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Differential Diagnosis & Med Screening > COMPS:GULICK: Medical Screening Pt. 1 Systemic Pathology > Flashcards

COMPS:GULICK: Medical Screening Pt. 1 Systemic Pathology Flashcards

1
Q

What is a RED Flag?

A

Predictor of pathology

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2
Q

From exam to either Initiating PT OR REFER OUT!

A

SEE PICS

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3
Q

Dx Tests Ex’s

A

X-ray, MRI, CT, US, Bone Scan, DEXA, EMG/NCV, EKG, EEG, Urine Analysis, Blood Work,

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4
Q

Statistics: Sensitivity

SnNOUT==>

A
  • SnNOUT→ If the test is NEGATIVE, it is effective @ RULING OUT dysfunction
    • Sn== good ScreeNing tool
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5
Q

Generalized Systemic RED FLAGS!

Big picture, Key words, things that raise concern****

A
  • Insidious, NO known MOI
  • Sx’s out of proportion to injury
  • NO change in sx’s, despite position, rest, tx
  • NO pattern to sx’s; unable to reproduce sx’s
  • Sx’s persist beyond expected healing time
  • Recent OR Current fever, chills, night sweats, infx
  • Unexplained wt loss, pallor, nausea, dizzy, vom, B&B changes (constitutional sx’s→ involve lots of systems)
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6
Q

MORE Generalized Systemic RED FLAGS

A
  • HA/Visual changes
  • *Change in vital signs→ NEED BASELINE!!
  • B/L sx’s
  • Pigmentation changes, edema, rash, nail changes, weakness, numb, tingle, burning→ all Endocrine***
  • Hx of Cx
  • >40yo gender, ethnicity, race
  • Night pain
  • Progressive neurology sx’s
  • Cyclic presentation
  • Jt pain w/ skin lesions
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7
Q

Dev’t of a Review-of-Systems Screening Tool for Ortho PT

23-Item tool correctly ID’d 100% of (+) responders

23 Questions:

A
  1. abnormal sensations (numb, pins, needles)?
  2. HAs?
  3. Night pain?
  4. Sustained morning stiffness?
  5. Light-headed?
  6. Trauma (MVA, fall)?
  7. Night sweats?
  8. Constipation?
  9. Easy bruising?
  10. Changes in vision?
  11. Changes in menstrual pattern?
  12. Balance disturbs?
  13. Chest pain w/ rest?
  14. SOB?
  15. MM weakness?
  16. Failure of conservative intervention (30d)?
  17. Excess sweating?
  18. Edema/wt gain?
  19. Heartbeat in abdomen when lie down?
  20. Cramps in legs when walk several blocks?
  21. Abdom pain?
  22. Changes in integrity of nails?
  23. Prolonged use of corticosteroids?→ myopathy!
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8
Q

Vital Signs

A
  • ALWAYS TAKE THEM!!!
  • MUST establish Baseline!!!!
  • Standard of Minimal Acceptable Care!!!
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9
Q

Early Warning Signs of Cx

Mnemonic to use?

A

CAUTION

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10
Q

Early Warning Signs of Cx

CAUTION

A
  • C: Change in B&B
  • A: A sore that fails to heal in 6wks
  • U: Unusual bleeding or discharge
  • T: Thickening/lump (breast or elsewhere)
  • I: Indigestion or diff swallowing
  • O: Obvious change in wart, mole, freckle
  • N: Nagging cough, hoarseness, rust colored sputum
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11
Q

Early Warning Signs of Cx

CAUTION

More on the O: Obvious change in wart, mole, freckle

A

ABCDE:

  • A: Asymmetrical shape
  • B: Border irregularities
  • C: Color→ pigmentation is not uniform
  • D: Diameter >6mm
  • E: Evolution (change in status)
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12
Q

Cx Screenings:

WHY?

A

Many Cx’s do NOT display sx’s in early stages*****

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13
Q

Cx Screenings:

Many cx’s do not display sx’s in early stages!!!

Best approach?

