Differential Diagnosis Unit 2 Flashcards
What are the Mechanisms of referred Visceral Pain?
- Embryologic Development
- Multisegmental Innervation
- Direct Pressure and Shared Pathway
With the Mechanisms of referred Visceral Pain, Where is pain referred to with Embryologic Development?
Pain is referred to a site where the organ was located in fetal development
- Chest structures and pericardium were part of the gut embryology
With the Mechanisms of referred Visceral pain, What is Multisegmented Innervation? Visceral Pain can be referred to the corresponding somatic area because…?
- The visceral afferent fibers mediating pain travel with the sympathetic nerves, except for those from the pelvic organs, which follow parasympathetic of the pelvic nerve.
- Because sensory fibers for the viscera and somatic structures enter the spinal cord at the same levels converging on the same neuron
With Direct Pressure and Shared Pathways, What referred pain to the shoulder and what referrers pain to the Neck/Upper Trapezius?
(Shoulder)
- Direct pressure from any inflamed, infected or obstructed organ in contact with the respiratory diaphragm can refer pain to the ipsilateral shoulder.
(Neck and Upper-Trap)
- Irritation of the Peritoneal (outside) or pleural (inside) surface of the central area of the respiratory diaphragm can refer sharp pain to the upper trapezius muscle, neck and supraclavicular fossa
What are Characteristics of Pain?
It helps define the source or type of pain in question
- Location: localized, diffuse, segmental
- Description of sensation: dull, achey, burning, etc
- Intensity: Severe vs. mild
- Frequency and duration: Constant vs intermittent
- Patten: Progressive pattern with onset vs. worse or better, or improvement
What are associated symptoms?
These are symptoms that occur alone or in conjunction with the pain of systemic disease
For ex: Burning, difficulty breathing, Night sweats, weakness, numbness/tinging, Heart Palpations
What are the 5 sources of pain?
- Somatic: located in skin and subcutaneous tissue, localized with one finger
- Somatic: 3 layers; Superficial, Deep Somatic, Psychosomatic
- Visceral: Internal organs in the trunk or abdomen
- Neurogenic: Injury to the peripheral nerves, spinal cord pathways, or neurons in the brain
- Referred: Pain is felt in an area far from the site of the lesion but supplied by the same or adjacent neural segments
With the somatic pain mechanism, what is the referral site with a C7, T1-5 vertebrae lesion site?
Interscapular area, posterior
With the somatic pain mechanism, what is the referral site with a shoulder lesion site?
Neck, upper back
With the somatic pain mechanism, what is the referral site with a L1 and L2 vertebrae lesion site?
SI joint and hip
With the somatic pain mechanism, what is the referral site with a Hip joint lesion site?
SI and Knee
With the somatic pain mechanism, what is the referral site with a Pharynx lesion site?
Ipsilateral ear
With the somatic pain mechanism, what is the referral site with a TMJ lesion site?
Head, Neck, Heart
With the Neuropathic pain mechanism, what is the referral site with a nerve or Plexus lesion site?
Anywhere in distribution of a peripheral nerve
With the Neuropathic pain mechanism, what is the referral site with Nerve Root lesion site?
Anywhere in corresponding dermatome
With the Neuropathic pain mechanism, what is the referral site with Central Nervous System lesion site?
Anywhere in region of body innervated by damaged structure
With the Visceral pain mechanism, what is the referral site with Diaphragmatic Irritation?
Shoulder, Lumbar Spine
With the Visceral pain mechanism, what is the referral site with Heart lesion site?
Shoulder, Neck, Upper Back, TMJ
With the Visceral pain mechanism, what is the referral site with Urothelial Tract?
Back, Inguinal Region, anterior thigh, and genitalia
With the Visceral pain mechanism, what is the referral site with Pancreas, Liver, Spleen, and Gallbladder?
Shoulder, Mid-thoracic or low back
With the Visceral pain mechanism, what is the referral site with Peritoneal or Abdominal Cavity?
Hip pain from abscess of psoas or obturator muscle
What can be the underline factor or mimic system that can cause visceral or Neuro-Muscular conditions?
Physiological factors such as anxiety, depression and panic disorder
What 3 things can influence patient demographics on the condition?
- Sex and Gender
- Race and Ethnicity
- Substance Abuse
During the Integumentary Screening, what is Hemosiderin Straining?
Rusty brown darkening of skin
- Vein valves fail
- Regurgitated blood forces RBCs out of capillaries
- Dead RBCs release iron
Lipodermatosclerosis
- Inflammation of sub-cutaneous fat
- Skin induration (hardening)
Most common: Distal Lower Extremities
During the Integumentary Screening, what is Pitting Edema?
A depression (“Pit”) remains in the edema for some minutes after firm fingertip pressure is applied
During the Integumentary Screening, what is Skin Turgor?
A test to pinch the skin and see how quickly the skin goes back to normal
- A decrease on skin turgor is a late sign of dehydration
During the Integumentary Screening, what is the Capillary Refill Test?
- Have the pt. hand or foot above heart level
- Compress tip of digit until it blanches (Can press nail bed or tip of finger)
- Release pressure, color (Blood) should return in 2 seconds
- Check local arterial circulation, dehydration, shock, PAD
During the Integumentary Screening, what is the Cellulitis?
A bacterial infection that affects the skin’s deeper layers and underlying tissue
- Can make the skin hot
- Can be acutely painful
- Can cause edema
- Can cause induration
- Can have spreading of redness
- May cause irregular, sharp, or elevated borders
During a Nail Bed assessment, what can cause Koilonychia?
“Spooning of the nail”
Can be caused by Anemia, Thyroid, and syphilis
During a Nail Bed assessment, what can cause Beau’s Lines?
Alcohol, Nutrition, MI
During a Nail Bed assessment, what can cause Nail Pitting?
Psoriasis
During a Nail Bed assessment, what can cause Nail Thickening?
Circulation issues and fungus
During a Nail Bed assessment, what can cause Melanoma?
Malignancy
What are the different Skin Cancer Types?
- Actinic Keratoses (Pre-Cancerous Growth)
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Melanoma
What is Melanoma? What are the 2 growth phases?
Out of control melanocyte growth
- Radial Growth Phase
- Vertical Growth Phase
Lifetime risk 2.6%
What are some Rick Factors for Skin Cancer?
Ultraviolet Light (Sun) Exposure
- Intensity
- Duration
- Age at which exposure occurs
- Tanning bed
- Cumulative (Multiple severe sunburns)
- Degree of pigmentation in that person
- Weakened Immune System
- Family or Personal History of Skin Cancer
What are the characteristics of Normal Moles (Nevus)?
- Round or close to round
- Nice even border
- Brown or tan
- Stable - Not changing over time
- 1/4 diameter (Size of pencil eraser)
When Screening for Skin Cancer, What is the ABCDE of Melanoma?
- Asymmetry: One half of a mole or birthmark does not match the other
- Border: The edges are irregular, ragged, notched, or blurred
- Color: The color is not the same all over and may include different shades of brown or black, or sometimes with patches of pink, red, white or blue
- Diameter: The spot is larger than 6mm across, although melanomas can sometimes be smaller than this
- Evolving: The mole is changing is size, shape or color
What are warning signs of Melanoma?
- Itching
- Pain
- Elevation
- Bleeding
- Crusting
- Swelling
- Oozing
- Ulcerations
What should you look out for, for Nodular Melanoma? Who is more susceptible for this?
Look for
- Elevation
- Firmness
- Growth
(Can happen in any part of the body, can be aggressive)
Men > 60 are more susceptible
