Advanced Screening Exam 3

True or false:

Upper GI and pancreatic problems are more likely than lower GI disease to cause chest pain.

true

Which portion of the GI system can refer pain to the anterior neck?

upper esophagus

The pancreas often refers to the

upper part of the abdomen and radiates to the back (T10-L2)

What GI/hepatic organ refers pain to the 10th rib?

gallbladder

When looking for MSK causes of chest pain, what nerves can cause pain in the chest?

pectoral, suprascapular, dorsal scapular, and long thoracic

Pain in the costochondral articulations without swelling is known as

Costochondritis

Pain in the costochondral articulations with swelling is known as

Tietze's syndrome

Pain associated with Tietze's syndrome is aggravated by

sneezing, twisting, coughing, deep breathing, horizontal shoulder abduction and adduction

Costochondritis often occurs in what demographic?

women 70% of the time, usually older than 40 years old

Hypersensitive Xiphoid syndrome is manifested as _________ pain.

epigastric

What are the peak ages of shingles?

college age or adults >70

Dorsal nerve root irritation refers to where?

the chest wall

Which pathology is characterized by raised, fluid-filled clusters unilaterally along a dermatome?

shingles/herpes zoster

____________ of increasing back pain, especially with older clients, may be a signal of lumbar metastases.

6 weeks to 6 months

What are the red-flag ages for headaches being a sign of serious spinal pathology?

under 20 and over 50

What types of medication can lead to vertebral compression fractures?

corticosteroids

The highest likelihood of a vertebral fracture occurs with which demographic?

females age 75 or older

True or false:

Systemic pain is relieved by recumbent positioning.

false-- is not relieved

_________ disease that causes back pain causes the client to curl up, sleep in a chair, or pace the floor at night.

Visceral

Low back pain being caused by cancer can be ruled out with 100% sensitivity if the patient is/has:

younger than 50

no history of cancer

no unexplained weight loss

responsive to care

What 3 factors increase the risk for vertebral fractures for patients with acute LBP?

age >70, steroid use, major trauma

What are the indications for lumbar imaging?

1. history of trauma

2. history of cancer

3. older adults with minimal trauma

4. failure to respond to treatment

What are the primary symptoms of head and neck cancers?

neck or facial pain

numbness in face, ear, mouth, and lips

What are the red flags related to headaches?

1. headache is present when awakening but is better with standing

2. headache is intensified by activities that increase ICP

3. headache is relieved by moderate pain killers

4. headache occurs with vomiting with or without nausea

Your patient comes to outpatient PT for cervical spine pain. They report neck pain and stiffness, paresthesia in both arms, and clumsiness. They say that when they go to urinate, they feel like they aren't able to void fully. When you do your exam, you notice hyperreflexia, a positive Babinski, a positive Hoffman's, and the Lhermitte's sign. What diagnosis is consistent with these findings?

cervical myelopathy

Severe tearing pain with sweating and dizziness is characteristic of which viscerogenic pathology?

abdominal aortic aneurysm

Duodenal ulcers usually cause what type of pain?

burning

Muscle spasms along the vertebrae on the right side are most likely caused by which organ?

gallbladder

Tenderness and spasms at T9-11 on the left is usually caused by which organ?

spleen

Tenderness, spasms, and possible cutaneous pain at the 11th and 12th ribs is the result of pathology of which organ?

kidneys

What type of pain may be described as throbbing and increases with activity that requires a greater cardiac output?

vasculogenic

True or false:

Angioplasties with the insertion of a stent do not reduce the risk of heart attacks for most people with stable angina.

true

________ are more likely to develop CAD at a younger age.

Men

What are the 3 P's that help determine whether chest pain is of a cardiac nature?

1. Pleuritic pain (exacerbation by deep breathing)

2. pain during Palpation (MSK cause)

3. pain with changes in Position (MSK cause)

What type of angina can be relieved by nitroglycerin?

stable

How long does stable angina last?

2-5 minutes

Your patient has angina. What symptoms may they have that signal a higher risk for a heart attack?

pain that occurs without exertion, lasts longer than 10 minutes, is not relieved by rest or nitroglycerin

Where will pain be felt from outer quadrant breast tumors?

upper and inner arm

True or false:

Discharge from just one nipple is considered abnormal.

true

The irritation of the upper dorsal intercostal nerve is known as

Mastodynia

Mastodynia is almost always associated with

ovulatory cycles

Unilateral breast or chest pain that initially occurs at the premenstrual period is known as

mastodynia

Are symptoms of mastodynia unilateral or bilateral?

unilateral

Mastitis is an inflammatory condition most associated with ____________.

lactation

What are the risk factors for mastitis?

history of mastitis

cracked, bleeding, or painful nipples

stress or fatigue

What are the symptoms of mastitis?

breast becomes red, swollen, warm/hot (flu-like symptoms are also common)

The majority of breast cancer diagnoses are a result of what factors?

1. advancing age (>60)

2. race (white)

3. smoking

4. obesity

5. physical inactivity

6. excess alcohol intake

7. exposure to ionizing radiation

8. exposure to estrogens

What are the main cancers that metastasize to the breast?

uterine, ovarian, colon

What is the 2nd most common cause of death from cancer?

breast cancer

What is the leading cause of premature mortality from cancer in women?

breast cancer

Breast cancer has a clinical presentation acronym of BREAST. What do the letters in that acronym stand for?