A

Mammos, colonoscopy, pap smear & pelvic exam, prostate exam, skin exam

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14
Q

Monohemispheric Brain Tumor

Clinical Tests studied

A
  • Spasticity of conjugate gaze
  • Platysma sign
  • Forearm rolling test
  • Finger rolling test
  • Digit quinti sign
  • Souques interosseus sign
  • Pronator drifting test
  • Mayer sign
  • Finger tapping sign
  • Digit quinti rolling sign
  • Foot tapping sign
  • Babinski
  • Chaddock sign
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15
Q

Monohemispheric Brain Tumor

6 of the tests that are great Dx TOOLS bc they have HIGH SPECIFICITY (SPPIN)

A
  1. Forearm rolling: Sp= 100%, PPV= 100%
  2. Finger rolling: Sp= 93%, PPV=92%
  3. Souques interosseus sign: Sp= 80%, PPV=70%
  4. Finger tapping: Sp= 90%, PPV= 78%
  5. Foot tapping: Sp= 93%, PPV=87%
  6. Babinksi: Sp= 100%, PPV=100%
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16
Q

Cerebral Lesions

What TEST was found to be MOST EFFECTIVE for this?

A

DTRs!!!!

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17
Q

DTRs

A

Cerebral Lesions!!!

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18
Q

Pain Patterns

3:

A
  1. Dermatomes
  2. Myofascial Trigger Points
  3. Viscera
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19
Q

Visceral Referral Patterns

A
  • Epigastric
  • RUQ, LUQ, RLQ, LLQ
  • Suprapubic
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20
Q

RUQ, LUQ, RLQ, LLQ Review

See Anatomy notes for mnemonic!!!!!

A
  • RUQ:
    • Pylorus, Duodenum, Liver, Rt kidney and adrenal gland, Hepatic flexure of colon, Head of pancreas
  • LUQ:
    • Stomach, Spleen, L. kidney and adrenal gland, Splenic flexure of colon, Body of pancreas
  • RLQ:
    • Cecum, Appendix, R. ovary and fallopian tube (female), R ureter and lower kidney pole, R spermatic cord (male)
  • LLQ:
    • Sigmoid colon, L. ovary and fallopian tube (female), L. ureter and lower kidney pole, L. spermatic cord (male)
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21
Q

Visceral Anatomy

Say OUT LOUD where things are/what side!!!!

A

see pics

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22
Q

Visceral Referral patterns!!!! know them all/label!!!!

A

see pics

Slide 40…. go back and make blank one to practice!!!!

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23
Q

Purpose of Visceral Palpation

ID 3 things:

A
  1. Masses
  2. Tenderness
  3. Irregularities
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24
Q

Systemic Patho: Cardiovascular

Risk factors for Coronary Artery Disease (CAD)

Modifiable, Non-modifiable, Contributing

A
  • Modifiable:
    • Phys act, smoking, alcohol
    • CHO:
      • HDL <40
      • LDL >130
      • Total >200
    • BP:
      • SBP >140
      • DBP >90
  • Non-modifiable
    • Age, gender, family hx, race, post-menopausal
  • Contributing:
    • Obesity
      • Females: waist >88cm
      • Males: waist >102cm
    • stress, personality, PVD, hormones, fasting blood glu >100***
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25
Q

Systemic Patho: Cardiovascular

Cardiac s/s

A
  • Chest pain, irreg heartbeat (palpitations), dyspnea/orthopnea, fainting/dizzy, rapid onset fatigue, peripheral edema, cold hands/feet, DEC peripheral pulse, LE claudication, Cyanotic nail beds
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26
Q

Systemic Patho: Cardiovascular

Cardiac pain referral

C= Cardiac Pain

L= Lung Pain

A

see pics!

HIGH Sn==> good ScreeNing test!

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27
Q

Heart Sounds

APT-M 2245

A

see pics

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28
Q

Systemic Patho: Cardiovascular

Frank’s Sign

A
  • 45* angle crease in earlobe
  • Risk of heart disease
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29
Q

Palpation of Aorta

Instructions in Pics

Red Flag:

A

Aortic pulse width >3cm; Back pain w/ palpation; Bruit on auscultation

NOTE: screening men or women >80yo NOT recommended*

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30
Q

Systemic Patho: Pulmonary

S/S

A
  • Sharp, localized pain
  • Fever, chills
  • Sx’s aggravated by cold air or exertion
  • INC pain→ recumbent, DEC pain→ lying on involved side
  • Cough w/ or w/out blood
  • Sputum
  • SOB/DOE
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31
Q

