Conditions and tests Flashcards
Abdominal aortic aneurism
CV: May see visible pulsing. Bruits heard. Weak pulses in lower limbs. Pale lower limbs. Cap refil. Peripheral blood pressure low. Buergers test.
Acoustic neuroma
Webers and Rinnes both positive. CN V, CN VIII.
Acute calific tendonitis
Tender to touch. Restricted Shoulder ROM, due to pain.
Acute cholecystitis/Cholelithiasis
Right hypochondrial tenderness. Rigidity worse on inspiration (Murphy’s sign). May find palpable gall bladder mass (30%). Absent bowel sounds due to gallstone ileus.
Acute liver failure
Mental changes. Sweet musty odour on breath. Yellow skin colour. Fever. Low blood pressure. Spacticity.
Acute pancreatitis
Epigastric tenderness. Absent bowel sounds due to paralytic ileus. Ascites. Pleural effusion. Discoloration of flanks (grey Turners sign) or periumbilical region (Cullen’s sign).
Acute pyelonephritis
High grade fever. 39.5C. Costovertibral angle tenderness.
Acute renal failure (ARF)
Repiratory rate increased due to acidosis. Pulmonary oedema found on percusion. Prerenal reversible: Low BP. Poor periphereral perfusion. Postural hypotension
Adrenal disorders - Addison’s disease (hypoadrenalism)
Muscle weakness. Low BP. Orthostatic BP. Hyperpigmentation on skin creases and scars, knuckles and knees.
Adrenal disorders - Cushing’s syndrome (hypercortisolism)
Reddish purple stretch marks on thighs, stomach, buttocks, arms legs or breasts. Round face. Muscle weakness
Alchoholic liver disease (ALD)
Enlaged liver. Enlarged spleen. Portal hypertension: visible collateral vessels, ascites, variceal bleeding. Hepatic insufficiency: Yellow skin colour. Other: Digital clubbing. Dupyens contracture. Right pleural effusion. Peripheral oedema.
Anaemia
Pale skin.
Anaphalaxis
No specific tests
Angina equivalent
BP high, tachycardic and gallop rhythm if in attack and shallow breathing. May be no signs if not in attack.
Anxiety
BP & pulse rate may be high. Respiration fast and shallow.
Aortic disection (thoracic)
Emergency. No time for tests.
Appendicitis
Patient prefers flexed right hip or foetal position. Obturator/psoas sign. McBurneys sign. Rebound tenderness. Posible fever and flushed face.
Arachnoiditis
SLR and braggards +ve. Kernigs sign.
Arrhythmia
Regularly irregular pulse and heart rythmn - pattern with skipped beats. Irregularly regular - no pattern. Can be atrial fibrillation (AF - irregular and fast), supraventricualr tachycardia (episodes of fast beating at rest), bradycardia (slow). May hear abnormal sounds if there is a structural anomaly. For AF juggular pulse may be visible.
AS
Reduced ROM in low back. Possible CV signs
Asthma
Percussion may show greater ares of hyperresonance. Wheezes and crackles on respiratory auscultation.
Atherosclerosis
Possible high blood pressure.
Autoimmune hepatitis
Possible fever. Signs of dhronic liver disease ( Cushingoid face with acne, hirsuitism, pink cutaneous striae on thighs and abdomen).
Benign Positional Vertigo.
Hallpike manouvre positive. Fitz ritson - moving body without head does not provoke dizziness.
Benign prostatic hyperplasia (BPH)
Possible distended bladder. If painful then emergency.
Bornholm disease /epidemic myalgia/coxsackie viral infection)
Fever
Brain stem or cerebellar tumour
CN signs. Nystagmus changes in different fields of gaze, lasts for > 1m and does not fatigue. Depression of corneal reflex (cerebellopontine angle). Cerebellar signs - Standing and walking: Veering, poor balance, intention tremor, ataxia. Tandem walk: veering. Rebound: excessive swinging. Finger to Nose: tremor or dysmetria. Rapid alternating hand: dysdiadochokinesia. Heel down shin: Lack of co-ordination.
Brain tumour
Progressive neurological signs.
Bronchiectasis
Course crackles in chest. Diminished breath sounds.
