Exam 1 Flashcards
What is anchoring?
latching onto 1 diagnosis
What is confirmation bias?
determine diagnosis and everything else done, confirms diagnosis
What is outcome bias?
choose a diagnosis because it has better prognosis
- ex: saying its a facet arthropathy vs a fx
What is overconfidence bias?
thinking you are better than you are; thinking you can perform a specific testing procedure better than another clinician
What is premature closure?
disregard diagnosis too quickly
What is search satisfying?
once something is found, you stop searching for other things
What is commission bias?
I have to do something or something bad will happen to the patient
What is omission bias?
not doing anything because it may make them worse
What is base-rate neglect?
ignoring the true prevalence of the condition
What is playing the odds?
more likely to be something benign than something serious
What is ascertainment bias?
stereotyping based on prior experience
What is availability bias?
talks about something, fresh on mind, so think everyone has it
What is representativeness restraint?
overgeneralized script
- ex: if it flies and makes noise out of its beak then its a duck
What is a red flag for a menopause patient?
bleeding after menopause
_______ can lead to diminished bone mineral density in females
Amenorrhea – absence of menstruation
What is CAGE questionnaire? What population is it used on?
substance/alcohol abuse
C: Have you ever though you should cut down your drinking?
A: Have you ever been annoyed by criticism of your drinking?
G: Have you ever felt guilty about your drinking?
E: Do you ever have an eye-opener (drink in the morning)?
What does 1 yes and/or 2 or more yesses to the CAGE questionnaire mean?
1 yes - suggests need for discussion and follow-up on alcohol
2 or more yesses - indicate a problem with alcohol
2 or more yes answers to which questions is a red flag for substance/alcohol abuse
- Have you had any fractures or dislocations to your bones or joints?
- Have you been injured in a road traffic accident?
- Have you ever injured your head?
- Have you been in a fight or been hit or punched in the last 6 months?
What is the leading cause of TBI in the US?
falls
What type of pain is well localized and can result in trophic changes?
cutaneous
How is somatic pain produced? What are common descriptors?
- stimulation of nerve endings in somatic structures
common descriptors - dull, aching, gnawing, diffuse, pressure
- named by the source
What type of pain is poorly localized, may refer to body surface (cutaneous), and associated with autonomic phenomenon (diaphoresis, pallor, changes in BP/pulse, nausea, and faintness)?
deep somatic
- periosteum, cancellous bone, nerves, muscles, tendons, ligaments, blood vessels, deep fasciae, joint capsules
What type of pain refers to the mind-body connection? How does this occur?
psychosomatic
- occur when emotional or psychologic distress produces physical symptoms
What is the difference between viscero-somatic pain and somatovisceral pain?
viscero-somatic (response) - visceral structures affect the somatic musculature
- abdominal muscles rigidity response to acute appendicitis
somatovisceral - occurs when myalgic conditions cause disturbance of underlying viscera
- trigger points of abdominal muscles causing diarrhea, vomiting, excessive burping
________ includes all body organs located in the trunk/abdomen
visceral
- respiratory, digestive, uropgenital, endocrine systems
- spleen
- heart
- great vessels
T/F: Visceral pain is poorly localized/diffuse.
true
Does visceral pain refer? If so, where
visceral pain can produce referred pain that corresponds to dermatomes from which the organ receives innervation
What is visceral pain accompanied by?
ANS response
- often visceral pain is not felt until the organ is inflamed or distended to impinge on nearby structures b/c the viscera have few nerve endings
What type of pain is caused by a lesion or disease of the somatosensory nervous system?
neuropathic
Neuropathic pain results from what?
damage or pathophysiologic changes to PNS or CNS
T/F: Neuropathic pain is alleviated with opiates or narcotics
false - it is not alleviated with opiates or narcotics
______ pain is localized, though with poorly defined borders.
referred
What is referred pain?
perceived in area far from the site of the lesion but supplied by the same or adjacent neural segments
What type of pain is typically not better after rest or recumbency?
visceral pain
What is nociception?
