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CSA > CSA CSPE Main Points > Flashcards

CSA CSPE Main Points Flashcards

1
Q

AAA:

Age of Risk=

A

Men= 50+, Peak 80-85

Women= 60+, peak 90+

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2
Q

AAA:

Most common Symptom=

A

Pain in Back, Flank, Going, Testes

More often on left
Sometime pulsating

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3
Q

AAA:

First Clinical Sign=

A

Pulsatile abdominal mass

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4
Q

AAA:

Classic Triad of rupture=

A

Hypotension
Back Pain
Pulsatile Mass

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5
Q

AAA:

Who should be screened with ultrasound?

A

Men 65 and 70 who have ever smoked.

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6
Q

Ancillary study of choice for AAA rupture

A

CT

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7
Q

Can you see a AAA on an x ray?

A

Yes, often on a lateral film due to calcification

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8
Q

Cut off between dilation and aneurism of AAA=

A

3.8 cm

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9
Q

AAA:

Emergent referral=

Urgent Referral (same day)=

Semi urgent (48h)=

Non- Urgent=

A

Emergent referral= >6cm with pulsating pain, nausea, vomitting, rapidly elevating LBP, Hypotension, non-positional pain.

Urgent Referral (same day)= >6cm on x-ray with LBP but no other sx

Semi urgent (48h)= >6cm w/o any sx

Non- Urgent= <6cm with mechanical LBP and no red flads

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10
Q

What % of AAA lead to rupture?

A

1/3

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11
Q

Risk of death with Untreated AAA

1 year=
2 year=
5 year=

After rupture=

A

1 year= 50%
2 year= 75%
5 year= 90%

After rupture= 75%-90%

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12
Q

What are the 3 most common causes of CES?

A

Midline Disc

Spinal Stenosis

Tumor/SOL

(Rare= Trauma, Manipulation, ASA, Pagets, Meningitis)

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13
Q

Typical Presentation of CES

A

51% of time only urinary Sx (retention, urgency, or incontinence)

Bladder Sx often develop simultaneously with back or leg pain.

Saddle Anesthesia or sexual dysfunction

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14
Q

What is the gold standard test for CES?

A

MRI

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15
Q

How do you manage CES

A

Refer to neurologist, same day

Decompression surgery

Manipulation contraindicated

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16
Q

What are potential residual complication of CES

A

Weakness
Impotence
Sensory loss
Incontinence

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17
Q

What is the prognosis for CES post surgery?

Indicators making full recovery less likely=

A

Deends heavily on the amount of time the patient was symptomatic.

Indicators making full recovery less likely=

  • Delayed tx
  • Degree of sphincter involvement
  • Sensation loss distribution
  • Speed of onset
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18
Q

Mgmt for Chest pain/MI

A

Reassure the patient

Monitor vitals

Chew 325mg asprin

Ask history questions

Dont apply oxygen unless they are in shock

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19
Q

What is the risk with proximal DVTs?

A

50% lead to pulmonary emboli.

95% of pulmonary emboli are from DVTs

30% mortality rate.

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20
Q

What veins are usually involved in proximal DVTs?

A

popliteal veins

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21
Q

What veins are usually involved in distal DVTs?

A

Tibial veins (much lower risk of embolii)

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22
Q

Classic presentation of DVT:

A

Leg is swollen, tender, red, and warm.

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23
Q

What are major risks of DVT

A 
Active cancer
Immobilization
>75
Bedridden
Major surgery
Hx of embolii
Genetics
Heparin induced thrombocytopenia
Clotting disorder
CVA->50% DVT
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24
Q

Physical signs of DVT:

Palpation=

Observational=

A

Palpation=

  • Tenderness/ palpable hard cord
  • Erythema/temp change

Observational=

  • Pitting edema
  • Dilated collateral veins
  • Calf Swelling
  • Entire leg swollen
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25
Q

DDX for DVT

A

Bakers cyst
Hematoma
Muscle Strain
Acute Cellulitis

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26
Q

Ancillary Studies for DVT

A

Ultrasound (test of choice)

D-Dimer (Sensitive-rule out)

Venography (done after US & DD)

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27
Q

MGMT of DVT

A

Refer out immediately

Anticoagulant therapy for confirmed DVT

Wear elastic compression stockings and stay mobile.