Carcinoid bowel tumour/carcinoid syndrome
No specific tests
Cervical facet syndrome
Aggrivated by extention, relieved by flexion. Max forminal compression positive with or without radicular symptoms. Distraction helps.
Cervical spondylosis with radiculopathy
Tenderness over Cx affected. Pain worse on extension, lat flex or rotation. Pain better with flexion. Bakody sign positive.
Cervical stenosis/Cervical myelopathy
Pain worse with extention, lat flex and rotation. Better with flexion. UMN signs below lesion. LMN at leesion level. Babinski.
Cervicogenic headache
Reduced ROM in neck. Neck movement makes headache worse.
Cholelithiasis/chronic cholecystitis
Right hypochondrial tenderness. Murphy’s sign. May find palpable gall bladder mass.
Chronic kidney disease (CKD)/ Glomerolunephritis
May have high BP as a cause. At end stage may present like acute renal failure. (Repiratory rate increased due to acidosis. Pulmonary oedema found on percusion. Low BP. Poor periphereral perfusion. Postural hypotension) Small kidneys.
Chronic liver failure
Nuerological signs. Changes to conciousness. Conulsions. Hyperrefexia
Chronic obstructive pulmonary disease (COPD)
Breath sounds quiet. Crackles and wheeze heard on auscultation. Larger area of resonance on percussion.
Chronic pancreatitis
Thin and malnousished looking. Skin pigmentation from using hot water bottle on abdomen and back. Epigastric tenderness.
Chronic pyelonephritis
Small kidneys. High grade fever. 39.5C. Costovertibral angle tenderness.
Cirrhosis of the liver
Enlaged liver. Enlarged spleen. Portal hypertension: visible collateral vessels, ascites, variceal bleeding. Hepatic insufficiency: Yellow skin colour. Other: Digital clubbing. Dupyens contracture. Right pleural effusion. Peripheral oedema.
Cluster headache
No specific tests
Coeliac disease
No specific tests
Colorectal cancer
No specific tests
Compartment syndrome
Sensory loss in compartment area. Peripheral pulse weak beyond area.
Costochondritis
Tenderness around ribs
Cranial nerve lesion
CN Tests positive.
Cystic fibrosis
Course crackles in chest. Diminished breath sounds. Possible hepatomegaly, murphys sign. Lack of bowel sounds.
Dehydration headache
No specific tests.
Dementia
Doesnt know time, day, date, place. Cannot name everyday objects. Cannot follow verbal instructions. Difficulty writing. Difficulty speaking, articualtion, fluency, vocabulary.
Diabetes mellitis
Stocking distribution neuropathy. Poor vibration sense. Poor peripheral perfusion. Muscle wasting and weakness. Cognitive deficit.
Diabetic Ketoacidosis
Smell of pear drops. Tachycardia.
Diffuse idiopathic skeletal hyperostosis (DISH).
Lack of ROM in flexion and extension.
Dorsal column lesion.
Tandem walk: Patient veers to the side. Rhombergs positive. Vibration sense: Impaired. Proprioception, limb repositioning and touch localisation tests positive. Graphesthesia.
Drug related headache
No specific tests
DVT
Unequal BP in legs. Homan’s sign. Weak pulse in leg. Cap refil.
Ectopic pregnancy
Palpable abdominal mass in lower abdomen.
Eczema
Observe.
Endometriosis
No specific tests
Facet syndrome (Lumbar)
Aggrivated by extention, relieved by flexion. Kemps positive but not radicular.
Fibromyalgia
No specific tests.
Frozen shoulder/Adhesive capsulitis
Symptoms on both active and passive movement. No passive ext rotation in frozen phase. Decreased abduction. Pain on A to P movement. Appley scratch +ve.
Gastric carcinoma
Signs of tumour spread to supraclavicular lymph nodes (Troisiers sign), Umbilicus (Sister Josephs nodule), Ovaries (Kruckenberg tumour) Acanthosis nigricans. Thrombophlebitis (Trousseau’s sign).
Gastritis
No specific tests
Gastrooesophageal reflux disease
No specific tests
Gilberts syndrome
No specific tests
Graves’ disease - (overactive thyroid)
Muscle weakness.Enlarged thyroid gland. Irregular heat rate, palpitations, tremor, warm moist skin, red palms, loose nails, hives, patchy hair loss, twitching in face or limbs.