the neural process of encoding noxious stimuli
What is nociceptive pain? Examples?
pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors
ex: osteoarthritis, ankle sprain, RA
What is neuropathic pain? Examples
pain caused by a lesion or disease of the somatosensory nervous system
- central (coming from CNS) and peripheral (coming from PNS)
ex: diabetic neuropathy, carpal tunnel syndrome, complex regional pain syndrome
What is nociplastic pain? Examples
pain that arises from altered nociception despite no clear evidence of actual tissue damage
- causes activation of peripheral nociceptors
ex: fibromyalgia, Temporomandibular disorder, nonspecific low back pain
What is a red flag of cancer or neurologic impairment in regards to muscles?
proximal muscle weakness with change in one or more DTRs
What 3 things are needed for a trigger point?
- focal tenderness
- referred regional pain
- local twitch response
SxS of Infectious Arthritis
- fever
- recurrent sore throat
- persistant joint pain - single and multiple joint pain
- pain during weight bearing
- skin lesions
- conjunctivitis
- other MSK symptoms - myalgias, tenosynoviits, elevated c-reactive protein and sedimentation rate
What should be done if pt has joint pain of unknown origin, genital lesions, and recent hx of infection?
refer - red flag
T/F: Radicular pain can not occur with radiculopathy
false - can occur with or without radiculopathy
What type of pain alters CNS and PNS through neural plasticity and central sensitization?
chronic pain
increased pain from a stimulus that normally provokes pain
hyperalgesia
increased sensitivity to stimulation, excluding the special senses
hyperesthesia
Increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally subthreshold inputs
sensitzation
- central and peripheral
waddell’s nonorganic signs
Tenderness
- superficial - tender to touch
- nonanatomic - deep tenderness felt over a wide area
Simulation tests
- axial loading
- acetabular rotation
Distraction Tests
- single leg raise discrepancy - worse in supine than sitting
- less double leg raise than single leg raise
Regional Disturbance
- weakness
- sensory disturbance (stocking distribution)
Overreaction
- guarding, bracing, rubbing, sighing
What signs and symptoms of palpitations require medical evaluation?
palpations lasting for hours with pain, SOB, fainting or severe lightheadednes
- medical referral if observed with a family hx of unexplained sudden death
What signs and symptoms of dyspnea require medical evaluation?
- cannot climb a single flight of stairs w/o feeling winded
- reports waking at night or observes SOB when lying down
What signs and symptoms of syncope require medical evaluation?
syncope without warning of lightheadness, dizziness, or nausea
- potential sign for heart valve or arrythmia problems
edema red flag
> /= 3 lb weight gain or gradual, continuous gain over several days without swellling in ankles, abdomen and hands
side effects of statins
- myopathy
- unexplained fever
- N/V
- liver impairment
risk factors for atherosclerosis and coronary artery disease
- hypercholesteremia
- elevated LDL
- elevated triglycerides
- decreased HDL
prinzmetal’s angina
angina that doesn’t have plaque build up
- caused by abnormal coronary artery spasm
when are medical services needed after angina
- pain not relieved with rest
- after 3 nitroglycerin tablets (5 min apart for each) ~15 minutes
signs and symptoms of pericaditis
- substernal pain (may radiate) and moving hurts
- pain relieved by leaning forward or sitting upright, holding breath
- pain aggravated by movement associated with deep breathing and trunk movements
Which side of HF has cyanosis of nail beds?
right sided HF
What is diastolic HF? Signs and symptoms?
