1C: differential diagnosis Flashcards
Subjective data can assist PT in
determining the following about
pt’s condition:
• Severity
• Irritability
• Nature
• Stage
• Stability
what describes clinician’s assessment of intensity of pt’s symptoms as they relate to a functional activity
severity
what describes clinician’s assessment of ease w/ which symptoms can be provoked or stirred up
irritability
- Amount of activity needed to trigger pt’s symptoms
- Severity of symptoms provoked
- What activity & amount of time before pt’s symptoms subside
these questions are under what SINSS definitions
irritability
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)
nature of complaint
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
state of pathology
whqt describes progression of pt’s symptoms over time (i.e. getting better, worse or staying the same
stability
what kind of questions should you start with
start w open ended questions
id someone has a hx of major or into trauma what is the rationale
possible fx
if someone is > 50 years of age what is the rationale
increase risk of cancer, AAA< fx and infection
if someone has past or present hx of any kind of cancer what is the rationale
increase sink of cancer metastasizing to other body regions
if someone has >100ºF, sensation of being cold, waking up
sweating, temperature △’s at night what is the rationale
may increase risk of infection or cancer
if someone has loss of > 10 lbs in 3 months w/o explanation what is the rationale
may indicate cancer or infection
if someone has a recent infection what is the rationale
increase risk for subsequent infection
if someone has immunosuprresion resulting from organ transplant , IV drug use or prolonged CS use rationale
increase risk for infection
if someone has pain not relieved w rest and awakens pt at night what is the rationale
increase risk of cancer , infection and AAA
if someone has saddle anesthesia , an absence of sensation in 2nd -5th sacral nerve roots, perineal region what is the rationale
cauda equina syndrome
if someone has Urinary retention, △’s in frequency or urination , in continence , dysuria , and hematuria what is the rationale behind it
cauda equina or infection
what should you have following a subjective HX
top 3 dx’s
where does the heart refer symptoms to
left chest and down the medial border of left arm
if someone has right shoulder/neck and back pain what would it be not MSK
liver and gallbladder
if someone has pain on the right lower abdominal area what could it be if it is not MSK
gallbladder
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
stomach
what are the symptoms related to MSK
pain that fluctuates over 24 hour period
motions or activities make pain change
what are the most common chief complains patients seek pt treatment for
LBP , shoulder pain and knee pain
if they have vague , dull ache not located near typical MSK structures is that related to MSK or not
no
what kind of disorders are throbbing , pounding , and pulsating
vascular disorders
what kind of disorders is sharp , lancinating , shocking, and burning
neurologic disorders
what kind of disorders is aching , squeezing , gnawing , burning and cramping
visceral disorders
what data is obtained during physical exam for a back related tumor
• Constant pain not affected by position or
activity
• Worse at night
• 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
back related tumor
• Recent infection
• IV drug user/abuser
• Concurrent immunosuppressive
disorder
these are data that is obtained during a pateints HX for what condition
back related infection
what kind of pain is associated with back related infection
deep constant pain , with increase with WB
what other data is obtained during physical exam for back related infection
favre , malaise , swelling
spine rigidity
•Hx of spinal stenosis
• Hx of DDD
these are data that is obtained during a patients hx for what condition
cauda equina
what weakness will someone experience with cauda equina condition
ankle DF , toe ext and ankle PF
global or progressive weakness in LEs
what type of incontinence wis associated with cauda equina
urinary retention/ incontinence and fetal incontinence
what kind of anesthesia will associated with cauda equina
saddle anesthesia
- 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
spinal fx
where will it be tender for people with a spinal fx
tender w palpation over the fx site
when will someone have increasead pain with a spinal fx
with weight bearing
- 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
abdominal aneurysm
what data will be obtained during a physical exam for a pt with an abdominal aneurysm
abdomen width of aortic or iliac arterial pulses
presence of a bruit
• 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
colon cancer
in the later stages of colon cancer what data may be obtained during a physical exam
may have hypoactice or hyperactive bowel sounds from obstruction
the 1st sign obtained during a physical exam with someone who has colon cancer may be what
may be metastases to liver, lung , bone or brain
• 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
pathologic fx in femoral neck
how will someone LE be during a physical exam with a pathologic fx in femoral neck
shortened and ER
what kind of pain will someone have with a pathologic fx in the femoral neck
severe , constant pain and worse with movement
- 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
osteonecrosis of femoral head (aka AVN)
what kind of pain will be obtained during a physical exam with a pateint that had osteonecrosis of femoral neck
gradual onset of pain that worsens with WB
Pain may refer to groin , thigh or medial knee
what is the primary restriction for someone with osteonecrosis of femoral head
IR and flexed
• 5-8 yr old boys w/ groin/thigh
pain
this is data obtained during a patients hx with what kind of condition
legg calve perthes disease
what data will be obtained during a physical exam of someone with legg calve perthes disease
antalgic gait
pain complaints aggravated with hip movement esprecially hip abd , anf I R
• Overweight adolescent
• Hx of a recent growth spurt or
trauma
this data is obtained during a patients hx of what kind of condition
slipped capital femoral epiphysis
what is the invovled leg held in with someone with slipped capital femoral epiphysis
ER
if you obtained
• Aching in groin exacerbated w/ WB
• Involved leg held in ER
• ROM limitations in hip IR
what condition do u suspect
slipped capital femorla epiphysis
• 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
peripheral arterial occlusive disease
what are the 5 things obtained during the physical exam for peripheral arterial occlusive disease
*uniliteraly cool extremity
* prolonged capillary refill time
* decrease pulses in arteries below level of occlusion
*prolonged vascular filling time
* ankle brachial index <.9
• Recent surgery, malignancy,
pregnancy, trauma, or leg
immobilization
this data will be obtained during a patients hx of what condition
deep vein thrombosis
• 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
DVT
• Hx of blunt trauma, crush injury,
or unaccustomed exercise
if this data is obtained during hx what condition can we suspect
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
