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Med Screening > Screening Chest, Breast, and Ribs > Flashcards

Screening Chest, Breast, and Ribs Flashcards

1
Q

what should your 2 initial thought processes when screening

A

cardiac vs non cardiac
systemic vs NMS

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2
Q

what about clinical presentation are we specifically looking for? why?

A

pain patterns
- inc chance of NM if tenderness w movement (esp resisted) or TTP

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3
Q

what are 2 associated sx with screening chest and ribs

A

constitutional sx
changes w food ingestion

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4
Q

what pain patterns are we more or less concerned with

A

more: radiating chest pain
- to shoulders and arms
- worse w exertion, esp if exertion only w LE

less: chest pain changes w positional changes or can be reproduces mechanically

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5
Q

what is a consideration if we do a screen of chest and ribs

A

rarely the primary complaint
- usually an additional sx randomly brought up

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6
Q

what are 8 potential causes of chest, breast, and rib pain

A

oncologic
cardiovascular
pleuropulmonary
GI
breast conditions (ie CA)
anxiety
drug use
neuromuscular

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7
Q

what PMH is especially significant with oncologic causes of chest/rib pain

A

any cancer
- esp lung, breast

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8
Q

what are 4 clinical sx of an oncologic cause

A
  1. mets to pulm system
  2. mets to bone or primary CA
  3. skin changes
  4. palpable mass
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9
Q

what are sx of mets to pulmonary system leading to an oncologic cause (3)

A

pleural pain
dyspnea
persistent cough

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10
Q

what are sx of mets to bone or primary CA leading to an oncologic cause (1)

A

costochondritis sx

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11
Q

what skin changes are seen in an oncologic cause (2)

A

met carcinoma on chest wall from lung CA

liver CA/impairment -> spider angiomas on chest wall

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12
Q

describe characteristics of a palpable mass of an oncologic cause

A

usually metastatic from distant primary site: lymph, multiple myel, or carcinoma of breast, kidney, or thyroid

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13
Q

how do sx of a palpable mass of oncologic cause present

A

asymptomatic until compressing other structures:
- pain or paresthesias that are diffuse or along dermatomal/intercostal nerve pattern

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14
Q

triage a suspected oncologic cause of chest/rib pain

A

ask follow up questions related to cancer
- relay to referring provider

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15
Q

what are 6 cardiovascular things chest/breast/rib pain may be related to

A

angina
MI
pericarditis
endocarditis
mitral valve prolapse
aortic aneurysm

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16
Q

what demographic are at inc risk for cardiovascular cause (3)

A

older age
menopausal women
african-american women

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17
Q

what are 5 general risk factors for a cardiovascular cause

A

hx of HTN
elevated cholesterol
smoking
diabetes
general CV risk factors

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18
Q

what are 4 clinical sx presentation of a cardiovascular cause

A
  1. cardiac arrest
  2. 3 P’s - not MI related
  3. chest pain w activity = red flag
  4. higher risk for heart attacks
19
Q

what are 3 sx of a cardiac arrest

A

loss of responsiveness
no breathing
no circulation

20
Q

what are 3 P’s that mean the CV sx aren’t MI related

A
  1. Pleuritic pain = pulm
  2. pain w Palpation = MSK
  3. pain w change in Position -= MSK
21
Q

triage chest pain w activity

A

red flag - 5-10min after activity begins (“lag time”), screening tool for cardiac involvement

MSK cause will have sx onset w activity

22
Q

sx of heart attack

A

pain w/o exertion, lasts >10min, not relieved w rest or NTG

immediate red flag referral duh

23
Q

how do cardiac patterns present in men

A

uncomfortable pressure, squeezing, fullness or pain in substernal/mid chest/entire upper chest

jaw, upper neck, mid-back, or down arm w/o chest pain

24
Q

how do cardiac patterns present in women

A

sx more subtle or atypical

prodromal sx: pain in shoulder, chest, back, radiating in UEs, dyspnea, fatigue 12mo prior and up to 1mo before MI

25
Q

what is angina

A

collateral blood flow from anastomoses eliminate cardiac pain until physical exertion or exercise cause sx

26
Q

what is angina often confused with (5) and how to differentiate angina from them

A

heart burn
indigestion
hiatal hernia
esophageal spasm
gallbladder dz

angina sharper and more “knife-like”

27
Q

describe stable angina

A

develops slowly, lasts 2-5min
pain may radiate to neck, shoulders, or back w SOB

relieved w rest or NTG

not reproduced with: AROM, resisted motions, heat/stretching

28
Q

describe unstable angina

A

rest and NTG don’t relieve sx
sudden change in stable anginal sx

29
Q

what are 7 possible pulmonary causes

A
  1. pulm HTN
  2. pulm embolism
  3. mediastinal emphysema
  4. asthma
  5. pleurisy
  6. pneumonia
  7. pneumothorax
30
Q

what are 4 components of PMH that are significant when screening for a pulm cause

A

cancer or recent infection
accident
hospitalization
smoking

31
Q

what are 4 clinical sx of a pulmonary cause

A
  1. chest pain that worsens w coughing, deep breathing, respiratory movements of motions of chest wall
  2. bloody or rust colored sputum
  3. SOB
  4. sx relieved w sititng upright
32
Q

what of the GI system are likely to cause chest/rib pain

A

upper GI
pancreas

33
Q

what are 6 PMH components that could lead to a GI cause

A

alcoholism
cirrhosis
esophageal varices
esophageal cancer
peptic ulcers

long term NSAID use

34
Q

what are 4 general GI clinical presentations

A

esophageal dysfunction
epigastric pain
GERD
hepatic & pancreatic

35
Q

how does esophageal dysfunction present?

A

difficulty or pain w swallowing
- upper = ant neck
- lower = down by xiphoid

36
Q

location of epigastric pain

A

substernal or upper abdominal

37
Q

radiation of pain to back is indicative of what GI presentation

A

long-standing duodenal ulcers

38
Q

lower chest pain is indicative of what GI presentation

A

gastric ulcers

39
Q

pain immediately relieved w antacids or food is indicative of what GI presentation? how will this pain present?

A

ulcers

doesn’t worsen w exertion
lasts longer than angina

40
Q

cluster of sx that worsen w exertion

A

immediate referral

41
Q

describe GERD pain

A

lower substernal region, gripping, squeezing, burning
- no change w exercise

42
Q

how does GERD’s presentation differ from angina

A

no change w exercise
improves w antacids

43
Q

what are aggravating and relieving factors of GERD

A

aggravating - recumbency, post meals (like angina)

relieving - antacids

Med Screening (17 decks)

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