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becky: Primary Care > 1C > Flashcards

1C Flashcards

1
Q

components of PT exam (7)

A
  1. review ALL MED HX
  2. Pt interview/history
  3. chief complaints
  4. functional limits
  5. review relevant med hx
  6. review systems
  7. physical exam (vitals, anthropometric measures, UQ/LQ/thoracic scanning, systems review)
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2
Q

what does a physical exam compose of?

A

vitals
anthropometric measures
Scanning exams (UQ/LQ/thoracic)
systems review!

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3
Q

During patient history, what are you listening for in regards to patient’s symptoms?

A

SINSS

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4
Q

Severity is….

A

intensity of symptoms related to functional activity
(high symptoms=low function)

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5
Q

What is irritability?

A

(how easy/hard to tick off=what activity and time?)

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6
Q

What is Nature of Complaint?

A

what could it be? Anything that you need to be cautious of during exam…and how does it present based on psych/personality/ethnicity/SES)

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7
Q

Describes acute, subacute, or chronic stages

A

stage of pathology

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8
Q

time frame for acute, subacute, chronic

A

acute: 3-7 days
subacute: over 7
chronic: over 3 months

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9
Q

progression of patient’s symptoms over time…is it getting better, worse, or same?

A

stability

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10
Q

What are RED FLAGS to be cautious of?

A
  1. Trauma
  2. Age over 50
  3. Cancer
  4. fever, chills, sweats
  5. unexplained weight change
  6. recent infection
  7. immunosuppression
  8. rest/night pain
  9. saddle anesthesia
  10. bowel/bladder dysfunction
  11. LE neuro deficits
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11
Q

Why are you worried about unexplained weight loss or fever/chills?

A

infection or cancer

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12
Q

Why are you worried about night pain?

A

cancer
infection
AAA

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13
Q

three red flags associated with cauda equina

A

saddle anesthesia
B&B dysfunction
LE neuro deficits

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14
Q

What is a patient centered interview model?

A

Exploring pt’s disease/diagnosis & its effect on their life
Understanding the whole person
Finding common ground regarding intervention &/or management
Advocating prevention & health promotion
Enhancing pt-provider relationship
Providing realistic expectations

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15
Q

If someone comes in with cervical and shoulder (shoulder girdle, L/R) pain….what 3 systems should I check first?

A
  1. CV
  2. Pulm
  3. GI
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16
Q

If someone comes in with thoracic spine/back pain…what 4 systems should i check?

A

1.CV
2.Pulm
3. GI
4. Genitourinary (T-L junction)

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17
Q

If someone has lumbar-pelvic pain…what 3 systems should I check first?

A
  1. GI
  2. Urogenital
  3. peripheral vascular
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18
Q

If someone has mid-humerus to hand or femur to foot pain, what system should I check first?

A

peripheral vascular

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19
Q

What systems have inconsistent symptom patterns?

A

Psychologic
Endrocrine
Neurologic
Rheumatic disorders
Adverse drug reactions

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19
Q

Referred pain can be mechanical or nonmechanical (T/F)

A

TRUE
(dermatomal symptoms due to back)

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20
Q

Most common MSK pain that PTs treat

A
  1. LBP
  2. shoulder
  3. knee
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21
Q

What does MSK pain sound like?

A

pain fluctuates in 24 hour time period (time frame increases in patients with neuro stuff like CVA, MS, TBI)

AND
motion makes pain change, varies consistently!

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22
Q

NON MSK pain sounds like

A

inconsistent locations of pain
no obvious MOI
vague, dull ache not located near normal MSK structures
does not fluctuate/change with positions or movement
pain during/after eating or urinating

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23
Q

If its throbbing, pounding, pulsating….could be

A

vascular disorder

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24
Q

If its sharp, shocking, burning, lancinating….could be

A

neurologic disorder

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25
Q

If it is aching, squeezing, burning, cramping, gnawing…could be

A

visceral disorder

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26
Q

If they have LBP, what else could it be?