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28
Q

Natural supplements for dyslipidemia:

A

Garlic

Red yeast rice

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29
Q

Emergent Referral for Neuromusculoskeletal presentations

A

Cauda Equina Syndrome
- rapid onset of sx

Dislocation

  • Open dislocation
  • Knee Dislocation
  • Vascular, or neuro signs

Fracture

  • Compound/open
  • Unstable

Head Trauma
- Progressive or neuro sx

Paralysis
- Acute

Septic Arthritis or Osteomyelitis

Stroke

TIA

Vertigo

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30
Q

Emergent Referral: Visceral Presentation

A

AAA

Acute Severe Abdominal Pain

Arrythmias or Altered Pulses

Diabetic Crises

Dehydration

Detached Retina

Ectopic Pregnancy

Meningitis

Myocardial Infraction

Poisoning or drug overdose

Pregnancy with danger signs

Respiratory Distress, Acute

Septicemia

Strangulation Hernia

Unstable Angina

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31
Q

Urgernt Referral Neuromusculoskeletal presentations

A

AC joint dislocaton

Compartment Syndome

Cauda Equina Syndrome of recent onset

Dislocation, closed unreduced

Fracture

Hemarthrosis

Infection
Suspected bacterial pneumonia

Subdural hematoma

Slipped capital femoral epiphysis

Thoracic outlet syndrome with evidence of vascular compromise

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32
Q

Urgent referral for Visceral presentation

A

AAA with back pain but no other Sx

Arrhythmias or altered pulse

Bladder infection

Cellulitis, Lymphagitis

DVT

Esophageal tear, post traumatic

Fever (>104, infant >100, infant over 2 months with >104)

Renal infection

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33
Q

What are two possible consequences of VBD?

A

1) Wallenberg Syndrome

2) Locked in Syndrome

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34
Q

What is Wallenberg Syndrome?

A

Posterior inferior cerebellar artery occlusion that results in vertigo, diplopia, and/or dysarthria

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35
Q

What is Locked in Syndrome

A

More serious than Wellenbergs, leaves the patient conscious but paralyzed.

Result of VBD

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36
Q

Signs/Sx of Vertebrobasilar Dissection

A

Episode of neurologic dysfunction with sudden onset lasting no more than 24 hours including 2 of:

  • Numbness, weakness or paralysis of face arm or leg.
  • Blurred or decreased vision or loss of vision in one or both eyes
  • Difficulty speaking or understanding speech
  • Decline in consciousness or mental function
  • Severe headache or neck stiffness
  • Loss of balance or coordination
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37
Q

5Ds and 3 Ns of neurologic dysfunction

A 
Dizziness
Drop attacks
Dysarthria
Dysphagia
Diplopia
Ataxia of gait
Nausea
Nystagmus
Numbness on one side
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38
Q

`Tx for VBD

A

Call 911

Med: Anticoagulant or antiplatelet agents

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39
Q

Presentation of HLD with Sciatica

3+ OR 2+ with imagery

A

Dermatomal Paresthesia

Dominating leg pain (worse than back)

+ SLR or other nerve tension tests

Neurologic deficits (20% have none)

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40
Q

Lumbar Discogenic Clues

A

Decreased sagittal Tx/Lx ROM

Mannequin sign

P centralization with repetitive end range loading

+ Valsalva

Sitting poorly tolerated

DeJerines Triad

Flexion load sensitivity

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41
Q

If neurological signs migrate in the lower extremities, what may this be a sign of?

A

Uncontained or sequestered herniation

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42
Q

When to order MRI or CT with a herniated disc

A

Signs of CES

Progressive muscle weakness

Herniated disc in doubt

Profound muscle weakness at first

Presurgical assessment

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43
Q

HTN Classification

Normal=
Pre-Hypertension=
HTN 1=
HTN 2=

A

Normal= <120/<80

Pre-Hypertension= 120-139/80-89

HTN 1= 140-159/90-99

HTN 2=160+/100+

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44
Q

How do you make the Dx or HTN?

A

4 measurments on 2 subsequent visits withing 1 month?

45
Q

When do you refer out immediately with HTN?

A

> 180/>110

46
Q

Best non pharmacologic Tx for HTN

A

Lose weight (5-20 points every 10% loss)

DASH diet (4-14 points)

CoQ10 (11 points)

47
Q

MGMT of HTN

A 
Weight loss
Reduce sodium
Stop smoking
Smaller meals
Exercise
Decrease alcohol
Limit sugar and caffeine
DASH diet

Supplements:

  • CoQ10
  • Fish oil
  • Magnesium
  • Potassium
  • Calcium
  • Garlic Powder
48
Q

Is lumbar functional instability the same thing as Lumbar Hypermobility or Radiographic Instability?

