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PRIMARY CARE > 1C: differential diagnosis > Flashcards

1C: differential diagnosis Flashcards

1
Q

Subjective data can assist PT in
determining the following about
pt’s condition:

A

• Severity
• Irritability
• Nature
• Stage
• Stability

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2
Q

what describes clinician’s assessment of intensity of pt’s symptoms as they relate to a functional activity

A

severity

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3
Q

what describes clinician’s assessment of ease w/ which symptoms can be provoked or stirred up

A

irritability

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4
Q
  1. Amount of activity needed to trigger pt’s symptoms
  2. Severity of symptoms provoked
  3. What activity & amount of time before pt’s symptoms subside

these questions are under what SINSS definitions

A

irritability

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5
Q

what describes clinician’s assessment of
1. Hypotheses of structures, syndrome/classification or pathoanatomic structures or syndromes responsible for producing pt’s
pain
2. Anything about the problem or condition that may warrant caution w/ physical exam
3. Character of presenting pt or problem (i.e. psychological, personality, ethnicity, SES factors)

A

nature of complaint

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6
Q

what describes clinician’s assessment of stage in which pt is presenting (acute, sub-acute, chronic, acute on chronic); may be obtained from past & present hx

A

state of pathology

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7
Q

whqt describes progression of pt’s symptoms over time (i.e. getting better, worse or staying the same

A

stability

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8
Q

what kind of questions should you start with

A

start w open ended questions

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9
Q

id someone has a hx of major or into trauma what is the rationale

A

possible fx

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10
Q

if someone is > 50 years of age what is the rationale

A

increase risk of cancer, AAA< fx and infection

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11
Q

if someone has past or present hx of any kind of cancer what is the rationale

A

increase sink of cancer metastasizing to other body regions

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12
Q

if someone has >100ºF, sensation of being cold, waking up
sweating, temperature △’s at night what is the rationale

A

may increase risk of infection or cancer

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13
Q

if someone has loss of > 10 lbs in 3 months w/o explanation what is the rationale

A

may indicate cancer or infection

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14
Q

if someone has a recent infection what is the rationale

A

increase risk for subsequent infection

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15
Q

if someone has immunosuprresion resulting from organ transplant , IV drug use or prolonged CS use rationale

A

increase risk for infection

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16
Q

if someone has pain not relieved w rest and awakens pt at night what is the rationale

A

increase risk of cancer , infection and AAA

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17
Q

if someone has saddle anesthesia , an absence of sensation in 2nd -5th sacral nerve roots, perineal region what is the rationale

A

cauda equina syndrome

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18
Q

if someone has Urinary retention, △’s in frequency or urination , in continence , dysuria , and hematuria what is the rationale behind it

A

cauda equina or infection

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19
Q

what should you have following a subjective HX

A

top 3 dx’s

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20
Q

where does the heart refer symptoms to

A

left chest and down the medial border of left arm

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21
Q

if someone has right shoulder/neck and back pain what would it be not MSK

A

liver and gallbladder

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22
Q

if someone has pain on the right lower abdominal area what could it be if it is not MSK

A

gallbladder

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23
Q

if someone has pain in the upper abdomen are and mid thoracic area what could be causing this pain that isn’t related to MSK

A

stomach

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24
Q

what are the symptoms related to MSK

A

pain that fluctuates over 24 hour period

motions or activities make pain change

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25
Q

what are the most common chief complains patients seek pt treatment for

A

LBP , shoulder pain and knee pain

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26
Q

if they have vague , dull ache not located near typical MSK structures is that related to MSK or not

A

no

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27
Q

what kind of disorders are throbbing , pounding , and pulsating

A

vascular disorders

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28
Q

what kind of disorders is sharp , lancinating , shocking, and burning

A

neurologic disorders

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29
Q

what kind of disorders is aching , squeezing , gnawing , burning and cramping

A

visceral disorders

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30
Q

what data is obtained during physical exam for a back related tumor

A

• Constant pain not affected by position or
activity
• Worse at night

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31
Q

• Age >50 yrs
• Hx of cancer
• Unexplained weight loss
• Failure of conservative tx

