2a: review of systems Flashcards
what is Uneasiness, feeling that ‘something isn’t right
malaise
dyspnea , cough , clubbing of nails , and wheezing/stridor indicate what system problem
pulmonary
- Dyspnea
- Cough (duration, positional,
productive, sputum?) - Palpitations
- Syncope
- Sweats
- Edema
- Cold distal extremities
- Skin discoloration
- Open wounds/ulceers
this all indicate what systems disorder
cardio and peripheral vascular systems
- Exertional dyspnea
- Palpitations
- Anginal pain patterns
- Fatigue
- Pallor
- Digital clubbing
- Lightheadedness
- Syncope
- Drowsiness
- Confusion
- Easy bruising & bleeding
- Fever, chills, sweats
- Malaise
these al indicate what system problem
hematologic system
for hematologic system you are looking for what
•Erythrocyte, leukocyte, platelet conditions
• Bleeding disorders
if your stool color is black , tarry , shiny and sticky what does that mean
upper gi bleeding
if your stool is black but not sticky what does that mean
ingestion or iron and bismuth salts , black licorice , some commercial cc cookies
what does light gray, pale stool color mean
obstructive jaundice
what does bright , blood red stool mean
lower GI bleeding
- Swallowing difficulties
- Indigestion, heartburn
- Food intolerance
- Bowel dysfunction
• Color of stool
• Shape, caliber of stool
• Constipation
• Diarrhea
• Difficulty initiating (i.e. constipation)
• Incontinence
these are all problems with what system
gastro intestinal systems
what does dark urine mean
hepatic or biliary obstructive disease , acute rhabdomyolysis
what does red blood mean
many GI disorders
what does reddish urine mean
blood, ingestion of vegetable dyes , beets, use of some meds (phenazopyridine)
- Flow – frequency, urgency, output,
retention, dysuria - ↓ caliber or force of urine stream
- Difficulty initiating urine stream
- Incontinence
these are all problems of what system
urinary system (genito urinary system)
Male
1. Urethral d/c
2. Sexual dysfunction
3. Pain during intercourse, ejaculation
these are problems with what system
reproductive system
- Numbness, tingling
- Weakness
- Tremors
- Seizures
- Vision △’s
- Sexual difficulties
- Hearing problems
- Difficulty swallowing
- Urinary incontinence
- Vomiting w/o nausea
- Dizziness
- Recent falls
- Balance problems
these are all problems of what system
nervous system
- △’s in skin
• Color, sores, moles, rashes, lumps - △’s in nails
• Discoloration, thickening, ridges,
splitting or separation from nail
bed - △’s in hair
• Hair loss, ↑ in hair, △ in thickness
or distribution - Pruritus (itching)
- △ in sweating or dryness in
skin
these are problems in what system
integumentary system
- General health
• Fatigue, unexplained weight △,
weakness - Psychologic, cognitive
• Personality △’s, memory loss, confusion, irritability - GI
• N&V, anorexia, dysphagia, diarrhea, constipation - Uro-genital
• Impotence, intermittent urine stream, dribbling, straining to void - MSK
• Muscle weakness & cramps, arthralgias, myalgias, stiffness, bone
pain - Sensory
• Paresthesia, numbness - Dermatologic
• Foot ulcerations, edema, dry/coarse skin, impaired would healing - Miscellaneous
• Temperature intolerance, visual △’s,
orthostatic hypotension
these are problems of what system
endocrine system
what are the chief complaint by symptom
joint pain
limb (not joint related pain)
dizziness
HA
what is the most common cause of joint pain and how many people does it effect each year
OA and 30 mil
who should be the primary care providers for OA
PTS
what are the historical symptoms of back pain
•morning stiffness > 30 min
• improvement w exercise but not w rest
•awaken during 2nd half of night bc pain
•alternatin butt pain