A
  1. tumor
  2. infection
  3. cauda equina
  4. spinal fx
  5. abdominal aneurysm
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27
Q

LBP that is constant, not changing with position/mvmt
worse at night…DIFF DX is

(age over 50, also weight loss)

A

TUMOR

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28
Q

LBP, deep constant that is worse with WB
-fever, swelling
-spine rigidity

(pt is IV drug user or immunosuppressed)

DIFF DX is

A

osteomyelitis (or infection)

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29
Q

Pt has hx of spinal stenosis or DDD.
LBP with weak LEs…what are you worried about

A

cauda equina
other symptoms:
-urinary retention/B&B
-saddle anesthesia
-LE weakness
-sensory deficits
-ankle DF, toe ex, ankle PF weakness (L4, L5, S1)

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30
Q

What are risk factors for spinal fx?

A
  1. over 70
  2. history of trauma/overuse for osteoporotic pts
  3. steroid use long term
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31
Q

Patient comes in with LBP, very tender to palpation. Hurts to stand/WB. There is edema.
HX OF TRAUMA.
What is diff dx?

A

spinal fx

Exquisitely tender w/ palpation over fx site
↑’d pain w/ WB
Edema in local area

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32
Q

Someone comes in with back pain (or ab/groin). They have PVD/CAD and risk factors like over 50, smoker, HTN, DM

pain does not change with movement. What should you be worried about/check?

A

AAA
ascultate for bruit

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33
Q

Patient is over 50, has pain in pelvis that is tender to touch in abdomen. may have ascites. unexplained weight loss, bowel issues….
diff dx is

A

COLON CANCER

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34
Q

Patient is woman over 70 with hip/thigh pain.
In constant pain, hurts more when moving it. Walking with leg in ER.
MOI: fall…
Diff dx is

A

pathologic fx in femoral NECK

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35
Q

AVN patient looks like…

A

osteonecrosis of femoral head

-long term steroid use (has SLE, asthma, RA)
-has had osteonecrosis in opp hip before
-trauma hx

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36
Q

Patient has gradual onset of pain in hip and medial knee, worse with WB.
Hip is stiff and restricted in IR and flexion. DIFF DX is

A

AVN
-gradual
-groin, thigh, medial knee referred pain
-stiff hip restrict: IR, flex

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37
Q

Patient is 5-8 yr old boy LIMPING with groin pain.
Pain hurts more with hip abduction/IR. Diff Dx is…

A

Legg-Calve-Perthes
(head of femur loses blood supply)

-young boy
-antalgic gait
-hurts with hip abd, IR

38
Q

Patient is overweight adolescent that fell on bike…pain in groin, hurts to put weight on it. Leg is held in ER, can’t IR.
Diff dx is…

A

SCFE (epiphysis/head slips off femoral neck)

-groin ache, worse with WB
-leg in ER
-ROM limits in IR

39
Q

What are knee/leg/ankle/ft red flags conditions to be aware of?

A
  1. peripheral arterial occlusive disease
  2. DVT
  3. compartment syndrome
  4. septic arthritis
  5. cellulitis
40
Q

Risk factors for peripheral arterial occlusive disease

A
  1. over 60
  2. Hx of DM, heart disease
  3. smoking
  4. sedentary
  5. intermitt. claudication
41
Q

Pt is 60 year old, diabetic smoker: comes in with pain in leg. Leg is cool to touch with decreased pulses. Prolonged vascular filling time.
What are you worried about

A

peripheral arterial occlusive disease

-unilat cool extremity or bilateral if its aorta
-capillary refil time over 2 seconds
-decreased arterial pulses
-long vascular filling time
-Ankle brachial index below 0.9

42
Q

Patient has calf pain, edema, tenderness. Warm to touch.
Hurts more to stand/WB, better with rest/elevation

Leg is pale, no pulse.
DIFF DX

A

DVT
-edema, tender, warm
-worse with WB, better w rest
-pale, loss of dorsalis pedis pulse

recent sx, cancer, immob, trauma, pregnancy

43
Q

Leg pain that is severe, worse with stretching.
Edema, tender, tension/hardness
Leg is also weak, numb, and pale. No pulse.