Systemic Patho: Pulmonary

INC pain in ______

DEC pain in _____

A

INC pain→ recumbent

DEC pain→ lying on involved side

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32
Q

Systemic Patho: Pulmonary

More S/S

A
  • Crackles, wheezes, pleural friction rub on auscultation
  • Clubbing of nails
  • Pain w/ deep inhale
  • DEC O2sats
  • Weak/rapid pulse w/ DEC BP==> Pneumothorax
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33
Q

Systemic Patho: Pulmonary

Pancoast Tumor referral pattern

A

See pics (highlighted dark gray area)

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34
Q

Systemic Patho: Pulmonary

Auscultation

A

see pics and note lobes

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35
Q

Systemic Patho: Pulmonary

Sputum

ALL FIRST in table

A

see table

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36
Q

Systemic Patho: Pulmonary

Sputum

Presentation: White

A

Possible Patho:

Bronchitis, CF

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37
Q

Systemic Patho: Pulmonary

Sputum

Presentation: Rusty

A

Possible Patho: PNA

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38
Q

Systemic Patho: Pulmonary

Sputum

Presentation: Hemoptysis (bloody)

A

Possible Patho: PNA, acute bronchitis, lung Cx, TB

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39
Q

Systemic Patho: Pulmonary

Sputum

Presentation: Stringy mucous

A

Possible Patho: After Asthma attack

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40
Q

Systemic Patho: Pulmonary

Integumentary System we think 3 things:

A

Skin←→Hair←→Nails

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41
Q

Integumentary Screen:

Includes ALL of the following:

A
  • Color
  • Integrity
  • Temperature
  • Moisture
  • Texture
  • Mobility
  • Shape & Size
  • Hair
  • Nails
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42
Q

Integumentary Screen:

Color

A
  • Yellow→ jaundice
  • Red→ irritation, pressure
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43
Q

Integumentary Screen:

Integrity

A
  • Wounds
  • Ulcers
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44
Q

Integumentary Screen:

Temperature

A
  • Palpate w/ dorsum of hand
  • Cold vs Warm
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45
Q

Integumentary Screen:

Moisture

A
  • DRY→ arterial insuff., absent sweating
  • WET→ venous insuff.
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46
Q

Integumentary Screen:

Texture

A

Smooth & Soft vs.

Thick or leathery

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47
Q

Integumentary Screen:
Mobility

A
  • Turgor= “tenting” of dorsal hand= dehydration
    • skin stays up when pulled on
  • Stemmer Sign= inability to lift skin= fibrotic or lymphedema
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48
Q

Integumentary Screen:

Shape & Size

A

Edema→ pitting

Stretched or shiny

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49
Q

Integumentary Screen:

Hair

A

Decd or absent

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50
Q

Integumentary Screen:

Nails

A

Capillary refill*

Beau’s, Spoon, Clubbing

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51
Q

Systemic Patho: Pulmonary

Integumentary Screen:

Beau’s Lines

A
  • *ASK: “Tell me about illness 1-2mos ago”
  • Temporary arrest of nail growth due to systemic insult, fever, infx, renal/hepatic px
  • *Appears 1-2mos AFTER systemic problem
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52
Q

Systemic Patho: Pulmonary

Clubbing aka

A

Chronic hypoxemia

  • Respiratory/CV patho, thyroid, ulcerative colitis, cirrhosis, Cx
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53
Q

Malignant Melanoma we are looking for ______ in the nails

A

Streaks

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54
Q

Systemic Patho: Gastro-Intestinal

Cologuard (talked about in class)

A

Just know its a GI screening checking for blood in stool as an indicator of Cx

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55
Q

Systemic Patho: Gastro-Intestinal

GI anatomy

A

Know sides of everything!!!!

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56
Q

Systemic Patho: Gastro-Intestinal

Rebound Tenderness test aka

A

Blumberg!!!!

