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Differential > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is anchoring?

A

latching onto 1 diagnosis

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2
Q

What is confirmation bias?

A

determine diagnosis and everything else done, confirms diagnosis

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3
Q

What is outcome bias?

A

choose a diagnosis because it has better prognosis
- ex: saying its a facet arthropathy vs a fx

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4
Q

What is overconfidence bias?

A

thinking you are better than you are; thinking you can perform a specific testing procedure better than another clinician

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5
Q

What is premature closure?

A

disregard diagnosis too quickly

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6
Q

What is search satisfying?

A

once something is found, you stop searching for other things

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7
Q

What is commission bias?

A

I have to do something or something bad will happen to the patient

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8
Q

What is omission bias?

A

not doing anything because it may make them worse

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9
Q

What is base-rate neglect?

A

ignoring the true prevalence of the condition

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10
Q

What is playing the odds?

A

more likely to be something benign than something serious

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11
Q

What is ascertainment bias?

A

stereotyping based on prior experience

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12
Q

What is availability bias?

A

talks about something, fresh on mind, so think everyone has it

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13
Q

What is representativeness restraint?

A

overgeneralized script
- ex: if it flies and makes noise out of its beak then its a duck

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14
Q

What is a red flag for a menopause patient?

A

bleeding after menopause

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15
Q

_______ can lead to diminished bone mineral density in females

A

Amenorrhea – absence of menstruation

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16
Q

What is CAGE questionnaire? What population is it used on?

A

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)?

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17
Q

What does 1 yes and/or 2 or more yesses to the CAGE questionnaire mean?

A

1 yes - suggests need for discussion and follow-up on alcohol

2 or more yesses - indicate a problem with alcohol

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18
Q

2 or more yes answers to which questions is a red flag for substance/alcohol abuse

A
  • 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?
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19
Q

What is the leading cause of TBI in the US?

A

falls

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20
Q

What type of pain is well localized and can result in trophic changes?

A

cutaneous

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21
Q

How is somatic pain produced? What are common descriptors?

A
  • stimulation of nerve endings in somatic structures

common descriptors - dull, aching, gnawing, diffuse, pressure
- named by the source

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22
Q

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)?

A

deep somatic
- periosteum, cancellous bone, nerves, muscles, tendons, ligaments, blood vessels, deep fasciae, joint capsules

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23
Q

What type of pain refers to the mind-body connection? How does this occur?

A

psychosomatic
- occur when emotional or psychologic distress produces physical symptoms

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24
Q

What is the difference between viscero-somatic pain and somatovisceral pain?

A

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

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25
Q

________ includes all body organs located in the trunk/abdomen

A

visceral
- respiratory, digestive, uropgenital, endocrine systems
- spleen
- heart
- great vessels

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26
Q

T/F: Visceral pain is poorly localized/diffuse.

A

true

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27
Q

Does visceral pain refer? If so, where

A

visceral pain can produce referred pain that corresponds to dermatomes from which the organ receives innervation

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28
Q

What is visceral pain accompanied by?

A

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

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29
Q

What type of pain is caused by a lesion or disease of the somatosensory nervous system?

A

neuropathic

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30
Q

Neuropathic pain results from what?

A

damage or pathophysiologic changes to PNS or CNS

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31
Q

T/F: Neuropathic pain is alleviated with opiates or narcotics

A

false - it is not alleviated with opiates or narcotics

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32
Q

______ pain is localized, though with poorly defined borders.

A

referred

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33
Q

What is referred pain?

A

perceived in area far from the site of the lesion but supplied by the same or adjacent neural segments

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34
Q

What type of pain is typically not better after rest or recumbency?

A

visceral pain

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35
Q

What is nociception?

A

the neural process of encoding noxious stimuli

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36
Q

What is nociceptive pain? Examples?

A

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

37
Q

What is neuropathic pain? Examples

A

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

38
Q

What is nociplastic pain? Examples

A

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

39
Q

What is a red flag of cancer or neurologic impairment in regards to muscles?

A

proximal muscle weakness with change in one or more DTRs

40
Q

What 3 things are needed for a trigger point?

A
  • focal tenderness
  • referred regional pain
  • local twitch response
41
Q

SxS of Infectious Arthritis

A
  • 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
42
Q

What should be done if pt has joint pain of unknown origin, genital lesions, and recent hx of infection?

A

refer - red flag

43
Q

T/F: Radicular pain can not occur with radiculopathy

A

false - can occur with or without radiculopathy

44
Q

What type of pain alters CNS and PNS through neural plasticity and central sensitization?

A

chronic pain

45
Q

increased pain from a stimulus that normally provokes pain

A

hyperalgesia

46
Q

increased sensitivity to stimulation, excluding the special senses

A

hyperesthesia

47
Q

Increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally subthreshold inputs

A

sensitzation
- central and peripheral

48
Q

waddell’s nonorganic signs

A

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

49
Q

What signs and symptoms of palpitations require medical evaluation?

A

palpations lasting for hours with pain, SOB, fainting or severe lightheadednes
- medical referral if observed with a family hx of unexplained sudden death

50
Q

What signs and symptoms of dyspnea require medical evaluation?

A
  • cannot climb a single flight of stairs w/o feeling winded
  • reports waking at night or observes SOB when lying down
51
Q

What signs and symptoms of syncope require medical evaluation?

