1A Flashcards
nine DEADLY conditions
- depression
- suicidal
- cervical myelopathy
- cauda equina
- AAA
- DVT
- PE
- femoral head/neck fx
- atypical MI
risk factors for depression
Current or PMH of depression
Female (especially during pregnancy or post-partum)
Hx of DM, MI, cancer, CVA, chemical dependency
Significant loss suffered
(+) family hx (1º relative)
2 question depression screening tool
- over past 2 weeks have you felt down, depressed, hopeless?
- have you had little interest/pleasure in doing things?
suicide risk factors
solo
-90% have history of psychiatric illness (depression, substance abuse)
-previous attempt/fam hx
-history of CHRONIC progressive illness
-sense of hopelessness
-unemployed
-recent significant loss
what is the 2nd leading cause of death in ages 10-14 and 20-34?
SUICIDE
what 2 questions to ask after asking do you have thoughts of trying to harm yourself?
- plan?
- access to resources?
if yes-ambulance
Patient comes in with groin pain, hurts to WB. There is edema, bruising, and LLD. What could it be?
femoral head and neck fx
If I am suspecting femoral head/neck fx, what two tests?
patellar-pubic percussion test
fulcrum test
Patient comes in with lower back pain, gait ataxia, LOB, heavy legs, and urinary retention. What could it be?
cauda equina!
risk factors: stenosis, spinal fx, AS, TB and potts
Patient comes in with UE and LE numbness, urinary retention, STIFF NECK, and weak triceps/grip. Gait problems. What could it be?
CERVICAL MYELOPATHY
most common cause of non-traumatic para/quadriparesis?
cervical myelopathy
AAA can also present with
back, ab, hip, groin, butt pain! but NON MSK pain behaviors
insidious onset.
most people with AAA are symptomatic or asymptomatic?
asymptomatic
risk factors for AAA
over 60
male
smoking, high cholesterol, CAD
fam hx
patient presents with back pain. doesn’t change with rest/activity
insidious onset
also has weight loss, nausea, early satiety. On palpation, abdominal mass with VISIBLE PULSE!
What do they have?
AAA
+test: bruit
DVT presents as…
edema
aching, tight, tender
pitting edema
superficial venous plexus
HOT
clinical decision rule for DVT
1 point each!
- cancer
- immobilized
- bed ridden 3+ days, major surgery in past 3 months
- tender
- whole leg is swollen
- calf swelling more than 3 cm
- pitting edema
- collateral superficial viens
- hx of DVT
- -2 points if theres another diff dx also as likely
2+ = DVT likely
risk factors for PE!
- DVT
- immobile
- hx PE
- hx of ab/pelvic surgyer
- THR, TKR (bone or fat embolism)
- pregnancy late stage
- leg fx
- cancer in pelvis/abdomen
what does PE present as?
fast/abnormal breath
chest pain worse with cough
COUGH
anxiety
FAST HEART RATE
PALPITATIONS
Well’s criteria for PE
signs of DVT 3+
HR over 100 bpm 1.5+
immob 3+ days/surgery in last month 1.5+
previous PE/DVT 1.5+
hemoptysis 1+
cancer 1+
other diff dx are less likely 3+
2-6 mod, over 6 high
leading cause of death in women
MI
signs of MI
SOB
Fatigue
Sleep disturbance
Nausea (w/ & w/o vomiting)
Palpitations
Dizziness
Diaphoresis
Anxiety
Chest pain (w/ & w/o L UE pain)
Upper abdominal, epigastric, jaw, neck &/or tooth pain
Pain may or may not be associated w/ exertion
primary care is defined as…
“Accessible, comprehensive, coordinated and continual care delivered by accountable providers of personal health services.”
PTs have how many days of direct access?
10-15 days
How many PTs formally screen for depression?
18%
How does femoral head/neck fx present?
pain in groin/anterio-medial thigh, GT, butt, WORSE WITH WB
-bruising, edema, loss of function/mobility
-leg is shortened
+ patellar-pubic percussion test and +fulcrum test are for what condition?
femoral head/neck fx
risk factors for cauda equina
-LBP, central disc hern
-spinal stenosis
-spinal fx
-ankylosing spondylitis
-TB, Potts
Clinical manifestations of CAUDA EQUINA
1: urinary retention
neuro compromise (motor, sensory LE, urinary/B&B, sexual dysfunction)
-LBP
-LE pain/heavy weak legs
-LOB, gait ataxia
can be quick or gradual!
risk factors for cervical myelopathy
c-spine spondylosis or instability
-young people: RA, trauma
-older: 50-60s gradual
what does cervical myelopathy look like?
usually gradual, step-wise progression
lots of neuro signs!
1. hand intrinsic atrophy
2. tricep weakness/UE weakness
3. gait/balance loss
4. NECK STIFFNESS*
5. prox LE weaknes
6. UMN signs
7. urinary retention*
What does AAA look like?
- MSK pain in back, abs, pelvis, butt! But non-MSK pain behaviors
- weight loss, nausea, full easily
- abdominal mass with VISIBLE PULSE
*if you hear bruit with ab ascultation, AMBULANCE
*if they say pain is HOT, SEARING, RIPPING, TEARING= S T O P all activity!
What are 5 risk factors for AAA?
- over 60
- male
- smoking hx
- high cholesterol/CAD
- AAA in fam hx
what is an AAA?
Aneurysm distal to the renal arteries (>3 cm in diameter)
Risk for rupture ↑’s when diameter approaches 5-6 cm
Requires surgical intervention that is not w/o risks
What are the risk factors for DVT?
- previous DVT
- cancer/CHF, SLE
- infection
- chemo
- central venous cath
- major surgery
- major trauma
- immobility
- paralysis
- pregnancy/6 weeks post partum
- over 60
What does a DVT look like?
- Achy, tight, tender
- general swelling
- pitting edema
- prominent superficial venous plexus
- HOT
What percent of people with DVT are asymptomatic in early stages?
50%
Patient presents with fast, abnormal breathing. They have chest pain that gets worse with breathing/coughing. Heart rate is fast.
What do they have?
maybe PE!
-pleuritic chest pain, worse w breath/cough
-cough
-tachypnea/dyspnea
-tachycardia
-palpitations
Proximal LE DVTs comprise what percent of pulmonary embolisms?
70%
If diagnosed earlier, what percent of PE related deaths are potentially preventable?
over 50%
What are the risk factors for atypical MI?
smoking
high cholesterol, HTN, DM, obesity
sedentary lifestyle
excess alcohol
women over 55, men over 45
fam hx
ethnicity (highest for african american)