Haemophillia
If any neuro signs treat as emergency.
Haemorrage - Cerebellar
Cerebellar tests.
Haemorrage - Intracerebral
High BP. Various and widespread neuro signs.
Haemorrage - Subarachnoid
Positive Kernigs sign.
Haemorrage - Subdural and extradural
Various neurological signs including sensory loss and hemiparesis.
Haemorrhoids (Piles)
No specific tests
Haemothorax
Pleral effusion. Asymmetric rib expansion. Decreased femitus. Dull sound on repiratory percussion.
Hashimoto’s thyroiditis or other hypothyroidism
Muscle weakness. Later signs: Puffy face, tachycardia, low hoarse voice, thin eyebrows, hearing loss. Anaemia.
Heart failure (dilated cardiomyopathy) - acute
High BP or low BP if in cardiogenic shock. JVP elevated. Murmer and triple gallop ryythm. Basal crepitations. Pulmonary oedema.
Heart failure (dilated cardiomyopathy) - chronic
Low BP. Raised JVP. Peripheral oedema. Acites or pleural effusion.
Hepatic encephalopathy
Diverse neuro signs may be present affecting brain function.
Hepatic tumour - Hepatocellular carcinoma (HCC)
Hepatomegaly. Right hypochondrial mass. Abdominal bruit.
Herpes Zoster (Shingles)
No specific tests
Hodgkin’s lymphoma (HL) or Non-hodgkin lymphoma (NHL)
Lymph nodes will be enlarged but not swollen (this would be infection). Fever.
Horner’s syndrome
No specific tests
Hypertention
Blood pressure: Optimal under 120/80. Normal under 130/85. High-normal under 140/90. Hypertension from 140/90: grade 1 (mild) under 160/100, grade 2 (moderate) under 180/110. Grade 3 (severe)over.
Hyperventilation syndrome
Pulse and BH high. Fast shallow breathing
Hypothalamic/Pituitary - Acromegaly
Abnormaly large hands and feet, large prominent facial features. Abnormally tall , thick course oily skin, enlarged tongue. Protruding jaw and brow. Impaired vision.
IBD - crohn’s disease
Tenderness and mass in right iliac fossa. Low grade fever. Enlarged liver.
IBD - ulcerative colitis
Mild tenderness in left iliac fossa. Fever. Enlarged liver
Infectious mononucleosis
Fever.
Infective endocarditis
Fever. Heart murmers.Petechiae or rash. Digital clubbing or splinter heamorrhage in nails. Oslers nodes - painful red raised lesions on hands and feet.
Infective/Septic arthritis
No specific tests
Intercostal muscle injury/strain
Pain on active > passive movement.
Irritable bowel syndrome
No specific tests. May hear altered bowel sounds.
Labrithitis
Possible nystagmus. Balance problems.
Leukemia
Pale skin. Possible swollen spleen and lymph nodes. Fever
Mallory - Weiss syndrome
No specific tests
Meniere’s disease
Nystagmus during attacks. No specific tests.
Migraine
Possible transient neurological signs and symptoms.
Mitelschmertz
No specific tests
Mitral valve prolapse
CV exam: Check for mitral regurgitation.
Motor Neuron Disease
Toe drop. Heel drop. Weak muscles. Spacticity or flaccidity. Any neuro signs.
MS
Pursuit and Vergence: Nystagmus. Any other Neurological symptoms. Intention tremor. Ataxia. Spacticity.
Multiple myeloma
No specific tests. Possible renal signs.Fever.
Muscle enzyme deficiency syndrome
No specific tests
Muscle strain (limb)
Pain on active > passive movement.
Muscle strain (lumbar)
Pain on active > passive movement.
Myesthenia gravis
Pursuit and vergence positive. Weak muscles.
Myocardial Infaction (MI) - Heart attack
Carotid bruits may be heard. Gallop rythm (4 heart sounds).High or low BP. Tachycardia, bradycardia or irregualr heartbeat. Shallow breathing.
Neurogenic claudication
Valsalvas, SLR 30 to 60, Kemps iindicate nerve root involvement. No vascualr signs.
