Clinical screening of shoulder

Question 1

primary bone neoplasm

Answer 1

arms, heavy loss of strength
Weak with elevation, but full passive range of motion possible mass on humerus

Question 2

cervical cancer

Answer 2

Presents at cervical radiculopathy versus upper extremity conditions

Dysphasia, fatigue, thyroid, or esophageal symptoms, hearing loss, constitutional symptoms, enlarged lymph nodes

Question 3

thyroid cancer

Answer 3

Risk factors age 40 to 60
Women more than men
Family history
Radiation therapy
palpable Lymph nodes

wry neck torticollis
CT or shoulder pain, worse with movement or swallowing

Question 4

Hodgkin lymphoma

Answer 4

age 15 to 35
History of mononucleosis or Epstein-Barr virus

Constitutional symptoms, fever, night sweats, fatigue, weight loss, swollen, painful lymph nodes

Question 5

Multiple myeloma

Answer 5

Older adults, anemia, weakness, fatigue, bleeding, recurrent infections, spontaneous fractures, osteoporosis, increased urination, loss of appetite

Question 6

Pancoast tumor

Answer 6

malignant lung tumor smoking history is major risk factor

Typically pain-free in initially, the nagging CT shoulder pain, extending to medial scapular border and along ulnar distribution

unilateral Horner syndrome, pulmonary symptoms, shortness of breath, coughing blood, and sputum until late in disease and weight loss

Question 7

breast cancer

Answer 7

Family history, chronic mastitis, Caucasian females over age 60, personal history of cancer of breast colon uterus or ovaries

Change in breast tissue
Pain and breast
Changes in clavicular or axillary lymph nodes

Question 8

General infection

Answer 8

Constitutional signs and symptoms
recent bacterial infection

Diabetes IV drug use alcohol use long-term corticosteroids
Recent open wounds or surgery
Vascular or immune compromise

Question 9

osteomyelitis

Answer 9

Risk factors diabetes IV drug use alcohol use LT steroids other immuno suppression

Swelling, warmth, redness, and pain in area
Fever and fatigue

Question 10

cellulitis

Answer 10

More common in those with vascular compromise

Sensitive, swollen, warm week and a regular pattern of erythema

Question 11

Inflammatory arthropathies

Answer 11

rheumatoid arthritis
Ankylosing spondylitis
septic arthritis
Reactive arthritis
Lupus
Gout

Question 12

Angina or acute myocardial infarction

Answer 12

Substernal, chest pain, pressure or gripping sensation

present similar to heartburn or indigestion

Aggravated by exertion, stress, heavy meals, or cold weather

Question 13

angina

Answer 13

Chronic or stable , unstable, resting, nocturnal angina

New onset or unstable needs to be evaluated by their physician

Symptoms onset typically 5 to 10 minutes after initiating exercise stop and take nitroglycerin or refer

Question 14

MI

Answer 14

Morning is most common timeframe fatigue often for days

Angina greater than 30 min, not relieved by rest, antacids or nitro glycerin

Nausea, calor, sweating, shortness of breath, weak or faint feeling speech vision impairments

Question 15

pericarditis

Answer 15

Inflammation of the pericardium surrounding heart

Chest pain, shortness of breath fever increased heart rate
Sharp and can burst following changes in positions
Substernal pain and cough referral to the left side of the neck, thoracic chest or upper extremity

Aggravated by breathing coughing or with lying down
eases with holding breathing or sitting up right

Question 16

aortic aneurysm

Answer 16

Thoracic region AA 10% of all aortic aneurysms

Hypertensive men 40 to 70 years of age

Knife, tearing pain, mid thoracic or mid chest and can radiate to between shoulders

Hoarseness, swallowing, strider, nausea, vomiting, elevated HR

Question 17

Pulmonary referral

Answer 17

Interior posterior chest, but can refer to neck, upper trapezius, costal, margins and scapular and shoulder

Sharp and localized pain

Question 18

pleurisy

Answer 18

Fever, chills, sharp pain and chest CT upper trapezius region

Aggravates with recumbent, coughing, shortness of breath, tachypnea, and dyspnea
Eases with sitting up

Question 19

pulmonary embolism

Answer 19

Advanced age prior PE or DVT or risk factors of DVT trauma obesity pregnancy

Shortness of breath, tachypnea, lytic, chest pain, coughing, shoulder, or neck, pain, tachycardia, fever

Question 20

pneumothorax

Answer 20

Trauma or perforation of a chest wall, dry, needling, surgery, or rib fractures

Shortness of breath, dry, cough, sharp chest pain drop in blood pressure jugular distention

Monitor vitals and seek medical attention

Question 21

G.I. signs and symptoms

Answer 21

difficulty swallowing
Heartburn or indigestion
Intolerances of certain food
Changes in appetite
Bowel dysfunction
Abdominal distention or bloating
Constitutional signs and symptoms
Rebound tenderness
Pain eased in seated flexion

Question 22

kehrs sign

Answer 22

Left shoulder pain due to a ruptured spleen

Question 23

Acute polynephritis

Answer 23

Women four times more likely

Symptoms, fever, chills, frequent or painful urination, nausea, vomiting, cloudy or smelly, urine pain in the back or sides

Question 24

Renal calculi

Answer 24

pain and waves pain with urination, discolored urine, frequent urination in small amounts

Question 25

Ectopic pregnancy

Answer 25

pregnancy signs and symptoms, sudden constant lower abdominal pain on one side, irregular bleeding, spotting urge to have a bowel movement, shoulder pain

Question 26

Graves’ disease

Answer 26

A thyroid condition, can increase the chance of adhesive capsulitis in the shoulder

Question 27

observe the eyes for

Answer 27

Ptosis, infections, graves disease, sclera color, nystagmus, gaze abnormalities

Question 28

Spoon nails

Answer 28

Iron deficiency

Question 29

terrys nails

Answer 29

whites of nails are >2/3 length
Cirrhosis of liver and hypoalbuminemia

Question 30

pitting of nailbed

Answer 30

Psoriasis

Question 31

mees line

Answer 31

White discoloration of nail plate
Transverse lines across nail
Do not extend entire nail arsenic poisoning, Renal failure, heart disease, pneumonia