these are all data obtained during the patients HC for which condition

A

back related tumor

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32
Q

• Recent infection
• IV drug user/abuser
• Concurrent immunosuppressive
disorder

these are data that is obtained during a pateints HX for what condition

A

back related infection

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33
Q

what kind of pain is associated with back related infection

A

deep constant pain , with increase with WB

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34
Q

what other data is obtained during physical exam for back related infection

A

favre , malaise , swelling

spine rigidity

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35
Q

•Hx of spinal stenosis
• Hx of DDD

these are data that is obtained during a patients hx for what condition

A

cauda equina

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36
Q

what weakness will someone experience with cauda equina condition

A

ankle DF , toe ext and ankle PF

global or progressive weakness in LEs

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37
Q

what type of incontinence wis associated with cauda equina

A

urinary retention/ incontinence and fetal incontinence

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38
Q

what kind of anesthesia will associated with cauda equina

A

saddle anesthesia

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39
Q
  • Hx of trauma (including minor falls or heavy lifts for osteoporotic or elderly pts)
  • Long-term steroid use
  • Age >70 yrs

this data is obtained during hx for what condition

A

spinal fx

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40
Q

where will it be tender for people with a spinal fx

A

tender w palpation over the fx site

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41
Q

when will someone have increasead pain with a spinal fx

A

with weight bearing

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42
Q
  • Back, abdominal or groin pain
  • Presence of PVD or CAD & associated risk factors (age >50 yrs, smoker, HTN, DM)
  • Symptoms NOT related to movement stresses associated w/ somatic LBP

this is data obtained during hx of a pateint with what condition

A

abdominal aneurysm

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43
Q

what data will be obtained during a physical exam for a pt with an abdominal aneurysm

A

abdomen width of aortic or iliac arterial pulses

presence of a bruit

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44
Q

• Age >50 yrs
• Bowel disturbances
• Unexplained weight loss
• Hx of colon cancer in immediate
family
• Pain unchanged by position or
movement

this data is obtained during a patient hx with what condition

A

colon cancer

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45
Q

in the later stages of colon cancer what data may be obtained during a physical exam

A

may have hypoactice or hyperactive bowel sounds from obstruction

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46
Q

the 1st sign obtained during a physical exam with someone who has colon cancer may be what

A

may be metastases to liver, lung , bone or brain

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47
Q

• Older women (age >70 yrs) w/
hip, groin, or thigh pain
• Hx of a fall from standing
position

this is data obtained during a patients hx of what condition

A

pathologic fx in femoral neck

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48
Q

how will someone LE be during a physical exam with a pathologic fx in femoral neck

A

shortened and ER

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49
Q

what kind of pain will someone have with a pathologic fx in the femoral neck

A

severe , constant pain and worse with movement

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50
Q
  • Hx of long-term corticosteroid use (i.e. pts w/ RA, SLE, asthma)
  • Hx of osteonecrosis of contralateral hip
  • Trauma

this is data obtained during a pateitns hx with what condition

A

osteonecrosis of femoral head (aka AVN)

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51
Q

what kind of pain will be obtained during a physical exam with a pateint that had osteonecrosis of femoral neck

A

gradual onset of pain that worsens with WB

Pain may refer to groin , thigh or medial knee

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52
Q

what is the primary restriction for someone with osteonecrosis of femoral head

A

IR and flexed

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53
Q

• 5-8 yr old boys w/ groin/thigh
pain

this is data obtained during a patients hx with what kind of condition

A

legg calve perthes disease

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54
Q

what data will be obtained during a physical exam of someone with legg calve perthes disease

A

antalgic gait

pain complaints aggravated with hip movement esprecially hip abd , anf I R

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55
Q

• Overweight adolescent
• Hx of a recent growth spurt or
trauma

this data is obtained during a patients hx of what kind of condition

A

slipped capital femoral epiphysis

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56
Q

what is the invovled leg held in with someone with slipped capital femoral epiphysis

A

ER

57
Q

if you obtained
• Aching in groin exacerbated w/ WB
• Involved leg held in ER
• ROM limitations in hip IR

what condition do u suspect

A

slipped capital femorla epiphysis

58
Q

• Age >60 yr
• Hx of Type 2 DM
• Hx of ischemic heart disease
• Smoking hx
• Sedentary lifestyle
• Concurrent intermittent
claudication

this data is obtained during a patients HX for which condition

A

peripheral arterial occlusive disease

59
Q

what are the 5 things obtained during the physical exam for peripheral arterial occlusive disease