what is the inclusion criteria for inflammatory back pain
<50 years of age and a minimus of 3 months of LBP
what is the expert opinion of symptoms for inflammatory back pain
•improvement with exercise
•no improvement with rest
•pain at night
•age onset at 40 or younger
•insidious onset
• Autoimmune arthritis, typically in spine
• May have a (+) family hx
• Pain &/or stiffness in hip &/or neck
• Symptoms ↑ w/ rest
• Symptoms ↓ w/ activity
• Pain at night (particularly last half)
• Non-joint conditions: uveitis, irritable bowel syndrome
these are all related to what disease
anklosing spondylitits
is non specific LBP or Ankylosing Spondylitis more common
non specific LBP
• 35-55 yrs of age
• Male-female ratio – 1:1
• Degenerative arthritis
• Potential pain referral to hip
• Symptoms vary, but can ↓ w/ rest or position
△’s
• Non-joint conditions: n/a
these are all common with what pathology
non specific lbp
what is the 7 classification criteria for RA
•morning stiffness
•arthritis of >3 joint
•arthritis of hand joints
• symmetric arthritis
•rheumatoid nodules
•serum rheumatoid factors
• radiographic changes
for the classification criteria for RA … Abnormal amounts of serum rheumatoid factor determined by any method for which result has been (+) in <__ % of normal control subjects
5
how long does mornign stiffness last for RA classification criteria
> 1 hour before max improvement
____+ criteria in pt w/ disease <1 yr: sensitivity – 85%, specificity – 90%
criteria must be present for >___ weeks
4
6
when is the peak onset for SLE
15-40
are females or males more likely for SLE
females
when do SX increase and decrease for SLE
increase with rest , intense activity
decrease with short rest and mild activity
do pt with SLE have post rest stiffness > 60 mins
yes
how is night pain for people with SLE
less evident
• Peak onset b/t 15-40 yrs
• Insidious
• Females more likely than males
• African-American females 3x
more likely than Caucasians
• (+) family hx
• Infection, sunlight or ultraviolet
light exposure, meds
• Sx ↑: rest, intense activity
• Sx ↓: short rest, mild activity
• Tenderness at affected joints
• Moderate post-rest stiffness >60
min
• Night pain less evident
• Can progress rapidly or slowly
• Symptoms vary from mild to
severe
these are all common demographics and medical hx for someone with what condtion
SLE
when is the peak onset for gout
5th decade for men (40’s) and 6th decade for women (50;s)
are men or women more likely to get gout
men
Renal disorders associated w/ ↑’d
levels of uric acid, leukemia,
lymphoma, psoriasis, chemotherapy, hypothyroidism , HTN , heavy ETOH consumption , taking diuretics and salicylates are associated with what disease
GOUT
when do sx increase and decrease with gout
increase with wb activity and joint use
decrease with rest but unrelenting
do people woth gout have night time pain
yes
• Excruciating pain
• Post-rest stiffness less evident
• Night pain (+)
• Rapid progression
• Symptoms are severe • Peak onset 5th decade for men, 6th
decade for women
• Sudden, often at night
• Males more likely than females
• (+) family hx
• Renal disorders associated w/ ↑’d
levels of uric acid, leukemia,
lymphoma, psoriasis, chemotherapy, hypothyroidism, HTN, heavy ETOH consumption, taking diuretics & salicylates
• Sx ↑: WB activity, joint use
• Sx ↓: ↓ pain w/ rest, but unrelenting
these are all commonly seen with people with what condition
gout
when is the peak onset for psoriatic arthritis
peak onset 2nd and 3rd decades w arthritis following up to 20 years later
how are the sx increased and decreased with psoriatic arthritis
increased with rest and intense activity
decreased with short rest and mild activity
Psoriatic Arthritis is similar to what other 2 conditions ?