if this data is obtained during a physical exam we can suspect the pateint has what condition
compartment syndrome
Hx of recent infection, surgery or
injection
• Coexisting immunosuppressive
disorder
if this data is obtained during HX what condition can we suspect
septic arthritis
what data is obtained during the physical exam for someone with septic arthritis
constant aching or throbbing pain , joint swelling , tenderness and warmth
may have elevated body temp
• 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
cellulitis
- 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
cellulitis
• 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
myocardial infarction
what data is obtained during a physical exam of someone with myocardial infarction
chest pain
pallor , sweating , dyspnea, nausea , palpation (symptoms lasting >30 mins and not relieved with sublingual nitroglycerin)
what data is obtained during hx for someone with unstable angina pectoris
hx of CAD
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
unstable angina pectoris
what condition has this data obtained during hx
• Common in people >65 yrs
• More common in men
• Hx of CAD
stable angina pectoris
• 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
stable angina pectoris
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
pericarditis
what kind of pain will someone have with pericarditis
sharp/stabbing chest pain that may be referred to lateral neck or either shoulder
when is pain increased with pericarditis
w L sidelying
when is pain relieved for pericarditis
w forward leaning while sitting
• Hx of, or risk factors for
developing, DVT
• Immobility
• Trauma
• Cancer
this data is obtained during the hx of what condition
pulmonary embolism
what data will be obtained during the physical exam for someone with pulmonary embolism
chest, shoulder or upper abdominal pain
dyspnea
tachynpena
tachycardia
• Hx of recent or concurrent
respiratory disorder (i.e.
infection, pneumonia, tumor, TB
this data will be obtained during the hx of what condition
pleurisy
what condition has this data during the physical exam
• Severe, sharp, knife-like pain w/ inspiration
• Dyspnea, ↓ chest wall excursion
pleurisy
• Recent bout of coughing or
strenuous exercise or trauma
this data is obtained during hx of what condition
pneumothorax
• 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
pneumothorax
• Hx of bacterial, viral, fungal or
mycoplasmal infection
if this data is obtained during hx what condition can we say they have
pneumonia
what is going to be obtained during a physical exam with someone with pneumonia
pleuritic pain
fever, chills ,HAs, malaise , nausea
• 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
choleysitiis
• 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
cholecystitis
• 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
peptic ulcer
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
peptic ulcer
• 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
pyelonephritis
where will someone experience tenderness over with pyelonphritis
over costovertebral angle (murphy sign)
• 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
pyelonephritis
• 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
nephrolithiasis (kidney stones)
if a patient has
• Sudden, severe back or flank pain
• Chills, fever, nausea & vomiting
• Renal colic
• Symptoms of UTI
what condition is it
nephrolothiasis (kidney stones)
• 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
spinal fx
what are the most common fx level
T11-L1
• Hx of recent bacterial or viral
infection (influenza)
• Hx of skull fx
this data will be obtained during the hx for what condition
meningitis
• (+) 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
meningitis
when are brain tumors common
age 20-64
• 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
brain tumor
• 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
subarachnoid hemorrhage
• 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
subarachnoid hemorrhage
• 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
cervical ligament out instability w/ possible cord compromise
• 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
cervical ligament out instability w/ possible cord compromise
• 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
cervical anf shoulder girdle peripheral entrapment neuropathies
• 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
cervical anf shoulder girdle peripheral entrapment neuropathies
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
spinal accessory nerve
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
spinal accessory n
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
axillary n
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
axillary nerve
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
long thoracic nerve
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
long thoracic n
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
suprascapular n
if someone has suprascapular n condtion what will they have a loss of strength of
shoulder abd and er
Men >50 yrs w/ hx of cigarette smoking can have what condtion
pancosts tumor (superior sulcus lung tumor)
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
pancoasts tumor
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
fx
what elbow , wrist and hand region condtion can it be if this is obtained during the physical exam
• Pain, tenderness, swelling, ecchymosis
fx
what elbow , wrist and hand region condtion can it be if this is obtained during the hx
• Fall onto outstretched hand (FOOSH) w/
supin
radial head fx
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
radial head fx
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
distal radial fx (colles) MOST COMMON
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
distal radius fx (colles’) most common
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’
scaphoid fx
what elbow , wrist and hand region condtion can it be if this is obtained during the hx
• FOOSH
• Diffuse synovitis
lunate fx or dislocation
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
lunate fx or dislocation
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
triangular fibrocartilagnous complex tear
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
triangular fibrocartilaginous complex tear
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
space infection of the hand
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
space infection of the hand
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
long flexor tendon rupture
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
grade 1 and 2 mm tear
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
grade 3 mm rupture
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
raynaud’s phenomenon or raynaud’s disease
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
Raynaud’s
phenomenon or
Raynaud’s disease
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
Complex regional pain
syndrome
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
Complex regional pain
syndrome
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
Complex regional pain
syndrome
does one red flag automatically mean serious pathology and that u need to refer
no
does one red flag automatically mean serious pathology and that u need to refer
no
