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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (tx-wall-chest-pain.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Tx wall + chest pain Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Tx wall + chest pain Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/23089/}}}
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\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 2nd July, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
\raggedright
\raggedcolumns

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\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Serious Disorders}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Heart:}} Myocardial Infarction, angina, pericarditis (\textgreater{}15 mins angina pain = consider MI)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Great Vessels:}} Dissecting Aneurysm, Pulmonary Embolism, Pulmonary Infarction, Pneumothorax, Pneumona, Pleurisy} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Oesophagus:}} Oesophageal Rupture, Oesophageal Spasm, Oesophagitis} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Subdiaphragmic Disorders:}} Gallbladder, Stomach, Duodenum, Pancreas, Subphrenic collection} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Infections:}} Herpes Zoster, Pleurodynia, Infective Endocarditis, Osteomyelitis, Discitis, Tuberculosis, Epidural infections} \tn 
% Row Count 12 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Malignancy (Back pain in elder person, unrelenting back pain, night pain, rapidly increasing back pain, weight loss, fever, malaise, hx of cancer, neuro signs in LL)} \tn 
% Row Count 16 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Mechanical Pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Pitfalls:}} Ischaemic Heart disease (interscapular pain) \{\{nl\}\} Herpes Zoster \{\{nl\}\} GI disorders \{\{nl\}\} Penetrating duodenal Ulcer - lower tx back pain \{\{nl\}\} Oesophageal spasm} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Refer:}} Persistant pain, Evidence/suspicion of sinsiter cause (Cardiac/GI) , Significant Idiopathic Scoliosis/kyphosis} \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Tx Pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Defined as pain between superiorly by a transverse line through the tip of the T1 Spinous Process, Inferiorly by a transverse line through the tip of the spinous process of T12 and laterally by vertical lines to the most lateral margins of the ES muscles} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Divided into upper, middle and lower thirds} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{MSK chest pain}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Costochondritis} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Muscle Strains} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Sterno-costal dysfunction (2nd-7th joints)} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Lower Cx Dysfunction} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Upper tx dysfunction} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Tx back pain}}} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Myofascial Pain Syndrome} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Musculoligamentous Strains - poor posture} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Dysfunction of the lower Cx + Tx (interscapular)} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Pain radiates from back to the front of the chest}}} \tn 
% Row Count 12 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Vertebral Disorder - irritation of an intercostal nerve root} \tn 
% Row Count 14 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Herpes Zoster} \tn 
% Row Count 15 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- TrP in intercostal Muscle} \tn 
% Row Count 16 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{In Hx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Neck and upper back pain = Cx spine} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Anterior Chest pain + Tx spine pain = IHD/Dissection of Tx aorta} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Penetrating injury - surgical, dental, \seqsplit{catherisation/cannulation/self} injection/injury = tx osteomyelitis, epidural abscess, discitis} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{COPD}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Chronic bronchitis, emphysema or both} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Caused by smoking, occupational exposure to noxious gases, Alpha 1 antitrypsin deficiency} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Airflow limitation, unlike asthma it is permanent} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S:}} \textgreater{}35 yo + Hx of smoking and respiratory symptoms: SOB on exertion, Cough + sputum production, Wheezing, frequent chest infections, pursed lip breathing, increased RR, Increased use of accessory muscles of respiration, Underweight, Cyanosis, Hyperinflation of the chest, Downward Displacement of liver, Prolonged forced expiratory time} \tn 
% Row Count 12 (+ 7)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Investigations:}} Spirometry - Reduced FEV1 +  reduced FEV1/FVC ratio} \tn 
% Row Count 14 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Management:}} To GP = Stop smoking, Pulmonary Rehab, Pneumococcal + influenza vaccine, Medications - Bronchodilator inhalers, steriors, antibiotics and inhaled oxygen} \tn 
% Row Count 18 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Asthma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Inflammatory disease , intermittent and reversible obstruction of the airways:} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Spasm of the smooth muscle that pulls on the cartilaginous support} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Excessive production of secretions and oedema} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S:}} Wheezing, Coughing, SOB, Tightness /pain in the chest} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Triggers:}} URTI, Cold Air, Exercise, Pollution, Animals, Time of the day (early morning)} \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Diagnosed by:}} Spirometry - measures PEFR - reduced FEV1 in the second PEF} \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Classifications:}} \textgreater{}1 of the symptoms above/ Hx of atopic disorder, Family Hx of asthma/atopic disorder, Widespread wheeze heard} \tn 
% Row Count 14 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Management:}} Medication (shortacting B2 Agonist - Salbutamol, Long acting B2 agonist - Salmeterol. Steroids, Leukotriene receptor antagonist, Oral Steroids), Asthma support groups, recognise when their asthma is bad} \tn 
