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Clinical Dx & Case Management 1 > Thoracic and Lumbar Complaints (Exam 2) > Flashcards

Thoracic and Lumbar Complaints (Exam 2) Flashcards

1
Q

What is the ddx for a sudden thoracic flexion injury?

A

compression or chance fracture

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2
Q

What is the ddx for an older patient with thoracic pain after coughing, sneezing, or stepping off a curb?

A

compression fracture

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3
Q

What is the ddx for a blow to the chest?

A

rib fracture

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4
Q

What is the ddx for pain radiating around the chest?

A

-intercostal strain
-intercostal neuritis
-herpes zoster
-diabetes
-neurofibroma
-DJD

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5
Q

What is the ddx for pain that radiates around the chest and has associated skin lesions?

A

herpes zoster

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6
Q

What is the ddx for someone with thoracic pain increased with stretching or yawning?

A

intercostal strain

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7
Q

What is the ddx for someone with thoracic pain that gets worse at night and is unrelieved with rest?

A

-osteoid osteoma
-cancer
-rib fracture

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8
Q

What is the ddx for someone with thoracic pain that gets worse at night and is unrelieved with rest but aspirin helps?

A

osteoid osteoma

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9
Q

What is the ddx for someone with thoracic pain that gets worse at night, unrelieved with rest, and is more difficult to lie on back?

A

rib fracture

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10
Q

What is the ddx for chest or abdominal pain?

A

referral or radiation from chest or abdominal disease

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11
Q

What is the ddx for epigastric pain?

A

-pelvic ulcer
-esophagitis
-pancreatitis

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12
Q

What is the ddx for URQ abdominal pain?

A

cholecystitis or lithiasis

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13
Q

What is the ddx for chronic thoracic pain?

A

-myofascial pain due to poor posture
-ergonomic strain at work
-fibromyalgia
-depression

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14
Q

What is the ddx for someone who is seated with forward head posture?

A

postural syndrome

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15
Q

What is the ddx for someone with middle or upper scapular pain?

A

postural syndrome

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16
Q

What is the ddx for pain all over the body or both sides of thorax?

A

fibromyalgia

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17
Q

What is the ddx for pain associated with globally restricted thoracic spine movement?

A

ankylosing spondylitis

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18
Q

What is the ddx for an observed thoracic deformity?

A

-postural kyphosis
-scheuermann’s ds
-compression fracture
-scoliosis
-scapular winging due to nerve damage

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19
Q

What is the ddx for someone with a sudden onset of a hunched appearance or gradual height loss in a senior?

A

compression fracture (osteoporosis, trauma, or pathology related)

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20
Q

What is the ddx for an adolescent constantly hunched forward?

A

postural syndrome or scheuermann’s disease

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21
Q

What is the ddx for a curving back with a high shoulder or bulging ribs?

A

scoliosis

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22
Q

What is scheuermann’s disease?

A

-vertebrae grow unevenly with respect to the sagital plane
-causes anterior wedging shape of the vertebrae
-typically 13-17 years old
-complains of midback pain and fatigue
-may have increase kyphosis

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23
Q

What is osteoid osteoma?

test q

A

-benign bone tumor usually affecting a long bone (femur/tibia) but some affect the spinal lamina, pedicle, facet, or SP
-typically younger patients
-complaining of well-localized midback pain with the pain being worse at night be relived by aspirin

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24
Q

What is a compression fracture?

A

-typically older patients will have sudden onset of thoracic or lumbar pain after a minor event (stepping off a curb or sneezing)
-typically younger patients have trauma (fall on butt, hyperflexion injury)
-may be secondary to osteoporosis, menopause, long term corticosteroid use, hyperthyroidism, or malignancy