A

*uniliteraly cool extremity
* prolonged capillary refill time
* decrease pulses in arteries below level of occlusion
*prolonged vascular filling time
* ankle brachial index <.9

60
Q

• Recent surgery, malignancy,
pregnancy, trauma, or leg
immobilization

this data will be obtained during a patients hx of what condition

A

deep vein thrombosis

61
Q

• Calf pain, edema, tenderness, warmth
• Calf pain that is intensified w/ standing or
walking & relieved by rest & elevation
• Possible pallor & loss of dorsalis pedis pulse

if you obtain this data during the physical exam what condition can we suspect our patient has

A

DVT

62
Q

• Hx of blunt trauma, crush injury,
or unaccustomed exercise

if this data is obtained during hx what condition can we suspect

A

compartment syndrome

63
Q

• 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

if this data is obtained during a physical exam we can suspect the pateint has what condition

A

compartment syndrome

64
Q

Hx of recent infection, surgery or
injection
• Coexisting immunosuppressive
disorder

if this data is obtained during HX what condition can we suspect

A

septic arthritis

65
Q

what data is obtained during the physical exam for someone with septic arthritis

A

constant aching or throbbing pain , joint swelling , tenderness and warmth

may have elevated body temp

66
Q

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

if this data is obtained during a hx what can we suspect a pateint has

A

cellulitis

67
Q
  • Pain, skin swelling, warmth, advancing irregular
    margin of erythema/reddish streaks
  • Fever, chills, malaise & weakness

if this data is obtained during a **physical exam **we can suspect what condition

A

cellulitis

68
Q

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

this is obtained during a hx for what condition

A

myocardial infarction

69
Q

what data is obtained during a physical exam of someone with myocardial infarction

A

chest pain

pallor , sweating , dyspnea, nausea , palpation (symptoms lasting >30 mins and not relieved with sublingual nitroglycerin)

70
Q

what data is obtained during hx for someone with unstable angina pectoris

A

hx of CAD

71
Q

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

this data obtained during a physical exam will be relevant to which condition

A

unstable angina pectoris

72
Q

what condition has this data obtained during hx

• Common in people >65 yrs
• More common in men
• Hx of CAD

A

stable angina pectoris

73
Q

• Chest pain/pressure that occurs w/ predictable
levels of exertion
• Symptoms predictably alleviated w/ rest or
sublingual nitroglycerin

if this data is obtained during physical exam what condition will we suspect

A

stable angina pectoris

74
Q

if this data is obtained during hx what condition do they have

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

A

pericarditis

75
Q

what kind of pain will someone have with pericarditis

A

sharp/stabbing chest pain that may be referred to lateral neck or either shoulder

76
Q

when is pain increased with pericarditis

A

w L sidelying

77
Q

when is pain relieved for pericarditis

A

w forward leaning while sitting

78
Q

• Hx of, or risk factors for
developing, DVT
• Immobility
• Trauma
• Cancer

this data is obtained during the hx of what condition

A

pulmonary embolism

79
Q

what data will be obtained during the physical exam for someone with pulmonary embolism

A

chest, shoulder or upper abdominal pain

dyspnea

tachynpena

tachycardia

80
Q

• Hx of recent or concurrent
respiratory disorder (i.e.
infection, pneumonia, tumor, TB

this data will be obtained during the hx of what condition

A

pleurisy

81
Q

what condition has this data during the physical exam

• Severe, sharp, knife-like pain w/ inspiration
• Dyspnea, ↓ chest wall excursion

A

pleurisy

82
Q

• Recent bout of coughing or
strenuous exercise or trauma

this data is obtained during hx of what condition

A

pneumothorax

83
Q

• Chest pain, intensified w/ inspiration
• Difficulty ventilating or expanding rib cage
• Hyperresonance on percussion
• ↓ breath sounds

this data is obtained during a physical exam of what condition

A

pneumothorax

84
Q

• Hx of bacterial, viral, fungal or
mycoplasmal infection

if this data is obtained during hx what condition can we say they have

A

pneumonia

85
Q

what is going to be obtained during a physical exam with someone with pneumonia

A

pleuritic pain

fever, chills ,HAs, malaise , nausea

86
Q

• Most common in middle age
(particularly in women)
• WBC count may be elevated
(12,000-15,000/mL)