B: breast mass

R: retraction

E: edema

A: axillary mass

S: scaly nipple

T: tender breast

What types of lumps raise suspicion of cancer in a breast exam?

hard, immovable, irregular and nontender lumps

What cardiovascular symptoms are commonly seen in young adults who take anabolic-androgenic steroids?

chest pain of unknown cause, possibly accompanied by dyspnea and elevated BP, no evidence of NMS involvement

What symptom is specific to children who take anabolic-androgenic steroids?

pediatrics: decreased or delayed bone growth (tendon and muscle strains are common and take longer to heal)

What is the most dramatic sign of anabolic-androgenic steroid use?

change in personality

What symptoms are specific to women who take anabolic-androgenic steroids?

muscular hypertrophy, male pattern baldness, excess hair growth on the face/breasts/arms, breast tissue atrophy

What symptoms are specific to men who take anabolic-androgenic steroids?

acne, gynecomastia, cutaneous striae in the deltopectoral region

70% of adults who die of cancer have ________ metastases.

spinal

Brain tumors in the __________ can present as LBP.

motor cortex

______________ is the most common primary malignancy involving the spine, often resulting in diffuse osteoporosis and pain with movement that is not relieved while the person is recumbent.

Multiple myeloma

When cancer metastasizes to the lumbar spine, it is most likely coming from cancers of which origins?

breast, lung, prostate or kidney (can also come from GI system)

True or false:

Back pain associated with cancer is usually constant, intense, and worse at night or with WB.

true

X-rays do not show bone destruction from metastatic lesions until _____% of the bone is destroyed

30-50

What are the red flags associated with back pain that could be caused by cancer?

1. age 50 or older

2. previous history of cancer

3. unexplained weight loss

4. failure to improve after 1 month of conservative treatment

Where does angina pain radiate to?

anterior neck and jaw

Which type of cardiac pathology can be misdiagnosed as TMJ dysfunction?

angina

What are the most common referred cardiac patterns seen in PT?

angina, MI, aneurysm

What is the bicycle test use to assess?

if the cause of back pain is vascular or neurogenic

Your patient is doing the bicycle test to assess their cause of their back pain. They lean forward and continue to pedal and there is no change in symptoms. Their pain is likely from a __________ origin.

vascular

Your patient is doing the bicycle test to assess their cause of their back pain. They lean forward and continue to pedal and there is an improvement in symptoms. Their pain is likely from a __________ origin.

neurogenic

_____-induced back and/or leg pain is alleviated by rest, usually within 1-3 minutes. Skin or nail changes are also common.

Vascular

Walking usually brings on symptoms immediately or with use of the body part in ______-induced back pain.

neurogenic

What are the most common conditions known to refer pulmonary pain?

pleuritis, pneumothorax, pulmonary embolus, cor pulmonale, and pleurisy

What is the hallmark sign of pulmonary involvement in neck or back pain?

pain is reproduced or increased with respiratory movements

Lower urinary tract impairments are more likely to refer pain to what areas?

low back, pelvic, sacral

Which portion of the urinary tract can refer pain to the costovertebral area or shoulder?

upper

What is the most significant and common characteristic in someone's medical history that could lead to the GI system causing back pain?

long-term or chronic NSAID use

Long-term NSAID use is the most common cause of back pain referred from the __________ or ____________.

stomach or duodenum

Pathology of the stomach and duodenum can refer pain to the back. What spinal segments is the pain usually at when it is referred from these organs?

T6-T10

Where is pain usually felt when there is pathology in the small intestine?

midabdominal region around umbilicus, may be referred to the back

If someone is having pain caused by the esophagus, where are they likely having pain?

anterior neck and thorax

Where is the primary pain pattern from the liver?

right over the liver

True or false:

In primary liver pathology, palpation of the organ does not reproduce symptoms.

false-- it can reproduce symptoms

Your patient with back pain reports symptoms of back pain and nausea 1-3 hours after eating. What is likely the cause of their back pain?

gallstones

Your patient with back pain reports symptoms of back pain immediately after eating. What is likely the cause of their back pain?

gallbladder inflammation

Gynecologic-induced back pain most often occurs in which demographic?

women of childbearing ages

What are the risk factors for gynecologic-induced back pain?

multiple pregnancies and births, epidural during delivery, prolonged pushing

What is the 2nd most common cancer in males over the age of 60?

prostate

What is the most common cancer in males 15-35?

testicular

What are the most common symptoms of back pain caused by the male reproductive system?

back pain, issues with bladder function, sexual dysfunction

Which vertebrae are most commonly affected by vertebral osteomyelitis?

1st and 2nd lumbar vertebrae

Spinal cord tumors present as dull, aching discomfort or sharp pain in what type of distribution?

belt-like

Urethral pain usually begins where?

posteriorly in the costovertebral angle

What test is used to rule out the kidneys as the cause of someone's buttock, hip, or groin pain?

Murphy's percussion test

What GI symptom is a red flag associated with lower quadrant pain?

alternating abdominal pain with LBP at the same level or alternating abdominal pain with hip pain

What are the most common hematologic diseases that cause pain in the hip, groin, knee, and leg?

sickle cell anemia and hemophilia

Bilateral tarsal tunnel syndrome is likely caused by _________ disease.

liver

The patient leans ________ from the affected hip in an antalgic gait pattern.

away

If soft tissue is the cause of hip or buttock pain, the patient may lean ________ the affected side to compensate for the downward rotation of the pelvis

toward

What is the primary sign of the buttock?

passive hip flexion is more limited and more painful than the straight leg raise