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25
What is postural syndrome?
-caused by imbalance between anterior and posterior muscles -often accentuated by various postures that emphasize a hunched forward head position -constant aching pain in the middle and upper thoracic regions -made worse by forward engaging postures -usually relieved with activity
26
What is thoracic outlet syndrome (TOS)?
-neurologic or neurovascular compromise of the brachial plexus and or subclavian axillary vessel in the space -can be caused by injury, trauma, poor posture (rounded shoulders), anatomical abnormalities (cervical rib), tight muscles (scalene or pec minor) -diffuse symptoms down arm (numbness/tingling) usually medial arm to 4th/5th digits unilaterally -gets worse with overhead and repetitive activities
27
What is scoliosis?
-lateral bending and or rotary deformation of the spine, named for the side of convexity -can be classified as congenital, idiopathic (idiopathic subtypes are infantile, juvenile, adolescent, or adult according to onset), or secondary to primary condition like spina bifida, neurofibromatosis, cerebral palsy, etc
28
Which scoliosis is the most common?
idiopathic
29
What is tietze syndrome?
-rare msk condition -causes mostly unilateral localized chest pain, tenderness, swelling at the costochondral junction typically at the 2nd or 3rd costochondral joints -can be associated with chronic excessive coughing, trauma/impact to the chest, viral or bacterial infections
30
What is the ddx for someone who was in an MVA, fall, or lifting injury?
-disc lesion -lower back muscle strain -facet injury -lumbar fracture
31
What is the ddx for falling on butt?
compression or coccygeal fracture
32
What is the ddx for a sudden hyperflexion injury?
compression or chance fracture
33
What is the ddx for pain that appears while lifting or with sudden twisting?
disc lesion or muscle strain
34
What is the ddx for sudden extension injury?
lumbar facet injury
35
What is the ddx for lbp that continues into butt or leg?
-disc lesion -tumor -stenosis -referral from facet -piriformis syndrome
36
What is the ddx for lbp that extends below the knee?
nerve root pain due to disc, stenosis, or tumor
37
What is the ddx for lbp that extends into the butt or knee? test q
lumbar facet issue or sciatica
38
What is the ddx for someone with difficulty urinating or pooping with lbp?
-cauda equina syndrome -prostate disease -disc lesion (valsalva effect) -constipation
39
What is the ddx for lbp with numbness around groin or genital area?
cauda equina syndrome note: this is a lumbar red flag!!!!
40
What is the ddx for leg pain when pooping, coughing, or sneezing?
space occupying lesion indicating tumor or disc lesion
41
What is the ddx for lbp with often urination and or having difficulty stopping/starting?
prostate cancer
42
What is the ddx for lbp with abdominal pain?
genitourinary cause or abdominal aneurysm
43
What is the ddx for lbp with abdominal pain associated with mensuration?
-dysmenorrhea -endometriosis -PID
44
What is the ddx for lbp with abdominal pain that radiates around to the groin?
kidney infection or kidney stones
45
What is the ddx for lbp with abdominal pain associated with weakness in the legs?
abdominal aortic aneurysm (AAA) note: this is a red flag for lumbars!!!
46
What is the ddx for marked weight loss with past hx of cancer, night pain, or pain unrelieved with rest?
cancer
47
What is the ddx for any weakness in the legs with activity?
neurogenic or vascular claudication
48
What is the ddx for weakness in legs with activity that is quickly relieved with rest?
vascular claudication
49
What is the ddx for weakness in legs with activity that is better when flexed and or relieved 15-20 min later when resting?
neurogenic claudication (canal stenosis)
50
What is a disc lesion with radiculopathy?
-lbp and leg pain generally below the knee -sudden onset from bending and or twisting motion -often there is a past history of several bouts of lbp that resolved -numbness, tingling, and paresthesia -radiates though dematome -gets worse with extension and better with flexion
51
What is facet syndrome?
-localized lbp with some hip, butt, or leg pain generally above the knee -sudden onset after a misjudged movement or arising from a flexed position -increased pain with extension, decreased with flexion
52
What is a lumbar sprain/strain?
-decreased mobility, stiffness and or muscle spasm from acute traumatic overstretching of lumbar spine -may result from overuse, repetitive tasks or trauma (sports injury or MVA) -muscle strains are painful with active and isometric movements -ligamentous sprains are painful with active and passive ROM
53
What is canal stenosis?
-generally older patients 50+ -complains of back and leg pain -pain can be unilateral or bilateral diffuse -onset of leg pain with walking (neurogenic claudication) and relief after resting 15-20 min or by maintaining a flexed postured (bicycle posture)
54
What is a spondylolisthesis?
-asymptomatic or have lbp made worse with extension -in older patients it may cause stenosis
55
What is the most common type of spondylolisthesis?
isthmic
56
What is an SI sprain?
-pain over SI joint after straightening up from a stooped posture (often while lifting) -pain may radiate down the leg -pain is often sharp and stabbing
57
What is known as "fat wallet sciatica"?
piriformis syndrome
58
What is piriformis syndrome?
-compression of SI joint -butt and posterior leg pain w a non-traumatic onset -risk factors= sitting all day, fat wallet
59
What is ankylosing spondylitis?
-chronic lbp and stiffness with occasional radiation of pain into the butt, anterior, or posterior thighs -feels stiffness upon rising and generally have some relief with mild to moderate activity
60
What is reactive arthritis (reiter's syndrome)?
-lbp that began after the onset of urethritis, conjunctivitis, and skin lesions on the soles of feet/palms of hands "cant see, pee, or dance with me"
61
What is multiple myeloma?
-usually an older patient 50+ with complaints of persistent back pain that is unrelieved by rest -pain seems to be worse at night
62
What is metastatic carcinoma?
-insidious onset of pain that is persistent, worse at night and not mechanically affected -often an accompanying history of weight loss and fatigue
63
What is infectious spondylitis?
-deep back pain -often recent hx of a respiratory or urinary tract infection -patient is usually antalgic and complains of fever and difficulty sleeping due to pain
64
What are the red flags that could indicate need for immediate radiograph, special studies, or referral out?
-severe trauma -fever or recent bacterial infection -saddle anesthesia (anything that touches a saddle is numb)/signs of cauda equina syndrome -severe or progressive neurologic complaints -recent onset of bladder dysfunction in association with the lbp -unexplained weight loss -prior hx of cancer, IV drug use or immunosuppression -pain that is worse with recumbency or worse at night

Clinical Dx & Case Management 1 (6 decks)

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