Oesophageal tumour
No specific tests
Oral cancer
No specific tests
Oral candidiasis
Observe tongue - white and furry.
Oral ulcers
Observe in mouth. Sore patch will have grey/white centre and red halo.
Osteoarthritis
Crepitus in joint when moving. Reduced ROM. Restriction. Scouring test for hip. Joint deformity.
Osteomalacia/Rickets
Check for fracture - tuning fork. Observe Waddling gait, diminished stature, bent bones.
Osteomyelitis
Fever. Restricted ROM. Very tender in affected area. Possible lump on the bone.
Osteophitic Intercostal neuritis
No specific tests
Osteoporosis
None
Ovarian cyst
May be palpable in lower abdomen.
Paget’s disease
Reduced ROM. Any of kemps, SLR, valsalvas. Other neuro signs.
Pancreatic cancer (carcinoma)
Palpable gall bladder, hepatomegaly. Pancreatic tumour mass, sister josephs nodule. Erythema on stomach.
Parasitic infection
No specific tests
Parietal lobe lesion
Steriognosis. Graphesthesia. Sensory neglect. Sensory defeciency. Proprioception, limb repositioning and touch localisation tests positive. Tandem walk: Patient veers to the side. Rhombergs positive.
Parkinsons
Standing and walking: Shuffling gait, resting tremor. Motor function: Cogwheel rigidity. CN I: Anosmia.
Pelvic inflamatory disease possibly related to STD (Chlamydia, gonorrhoea)
Obturator sign
Peptic ulcer - gastric or duodenal
Possible reduced bowel sounds if obstruction.
Perforated ulcer
Low BP. Tachycardia.
Pericarditis (or myocarditis)
Low grade fever.
Peripheral artierial disease
Difference in BP between arm and ankle. Capillary refil.
Piriformis syndrome
Piriformis test. SLR pain at > 35 degrees.
Pituitary tumour (Benign adenoma)
Visual field defects.
Pleurisy
Pain on rib expansion. Fever.
Pneumonia
High fever. Low blood pressure. High heart rate. Reduce rib movement on breathing. Dullness on repiratory percussion. Wheezing on auscutation. Egophany sounds like “ay”. Whispered petriloquy can be heard.
Polycystic ovary syndrome
No specific tests
Polymyalgia rheumatica
No muscle tenderness or atrophy. No vascular signs.
Post herpetic nueralgia
No speific tests
Postural syndrome
Muscles tight on palpation. Observe posture.
Primary bone tumour
No specific tests
Primary dysmenorrhoea
No specific tests
Primary Lung Tumours
Supraclavicular lymph nodes may be palpably enlarged. Rib expansion aysymatric. Tactile fremitus decreased or absent.
Prolapsed intervertabral disc with radiculopathy (lumbar)
Kemps, Valsalvas, SLR at 30 to 70 egrees.
Prostate cancer
No specific tests for chiropractor.
Pulmonary embolism
Tachypnoea. Tachycardia. Hypotension. Raised JVP/ Right ventricular gallop rythmm. Loud P2 (separate sound of p valve closing, splitting S2 (second heart sound).
RA
Possible fever. Joints tender to touch.
Raised ICP
CN III or VI signs.
Referred viceral pain - Colon
Negative for neuro signs. May be positive for abdominal signs
Referred viceral pain - Gall bladder
Negative for neuro signs. May be positive for abdominal signs. Murphy’s sign
Referred viceral pain - Heart (Angina, MI)
Negative for neuro signs. May be positive for CV signs.
Referred viceral pain - Kidneys
Negative for neuro signs. May be positive for abdominal signs. Costovertebral angle tenderness.
Referred viceral pain - Liver or gall bladder
Negative for neuro signs. May be positive for Abdominal signs
Referred viceral pain - Lung or diaphram
Negative for neuro signs. May be positive for respiratory signs.
Referred viceral pain - Small intestine or ovaries
Negative for neuro signs. May be positive for abdominal signs
Referred viceral pain - Stomach
Negative for neuro signs. May be positive for Abdominal signs
Referred viceral pain - Urinary bladder
Negative for neuro signs. May be positive for abdominal signs
Renal adenocarcinoma
Enlarged kidney found on ballotment. Possibe high or low BP. Fever. Costovertebral angle tenderness.
