor (Cancer)

Answer 30

1. Check balance and coordination (cerebellum dysfunction)
2. Palpate swollen NON-tender lymph nodes
3. Observe speech impairment
4. Check vitals (high temp)

Question 31

PT objective: Thoracic Metastasis (Cancer)

Answer 31

1. Palpate swollen NON-tender lymph nodes
2. TTP due to possible fx
3. Check vitals

Question 32

PT objective: Angina/Myocardial Infraction (Cardiac)

Answer 32

1. Check vitals
2. Check ABI
3. Observe SOB
4. Observe sweating

Question 33

PT objective: Non-Traumatic Spinal Fxs (skeletal due to Osteoposoros)

Answer 33

1. Observe an increased kyphosis in thoracic spine
2. TTP at Fx
3. Tenderness w/vibration at SP
4. Tenderness w/percussons due to fx