DIFF DX

A

compartment syndrome!

Severe, persistent leg pain that is intensified w/ stretch applied to involved muscles
Swelling, exquisite tenderness & palpable tension/hardness of involved compartment
Paresthesia, paresis, pallor, pulselessness

Hx: trauma, crush injury, new exercise

44
Q

Patient has constant throbbing pain, joint swelling, warmth in knee/ankle. They have had a recent infection/Sx/injection.
Diff dx is…

A

septic arthritis!
*joint pain/swelling
*fever

*immunosuppressed or recent infection

45
Q

patient has pain in leg
swelling, warmth, reddish streaks.

They also have fever, malaise, weakness.
What could it be?

A

cellulitis!

Hx of recent skin ulceration or abrasion, venous insufficiency, CHF or cirrhosis

Pain, skin swelling, warmth, advancing irregular margin of erythema/reddish streaks
Fever, chills, malaise & weakness

46
Q

If patient has chest pain, pale, sweating, can’t breathe well, nauseous, palpitations
-not relieved by nitroglycerin, longer than 30 min symptoms
DIFF DX IS

A

MI

47
Q

Risk factors for MI

A

-Presence of risk factors: previous hx of CAD, HTN, smoking, DM, elevated blood serum cholesterol (>240 mg/dL)
Men >40 yr
women >50 yr

48
Q

unstable angina pectoris looks like

A

Chest pain that occurs outside of predictable pattern
Not responsive to nitroglycerin

(Hx of CAD)

49
Q

stable angina pectoris looks like

A

Chest pain/pressure that occurs w/ predictable levels of exertion

responds w/ rest or sublingual nitroglycerin

(common in 65+, esp men. Hx of CAD)

50
Q

If someone has hx of MI, renal failure, open heart surgery, radiation
autoimmune disease like RA/SLE….
what could their chest pain be caused by?

A

pericarditis

Often associated w/ autoimmune disease (SLE, RA)
Hx of myocardial infarction
Hx of renal failure, open heart surgery or radiation therapy

51
Q

Patient has sharp/stabbing pain in shoulder and/or neck
sidelying on left side increases pain
sitting and leaning forward decreases pain
DIFF DX

A

pericarditis

Sharp/stabbing chest pain that may be referred to lateral neck or either shoulder
↑’d pain w/ L sidelying
Relieved w/ forward leaning while sitting (supporting arms on knees or a table)

52
Q

Patient has chest/shoulder/upper ab pain.
1. abnormal, fast breathing
2. heart rate over 100 bpm
DIFF DX

A

PE

risk factors: DVT, immob, cancer, trauma

53
Q

Patient has severe, knife pain with inhaling. Abnormal breathing, decreased chest wall excursion.
Hx of infection/respiratory disorder (pneumonia, TB, tumor)

DIFF DX

A

Pleurisy/pleuritis

54
Q

Patient has chest pain, worse with inhaling.
difficulty expanding ribs
decreased breath sounds
hyperresonance percussion

DIFF DX

A

pneumothorax

hx: coughing, strenous exercise/trauma

55
Q

Patient has chest and shoulder pain
fever, chills, headache, malaise, nausea.
What could it be….

A

pneumonia
(hx of bacterial, viral, fungal, infection)
-pleuritic pain referring to shoulder too

56
Q

Patient is middle age woman.
Pain in R upper ab with R scapula pain
Worse with eating fatty foods.
Pain is not worse/better with activity/rest.
DIFF DX

A

cholecystitis (gall bladder!)
*WBC count elevated
*common in middle age women

colicky pain
R upper ab quad with R scap pain!