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57
Q

Systemic Patho: Gastro-Intestinal

Rebound tenderness aka Blumberg Sign

Red Flag:

A
  • (+)= pain on release
  • (-)= no pain

NOTE: tells us something is going on, will not tell you what

See pics for instructions

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58
Q

Liver and Gallbladder pain referral pattern

Li= Liver

GB= Gall Bladder

A

see pics

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59
Q

Systemic Patho: Hepatic (liver)

FACTS

A
  • RUQ pain
    • Referred pain to T-spine (scapula, R shoulder, R upper trap, R subscap region)
  • Wt change
  • Ascites/LE edema (see pics for distended stomach)
  • White (not pink) fingernails
  • Cold hands/feet
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60
Q

Systemic Patho: Hepatic

Talk about Referred pain

A
  • Referred pain to T-spine**
    • Scapula, R shoulder, R upper trap, R subscap region
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61
Q

Systemic Patho: Hepatic

Weight change

talk more about this

A
  • Weight change: lots of fluid OR
    • Gain→ fluid
    • Loss→ muscle mass
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62
Q

Systemic Patho: Hepatic

More Facts

A
  • Jaundice (BIG one for liver)/Bruising; Yellow sclera (eyes)
  • CTS sx’s→ B/L
  • Intermittent pruritus (itching)
  • Weakness & fatigue
  • Dark urine/Clay-colored stools
  • Brain fog
  • Chronic fatigue
63
Q

Systemic Patho: Hepatic

Asterixis aka

A

Liver flap or Flapping Tremor @ wrist or hips (exactly what it sounds like!!!)

see slide 65 and watch videos again!!!

64
Q

Systemic Patho: Hepatic

Asterixis aka Liver flap

A
  • Flapping TREMOR @ wrist or hips
  • Has to do w/ ammonia lvls
  • No sig. correlation bw number of flaps & MELD scores
65
Q

Liver palpation

A

RIGHT side, HOOKLYING****

*can go from front OR scoop from behind

66
Q

Gallbladder Palpation

Red Flag:

A

Sudden pain & abdominal muscle tensing that ceases inspiration is suggestive of gall bladder pathology; Pain also INC w/ FB

67
Q

Murphys Sign

Palpating on RIGHT side (scooping from behind) either Liver or Gallbladder (tough to do one and not other)

Red Flag or (+) Test:

A

Sharp pain OR unable to complete inspiration

Sn= 97%= good SCREENING tool!

68
Q

Gall Bladder Patho:

Risk Factors===== what rule should you remember about Gallbladder patho????

A

8 F’s!!!!!

69
Q

Gall Bladder Patho

Risk Factors== 8 F’s***

A
  • 8 F’s:
    • Female, Fair, Fertile (inc likelihood during pregnancy), Flatulent, Family hx, Fatty foods (bring on sx’s), Fat (overwt.), Forty
70
Q

8 F’s for Gallbladder patho

A

Female, Fair, Fertile, Flatulent, Family hx, Fatty foods, Fat, Forty

71
Q

Spleen side

72
Q

Spleen palpation and pain referral

Sp= splenic pain

E= Esophageal pain

73
Q

Patho HERE can result in Esophageal pain

74
Q

Spleen can refer pain to

75
Q

Kehr’s Sign is for the

76
Q

Kehr’s Sign for Spleen

A
  • Pt supine→ raise foot of bed (Trendelenberg)
  • Kehr’s Sign occurs 30mins AFTER spleen injury & can take days to subside
  • Red Flag: Presence of blood or other irritant in the peritoneal cavity will result in severe L shoulder pain a few mins AFTER LEs elevated***
77
Q

Systemic Patho: Gastro-Intestinal

S/S

A
  • Sx’s influenced by eating, swallowing→ Generic
  • Epigastric pain w/ radiation to the back
  • Blood or dark, tarry stool
  • Fecal incont/urgency, diarrhea/constipation
  • Nausea, vom, bloating
  • Wt loss, loss of appetite
  • (+) Blumberg (rebound tenderness) Sign
78
Q

Gastro-Intestinal pain referral patterns

Ga= Gastric pain

Duo= Duodenum pain

J= Jejunum pain

I= Ileum pain

Ce= Cecum pain

S= Sigmoid colon pain

79
Q

Bowel Changes

KNOW CHART

80
Q

Bowel Changes

Presentation: Melena (black, tarry)

A

Possible patho: Upper GI bleed (loss of >150-200 ml of blood)

81
Q

Bowel Changes

Presentation: Blood-red

A

Possible patho: Colon-rectal tumor, colon diverticulitis, hemorrhoids

82
Q

Bowel Changes

Presentation: Silvery*

A

Possible patho: Pancreatic Cx

83
Q

Bowel Changes

Presentation: Pencil-thin, ribbon stools

A

Possible patho: Distal colon/anal cx

84
Q

Role of Appendix

A

Houses GOOD bacteria

85
Q

When you see McBurney’s Point think…..