% Row Count 19 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Lung Cancer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Mainly Bronchial Carcinoma} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Can be small cell/non-small cell} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Risks: Active/passive cigarette smoking, increased age, industrial dust - asbestos, chromium, arsenic, iron oxides, radiation} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{S\&S:}} Cough, SOB, Chest pain, Haemoptysis, Bone pain, Weight loss, Finger Clubbing, Fever, Weakness,Dysphagia, Wheezing and stridor} \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Other S\&S:}} Reccurent/slowly resolving pneumonia, Pleural effusion, HPOA, Supraclavicular/axillary lymphadenopathy, Paraneoplastic syndrome (hormones released by tumour cells)} \tn 
% Row Count 12 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Paraneoplastic syndrome:}} Ataxia, dizziness, nystagmus, difficulty swallowing, loss of muscle tone , loss of fine motor skills, slurred speech, memory loss, vision problems, sleep disturbances, dementia, seizures, sensory loss in the limbs} \tn 
% Row Count 17 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Hypertrophic Pulmonary Osteoarthropathy:}} HPOA, joint stiffness and severe pain in the wrists and ankles, clubbing, gynaecomastia} \tn 
% Row Count 20 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Pancoast Tumour:}} Severe shoulder/arm pain + Horner's syndrome} \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pneumothorax}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Air trapped between lung and chest wall} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Young, thin men,  Trauma,Lung diseases, spontaneous = Marfan's} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S:}} Sudden, sharp stabbing pain on one side of the chest, SOB, Pain worse on inspiration , Tachycardia, Reduction in breath sounds on affected side, Chest expansion reduced , Resonant/hyperresonant percussion} \tn 
% Row Count 8 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Tension Pneumothorax - Rare complication - volume + pressure of the pneumothorax increases due to the tear acting as a one way valve. Puts pressure on lungs and heart - +ve mediastinal shift} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pleural Effusion}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Collection of fluid within pleural space} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Transudation:}} Accumulation of fluid due to excess fluid \{\{nl\}\} {\bf{Exudation of fluid:}} Inflammation - increased vascular permeability} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S:}} SOB, Pleuritic chest pain, Breath sounds absent, Stony Dull percussion, Reduced chest expansion, Mediastinal Shift if large} \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pleurisy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Inflammation of the pleura} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S}} Sharp, Stabbing, well localised pain. Worse on inspiration/coughing} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Causes:}} Pneunomia, PE, Chest injuries, Pneumothorax, Tumours of the lung, Inflammation associated with some forms of arthritis} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pneumonia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S:}} Cough, Sputum (can contain blood), SOB, Pleuritic Chest Pain, Weakness, Malaise, Myalgia, Fever, Breathless at rest, Chest expansion {\bf{reduced}} on affected side, Percussion is {\bf{dull}} over affected lobe, Auscultation - Crackles, bronchial breathing, pleural friction rub (heard more on expiration)} \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Bronchial Breathing - Harsher sound. Gap between inspiration + expiration.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pulmonary Embolus}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S:}} Pleuritic chest pain, Sudden onset SOB, Cough + Haemoptysis, Tachycardia, Increased breathing rate, Signs of DVT, Hypotension, Pleural Rub, S3,S4 heart sounds} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Virchow's Triad:}} Stasis of blood, Increased coaguability of blood (smoking, OCP, Cancer), Blood vessel abnormality (previous DVT/Surgery to veins} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Investigations:}} Leg US (DVT), V/Q scan, CTPA, D-Dimer} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Mangement:}} Refer to GP for \seqsplit{anticoagulation/prophylaxis}} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pericarditis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Inflammation of the pericardium} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S}} Patient complains of retro/left of sternum pain \{\{nl\}\} Constant Sharp/heavy and acting radiating into the axilla/left arm \{\{nl\}\} Fever and malaise present \{\{nl\}\} Aggravated by deep breathing, coughing and lying down \{\{nl\}\} Relieved by sitting forward} \tn 
% Row Count 7 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rib f\#}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Compression injury in the young. In the elderly it is caused by coughing/manipulation} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{S\&S}} \{\{nl\}\} Tenderness + swelling \{\{nl\}\} Local spasm \{\{nl\}\} Pain on respiratory movements \{\{nl\}\} Percussion/vibration \& Rib cage compression may be aggravating} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Management:}} Haemothorax and pneumothorax are complications - chest exam + chest x-ray \{\{nl\}\} refer to GP/A\&E} \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Mangement}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Refer if progressive neurological symptoms/myelopathy signs} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Soft tissue therapies and modalies} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Relaxation Techniques} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- PIR} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Disc Herniation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Most occur below T9 (T11-T12) , due to increase in stresss of the region + changes in facet orientation} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Back pain + radicular pain - may refer to chest wall or abdomen unilaterally/bilaterally} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Aggravated by bending forward, coughing, sneezing, straining} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- +ve