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Common Condition Revision > Thoracic spine/rib/abdominal pain > Flashcards

Thoracic spine/rib/abdominal pain Flashcards

1
Q

What are some red flags for thoracic pain?

A
  • Angina
  • AMI
  • Dissection
  • Lung / secondary metastases
  • Osteomyelitis
  • Pneumorthorax
  • Osteoporosis
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2
Q

What are some red flags for acute abdominal pain?

A
  • Fever
  • Collapse on toilet whilst straining
  • Ischaemic heart disease
  • Pallor/sweating
  • Progressive vomiting/pain/distension
  • Menstrual abnormalities
  • Atrial fibrillation (can cause blood clotting)
  • Rebound tenderness and guarding
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3
Q

Probable diagnosis of thoracic pain?

A
  • Musculoligamentous strains/sprains
  • CT/CV dysfunctions
  • Discogenic pain
  • Rib/ Vertebral #
  • Scheurrmans
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4
Q

How do you differentiate between a CV/CT/Facet, muscle strains and referred pain from the neck in the thorax?

A

CV/CT/Facet: Chronic postural, acute minor/major trauma, excessive coughing, pain on deep inspiration and tenderness of local structure

Muscle strains: Active movements into that direction + resistance from the muscle causes pain, pain on palpation, acute onset and usually clear mechanism

Referred neck pain: Radiation from neck, springing the Tx doesn’t reproduce pain, dysfunction seen on Cx ROM or palpation

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5
Q

What is Scheuermann’s Disease? How is it caused?

A

-Characterised by vertebral endplate irregularities of 3+ adjacent vertebral bodies - usually in the Tx but can also be present in the T/L junction

  • Caused by abnormal endplate ossification causing anterior wedging and an increase kyphosis
  • Genetic component?
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6
Q

Clinical features of Scheurmann’s disease?

A
  • Aggravated by activity and relieved by rest
  • Sometimes asymptomatic
  • Cervical/Lumbar hyperlordosis
  • +/- scoliosis
  • Tight hamstrings
  • Loss of disc space
  • Commonly affecting 12-17 year old males
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7
Q

What is osteoporosis?

A

Osteoporosis is a loss of bone density making the bones brittle, weaker and easy to fracture
Reduction in bone density

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8
Q

Risk factors for osteoporosis?

A
  • Elderly
  • Females
  • Long term corticosteroid/steroid/NSAID use
  • Malnutrition/calcium deficient
  • Coeliac/bowel/liver conditions
  • Eating disorders
  • Thyroid and parathyroid conditions
  • Excessive alcohol consumption
  • Smoking
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9
Q

What type of osteoporosis’s are there?

A

Primary: Menopausal (idiopathic) and Senile
Secondary: Iatrogenic (corticosteroids/ chemotherapy) and Pathological (Crohns disease)

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10
Q

What are the probable diagnoses for acute and chronic abdominal pain?

A

Acute: Appendicitis, gastroenteritis, painful ovulation, IBS, Musculoskeletal - myofascial, hernia, referred Tx pain, side strains

Chronic: peptic ulcer, IBS, painful ovulation

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11
Q

Serious disorders not to miss in the chest/abdomen?

A
  • Angina
  • AAA (hypertension, older age, pallor, high BMI, male, smoker)
  • Secondary neoplasia (metastasis)
  • Pneumothorax
  • Osteoporosis
  • Myocardial Infarction
  • Bowel/stomach/ovarian cancer
  • Hepatitis
  • Pelvic inflammatory disease
  • Menstral abnormalities
  • Atrial Fibrillation
  • Rebound tenderness
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12
Q

What is an abdominal hernia?

A

-The protrusion of abdominal contents (intestines, omentum) into the inguinal canal

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13
Q

Risk factors for an abdominal hernia?

A
  • Male
  • Advanced age
  • Occupations involving lifting
  • Connective tissue disorders
  • Inguinal cryptochidism
  • Smoking
  • High BMI
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14
Q

What types of abdominal hernias are there?

A

Indirect: Hernia sac passes through the deep inguinal ring and runs in the canal

Direct: Bulges directly through the canal

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15
Q

What is a side strain?