A

RIGHT SIDE

APPENDIX spot

86
Q

McBurney’s Point for Appendix

A
  • SUPINE→ ID pt ⅓ distance bw ASIS & Umbilicus
  • apply vertical pressure to this point
  • Red Flag: (+) test is INC abdom. pain
87
Q

RLQ Pain

McBurney’s Pt. test

A

*MOST discriminating feature of pts hx

Sn & Sp= ~80%

+LR= 3.18

-LR= .5

88
Q

RLQ Pain aka McBurney’s Point Test for appendix

Further explanation

A

Read, be familiar

89
Q

2 “Stretch” Signs for Appendicitis

A
  1. Psoas Sign (go into hip EXT)
  2. Obturator Sign (go into hip IR)
90
Q

Psoas Sign for Appendicitis

A
  • In L. S/L, hyperEXT R LE
  • Red Flag: (+) test= INC abdom pain
91
Q

Anatomic Basis for Psoas Sign for Appendicitis

92
Q

Obturator Sign for_______

A

Appendix!!!!

Stretch the R. ERs into IR

93
Q

Obturator Sign for Appendicitis

A
  • In SUPINE, raise pts R LE w/ knee in flexion
  • Rotate RLE into IR @ hip
  • Red Flag: (+) test is INC abdominal pain
94
Q

Anatomic basis for Obturator Sign for Appendicitis

95
Q

Systemic Patho: Renal

FACTS

A
  • (+) Percussion over kidneys***
  • Fever, chills
  • Dull aching pain aggravated by prolonged sitting
  • Blood in urine** (hematuria)
  • Cloudy/foul smelling urine
  • Painful/freq urination
  • Pain constant (stones)
  • Back pain @ lvl of kidneys** (costovertebral angle tender)
  • Skin hypERsensitivity
  • HTN
  • Bleeding tendencies; ecchymosis
  • HA
  • Pruritus (itchy)
96
Q

Systemic Patho: Renal

Renal pain patterns

K=kidney pain

T=testes pain

Pr=prostate pain

U=ureter pain

B=bladder pain

97
Q

Right Kidney palpation

98
Q

Kidney Percussion

A

see pics

NOTE: make sure you just REACH hand over when doing opp side!!!!

½ way bw last rib and iliac crest ***

99
Q

Urinary Changes

KNOW CHART!!!

100
Q

Urinary Changes

Presentation: Red

A

Possible Patho: Glomerulonephritis, TB, trauma, lupus, renal cystic disease

101
Q

Urinary Changes

Presentation: Orange/Brown

A

Possible Patho: Dehydration, INC bilirubin

102
Q

Urinary Changes

Presentation: Milky/Casts

A

Possible Patho: Infx*

103
Q

Urinary Changes

Presentation: DEC Flow

A

Possible Patho: Obstruction, UTI, Prostate hypERplasia

104
Q

Urinary Changes

Presentation: Fruity Odor

A

Possible Patho: Ketosis

105
Q

Incontinence

A

QoL Issue

  • Embarrassment; decd socialization
  • burden of care, risk of falls, cost
106
Q

Incontinence

Characteristics

A
  • 40% from 60-80yo
  • 36% after 3+ children
  • 26% w/ BMI >25
  • 26% diuretics
  • 18% after hysterectomy (prostate)
107
Q

Incontinence

Meds

A
  • Diuretics→ INC freq/urge
  • Ca+ channel blockers→ INC retention
  • Antidepressants→ Cause INcomplete emptying
108
Q

Prostate

Facts

A
  • Men >50yo w/ LBP or suprapubic pain
  • Diff starting/stopping urine flow
  • Change in freq; DEC urine flow
  • Nocturia, hematuria
  • Incont/dribbling
  • Sexual dysf.
  • PSA (Prostate-specific antigen) lvl >4 ng/ml
    • BPH
      • Easily confused w/ Prostate cx bc PSA lvls inc in BOTH
109
Q

Gynecological S/S

A
  • Cyclic pain → “comes and goes” and WHEN specifically?
  • Abnorm bleeding
  • Nausea, vom
  • Vaginal discharge
  • Chronic constipation
  • LOW BP (blood loss)
  • Missed or irreg. periods
  • Pain w/ cough/intercourse
110
Q

Evan’s Sign MOST COMMON in _________

A

Cervical Cx !!!!

111
Q

Cervical Cx and MOST COMMON sign associated w/ this????

