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ClinMed > Pathologies related to the throax: Test 2 > Flashcards

Pathologies related to the throax: Test 2 Flashcards

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1
Q

what is a multiple myeloma

A

primary malignant tumor in bone marrow

typically in older

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2
Q

describe spinal metasteses (prevalance, incidence, etiology, etc)

A

most common tumor in spine

2nd most serious spine pathology

bone = 3rd most common metastasis behind lung and liver

vertebral body, usually anterior, is most common place

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3
Q

spinal metastases are most commonly from what other types of cancers

A

most often from breast, lung, prostate, kidney, GI, and thyroid tumors

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4
Q

most common region for spinal malignancy

A

thoracic (70%)

20% create cord compression or myelopathy

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5
Q

risk factors and pathogenesis for spinal malignancy

A

history of cancer

healthy bone replaced by tumor

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6
Q

clinical manifestations of spinal malignancy

A

cancer S&S including spine P! that is the most common initial symptom

unfamiliar and severe pain that may become progressive/constant

possibly myeopathy S&S

possible bony alterations including fx or instability

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7
Q

with spinal malignancy, how might bony alterations present

A

unable to lie flat due to pain

may make the pain mechanical

possibly tender with palpation, percussion and/or vibration at SPs if a spinal fx

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8
Q

PT referral for spinal malignancy

A

urgent referral unless cord S&S; then you would want to immobilize for an emergency referral

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9
Q

what is thoracic spinal cord myelopathy

A

slow, gradual and often progressive compression on the cord

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10
Q

incidence of thoracic spinal cord myelopathy

A

most common region of the spine for myelopathy due to smaller ratio of canal to cord then other regions

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11
Q

etiology of thoracic spinal cord myelopathy

A

most commonly due to degenerative spinal changes
-lax ligamenyum flavum/buckling
-stenosis
-ARDD with herniation
-vertebral body collapse/fx
-pathological instability

malignancy 20% of the time (red flag = hx cancer)

rare central disc herniation

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12
Q

clinical manifestations for thoracic spinal cord myelopathy

A

neuro S&S depends on level of injury

extreme spinal P!

multi segment numbers and weakness/paralysis of extremities and trunk below level of injury

spastic/retentive bladder/bowel

hyperactive DTR

+ UMN tests

hypoactive superficial reflexes

immobilize and emergency referral

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13
Q

incidence of non-traumatic spinal fractures

A

most common serious spinal pathology

70% of non traumatic spinal fx occur in thoracic spine

predominately in older females with osteoporosis

most common between T8 and L4

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14
Q

etiology of non-traumatic spinal fx

A

malignancy

osteoporosis

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15
Q

risk factors for non traumatic spinal fx

A

prior osteoporotic or low impact spinal fx

more than 3 months corticosteroid use

female (late onset menarche or early menopause)

older age (women over 65, men over 75)

low evidence for hx of cancer

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16
Q

pathogenesis of non traumatic spinal fx

A

weakening and eventual failing of bone due to disease

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17
Q

clinical S&S of non traumatic spinal fx

A

thoracic pain with hx or malignancy or osteoporosis

low evidence for:
-unfamiliar/severe P!
-tender with palpation, percussion, and/or vibration
-sudden change in spine posture/shape
-likely mechanical P!
-rare neuro S&S in LE

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18
Q

preferred imaging for non traumatic spinal fx

A

x-ray is first choice; lateral views most useful (but they can’t determine age of fracture)

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19
Q

how useful are MRIs for non traumatic spinal fx

A

can differentiate between osteoporotic and soft tissue malignant fx

can determine age of fracture by identifying bone marrow edema that x-ray cant pick up

should be performed if multiple fractures are found with an x-ray

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20
Q

incidence of spinal infection

A

uncommon in wealthier countries but resurgence with longevity and IV drug use

in lower income countries more due to HIV/AIDS and TB

skeletal tuberculosis (aka potts disease) is more common in the thoracic spine

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21
Q

etiology of spinal infection

A

primarily from mycobacterium TB

staphylococcus aureus and brucella are also involved at times

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22
Q

risk factors for spinal infection

A

imunosuppresion
surgery (particularly of the spine and repeated procedures)
IV drug use
social depravation
Hx of TB
recent infection

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23
Q

pathogenesis of spinal infection

A

develops 2-3 years after initial air droplet infection into lungs

spreads via lymph and blood

infection starts in lungs (pulmonary TB), goes to vertebral body (osteomyelitis), and eventually the disc (disci tis) and adjacent vertebrae (skeletal TB)

