Thoracic & Ribs Clinical Presentations pt. 1

Question 1

what is a pancoast tumor

Answer 1

tumor at the apex of the lung

Question 2

what segment may a pancoast tumor involve

Answer 2

C8 and first thoracic structures

Question 3

what may a pancoast tumor present like

Answer 3

thoracic outlet syndrome

Question 4

symptoms of a pancoast tumor

Answer 4

chronic cough
bloody sputum
unexplained weight loss
malaise
dyspnea

Question 5

referred pain for MI

Answer 5

• localized to breastbone/chest area
• mid chest, neck, jaw
• mid chest and inside arms
• upper abdomen
• lower center neck
• inside arms from armpit
• between shoulder blades

Question 6

referred pain for pericarditis

Answer 6

substernal pain may radiate to costal margins, neck, upper back, UT, left supraclavicular area or down left arm

Question 7

referred pain for pneumothorax

Answer 7

upper lateral thoracic wall with referral to ipsi shoulder, across chest, or over abdomen

Question 8

referred pain for pleuritis

Answer 8

same side of lesion on lateral side

Question 9

vertebral fx increase what

Answer 9

mortality

Question 10

compression fx, what column is involved

Answer 10

traditional fx
anterior column affected

Question 11

common mechanism of compression fx

Answer 11

axial loading in flexed position

Question 12

burst fx involves what columns

Answer 12

anterior and middle

Question 13

what is the most common burst fx segment

Answer 13

T/L junction
T12 - L1

Question 14

MOI for burst fx

Answer 14

MVC
falls from height
high speed injury

Question 15

rotation/translation fx caused by what

Answer 15

fall from a height or heavy object falling on body with bent trunk

torsion and shear forces

Question 16

what columns does rotation/translation involve

Answer 16

all 3

Question 17

distraction fx

Answer 17

separation in the vertical axis
ALL, PLL and bony structures involved

Question 18

red flags for fx

Answer 18

older age
significant trauma
corticosteroid use
contusion/abrasion

Question 19

red flag cluster findings for fx

Answer 19

age >70
significant trauma
prolonged corticosteroid use
sensory alterations from the trunk down

Question 20

cluster findings to aid in identifying the presence of an osteoporotic fx

Answer 20

age >52 years
no presence of leg pain
BMI < 22
does not exercise regularly
female gender

Question 21

when do simple rib fx become stable

Answer 21

6 weeks

Question 22

rib fx symptoms

Answer 22

focal pain, radiating pain
pain with inspiration
pain coughing/sneezing

Question 23

scheuermann’s disease

Answer 23

defective growth of vertebral end plate

Question 24

who is at risk for scheuermann’s disease

Answer 24

manual workers who begin at early age
high intensity athletes
high BMI
short sternum

Question 25

criteria for diagnosing scheuermann’s disease

Answer 25

thoracic kyphosis > 45 deg
wedging x3 adjacent vertebrae > 5 deg
thoracolumbar kyphosis > 30 deg

Question 26

symptoms of scheuermann’s disease

Answer 26

thoracic pain
apex of curvature - muscle tension, IV disc bulging/spondylosis

Question 27

what condition will you see schmorl’s nodes

Answer 27

scheuermann’s disease

Question 28

costochondritis

Answer 28

inflammation of costochondral or chondrosternal articulations

Question 29

what causes costochondritis

Answer 29

repetitive stress - coughing