Chest & Thoracic Spine Differential Diagnosis & Screening Flashcards
When fluid builds up in the small space between the two layers of tissue it is called _____ ______.
pleural effusion
When a large amount of fluid in the pleural space can create pressure, compressing your lung to the point that it partially or completely collapses, leading to dyspnea and coughing, it is called ________.
atelectasis
When extra fluid in the pleural space also becomes infected, resulting in an accumulation of pus and a fever, it is called _______.
empyema
A procedure when your doctor injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor inserts a needle through your chest wall between your ribs to remove fluid for lab analysis and to help you breathe better. This is called _______.
thoracentesis
________ is inflammation of the pericardium, the thin two-layered membrane that covers and protects the outer surfaces of the heart. Sometimes this membrane is called the pericardial sac.
pericarditis
_______ ________ occurs when fluid collects between the layers of the pericardium.
pericardial effusion
___ ________ is right sided heart failure due to high blood pressure in arteries of lung and right ventricle of the heart, pulmonary hypertension is a culprit.
cor pulmonale
______ is inflammation of pleura, caused by viral infection, injury or tumor. It is associated with sharp pain with breathing, spontaneous, age 20-40 without trauma, cough, and hoarseness.
pleurisy
What are some questions to ask for differential diagnosis of chest pain related to the cardiac system? (5)
- Do you ever have discomfort or tightness in your chest?
- Have you ever had a crushing sensation in your chest with or without pain down your left arm?
- Do you have pain in your jaw, either alone or in combination with chest pain?
- If you climb a few flights of stairs fairly rapidly, do you have tightness or pressing pain in your chest?
- Have you ever had pain or pressure or a squeezing feeling in the chest that occurred during exercise, walking, or any other physical or sexual activity?
What are some questions to ask for differential diagnosis of chest pain related to the pulmonary system? (6)
- Do you ever have shortness of breath, breathlessness, or can’t quite catch your breath?
- How far can you walk before you feel breathless?
- What symptom stops your walking (e.g., shortness of breath, heart pounding, or weak legs)?
- Do you have any breathing aids (e.g., oxygen, nebulizer, humidifier, or ventilation devices)?
- Do you have a cough?
- Are you a smoker?
What are some questions to ask for differential diagnosis of chest pain related to the epigastric system? (2.5)
- Have you ever been told that you have an ulcer?
- Does the pain under your breastbone radiate (travel) around to your back, or do you ever have back pain at the same time that your chest hurts?
- Have you ever had heartburn or acid indigestion?
- If yes, how is this pain different?
- If no, have you noticed any association between when you eat and when this pain starts?
What are some questions to ask for differential diagnosis of chest pain related to the neurologic system? (3.5)
- Do you have any trouble taking a deep breath?
- Do you have feelings of weakness?
- Does your chest pain ever travel into your armpit, arm, neck, or shoulder blade?
- If yes, do you ever feel burning, prickling, numbness, or any other unusual sensation in any of these areas?
What are some questions to ask for differential diagnosis of chest pain related to the MSK system? (5)
- Have you strained a muscle from (repeated, forceful) coughing?
- Have you ever injured your chest?
- Does it hurt to touch your chest or to take a deep breath (e.g., coughing, sneezing, sighing, or laughing)?
- Do you have frequent attacks of heartburn, or do you take antacids to relieve heartburn or acid indigestion?
- Does chest movement or body/arm position make the pain better or worse?
What are some differential diagnosis in various systems for chest pain? (8)
Aortic dissection, Pulmonary Embolism, Esophageal Rupture, Pneumothorax, Pneumonia, Pericarditis, GI causes, MSK Causes
What are the 3 “P’s” to screen for cardiac pain?
- Pleuritic pain (exacerbation by deep breathing is likely pulmonary in nature).
- Pain during palpation (musculoskeletal cause).
- Pain with changes in position (musculoskeletal cause).
What are various MSK causes of chest pain?
Costochondritis/Tietze’s Syndrome
Muscle strains/Trigger points (thoracic paraspinals, pec major, scalenes, intercostals, etc)
Rib fractures (intense, well localized)
Lower rib pain syndromes
Cervical Spine Disorders
Thoracic Outlet Syndrome
Sternoclavicular subluxation/osteoarthritis
Intercostal Neuritis (Shingles)
Xiphoidalgia
Dorsal Nerve Root Irritation
Thoracic Dysfunction/Radiculopathy
Shoulder strain (biceps tendinopathy, pectoralis, etc)
[Costochondritis/Tietze’s Syndrome] is an inflammation of the cartilage that connects a rib to the breastbone (sternum). 3rd, 4th, & 5th CC joints. It causes sharp pain in the costosternal joint. Irritation without swelling.
costochondritis
[Costochondritis/Tietze’s Syndrome] is an inflammation of the costochondral cartilages of the upper front of the chest. Pain & swelling of costochondral articulation, most common 2nd or 3rd, aggravated by cough sneeze, breathing, twisting, shoulder motions, generally resolves in 12 weeks, though can be chronic.
Tietze’s Syndrome
_____ _____ are specific thoracic spine pain areas that are referred from disc injuries in the cervical spine.
Cloward areas