SLE and RA
• Psoriasis: peak onset 2nd & 3rd
decades w/ arthritis following
up to 20 yrs later
• Insidious
• No gender predilection
• (+) family hx
• Psoriasis
• Sx ↑: rest, intense activity
• Sx ↓: short rest, mild activity
• Tenderness at affected joints
• Moderate post-rest stiffness >60
min
• Night pain less evident
• Can progress rapidly or slowly
• Symptoms vary from mild to
severe
these are common demographics and medical hx for what conditions
Psoriatic Arthritis
when is the peak onset for reactive arthritis (reiter’s syndrome)
3th decade
is Reactive Arthritis (Reiter’s Syndrome) more common in females or males
males
what other disease is common with Reactive Arthritis
(Reiter’s Syndrome)
venereal or dysenteric disease
when are sx increased and decreased with Reactive Arthritis
(Reiter’s Syndrome)
• Sx ↑: rest, intense activity
• Sx ↓: short rest, mild activity
• Peak onset 3rd decade
• Acute
• More common in males
• Venereal or dysenteric disease
• Sx ↑: rest, intense activity
• Sx ↓: short rest, mild activity
• Moderate to severe post-rest
stiffness >60 min
• Night pain less evident
• Can progress rapidly or slowly
• Symptoms vary from mild to
severe
these are common demographics and medical hx for what condtion
Reactive Arthritis
(Reiter’s Syndrome)
what arthritis has an abrupt onset , excruciating pain , post rest stiffness less evident , increased night pain , rapid profession , sx are severe and Sx ↑: WB activity, joint use, Sx ↓: less pain w/ rest, but
unrelenting and Systemic corticosteroid use,
DM, infection elsewhere, direct
penetrating joint trauma
septic
what are the review os systems findings are gout
fever , malaise , tachycardia
if they systems findings are Skin rash (malar rash most common)
Fever, fatigue, malaise
Photosensitivity
Dyspnea, cough
Peripheral neuropathies
what joint disorder is it
systemic lupus erythematosus
what joint disorder will present with a review of systems findings of
Uveitis (20-30% of pts)
Fatigue, weight loess, fever, malaise
Cardiac & pulmonary complications
Ankylosing Spondylitis (AS)
what is the systems findings for joint OA
nothing
what is the systems findings for psoriatic arthritis
Fever, fatigue, malaise
Psoriasis
if someone has these findings what joints disorder do they have
Urethritis
Conjunctivitis
Nausea, vomiting, diarrhea
Weight loss
Reactive Arthritis (Reiter’s Syndrome)
what is the review of systems findings are septic arthritis
fever, chills , malaise
what is teh chief complaints of limb (non joint related) pain
calf or thigh pain
antalgic gait
difficulty walking
• Hypothyroidism
• Lyme disease
• Polymyalgia rheumatica
• Statin-induced myopathy
these are examples of what
conditions associated with limb pain that are not typically managed by us
what is impairment in spatial perception and stability
dizziness
what is the sensation of spinning
vertigo
what should be considered when evaluating dizziness
serious pathologic neck conditions
is dizziness or vertigo more common
dizziness
what are the 5 D’s for vertebral artery insufficiency
drop attack , dizziness, dysphasia , dysarthria , diplopia
what are 3 N’s are vertebral artery insufficiency
nausea, numbness , nystagmus
what else will be positive with Vertebral Artery Insufficiency (VBI)
cranial nerve signs
what does FAST stand for as a VBI S&S marker for impending CVA
• F – facial droop
• A – arm numbness/weakness
• S – speech difficulty
• T – time is brain (call EMS)
• Occipital HA & numbness
• Severe limitation during neck AROM in
all directions
• Signs of cervical myelopathy
this describes what instability
upper cervical ligamentous instability
what is vertigo causes by
asymmetrical involvement of vestibular system
40% of dizziness is causes by ___ and 25% is causes by ___
peripheral
central
• Dizziness, imbalance, unsteadiness w/o vertigo
• Degenerative △’s in brain or body
this describes what
Dysequilibrium
what is presyncope
vascular compromise to cerebellum
what are non CV causes for presyncope
hypoglycemia , certain meds
• Panic/anxiety
• Cervicogenic
what categorie of dizziness does this respond
non specific (psychophysiologic)
what is one of the most common and disabling conditions in the world
headaches
are headaches more common in women or men
women
what are the 4 types of headaches and which are primary and secondary
• Cervicogenic (2º)
• Migraine (1º)
• Cluster (1º)
• Tension-type (1º)
which headache is the most common
tension type (band , tightening)
what is tension type of HA casues by and what are the sx
stress, anxiety and or depression
bilateral sx
what is the 2nd most common headache
cervicogenic
what headache is Provoked by neck movements &/or sustained postures
cervicogenic
are the sx unilateral or bilateral for cervicogenic
uni
• 10-15% of all HAs
• Unilateral symptoms, but shifts sides
• >1 signs expected: nausea, vomiting,
photophobia, phonophobia
• Symptoms are severe
this describes what type of headache
Migraine (pounding, pulsating)
• <1% of all HAs
• Come in clusters at least every other day for
8 days
• Other S&S: lacrimation, nasal congestion &/or rhinorrhea, eyelid edema, forehead & facial sweating, ptosis, sense of restlessness
or agitation
• Symptoms are severe or very severe
this describes what headache
cluster (crushing)
red flags: double vision, severe or worsening HA, seizure or convulsion , LOC , deteriorating consciousness, vomiting , agitation and or combativeness … these are red flags for what trauma
head injury
what are the 7 high risk sites for stress reaction and stress fx injuries
• Femoral neck
• Anterior cortex of tibia
• Medial malleolus
• Tarsal navicular
• Base of 2nd & 5th metatarsal
• Talus
• Patella