57
Q

Dull or gnawing pain or burning sensation in epigastrium, mid-back or above clavicle
Symptoms relieved w/ food****

Hx of infection (H. pylori)
Hx of multiple stressors, poor coping skills, persistent anxiety & depression

A

peptic ulcer

58
Q

Patient is tender to touch in Right abdomen, and they are having poop problems (bleeding, vomiting, tarry colored stool, coffee ground emesis)

A

peptic ulcer!

59
Q

Patient has positive murphy’s sign (tender over costovertebral angle)
fever, chills, headache, flank pain
DIFF DX

A

pyelonephritis! UTI/KIDNEY INFECTION

60
Q

Patient has UTI symptoms with SUDDEN, SEVERE BACK PAIN
chills, fever, nausea, vomiting
renal colic

DIFF DX

A

nephrolithiasis (kidney stones!)
*hot climates, past episode of stones

61
Q

Patient presents with tenderness in mid back, bruising, LE neuro deficits like sensory and weakness.
increased thoracic kyphosis
DIFF DX

A

spinal fx!

esp if Hx of fall of MVA
Hx of osteoporosis
Long-term steroid use
Age >70 yrs
Loss of function or mobility

62
Q

most common thoracic fx levels

A

T11-L1

63
Q

What are red flag conditions to look out for with head/face/TMJ pain?

A
  1. meningitis
  2. tumor
  3. subarachnoid hemorrhage
64
Q

Patient presents with flu like symptoms.
Then, head/face pain.
+ slump test
headache, fever, nausea/vomiting
photophobia, confusion, sleepy, seizures

DIFF DX

A

meningitis!
*STIFF NECK, FEVER, confusion, vomiting, seizures, light sensitivity, headache

65
Q

Patient presents with:
headache
altered mental status
speech deficits
ataxia

visual changes, seizures, GI issues, sensory issues

A

BRAIN TUMOR
(age 20-64 yrs old)

66
Q

Patient suddenly has severe headache. Then, brief LOC.
fever, photophobia, nausea, vomiting, stiff neck (like meningitis)
brain tumor signs like nausea, vomit, neuro dysfunction

DIFF DX

A

subarachnoid hemorrhage!

67
Q

If someone has pain in neck and shoulder, what are red flag conditions?

A

MI
cervical ligament instability
cervical/shoulder peripheral nerve entrapment
pancoast’s tumor

68
Q

Patient hx:
-trauma (major)
-RA or AS
-uses birth control

presents with:
dizziness, nystagmus, vertigo with neck movement
+clonus
+babinksi

A

Cervical liagamentous instabilities w/ possible cord compromise

69
Q

If patient has neck/shoulder pain and muscles are tender to touch, muscles/sensory distribution follows specific nerve pattern
-patient reports paresthesias (numb/ting) and PAIN AT REST with possible retrograde distribution

A

Cervical & shoulder girdle peripheral entrapment neuropathies

70
Q

what are ways to injury spinal accessory nerve?

A

Hx of penetrating injury, such as stab or gunshot
Direct blow or stretching of nerve during a fall or MVA
Surgical hx of radical neck dissection for tumor or cervical lymph node biopsy
Hx of blow from a hockey stick or lacrosse stick

71
Q

what are ways to injure axillary nerve?

A

Pts >40 yrs w/ shoulder dislocation
Hx of traction force or blunt trauma to shoulder
Hx of brachial neuritis or quadrilateral space syndrome

72
Q

What are ways to injure long thoracic nerve?

A

Identified in players of many sports, including tennis, volleyball, archery, golf, gymnastics, bowling, weight lifting, soccer, hockey & rifle shooting

73
Q

Patient has suprascapular nerve injury. What could it be due to?

A

-Hx of fx of scapula w/ involvement of the notch & blade of scapula
-Traction injury mechanism
-Direct compression of suprascapular nerve at level of scapular notch or at spinoglenoid notch bc of a ganglion cyst or hypertrophied transverse scapular or spinoglenoid ligament

74
Q

Patient is male, over 50, smoker.