A

No

Functional instability is a loss of the spines ability to prevent unwanted movement or buking due to the spinal stabilization system that consists of mechanoreceptors located around the joint that provide proprioceptive feedback.

49
Q

What are the 4 factors that predict better outcomes with stabilization exercises.

A

<40
Abberent lumbar movement
SLR >91
+ prone instability test

50
Q

Clues from history for spinal instability

A

Immediate pain when sitting

Temporary response to manipulation

Decreased response to manipulation over time

Episodic in nature

Reports of catching, locking, giving way.

51
Q

Clues from Physical Exam for Spinal Instability

A

Altered quality of movement

  • Aberant motion (minors sign, catch, reversed lumbosacral rhythm)
  • Painful arc

Specific segmental findings

  • Positive prone instability test
  • Decreased resistance with prone joint play
  • Increased motion with motion palpation

Evidence of poor motor control

  • Segmental abnormal movements
  • Painful arc abolished with abdominal bracing
  • Poor motion control during hip extension
  • Poor motor control during single leg stand.
52
Q

What are the imaging guidelines for the low back? (When do you not need to order imaging)

A

Imaging is most appropriate when the results may affect the tx plan.

Imaging is NOT indicated in first six weeks of low back pain if the following criteria is met.

  • No neurological signs
  • Patient 18-15 years old
  • No signs of malignancy
  • No hx of trauma
  • No constitutional sx (weight loss, fever, malaise, diaphoresis, ect)
53
Q

What is the classic presentation of Central Lumbar Canal Stenosis?

A

Older patient with a wide based gait. No pain while sitting, thigh pain within 30 seconds of sustained extensions.

54
Q

What are common contributors to CLSS?

A

Facet Enlargement
Disc Bulge
Ligamentum Flavum enlargment

55
Q

Absolute Clinical Lumbar Spinal stenosis=

A

Absolute<10mm

Relative=<12mm

CT or MRI

56
Q

What is the pattern of Neurogenic Claudication

A

Usually seen in central canal stenosis

Paresthsia in dermatomal pattern

Pt sx worse when walking (heaviness, weakness, fatigue)

Leg sx relieved by flexion and worse by repetative extension.

May have neurological deficits.

57
Q

How do you tell the difference between Lateral Recess Stenosis and Spinal Canal Stenosis?

A

Lateral is more likely to be dermatomal patterns of radiculopathy.

Spinal Canal is more likely to be non dermatomal and can effect both legs.

58
Q

Best clue to rule OUT CLSS from Hx:

Best Clue to rule IN CLSS from Px:

Best Clue to rule OUT CLSS from Px:

A

Best clue to rule OUT CLSS from Hx: Absence of neurogenic claudication

Best Clue to rule IN CLSS from Px: Wide based gait, abnormal Rombers

Best Clue to rule OUT CLSS from Px: Forward flexion exacerbates leg pain.

59
Q

DDX for CLSS

A

Peripheral Artery Disease

Herniated Lumbar disc

60
Q

What is the typical presentation of a patient presenting with cervical radiculopathy.

A

Unilateral Neck and arm pain
Fingertip paresthesia
Sometime neurological deficits

61
Q

General Presentation of cervical myelopathy

A

Classic= Numb.clumsiness of hands, spastic gait, stiff neck.

Spastic gait
Clumsy hands
Atrophy/sensory impairment
Sphincter issues
Motor/reflex changes
Arm (uni/bi) sx's
62
Q

Clues from Hx for cervical radiculopathy

A

Shooting/Lancing pain in dermatome

Arm pain often exceeds neck pain

Aggrivated by minor movements (coughing/sneezing)

Acute NR pain may be unrelenting

Radiates into extremity in narrow specific band.

63
Q

Clues from Px for Cervical radiculopathy

A

Stiff neck (away from side of involvment)

Torticollis

Bakody’s sign

Palm to chest

Reduced active rotation towards side of involvement

+Orthos=

  • Compression
  • Distraction
  • Valsalva
  • Shoulder abduction
  • Brachial compression
  • ULTT
64
Q

When to order radiographs for radiculopathy

A

High impact injuries (MVA)

Head or neck trauma due to fall

> 50

Multiple injury areas

Cx inuries in people under the influence

Pts with special risks (downs, marfans, fused vertebrae)

Significant spasm d/t trauma

Sharp intolerable pain

Significant neck flexor weakness after an injury.

