Diff DX - Physician Referral

Question 1

Cardiovascular Signs for Physician Referral

Answer 1

• when pt has a combination of systemic s/s at presentation
• women with chest or breast pain who have a +family history of breast cancer or heart disease
• palpitation in any person with history of sudden death, more than 6 episodes in a min, or lasting several hours w/ s/s of pain, SOB, fainting, light headedness
• anyone who cannot climb a single flight of stairs without feeling moderately winded (dyspnea) or awakens at night (PND) or experiences SOB when laying down (orthopnea)
• a pt who is neurologically unstable as a result of recent CVA/TBI/SCI etc that experiences new arrhythmia

Question 2

Cardiac Pts should be sent back to their physician under which situations?

Answer 2

• nitroglycerin tablets do not relieve angina
• pattern of angina changes are noted
• obnormally severe chest pain with n/v
• anginal p! radiates to jaw or L arm
• anginal p! is not relieved by rest
• upper back feels abnormally cool, sweaty or moist to touch
• develops progressively worsening dyspnea
• individual with previous coronary artery stent experiences chest p!
• demonstrates greater than 40 mmHg difference in pulse pressure (SBP-DBP)
• pt reports “doubt” in their current condition

Question 3

Potential Red Flags for Cancer Screening

Answer 3

1. Age>50
2. Previous h/o CA or bilateral carpal tunnel syndrome, joint pain of unknown rheumatic cause
3. Anyone with back, pelvic, groin, or hip pain accompanied by abdominal complaint, palpable mass
4. Recent weight loss of 10% of total body weight within 2 weeks
5. Shoulder, back, hip, pelvic sacral pain accompanied by changes in b/b
6. Hip or groin pain reproduced by heel strike, hopping test or translation/rotational stress
7. Intense pain at night (7 or higher)
8. Signs of nerve root compression
9. Onset of new neurological deficits
10. Growing mass (p!ful or p!less) that continues to grow in size
11. disproportionate relief of pain from aspirin
    12.

Question 4

Cancer - Red Flags in Women vs. Men

Answer 4

Women

1. any woman with chest, breast, axillary, or shoulder pain of unknown cause especially over the age of 40
2. Prolonged or excessive menstrual bleeding or breakthrough bleeding

Men

1. Any man with hip, groin, SI or additional presence of sciatica with previous history or prostate cancer