A

Evans’ Sign

112
Q

Evans’ Sign

MOST COMMON in Cervical Cx***

A
  • AKA “Hot Foot Syndrome”
    • Sx’s→ warm, dry foot
  • Etiology→ Sympathetic disruption from lumbosacral plexus via tumors or other lesions (vasodilation w/ loss of perspiration)
113
Q

Evans’ Sign aka

A

Hot Foot Syndrome

MOST COMMON IN CERVICAL Cx ***

114
Q

Location of 9 Endocrine Glands

and more info on Endocrine system

A
  • *Hair, skin, nails
  • Sets our “meter”
  • Homeostasis regulation

WATCH!!!

115
Q

Endocrine S/S

A
  • Joint pain, muscle pain, parasthesia, dry, scaly skin, constipation, fatigue, dyspnea
  • Brittle nails/hair, heat/cold intolerance (remember thermostat), wt change, periorbital edema, hoarseness, polydipsia/polyuria (thirsty, abnorm lg amts urine)
116
Q

Vitamin Deficiencies

Sunshine Vitamin= Vitamin D

A
  • Recommended exposure: 10-15mins few times a week***
  • Food:
    • 6.5lbs mushrooms
    • 150 egg yolks
    • 3.75 lbs salmon
    • 30 servings fortified cereal
    • >2lbs sardines
    • 30 cups fortified OJ
117
Q

Vitamin D Insuff.

Factors:

A
  • How MUCH skin exposed
  • UV index:
    • >/= 3 bw 10:30-12:00 req’s 50-75% of skin exposed
    • <3 means INCd risk of UVA rays w/out benefit of UVB
    • Early morning & evening sunlight provides only UVA rays while mid-day has UVB
  • Darker skin req’s INCd exposure
118
Q

Vitamin D Insuff.

Clarifying Info:

A
  • When exposed to sunlight, you produce a mechanism to repair DNA which LOWERS risk of Cx
  • It is the sunburning that is the culprit for causing skin Cx

*NOTE: Vitamin D and Ca++ are “threshold nutrients” i.e. Deficiencies are bad, BUT once you reach adequate amt, higher doses are NOT beneficial

119
Q

Vitamin D. Insuff.

MORE

A
  • LOW serum lvls of Vitamin D are associated w/ clinically sig. sx’s of Depression
  • Ex. Healthy women followed x1mo
    • >⅓ had depressive sx’s
    • ~½ had vitamin D insuff.
    • Depressive sx’s were predicted by vitamin D lvls
120
Q

Trinity College in Dublin

A

LOWER lvl of Vitamin D, the HIGHER # of COVID-19 infx’s & the GREATER mortality ***

121
Q

Adding 4000 IU of Vitamin D to anagesic regimens in pts w/ MSK pain

A

Adding 4000 IU of Vit. D may lead to faster decline of consecutive VAS scores & a DEC in lvls of inflammatory & pain related cytokines

122
Q

Vit. D Supplementation

Breakdown

A
  1. ~10% of our Vit. D comes from food
  2. Body only makes Vitamin D3 (cholecalciferol)
  3. Abate jt pain, mm cramps, illness, fatigue
  4. Enhance bone health
123
Q

Headaches

KNOW CHART!!!

124
Q

Headaches

Type of Pain: Severe & Intense

A

Possible Etiology: Meningitis, aneurysm, brain tumor

125
Q

Headaches

Type of Pain: Throbbing/Pulsating

A

Possible Etiology: Migraine, fever, HTN, aortic insuff.

126
Q

Headaches

Type of Pain: Temporal

A

Possible Etiology: Eye or ear px, migraine, w/ visual changes→ temporal arteritis

127
Q

Headaches

Type of Pain: Occipital

A

Possible Etiology: Herniated disk*, eye strain, HTN

128
Q

Headaches

Type of Pain: Parietal

A

Possible Etiology: Meningitis, constipation, tumor

129
Q

Structured Migraine Interview

Sn= 87% (good SCREENING tool)

60% migraine sufferers not aware they had migraine*

A
  1. Have you ever had recurrent HAs?
  2. Have you ever had mod-severe HA accompanied by nausea and/or vom?
  3. Have you ever had mod-severe HA accompanied by hypersensitivity to sound or light?
  4. Have you ever had visual disturbs lasting 5-60mins f/b HA?
    1. NOTE: if answers to ALL Q1-Q4 are “NO” then finish here***
  5. Typically what kind of HA do you get?
  6. Typ are your HAs mild, mod, severe?
  7. What makes HAs worse?
  8. What do you do to relieve HAs?
  9. Typ how long HAs last?
  10. Have you been given a medical explanation and/or dx for recurrent HAs?
130
Q

Visual Changes

KNOW CHART!!!!