this data that is obtained during hx what condition may they have

A

choleysitiis

87
Q

• Colicky pain in R upper abdominal quadrant w/
accompanying R scapular pain
• Symptoms worsen w/ ingestion of fatty foods
• Symptoms not ↑’d by activity or relieved by
rest

this data will be obtained during the physical exam of what condition

A

cholecystitis

88
Q

• Dull or gnawing pain or burning
sensation in epigastrium, mid-
back or supraclavicular regions
• Symptoms relieved w/ food
• Hx of infection (H. pylori)
• Hx of multiple stressors, poor
coping skills, persistent anxiety &
depression

this will be included in the dat aobtained during hx of what condition

A

peptic ulcer

89
Q

if a patient has • Localized tenderness at R epigastrium
• Constipation, bleeding, vomiting, tarry-colored
stools, coffee-ground emesis

we can assume they have what condition

A

peptic ulcer

90
Q

• More common in women
• Recent or coexisting UTI
• Kidney stone or past episode of
kidney stone

this data will be obtained during hx in what condition

A

pyelonephritis

91
Q

where will someone experience tenderness over with pyelonphritis

A

over costovertebral angle (murphy sign)

92
Q

• Fever, chills, malaise, HA, flank pain
• Enlarged prostate
• Tenderness over costovertebral angle
(Murphy’s sign

this will be obtained during the physical exam of what condition

A

pyelonephritis

93
Q

• Residence in hot & humid
climates
• Past episodes of kidney stone
(50% of pts experience
recurrence

this data will be obtained during the hx of what condition

A

nephrolithiasis (kidney stones)

94
Q

if a patient has

• Sudden, severe back or flank pain
• Chills, fever, nausea & vomiting
• Renal colic
• Symptoms of UTI

what condition is it

A

nephrolothiasis (kidney stones)

95
Q

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

if this data is obtained in the hx what condition could it be

A

spinal fx

96
Q

what are the most common fx level

A

T11-L1

97
Q

• Hx of recent bacterial or viral
infection (influenza)
• Hx of skull fx

this data will be obtained during the hx for what condition

A

meningitis

98
Q

• (+) slump sign
• HA
• Fever
• GI signs: nausea &
vomiting • Photophobia
• Confusion
• Seizures
• Sleepiness

if someone presents with these during a physical exam what condition can they have

A

meningitis

99
Q

when are brain tumors common

A

age 20-64

100
Q

• HA
• Altered mental
status
• Ataxia
• Speech deficits
• Sensory
abnormalities
• GI signs: nausea &
vomiting
• Visual △’s
• Seizures

if someone presents with these conditions during a physical exam what condition may they ahve

A

brain tumor

101
Q

• Hx of smoking, HTN & ETOH
abuse
• HA of sudden onset (the worst
HA of pt’s life)

this data will be obtained during the hx of what condition

A

subarachnoid hemorrhage

102
Q

• Brief loss of consciousness
• Brain tumor signs: neurologic dysfunction,
nausea & vomiting)
• Meningeal irritation signs: nuchal rigidity, fever,
photophobia, nausea & vomiting

if someone obtains this’d during a physical exam what condition could they have

A

subarachnoid hemorrhage

103
Q

• Major trauma such as an MVA or
fall from a height
• Hx of RA or AS
• Oral contraceptive use

this is obtained during a hx of what condition

A

cervical ligament out instability w/ possible cord compromise

104
Q

• Long tract neurologic signs (especially present
in >1 extremity): dizziness, nystagmus, vertigo
w/ head/neck movements/positions, clonus,
(+) Babinski’s sign

this will be obtained during a physical exam with what condition

A

cervical ligament out instability w/ possible cord compromise

105
Q

• Paresthesias
• Pain present at rest & possibly
w/ a retrograde distribution

this may be obtained during the hx of what cervical spine anf shoulder region condtion

A

cervical anf shoulder girdle peripheral entrapment neuropathies

106
Q

• Muscles innervated by affected nerve can be
tender to palpate
• Muscles & sensory distribution follow specific
nerve pattern

this is obtained during the physical exam of what cervical spine and shoulder region condtion

A

cervical anf shoulder girdle peripheral entrapment neuropathies

107
Q

what cervical spine and shoulder region condtion can this be if this hx was obtained

• 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

A

spinal accessory nerve

108
Q

what cervical spine and shoulder region condtion can this be if this was found during the physical exam