65
Q

Presentation of Complex Regiona Pain Syndrome

A

5 main types

1) Pain:
- Dominant, severe, burning, regional with palamar or plantar dominance, with hyperalgesia and allodynia.

2) Autonomic Dysfunction:
- Nails thickened, rigid and brittle; darkened rapidly growing hair, temp changes (warm/red/mottled), spasms/ weakness/increased reflexes

3) Edema
4) Movement disorder
5) Dystrophy/atrophy

66
Q

What condition is difficult to tell from facet syndrome?

A

Disc Derangment

67
Q

Compair and contrast Acute Otitis Media vs Otitis Media with Effusion

A

AOM

  • Pt appears ill
  • Ear Pain
  • Fever
  • Rapid onset
  • Previous Upper Resp Tract Infection
  • Bulging/Cloudy Tympanic Membrane

OME

  • Pt normal to mildly ill
  • No pain of ear
  • No fever
  • Recent AOM
  • Slow onset
  • Normal or retracted tympanc membrane

Both:
-Conductive Hearing Loss

68
Q

Tx for AOM/OME

A

Address Sx

Affect Eustachian tube (endonasal)

Instruct patient how to autoinflate

CMT to upper Cx

Refer:

  • Infant
  • High temp
  • Severe ill
  • Hearing Loss
  • Facial Paralysis
  • Failure to improve in 5 days
69
Q

Red flags for serious disease causing LBP

  • Sensitive
  • Specific
A

Sensitive

  • > 50
  • No relief with bed rest

Specific

  • Previous Hx of cancer
  • Unexplained weight loss
  • Sx >1 month
  • No response to tx >1mo
70
Q

Red Flas from Ancillary Studies with LBP

A

Elevated ESR/CRP (ESR>50)

Increased Serum Calcium, Protein, or ALP

Anemia

Pathological image

71
Q

Structures that can compression nerves in the thoracic outlet.

A

Cervical Rib
SOL
Pec Minor
Ant/Middle Scalene

72
Q

What may require urgent referral in TOS? WHo is at risk?

A

Vascular TOS

Young physically active males

73
Q

What does vascular TOS present like

A

Cyanosis
No pulsating edema
Distender superficial veins
Fatigue in arm

Overhead TOS will irritate this form the best.

74
Q

What are the 3 products of bone marrow that a CBC measures?

A

Red Blood Cells

  • Number
  • Amount of hemoglibin
  • Hematocrit
  • Indices (MCV, MCH, MCHC)

White Blood Cells

  • Neutrophils
  • Basophils
  • Eosinophils
  • Lymphocytes
  • Monocytes

Platelets

75
Q

In an Anemic patient, how low does Hgb have to be before the patient might begin having symptoms?

How low does Hgb have to be before you start considering a transfusion?

A

Sxs= Hgb<10g/dl

Transfusion=Hgb<6.5g/dl

76
Q

What are the RBC indices?

Which one is most important on letting you know which category of anemia?

A

MCV
MCHC
MCH

MCV tells you which anemia (micro/Macro/normo)

77
Q

What are typical symptoms of anemia?

A

Fatigue

Pallor

78
Q

What CBC labs indicate Anemia?

A

Decreased Hgb, Hct, and/or RBC count.

Hgb most accurate.

79
Q

What are 4 causes for anemia?

A

1) Iron Deficiency (95%)
2) Thalassemia
3) Chronic Disease
4) Sideroblastic Anemia

80
Q

What do you order to confirm iron deficiency anemia

A

Iron Panel

81
Q

What is measured in an iron panel and what will they looks like if the patient has iron deficiency anemia?

A

Si (serum Iron)

TIBC (% iron carrier transferrin that is empty)

%TS (% of transferrin saturate with iron)

Serum Ferritin (storage form of iron)

SI  V
TIBC  ^
%TS  V
Serum Ferritin V
- first to go down and last to normalize
82
Q

What does RDW measure

A

If there is a large range in RBC width between cells.

(anisocytosis= cells of varying size)

Can only tell you that all cell are not the same size, but not if they are big or small

83
Q

Results for CBC and Iron panel for Iron Deficiency Anemia

A

CBC

  • RDW ^
  • MCV (micro) V
  • MCHC V (hypochromic)
  • MCH V (hypochromic)
  • PBS: Microcytosis, Hypochromia, Anisocytosis

Iron Panel

  • SI V
  • Serum Ferratin V
  • TBCI ^
  • %TS V
84
Q

What are the 3 most common causes of iron deficiency anemia?