131
Q

Visual Changes

Presentation: Spots

A

Possible Patho: Impending retinal detachment, fertility drugs

132
Q

Visual Changes

Presentation: Floating spots

A

Possible Patho: Diabetic retinopathy

133
Q

Visual Changes

Presentation: Flashes

A

Possible patho: Migraine, retinal detachment

134
Q

Visual Changes

Presentation: Loss of Peripheral vision, haloes around lights

A

Possible Patho: Glaucoma (Ocular HTN)

135
Q

Visual Changes

Presentation: Cloudy or Fuzzy vision

A

Possible Patho: Cataracts

136
Q

Amsler Grid for_______

A

Visual Changes!!!!

137
Q

Things the Eye Can Show you

ALL FIRST

A
  • PD
  • DM
  • HTN
  • Autoimmune disorders
  • High CHO
  • Thyroid dis.
138
Q

Things the Eye Can Show you

Parkinson Disease

A

Thinning of walls of the retina

139
Q

Things the Eye Can Show you

DM

A

Capillary leaks (retinopathy)

140
Q

Things the Eye Can Show you

HTN

A

Blood vessel kinks/tears

141
Q

Things the Eye Can Show you

Autoimmune disorders

A

Inflammation (Lupus)

142
Q

Things the Eye Can Show you

High CHO

A

Yellowish cornea OR plaques in blood vessels of retina

143
Q

Things the Eye Can Show you

Thyroid Dis.

A

Bulging of eyes (Graves Disease)

144
Q

Substance Abuse can include________

A

Tobacco, Caffeine, Alcohol, Food

145
Q

Risks of Patho assocd w/ Tobacco

A
  • Cerebrovascular Dis.
  • Tobacco amblyopia
  • COPD, PVD, Ischemic heart disease
  • Peptic Ulcer
  • Small babies; obstetric or fertility probs
  • Impaired insulin absorption***
  • INC risk of Cx→ mouth, lung, bladder, kidney, breast, cervix
  • Poor recovery from LBP, Sx
  • Premature aging***
146
Q

Risks of Patho assocd w/ Caffeine

A
  • INC blood fats, INC BP
  • Stimulates CNS→ tremors, irritability, nervousness
  • Irreg heart beat
  • INC Urinary Ca++, Mg++ losses (DEC bone mineralization)
  • INC stomach acid secretion
  • Disrupted sleep patterns→ anxiety & depression
  • INC sx’s of PMS***
147
Q

Coffee Perks???

A
  • Reg coffee drinkers live longer (2-3cups/day)
  • 3 cups caffeinated reduced risk Alzheimer’s & dementia**
  • Several cups w/ post-exercise meal==== faster muscle recovery***
148
Q

Caffeine use in Sport

A

>/= 3mg per kg of bw ==> Ergogenic effect***

149
Q

Excess Caffeine??

A

>350 mg/day

150
Q

Caffeine Content

A

FYI but COOOOOOOOL and good to know

151
Q

Risks of Patho assocd w/ Alcohol

A
  • Alcoholic dementia
  • Subdural hematoma from falls
  • Convulsions from w/drawal
  • Delirium tremens
  • Cardiomyopathy**
  • HTN
  • Hepatic cirrhosis
  • Pancreatitis
  • Dupuytren’s contracture **
  • Myopathy
  • Peripheral Neuropathy**
152
Q

Alcohol Use Disorders ID Test: Interview Version

A

whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf

153
Q

Fetal Alcohol Syndrome (FAS)

A

Common Signs

see pics

154
Q

Risks of Pathology assocd w/ Obesity

A
  • Arteriosclerosis & HTN
  • CVA & MI
  • Sleep apnea
  • HypOventilation & exertional breathlesness
  • Gallstones**
  • DM
  • GERD
  • OA
  • Abdominal striae & varicose veins
  • Impaired fertility
  • Dependent edema

Differential Diagnosis & Med Screening (12 decks)

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