- when the LV stiffens and hypertrophies
- fatigue/dyspnea after mild exercise
- orthopnea
- edema and weight gain
- JVD
What type of pain occurs with an ascending aorta aneurysm?
upper back and chest pain
What type of pain occurs with an descending aorta aneurysm?
abdominal and low back pain
abnormal findings of palpation of abdominal aortic aneurism?
width > 3 cm between hands
What is the most common symptoms of rheumatic fever? What are other symptoms?
fever and joint pain
- flat, painless skin rash
- chorea - jerky involuntary movements
- weakness, malaise, weight loss, and anorexia
- aquired valvular disease
What causes inflammation of cardiac endothelium and damages the tricuspid, aortic or mitral valve?
endocarditis
endocarditis signs and symptoms
- arthralgia
- low back pain
- myalgia
- petechiae/splinter hemorrhage
- cold and pain in extremities
- dyspnea, chest pain
What does a TIA warrent? Signs and symptoms
immediate medical referral
- slurred speech
- sudden confusion
- dizziness
- severe HA
- paralysis usually affecting 1 side
- imbalance
How much does BP have to change to be considered orthostatic hypotension?
systolic - drop of 15 or more mmHg
OR
diastolic - drop of 7 mmHg or more
superficial venous thrombosis signs and symptoms
- subcutaneous venous distention
- palpable cord
- warmth, redness
- indurated (hard)
DVT signs and symptoms
- unilateral tenderness or leg pain
- unilateral swelling (> 3 cm difference)
- warmth
- discoloration
Wells Criteria scale scoring for DVT
= 0: low probability of DVT
1-2: intermediate probability of DVT
>/= 3: high probability of DVT
6 Ps of associated symptoms
- pain
- pallor
- pulselessness
- paresthesia
- poikilothermia - coldness
- paralysis
lymphedema is usually _______
unilateral
rust-colored sputum could be a sign of _______
pneumonia
What type of pulmonary pain is referred to the neck and anterior chest at the same levels?
tracheobronchial pain
What is respiratory acidosis? Signs and symptoms
any condition that decreases pulmonary ventilation and increases retention and concentration of CO2
- decreased ventilation/shallow breathing
- confusion
- sleepiness
- diaphoresis
- cyanosis
What is respiratory alkalosis? What usually causes it?
results from increased respiratory rate and depth that decreases the amount of available CO2 and hydrogen
- usually caused by hyperventilation
signs and symptoms of respiratory alkalosis
- hyperventilation
- light-headedness/dizziness
- numbness and tingling of the face, fingers, an toes
- syncope
What is the leading cause of morbidity and mortality for smokers?
COPD - obstruction of air exiting and entering the lungs
What constitutes chronic bronchitis?
anyone who coughs for at least 3 months/year for 2 consecutive years without having had a precipitating disease
chronic bronchitis signs and symptoms
- persistent cough with production of sputum (worse in AM and evening)
- reduced chest expansion
- wheezing
- fever
- dyspnea
- cyanosis
- decreased exercise tolerance
What is bronchiectasis? signs and symptoms
- permanent dilation of bronchi and destruction of bronchial walls
- chronic wet cough and abundant foul-smelling secretions
- hemoptysis
- weight loss
- recurrent fever and chills
signs and symptoms of emphysema
- SOB
- barrel chest
- chronic cough
- weight loss
- wheezing
- pursed-lip breathing
- peripheral cyanosis
pneumonia risk factors
- age (very old, very young)
- smoking
- endotracheal intubation, nasogastric tube
- recent chest surgery
- prolonged immobility
- immunosuppressive therapy
- aspiration of oral/gastric material, foreign materials
signs and symptoms of scleroderma
- dyspnea on exertion
- nonproductive cough
- peripheral edema
- shiny skin and tightness in hands is first sign
cystic fibrosis signs and symptoms
- salty skin/sweat
- bulky, foul smelling stools
- recurrent pneumonia
- persistent coughing and wheezing
- excessive appetite, but poor weight gain
What side will referred pain be on during pleurisy?
ipsilateral
What is a common sign of pneumothorax?
abrupt onset of dyspnea in a healthy individual
What are some causes of pneumothorax?
- pulmonary disease
- trauma (with perforation of chest wall)/surgery
- scuba diving
- overexertion
signs and symptoms of pneumothorax. What is the most comfortable posiition?
- sudden, sharp chest pain
- increased neck distention
- weak and rapid pulse (>100 bpm)
- fall in blood pressure
- dry, hacking cough
- shoulder pain
- sitting upright is most comfortable
