E2- Spinal Malignancy

Question 1

what is multiple myeloma

Answer 1

primary malignant tumor in bone marrow

Question 2

where can spinal malignancy be metasized from

Answer 2

breast
lung
prostate
kidney
GI

Question 3

what structure in the spine is spinal malignancy most commonly at

Answer 3

vertebral body

Question 4

what is the main difference between myelopathy and spinal malignancy

Answer 4

myelopathy= C5-T1
malignancy= below T1

Question 5

what are the S&S of spinal malignancy

Answer 5

spinal pain- unfamiliar/severe
bony landmark alterations - fx
unable to lay flat
mechanical pain thats random
tenderness to palpation

Question 6

what is our referral for spinal malignancy

Answer 6

urgent
if spinal cord S&S are present then immobilize and becomes emergency

Question 7

what is the most common region for myelopathy

why

Answer 7

thoracic

due to smaller ratio of canal to cord then other regions

Question 8

what are the S&S of thoracic myelopathy

Answer 8

extreme spinal pain
multisegmental weakness/numbness
spastic or rententive bladder
dtr= hyperactive
UMN +

Question 9

where is the most common nontraumatic spinal injury

Answer 9

T8-L4 levels

Question 10

what is the most serious spinal injury

Answer 10

non traumatic spinal fx

Question 11

what is the cause for non traumatic spinal fx

Answer 11

malignancy
osteoporosis

Question 12

what are the RF for non traumatic spinal fx

Answer 12

osteoporotic
more than 3 months of corticosteriod use
female
older age

Question 13

what are the low evidence S&S of non traumatic spinal fx

Answer 13

unfamiliar/severe pain
tenderness
sudden change in posture
mechanical
rare neuro S&S

Question 14

what bacteria is most commonly involved with spinal infection

Answer 14

mycobacterium TB
Staph aureus
brucella

Question 15

what is Potts disease and where is it most commonly

Answer 15

skeletal TB
thoracic spine

Question 16

how can spinal infection happen

Answer 16

develops 2-3 years after initial air droplet infection into lungs
lungs to vb to disc to adjacent vb

Question 17

how does a spinal infection spread

Answer 17

lymph nodes and blood

Question 18

what can happen if an abcsess grows in a spinal infection

Answer 18

nerve root irritation
vb collapse/fx
cord compression

Question 19

what can happen if spinal infection goes untreated

Answer 19

neuro S&S influence LE coordination including bowel and bladder
increased thoracic kyphosis

Question 20

what are the early S&S of spinal infection

Answer 20

arthritic like back pain and stiffness

Question 21

how can spinal infection be shown on xray

Answer 21

body destruction
TB abscess
loss of height
sclerotic end plate
diminished disc space

Question 22

what is stable angina

Answer 22

occurring with stress, physical or emotional

Question 23

what is unstable angina

Answer 23

occuring at rest

Question 24

why CAD the cause of angina/MI

Answer 24

ischemia or limited circulation with imbalance between supply and demand for the heart

Question 25

where could pain be distributed with angina/MI

Answer 25

chest pain, pressure, tightness, or heaviness jaw or L arm referred pain in C4-T4

Question 26

what are atypical S&S of angina/MI especially females

Answer 26

intrascapular and R arm pain

Question 27

why can someone with diabetes have less pain with angina/MI

Answer 27

decrease circulation so decreased n function

Question 28

what do we do for stable angina

Answer 28

<20= urgent >20= emergency

Question 29

what do we do for unstable angina

Answer 29

emergency

Question 30

what is a pulmonary embolism

Answer 30

blockage of the pulmonary artery due to a traveling blood clot

Question 31

what are RF for pulmonary embolism

Answer 31

DVT immobility hx of abdominal/pelvic sx LE jt replacement late stage pregnancy LE fractures

Question 32

why could a femur fracture cause a pulmonary embolism

Answer 32

yellow marrow (fat) will act as a clot and could cause a PE

Question 33

where does the obstruction come from for a PE

Answer 33

the right side of the heart

Question 34

what is a pulmonary embolism labeled as

Answer 34

the great masqueraders gets diagnosed as other things

Question 35

what are the S&S of PE

Answer 35

chest pain- sudden, sharp, stabbing (T2-4) deep inspiration coughing reaching trunk motion

Question 36

what do we do for a pulmonary embolism

Answer 36

utilize CDR emergency referral

Question 37

what are severe S&S of PE

Answer 37

cough that is bloody painful breathing palpitations

Question 38

what are the factors of CDR for PE

Answer 38

DVT - LE pitting edema, TTP HR >100 immobilization > 4 wks prior DVT bloody cough malignancy

Question 39

what is GERD

Answer 39

backflow of stomach contents into esophagus

Question 40

what causes GERD

Answer 40

food obesity smoking hernia meds

Question 41

what happens with GERD

Answer 41

dysfunctional valve between stomach and esophagus allowing backflow increase acidity and acid volume

Question 42

what is scheuermann disease

Answer 42

ant vb wedging of adjacent thoracic vb

Question 43

what can cause scheuermann disease

Answer 43

persistent IDD

Question 44

what can scheuermann disease do to the vb

Answer 44

abnormal vb end plate mineralization and ossification during growth leads to: ant vb wedging disc herniates into vb

Question 45

what are S&S of scheuerman disease

Answer 45

excessive and rigid thoracic kyphosis possible counter hyperlordosis in cervical and lumbar regions

Question 46

what is varicella virus

Answer 46

chicken pox first time and shingles second time

Question 47

how is varicella transmitted

Answer 47

airborne or direct contact so isolate until lesions are crusted highly contagious

Question 48

what is the referral method for varicella

Answer 48

urgent but emergency if close to the eye

Question 49

what are the S&S of shingles

Answer 49

lesions in rose petal shape in dermatomal pattern pain and itching

Question 50

what are common S&S of pancoast tumors

Answer 50

shoulder pain (T2-4) TOS S&S UE swelling paresthesias

Question 51

what S&S does pancoast tumor share with horners syndrome

Answer 51

sucken eye droopy eye lack of face sweating on one side

Question 52

what is the RF for psoriatic arthritis

Answer 52

psoriasis

Question 53

what happens with persistent inflammation of psoarisis

Answer 53

targets the entheses and gradually thickens and erodes tissue- DIPs

Question 54

what are the S&S for psoriatic arthritis

Answer 54

sausage digit enthesis

Question 55

how do we treat psoriatic arthritis

Answer 55

urgent referral

Question 56

what do PsA and RA have in common

Answer 56

swelling and stiffness damage tissue and organ autoimmune disease

Question 57

what differs with PsA and RA

Answer 57

RA- attacks synovial jt= MCP and wrist and bilateral PsA- attacks entheses= DIP and unilateral

Question 58

what structures are involved with RA

Answer 58

loose connective tissue synovial membranes

Question 59

what conditions of the wrist can develop due to RA

Answer 59

boutonniere deformities spurring ulnar drift at wrist carpal tunnel syndrome

Question 60

how do we treat RA

Answer 60

POLICED orthotics/ergonomic JM MET with optimal stresses for cartilage integrity/jt mobility

Question 61

what is the prognosis of RA

Answer 61

more management