abcess grows

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24
Q

what happens when an abscess grows from a spinal infection

A

nerve root irritation

vertebral body collapse/fx

cord compression may develop

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25
early S&S of spinal infection
arthritic like back pain/stiffness = most common presenting constitutional symptoms not common initially
26
low evidence S&S of spinal infection
localized/progressive pain infection S&S (especially fatigue, fever since onset of pain, and unexplained weight loss) tenderness with palpation, percussion and vibration
27
what happens if spinal infection is left untreated
neuro S&S influence LE coordination as well as bowel/bladder function increased thoracic kyphosis
28
what might you see in an x-ray of a pt with spinal infection
body destruction TB abscess loss of height sclerotic end plates diminished disc space
29
what are the 2 types of angina
stable = occurring with stress; physical and/or emotional unstable = occurs at rest
30
incidence of angina and MI
most often in makes older than 65
31
risk factors for angina and MI
any condition that limits blood supply to or increases demand of the heart smoking metabolic syndromes -high cholesterol -HTN -diabetes -obesity -high triglycerides psychological disorders SAD
32
pathophysiology of angina or MI
ischemia or limited circulation with imbalance between supply and demand for the heart with possible complete occlusion and myocardial tissue death
33
typical manifestations/S&S of angina or MI
Pain (sudden chest pain, pain in jaw/L arm, referred pain) SOB Sweating nausea fatigue syncope
34
atypical manifestations/S&S of angina and MI
females = intrascapular pain, R arm pain, and lack of angina less pain with diabetes due to neuropathy pericarditis with autoimmune diseases most common S&S in older adults is SOB due to impaired ANS response and central P! mechanisms
35
PT implications for angina and MI
don't want to miss for stable angina, if less than 20 min then urgent referral; if more than 20 min then emergency referral unstable angina = emergency
36
what is a pulmonary embolism
blockage of the pulmonary artery
37
incidence of pulmonary embolism
associated with high morbidity/mortality half go undiagnosed 1/3 pts with untreated die only 8% of those who are diagnosed die more common in females over 50
38
risk factors for pulmonary embolism
prior PE or deep vein thrombosis immobility Hx of abdominal/pelvic sx or malignancy LE joint replacement late stage pregnancy LE fx
39
etiology of pulmonary embolism
most often deep vein thrombosis especially in LE other blockages may be from fat, air bubbles, amniotic fluid, clumps of parasites, or tumors
40
pathogenesis of pulmonary embolism
obstruction travels through the right side of the heart abd becomes lodged in smaller pulmonary artery feeding the lungs pulmonary infection results including damage and impaired gas exchange
41
clinical manifestations and S&S of pulmonary embolism
often non specific pleuritic chest pain (sudden sharp/stabbing chest pain) made worse by deep breath, coughing, trunk motion, reaching, and accessory motion testing SOB, wheezing, and/or rapid breathing
42
other S&S of pulmonary embolism
cough, possibly with blood painful breathing fainting tachycardia and palpitations
43
PT implications for pulmonary embolism
don't want to miss timely detection is critical utilize CDR and emergency referral is indicated
44
PT implications for upper GI system issues
need to differentiate from cardiopulmonary issues thoughtful positioning with interventions; keep more upright
45
incidence of gastroesophageal reflux disease
one of the most common digestive disorders, especially in older 2/3 of US adults will experience GERD S&S
46
etiology of gastroesophageal reflux disease
foods obesity smoking hiatal hernia medications
47
pathogenesis of gastroesophageal reflux disease
dysfunctional valve between stomach and esophagus allowing back flow of stomach contents increased acidity and acid volume esophagitis - inflammation/injury of esophagus
48
clinical manifestations and S&S of gastroesophageal reflux disease
heartburn or chest P!/tightness especially after meals, when reclining; may refer to the neck regurgitation dysphagia odynophagia (painful swallowing) belching nausea
49
what is a peptic ulcer
discontinuation of GI track lining
50
incidence of peptic ulcer
decreasing due to better hygiene and sanitation worldwide
51
etiology of peptic ulcer
H pyloric bacteria non steroidal inflammatory drugs (NSAIDs)
52
pathogenesis of peptic ulcer
imbalance of protective and destructive factors lining becomes more susceptible to acids not able to secrete neutralizing bicarbonate
53
clinical manifestations and S&S of peptic ulcer
check pain, possibly in the mid thoracic or supraclavicular regions (possibly at night; may be temporarily relieved with eating and antacids) abdominal bloating/fullness N&V, possibly with blood weight changes
54
PT implications of peptic ulcer
usually a urgent referral but emergency if: progressive dysphagia persistent vomiting family history of GI malignancy
55
what is scheurmann disease (kyphoscoliosis)
anterior vertebral body wedging of adjacent thoracic vertebrae in adolescents
56
incidence of scheuermann disease
most common cause of adolescent hyperkyphosis more often in males
57
etiology of scheuermann disease
possibly inherited but unknown, possible collagen abnormality medic changed following acute IDD
58
pathogenesis of scheuermann disease
abnormal vertebral endplate mineralization and ossification during growth that leads ro anterior vertebral wedging and schmorl's nodes (disc herniated into vertebral body)
59
clinical manifestations and S&S of scheuermann disease
excessive and rigid thoracic kyphosis that does not change in supine/prone positions thoracic pain worse with activity better with rest possible counter hyperlordosis in cervical/lumbar regions
60
what is varicella zoster virus
causes chicken pox (1st occurrence and typically milder) and shingles (2nd occurrence and typically more severe) mostly an urgent referral but an emergency referral if close to the eye
61
risk factors for varicella zoster virus
hx of chickenpox is necessary to develop shingles can develop shingles more than 1 time increased risk around 50 years of age significant decline since vaccine was developed
62
transmission of varicella zoster virus
airborne or direct contact so you should isolate until crusted lesions dry highly contagious to those who've not had chicken pox and 2-3 days prior to symptoms; you won't get shingles but you will get chicken pox
63
pathogenesis of varicella zoster virus
travels from lymph through blood and eventually to nerve endings eventually suppressed but can persist in latency in dorsal root subsequent infections are triggered with lowered immunity/stress
64
clinical manifestations and S&S of shingles
shingles skin lesions and paresthesias occur in dermatomal patter (typically T3-L3) "dewdrop on a rose petal" - vesicle on a red base that erupt may affect any dorsal root or even a cranial nerve P! and itching low risk of developing into postherpetic neuralgia (P! > 90 days after onset)

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