A

Chronic Bleeding (MC)

  • Menstration
  • GI (FIT test or >50 colonoscopy)

Dietary or increased demand (pregnancy)

Malabsorbtion (lack of stomach acids)

85
Q

What is Thalassemia a disease of?

A

Small red blood cells (MCV)

86
Q

Thalassemia CBC results

A

MCV= Disproportionately lower than anemia (<70)

RDW= Normal (though small cells)

RBC= ^ V or Normal

PBS= Target Cells

87
Q

If you suspect Thalassemia, what should you do next.

A 
Order iron panel to rule out iron deficiency anemia
SI= N/^
TIBC N
%TS= N/^
Serum Ferritin= N/^

Hgb Electrophoresis
- reverse HgbA1/A2 ratio (if beta thalassemia)

88
Q

What do CBC and Iron labs look like with chronic disease?

A

Anemia (Hgb V)

SI V
TIBC= N/V
Serum Ferritin= N/^

Serum Ferritin is biggest indicator.

Other clues=
Elevated WBC
Elevated CRP/ESR

89
Q

What is the indication of a Sideroblastic anemia?

A

PBS: Sideroblast

Often normocytic
SI: ^

90
Q

Your serum B12 test come back slightly decreased. What are two tests that can be ordered which could help confirm B12 deficiency?

A

Decreased cobalamin or increased methylmalonic acid.

91
Q

3 Causes of B12 deficiency

A

Diet
Pernicious Anemia
Malabsorption syndrome

92
Q

What blood test could confirm pernicious anemia

A

Antiparietal cell antibodies

93
Q

How does reticulocytoses cause macrocytic anemia?

A

Reticulocytes are immature red cells. Because they are larger than mature RBCs, if they increase in number it increases the average cell size until the MCV registers macrocytosis.

94
Q

What is the cause of Reticulocytosis

A

Increased bleeding

95
Q

What does BAAAGL stand for and what does that have to do with macrocytic anemia?

A

BAAAGL stands for bilirubin, alkaline phosphatase, AST, ALT, GGTP, and LDH. Any combination of these may increase signaling liver inflammation. The injured liver can affect size of the RBCs that are made.

96
Q

What is the most common type of macrocytic anemia?

A

Megaloblastic anemia

97
Q

What are the 5 most common causes of macrocytic anemia?

A 
Megaloblastic anemia
Chronic alcoholism
Reticulocytosis
Liver Disease
Hypothyroidism
98
Q

What will be the RDW value mostly likely do in a macrocytic anemia? Increase? Decrease? Remain normal?

A

Increase because some cells will be large, and some will be normal.

99
Q

What condition are hypersegmented PM

A

Megaloblastic Anemia

100
Q

What are the two most common causes of megaloblastic anemia?

A

B 12 deficiency and folic acid deficiency.

101
Q

Besides a change in indices, what are the 5 clues from a CBC that would be consistent with a megaloblastic anemia?

A

Decreased WBCs, decreased platelets, MCV > 110, hypersegmented neutrophils, and macroovalcytes.

102
Q

What are findings on a standard blood chemistry panel that would be consistent with megaloblastic anemia? Explain why they go up?

A

Increased bilirubin and LDH result from hemolysis due to the fact that the cells are too large and fragile to make their way through the spleen and capillary beds.

103
Q

What 3 values should you look at to determine the category of anemia?

A

3 Indices

- MCV, MCHC, MCH

104
Q

How do you treat B12 Deficiency?

A

Oral B12

Parenteral B12 (in patients with significant neurologic symptoms)

Sublingual B12

Intranasal B12 (Maintenance therapy)

105
Q

How do you tell is macrocytic anemia due to chronic alcoholism?

A

Increased GGTP

If significant liver cirrhosis blood chem panel will show: (Decreased Protein (albumin), trigs, BUN, and increased NG4 (amonium))

106
Q

What are some causes of reticulocytosis?

A

Early post bleeding periods

Hemolysis & other conditions

107
Q

What will you see on a CBC and Chem Panel in the case of anemia cause by liver disease?

A

^ MCV

V Protein, Trigs, BUN

^ NH4 (amonium)

^ BAAAGL ( Bilirubin,
ALT, AST, ALP, GGTP, LDH)

108
Q

How do you rule out Thyroid disease causing anemia?

A

TSH

109
Q

If you feel snapping or crepitus in the shoulder, what are some areas that this could come from?

A

Biceps tendon
Labrum
AC

CSA (3 decks)

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