Pain in shoulder and vertebral scapular border. Nagging, burning pain down arm into 4th/5th digits
DIFF DX

A

Pancoast’s tumor (superior sulcus lung tumor)

75
Q

Patient has weakness in abduction and ER
-atrophy of supra and infra, just like a rotator cuff tear.
-pain is deep, vague
what is the issue?

A

suprascapular nerve

76
Q

Patient has scapular winging
weakness in 45 degree scaption/flexion, protraction
-loss of scap/hum rhythm

A

SALT!
long thoracic

77
Q

Patient has drooping shoulder, can’t shrug. Lack of scap stabilization
weak abduction…

A

spinal accessory nerve

78
Q

patient has: weakness of shoulder abduction & flexion
Lack of sensation of lateral aspect of upper arm

A

axillary nerve

79
Q

Patient has pain, tenderness, swelling, bruising on arm. What are you suspecting

A

FX

data: Recent fall or trauma
Hx of osteoporosis
Extended use of steroids (i.e. respiratory problem)
Pathologies w/ improper bone remodeling

80
Q

Patient is holding elbow at 70 degree flexion, slightly supinated.
antero-lat pain and tender at elbow.
unable to supinate or pronate.

WHAT DO THEY HAVE

A

radial head fx

81
Q

MOI: FOOSH with supinated forearm. DIFF DX

A

radial head fx

82
Q

MOI: FOOSH with forceful wrist extension
woman over 40
hx of osteoporosis

A

colles fx (distal radius fx)

83
Q

Patient is holding wrist in neutral, swellling in wrist, and extending wrist is painful

A

Distal radius (Colles’) fx

84
Q

MOI: FOOSH
Wrist swelling
Wrist held in neutral position
Pain in ‘anatomic snuff box’

A

scaphoid fx

85
Q

MOI: FOOSH or diffuse synovitis
Generalized wrist swelling & pain
↓’d motion
↓’d grip strength (r/o capitate fx)

A

Lunate fx or dislocation

86
Q

MOI: fall! FOOSH, forearm pronated.

Ulnar-sided wrist pain
Tenderness & clicking w/ wrist movement (passive ulnar deviation)
Weakness w/ grip strength
Dorsal ulnar head subluxation

A

TFCC tear

Traumatic fall after slipping or tripping on outstretched hand w/ forearm pronated
*Commonly associated w/ Colles’ fx

87
Q

Recent puncture of skin
Recent insect bite
Presence of an abscess
Purulent tenosynovitis of tendons that go through a space

what are you worried about

A

Space infection of the hand

88
Q

Patient comes in with hand pain.
inflammation: swelling in palm, dorsum of hand or fingertips
Pain, tenderness, warmth, erythema
Signs of long-standing infection: high fever, chills, weakness, malaise

What are you worried about?

A

Space infection of the hand

89
Q

PAIN IN HAND>
local tenderness, swelling, muscle spasms, hematoma, pain w/ motion & w/ passive stretch of hand.

Patient has history of RA, steroids, respiratory issues, or trauma

A

grade 1 or 2 muscle tear of long flexor tendons

90
Q

HAND PAIN: total loss of motion & palpable defect in muscle, swelling, tenderness, ecchymosis of overlying skin

A

Long flexor tendon rupture grade III

91
Q

Hands or feet that blanch, go cyanotic & then turn red when exposed to cold or emotional stress
Pain & tingling in hands & feet when they turn red

PMH significant for RA, occlusive vascular disease, smoking or use of beta blockers

A

Raynaud’s phenomenon or Raynaud’s disease

92
Q

Trauma including fx, dislocation or surgery
Pain does not respond to typical analgesics

Severe aching, stinging, cutting or boring pain that is not typical of injury
Hypersensitivity
Area swollen (pitting edema), warm & erythematous

A

Complex regional pain syndrome (formerly reflex sympathetic dystrophy)

becky: Primary Care (7 decks)

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