• Asymmetry of neck line & drooping of shoulder
• Inability to shrug shoulders
• Lack of scapular stabilization
• Weakness of shoulder abduction

A

spinal accessory n

109
Q

what cervical spine anf shoulder region condition is it if this data was obtained during hx

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

A

axillary n

110
Q

what cervical spine and shoulder region condition could it be if this was obtained during the physical exam

• Weakness of shoulder abduction & flexion
• Lack of sensation of lateral aspect of upper
arm

A

axillary nerve

111
Q

what cervical spine and shoulder region condtion could if be if this was obtained during the hx

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

A

long thoracic nerve

112
Q

what cervical spine anf shoulder region condtion can this be if this was obtained during the physical exam

• Serratus anterior weakness w/ scapular
winging
• Loss of scapulohumeral rhythm

A

long thoracic n

113
Q

what cervical spine anf shoulder region condtion can if be if this was obtained during the hx

• Deep, poorly localized pain
• 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

A

suprascapular n

114
Q

if someone has suprascapular n condtion what will they have a loss of strength of

A

shoulder abd and er

115
Q

Men >50 yrs w/ hx of cigarette smoking can have what condtion

A

pancosts tumor (superior sulcus lung tumor)

116
Q

what cervical spine anf shoulder region condtion can a patient have if they present with his during the physical exam

• Nagging-type pain in shoulder & along
vertebral border of scapula
• Pain that has progressed from nagging
to burning in nature, often extending
down the arm & into ulnar nerve
distribution

A

pancoasts tumor

117
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

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

A

fx

118
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physical exam

• Pain, tenderness, swelling, ecchymosis

A

fx

119
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

• Fall onto outstretched hand (FOOSH) w/
supin

A

radial head fx

120
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physical exam

• Antero-lateral pain & tenderness at
elbow
• Inability to supinate or pronate forearm
• Elbow held against side w/ 70º of
flexion & slightly supinated

A

radial head fx

121
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

• FOOSH w/ forceful wrist extension
• Age >40 yrs
• Women affected more than men
• Hx of osteoporosis

A

distal radial fx (colles) MOST COMMON

122
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physical exam

• Wrist held in neutral resting position
• Wrist swelling
• Movements into wrist extension are
painful

A

distal radius fx (colles’) most common

123
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx and physcial example

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

A

scaphoid fx

124
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

• FOOSH
• Diffuse synovitis

A

lunate fx or dislocation

125
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physcial exam • Generalized wrist swelling & pain
• ↓’d motion
• ↓’d grip strength (r/o capitate fx

A

lunate fx or dislocation

126
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

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

A

triangular fibrocartilagnous complex tear

127
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physcial exam • Ulnar-sided wrist pain
• Tenderness & clicking w/ wrist
movement (passive ulnar deviation)
• Weakness w/ grip strength
• Dorsal ulnar head subluxation

A

triangular fibrocartilaginous complex tear

128
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

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

A

space infection of the hand

129
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physical exam

• Typical signs of inflammation: swelling
in palm, dorsum of hand or fingertips
• Pain, tenderness, warmth, erythema
• Signs of long-standing infection: high
fever, chills, weakness, malaise

A

space infection of the hand

130
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

• Hx of RA
• Hx of corticosteroid use for
chronic respiratory problems
• Hx of trauma

A

long flexor tendon rupture

131
Q

what grade is if for a long flexor tendon ruture if there is local tenderness,
swelling, muscle spasms, hematoma, pain w/
motion & w/ passive stretch

A

grade 1 and 2 mm tear

132
Q

what grade is if for a long flexor tendon ruture if there is total loss of motion
& palpable defect in muscle, swelling,
tenderness, ecchymosis of overlying skin

A

grade 3 mm rupture

133
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

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

A

raynaud’s phenomenon or raynaud’s disease

134
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physical exam

• 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

A

Raynaud’s
phenomenon or
Raynaud’s disease

135
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

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

A

Complex regional pain
syndrome

136
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the hx

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

A

Complex regional pain
syndrome

137
Q

what elbow , wrist and hand region condtion can it be if this is obtained during the physcial exam

• 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

138
Q

does one red flag automatically mean serious pathology and that u need to refer

A

no

139
Q

does one red flag automatically mean serious pathology and that u need to refer

A

no

PRIMARY CARE (9 decks)

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