A

syncope without warning of lightheadness, dizziness, or nausea
- potential sign for heart valve or arrythmia problems

52
Q

edema red flag

A

> /= 3 lb weight gain or gradual, continuous gain over several days without swellling in ankles, abdomen and hands

53
Q

side effects of statins

A
  • myopathy
  • unexplained fever
  • N/V
  • liver impairment
54
Q

risk factors for atherosclerosis and coronary artery disease

A
  • hypercholesteremia
  • elevated LDL
  • elevated triglycerides
  • decreased HDL
55
Q

prinzmetal’s angina

A

angina that doesn’t have plaque build up
- caused by abnormal coronary artery spasm

56
Q

when are medical services needed after angina

A
  • pain not relieved with rest
  • after 3 nitroglycerin tablets (5 min apart for each) ~15 minutes
57
Q

signs and symptoms of pericaditis

A
  • 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
58
Q

Which side of HF has cyanosis of nail beds?

A

right sided HF

59
Q

What is diastolic HF? Signs and symptoms?

A
  • when the LV stiffens and hypertrophies
  • fatigue/dyspnea after mild exercise
  • orthopnea
  • edema and weight gain
  • JVD
60
Q

What type of pain occurs with an ascending aorta aneurysm?

A

upper back and chest pain

61
Q

What type of pain occurs with an descending aorta aneurysm?

A

abdominal and low back pain

62
Q

abnormal findings of palpation of abdominal aortic aneurism?

A

width > 3 cm between hands

63
Q

What is the most common symptoms of rheumatic fever? What are other symptoms?

A

fever and joint pain

  • flat, painless skin rash
  • chorea - jerky involuntary movements
  • weakness, malaise, weight loss, and anorexia
  • aquired valvular disease
64
Q

What causes inflammation of cardiac endothelium and damages the tricuspid, aortic or mitral valve?

A

endocarditis

65
Q

endocarditis signs and symptoms

A
  • arthralgia
  • low back pain
  • myalgia
  • petechiae/splinter hemorrhage
  • cold and pain in extremities
  • dyspnea, chest pain
66
Q

What does a TIA warrent? Signs and symptoms

A

immediate medical referral

  • slurred speech
  • sudden confusion
  • dizziness
  • severe HA
  • paralysis usually affecting 1 side
  • imbalance
67
Q

How much does BP have to change to be considered orthostatic hypotension?

A

systolic - drop of 15 or more mmHg
OR
diastolic - drop of 7 mmHg or more

68
Q

superficial venous thrombosis signs and symptoms

A
  • subcutaneous venous distention
  • palpable cord
  • warmth, redness
  • indurated (hard)
69
Q

DVT signs and symptoms

A
  • unilateral tenderness or leg pain
  • unilateral swelling (> 3 cm difference)
  • warmth
  • discoloration
70
Q

Wells Criteria scale scoring for DVT

A

= 0: low probability of DVT
1-2: intermediate probability of DVT
>/= 3: high probability of DVT

71
Q

6 Ps of associated symptoms

A
  • pain
  • pallor
  • pulselessness
  • paresthesia
  • poikilothermia - coldness
  • paralysis
72
Q

lymphedema is usually _______

A

unilateral

73
Q

rust-colored sputum could be a sign of _______

A

pneumonia

74
Q

What type of pulmonary pain is referred to the neck and anterior chest at the same levels?

A

tracheobronchial pain

75
Q

What is respiratory acidosis? Signs and symptoms

A

any condition that decreases pulmonary ventilation and increases retention and concentration of CO2

  • decreased ventilation/shallow breathing
  • confusion
  • sleepiness
  • diaphoresis
  • cyanosis
76
Q

What is respiratory alkalosis? What usually causes it?

A

results from increased respiratory rate and depth that decreases the amount of available CO2 and hydrogen
- usually caused by hyperventilation

77
Q

signs and symptoms of respiratory alkalosis

A
  • hyperventilation
  • light-headedness/dizziness
  • numbness and tingling of the face, fingers, an toes
  • syncope
78
Q

What is the leading cause of morbidity and mortality for smokers?

A

COPD - obstruction of air exiting and entering the lungs

79
Q

What constitutes chronic bronchitis?

A

anyone who coughs for at least 3 months/year for 2 consecutive years without having had a precipitating disease

80
Q

chronic bronchitis signs and symptoms

A
  • persistent cough with production of sputum (worse in AM and evening)
  • reduced chest expansion
  • wheezing
  • fever
  • dyspnea
  • cyanosis
  • decreased exercise tolerance
81
Q

What is bronchiectasis? signs and symptoms

A
  • permanent dilation of bronchi and destruction of bronchial walls
  • chronic wet cough and abundant foul-smelling secretions
  • hemoptysis
  • weight loss
  • recurrent fever and chills
82
Q

signs and symptoms of emphysema

A
  • SOB
  • barrel chest
  • chronic cough
  • weight loss
  • wheezing
  • pursed-lip breathing
  • peripheral cyanosis
83
Q

pneumonia risk factors

A
  • age (very old, very young)
  • smoking
  • endotracheal intubation, nasogastric tube
  • recent chest surgery
  • prolonged immobility
  • immunosuppressive therapy
  • aspiration of oral/gastric material, foreign materials
84
Q

signs and symptoms of scleroderma

A
  • dyspnea on exertion
  • nonproductive cough
  • peripheral edema
  • shiny skin and tightness in hands is first sign
85
Q

cystic fibrosis signs and symptoms

A
  • salty skin/sweat
  • bulky, foul smelling stools
  • recurrent pneumonia
  • persistent coughing and wheezing
  • excessive appetite, but poor weight gain
86
Q

What side will referred pain be on during pleurisy?

A

ipsilateral

87
Q

What is a common sign of pneumothorax?

A

abrupt onset of dyspnea in a healthy individual

88
Q

What are some causes of pneumothorax?

A
  • pulmonary disease
  • trauma (with perforation of chest wall)/surgery
  • scuba diving
  • overexertion
89
Q

signs and symptoms of pneumothorax. What is the most comfortable posiition?

A
  • 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

Differential (5 decks)

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