A

Usually involves a tear of the I/O muscle at either the rib or costal cartilage attachment

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16
Q

Who is at greater risk of a side strain injury?

A

-Athletes involved in repetitive, unilateral and explosive trunk motions

17
Q

Clinical features of a side strain?

A
  • Acute pain and focal tenderness at costal margin
  • Reproduced by movements consistent with mechanism
  • Aggravated by deep breathing, coughing and rolling over in bed
18
Q

What are some causes of CV/CT joint dysfunction:

A
  • Mechanical joint sprains
  • Degenerative change (OA)
  • Inflammatory spondyloarthropathies
  • Chronic postural issue
  • Excessive coughing
19
Q

Clinical features of CV/CT joint dysfunction?

A
  • Localised tenderness 3-4cm lateral to midline on the rib
  • Restricted motion or catching sensation
  • Often evident on deep inspiration and Tx AROM
  • Hypertonicity of paraspinal musculature
  • Referral to other areas of the body
20
Q

Clinical features of Thoracic muscle strains?

A
  • Reproduction of pain when mm in activated
  • Active resisted
  • Pain on palpation
  • Postural or acute mechanisms
21
Q

Clinical features of Thoracic pain due to referred neck pain?

A
  • Pain travels
  • Are not able to reproduce pain on the Tx spine
  • Restricted ROM of Cx spine
22
Q

What ligaments make up the costovertebral joints?

A
  • Radiate ligament

- Intrarticular ligament

23
Q

What ligaments make up the costotransverse joints?

A
  • superior costotransverse
  • lateral costotransverse liagemnt
  • costotranservse ligament
24
Q

Where can C4-7 posterior disc bulges or tears refer to?

A 
Interscapular region (according to Cloward  1959)
Where as posterolateral injuries refer to upper limb
25
Q

What is a Schmorl’s node?

A

Schmorl’s node is when some of the IVD leaks into the vertebral body due to the compressive force

26
Q

What are some treatment techniques for scheuermann disease?

A
  • Conservative: stretching, lifestyle - modification, NSAIDs, physical therapy
  • Schroth Method
  • +/- Bracing
  • Surgical – anterior release with spinal fusion
27
Q

What are some radiological findings of scheuermann disease?

A
  • Loss of disc space
  • Schmorl’s nodes
  • irregular vertebral endplates
  • Scoliosis
28
Q

Treatment of post-menopausal osteoporosis?

A
  • Hormone replacement therapy (mainly oestrogen)
  • Bisphosphonates: bind to bone mineral and ingested by osteoclasts, inhibit osteoclast activity
  • Newer therapy: Dinosumab antibodies suppress the activity of osteoclasts
29
Q

Why does oestrogen play a role in bone health?

A

It regulates the activity of osteoclasts (make them undergo apoptosis) minor function of osteoblasts

30
Q

Adverse effects hormone therapy?

A
  • increase risk of CVS/ DVT
  • increased risk for AMI
  • Pre-menstral type symptoms
31
Q

Often missed diagnosis of thoracic pain?

A
  • GI (gord, gastritis, ulcers)
  • Herpes Zoster (cold sores type I, genital herpes type II, both cause shingles when in DRG)
  • Costochondritis (can refer to back)
32
Q

Causes of acute gastroenteritis?

A
  • E coli
  • H pylori
  • Salmonella
33
Q

Management for gastroenteritis?

A
  • Antibacterials (H pylori)
  • fluids, monitor
  • let the bug out
34
Q

Time-frame returning to work for a healthcare worker?

A

atleast 24 hours symptom free

Hospitals: 72 hours

35
Q

Most common cause of appendicitis?

A

A feacalith blocking the lumen of the appendix

36
Q

What are the different types of herniations?

A

Indirect (lateral) hernia
• Strong association with having patent vaginal process
Direct (medial) hernias
• Usually due to weakness in the transversalis fascia

37
Q

What is the most common type of hernia?

A

Inguinal hernias account for 75% of abdominal wall hernias

Other types: umbilical (also very common), femoral, incisional

Common Condition Revision (6 decks)

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