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Ortho Spine CT > Thoracic Eval & Treatment > Flashcards

Thoracic Eval & Treatment Flashcards

1
Q

History: what type of pain may be provoked or alleviated by movement or posture?

A

Musculoskeletal pain

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2
Q

History: what type of pain may be provoked by respiration?

A

Rib or pleuritic pain

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3
Q

History: what type of pain may be provoked by eating or drinking?

A

Gastric pain

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4
Q

History: what type(s) of screen(s) should be conducted for patients with both T spine and chest wall complaints?

A

Neurological

Systemic disease

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5
Q

Referral patterns for visceral organs: Thorocolumbar

A

Male genitalia

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6
Q

Referral patterns for visceral organs: Thorocolumbar T10-L2

A

Bladder/ureter

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7
Q

Referral patterns for organs: Right T7-9

A

Liver, gall bladder

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8
Q

Referral patterns for organs: T2-4

A

Lung

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9
Q

Referral patterns for organs: Right mid/lower T spine

A

Appendix

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10
Q

Referral patterns for organs: T6-T10

A

Stomach

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11
Q

Referral patterns for organs: T10-L1

A

Kidney

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12
Q

Referral patterns for organs: T1-5

A

Heart

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13
Q

Non-musculoskeletal T spine pain sources

A

Malignancy, viscera, shingles, cardiac or pulmonary issues

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14
Q

Cancers that commonly metastasize to spine

A 
Prostate
Thyroid
Breast
Lungs
Kidneys

Remember “PT Barney Loves Kids”

Also GI tract

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15
Q

Outcome measures for T spine

A

NDI above T4

ODI below T4

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16
Q

Upper rib motion

A

Anterior-posterior, “pump handle”

Ribs 1-4 or 5

17
Q

Lower rib motion

A

Medial-lateral, “bucket handle”

18
Q

Muscles contributing to respiratory dysfunction

A

Scalenes, intercostals, pec minor, serratus anterior, diaphragm, quadratus lumborum

19
Q

Muscle attachments to ribs: scalenes

A

Ribs 1-2

20
Q

Muscle attachments to ribs: pec minor

A

Ribs 3-5

21
Q

Muscle attachments to ribs: serratus anterior

A

Ribs 3-9

22
Q

Muscle attachments to ribs: diaphragm

A

Ribs 6-12

23
Q

Muscle attachments to ribs: quadratus lumborum

A

Rib 12

24
Q

What is an inhalation restriction?

A

Occurs when a rib or ribs do not rise with inhalation, but move freely with exhalation

Key rib is the uppermost affected rib

AKA exhalation dysfunction

25
Q

What is an exhalation restriction?

A

Occurs when a rib or ribs do not lower with exhalation, but move freely with inhalation

Key rib is the lowermost affected rib

AKA inhalation dysfunction

26
Q

Med conditions resulting in T spine pain: Cardiac pain

A

Pain from myocardium as a result of decreased bloodflow

Squeezing, sub-sternal sensation; tightness or pressure

27
Q

Med conditions/diff dx: acute MI

A

Intolerable gripping or crushing sensation substernally; sweating, shortness of breath

Also sx in jaw, neck, left chest and arm

Send to ED ASAP

28
Q

Med conditions/diff dx: Angina pectoris

A

Increased cardiac pn with exertion, relieved by rest

Physician referral

29
Q

Med conditions/diff dx: Aortic dissection

A

Sudden, severe, unrelenting pain substernally or btwn scapulae; pt may be pale or cyanotic

BP usually normal, distal pulses diminished or absent

Send to ED ASAP

30
Q

Med conditions/diff dx: pericarditis

A

Mild to severe chest pain aggravated by respiration, cough, motion, relieved by sitting and forward bending

Possible fever, chills, weakness, tachycardia, cough

Pn substernal, infrasternal, L upper trap

31
Q

Med conditions/diff dx: Mitral valve prolapse

A

Sharp, stabbing pn; also can be dull pn

Chest pn, angina-like pn; non-exertional pn

Stethoscope: systolic non-ejection click, late holosystolic murmur

Physician referral

32
Q

Med conditions/diff dx: Esophageal disorer

A

Mild to severe burning in epigastric or retro-sternal area

Pn often worse at night

C/o brackish taset, frequent belching

Pn diagram: horizontal band across chest or back, similar to radicular pn

33
Q

Med conditions/diff dx: Tracheobronchial Pn

A

Pn referred to upper and lateral sternum

34
Q

Med conditions/diff dx: Pleurisy

A

Sharp or stabbing pn at end of inspiration or exhalation

Pn felt over site of pleurisy or chest wall

35
Q

Med conditions/diff dx: Pulmonary embolism

A

Use Wells criteria to dx, dyspnea and tachypnea also very common

High risk: unilateral extremity swelling and chest pn

Send to ED ASAP

36
Q

Med conditions/diff dx: Cholecystitis

A

Pn typically occurs 1-2 hours after a meal

Pn peaks after 2-3 hours and resolves in 10 hours

Pn in upper right abdominal quadrant and/or right subscapular area

Fever, chills

37
Q

Med conditions/diff dx: Peptic ulcer disease

A

Burning pn below xiphoid process or left upper abdominal quadrant

Frequent, consistent NSAID use

Possibly relief via antacid use

38
Q

Med conditions/diff dx: Renal disease

A

Pn at costovertebral angle

Signs of UTI

Fever, chills, sweats

Physician referral

Ortho Spine CT (16 decks)

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