Beevor's sign + absent abdominal reflexes} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Look for signs of spinal compression; LL Ataxia, Bladder incontinence , UMNL} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Mobilisation/activator} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Heat} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Medication (analgesics, NSAIDs)} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Trigger point pressure relief} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Ultrasound to the tender points} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Encourage Abdominal breathing} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{MI} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Muscle Strain, SC joint injury} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Rib Fracture} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Rib Subluxation} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Fibromyalgia} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{GI Reflux} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Anxiety} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Lung Cancer} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Clinical Findings}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vital signs WNL} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{Palpation:}} Palpation of joint increases pain, swelling uncommon unless Tietze's syndrome, no warmth/redness} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Tx ROM limited - costosternal pain} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Crepitus not usually felt - consider f\#} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Costrochondritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Anterior chest wall pain, radiating into back, abdomen} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Unilateral + sharp in nature} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Exacerbated by breathing, physical activity} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Caused by exercise or URTI} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Differences between MI and Tx}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1593281998_diffieres.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{In the elderly}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Consider:}} MI, Angina, dissecting aneurysm, ruptured aorta, Herpes, rib fracture, malignancy, pleurisy, pulmonary embolus and GI reflux} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Other:}} Malignancy (multiple myeloma, lung, prostrate) , osteoporosis, vertebral pathological f\#, PMR, Paget's, IHD, Penetrating peptic ulcer, oesophageal disorders, biliary disorders} \tn 
% Row Count 7 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{In Children}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Can be Psychogenic/unknown (most cases)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Mean age for chest pain = 12 yo} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Usually MSK (strained pec, shoulder/back muscles after exercise), cough induced pain, costochondrtis, asthma} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- \textless{}12 yos consider cardiorespiratory causes - cough, asthma, pneumonia, heart disease} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Consider tuberculosis,  Discitis, osteomyelitis, osteoid osteoma, osteosarcoma for Tx back pain (rare)} \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Further investigations}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{X-ray} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Bone scan/MRI if X-ray normal} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{FBC, ESR, CRP} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Exam}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Generalised kyphosis - common in elderly, scheuermanns in younger patients} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Scoliosis = more prominent on forward flexion} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{Palpate:}} SPs, Facets, TVPs, Costotransverse junctions, posterior rib curve, surrounding muscles/fascia} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Tx spine Hx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Aggravation + relief on trunk rotation ( Aggravated by rotating to one side and relief by rotating opposite side)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Aggravation of pain by coughing, sneezing or deep inspiration - sharp, catching pain = costovertebral joint} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Key Hx Questions:}}} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Back Injury? Did you lift something heavy?} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Fall onto your chest/back?} \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Pain wake you at night?} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Low back pain/neck pain?} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Pain come on after walking/strenuous effort?} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Pain come on after eating/soon after going to bed at night?} \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Rashes?} \tn 
% Row Count 15 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Fever/sweats?} \tn 
% Row Count 16 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Taking medications?} \tn 
% Row Count 17 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{What happens when you take a  deep breath, cough or sneezing?} \tn 
% Row Count 19 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Red Flags}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Fever accompanying chest pain - pulmonary infections \{\{nl\}\} Abdominal/flank pain = acute pyelonephritis and cholecystitis} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Unexplained weight loss/fatigue, \textgreater{}50 yos, pain at rest, night pain, failure to improve with treatment = Malignancy} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Abdominal pain that comes and goes + Tx spinal pain = biliary/renal colic} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Shortness of breath, cough, abdominal symptoms, chest heaviness, movement /change of posture not related to pain = cardiac and visceral disorders} \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Unrelenting pain with NO relieving factors} \tn 
% Row Count 12 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Fracture - minor trauma = osteoporosis} \tn 
% Row Count 13 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}