Reumatic heart disease - acute rheumatic fever.
Heart murmur. Fever.
Reynauds phenomenum/disease - primary
None
Reynauds phenomenum/disease - secondary
Check for thoracic outlet obstruction (e.g. cervical rib).
Rib fracture
Tuning fork.
Ruptured abdominal aortic aneurysm
Low BP. Pulsatile abdominal mass.
Ruptured appendix/ Peritonitis
Fever. Tachycardia. Radid brathing. Swelling of the abdomen. Rebound tenderness.
Ruptured ovarian cyst
No specific tests.
Sacroiliac syndrome
Adams supported, goldthwaites, gaenslens, iliac compression, yeomans positive.
Sarcoidosis
Hepatomegaly. Lymphadenopathy. Cardiac arrythmia, heart block. Splenomegaly, renal stones, , erythema nodosum. Peripheral neuropathy.
Scheuermanns disease
Observed deformity.
Slipped rib
Palpation of lower rib tips or hooking fingers under and lifting anterior and superior.
Spinal tumour (Mets)
Possible signs of primary cancer - breast, lung, kidney.
Spinal tumour (Primary)
Fever. Severe pain on manipulation.
Spontaneous pneumothorax
Possible tachycardia, hypotension and cyanosis. Absent breath sounds, resonant percussion, tactile fremitus quiet or absent.
Stable angina
CV exam may be normal if not in an attack.. Carotid bruits may be heard. Gallop rythm (4 heart sounds) if in an attack.
Stress fracture
Tuning fork.
Temporal Arteritis
Temple is tender to touch. Mild fever.
Tension headache
No specific tests.
Testicular tumour
No specific tests for chiropractor.
Thoracic aortic aneurism
May be none.
Thoracic outlet syndrome
Tenderness over TOS area. Reduced ROM. Muscle weakness, depressed DT reflexes. Roos. Adsons/Halsteads (Ant/middle Scalenes), Wrights(Pec minor), Costoclavicular (rib or costoclavicualr syndrom ). May have weak peripheral pulse or poor cap refil.
Thyroid tumour
Lump or swelling in the neck.
Tietze’s syndrome
Tenderness and swelling 2nd/3rd costocondral joints around ribs
Trigeminal neuralgia
Face hypersensitive to touch. Possible sensory deficit for CN V.
Tuberculosis - milary
Hepatosplenomegaly. Crackles on repiratory auscutation. Possible neuro signs. Anaemia.
Tuberculosis - primary
High fever. Reduce rib movement on breathing. Dullness on repiratory percussion. Wheezing on auscutation. Egophany sounds like “ay”. Whispered petriloquy can be heard.
Unstable angina
CV exam may be normal if not in an attack.. Carotid bruits may be heard. Gallop rythm (4 heart sounds) if in an attack.
Urinary calculi (renal colic) /Nephrolithiasis (Kidney stones)/Obstructive nephropathy.
Costovertebral angle tenderness.
Urinary tract infection (Lower UTI)
No specific tests
Urinary tract infection (Upper UTI)
Fever of 38 or above.
Urothelial tumour (Bladder, ureteral, urethral or Kidney tumour)
No specific tests. Physical examination usually unremarkable unless in advanced stage.
URTI - cold, pharyngitis, acute bronchitis
Respiratory wheezing. Fever
URTI - Influenza
Fever.
URTI’s - Sinusitis
Fever
Vascular claudication
BP less in legs. Weak pulse in leg. Cap refil.
Venous hypertension
Possible change to BP?
Viral hepatits
Liver tender to palpate put minimal enlargement. Mild splenomegaly. Cervical lymphadenopathy
Whiplash
Reduced ROM in neck. Quabec taskforce gradings: 0. No symptoms. 1. Symptoms but no signs. 2. Decreased ROM. 3. Neuro signs. 4 Fracture or dislocation. Eliminate fracture or dislocation from diagnosis - Percussion. Vibration. Rusts sign & Bakodys sign should be -ve if no fracture or dislocation.
Wilson’s disease
Liver signs. Ataxia, parkinsonism - tremor, bradykinesia and balance disorder, dystonia, dememtia. Copper rings in eyes (Kayser-Fleisher rings). Possible heart and kidney signs.
