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Differential Dx > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

red flags

A

Signs and symptoms consistent with a non-musculoskeletal origin or serious musculoskeletal health condition that requires referral to another clinician

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2
Q

yellow flags

A

Indicate need for more extensive examination or cautions/ contraindications to certain tests/ interventions

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3
Q

category one red flags

A

factors that require immediate medical attention
REFER

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4
Q

category 2 red flags

A

factors that require subjective questioning and precautionary examination and treatment procedures
LOOK FOR CLUSTERING

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5
Q

category 3 red flags

A

factors that require further physical testing and differentiation analysis
CONSIDER ADDITIONAL CONSULTATION

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6
Q

intuitive method of problem solving

A

forward thinking
interpret findings as you go
more efficient
early dx= likely a correct one
commonly 5-7 dx hypotheses generated

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7
Q

analytical method of problem solving

A

working memory
multiple hypotheses based on data gathered

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8
Q

reasoning types

A

probabilistic
causal
case-based
narrative

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9
Q

Tests with low - Likelihood Ratio (-LR) are good to

A

refute a diagnostic hypothesis

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10
Q

Tests with high + Likelihood Ratio (+LR) are good to

A

confirm a diagnostic hypothesis

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11
Q

elimination strategy

A

seeking data to reduce suspicion of unlikely hypotheses

RULE OUT
-LR

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12
Q

confirmation strategy

A

seeking data to support a highly likely hypotheses

RULE IN
+LR

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13
Q

discrimination strategy

A

seeking information to discriminate between likely hypotheses

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14
Q

ockham’s razor

A

the simplest solution may be the best

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15
Q

Dx Requires:

A

Coherency
Adequacy
Parsimonious Nature

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16
Q

expert practice is distinguished by:

A

Academic and work experience
Utilization of colleagues
Use of reflection**
View of primary role
Pattern of delegation of care to support staff

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17
Q

hyperalgesia

A

Increased pain from a stimulus that normally provokes pain

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18
Q

hyperesthesia

A

Increased sensitivity to stimulation, excluding the special senses

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19
Q

sensitization

A

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

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20
Q

central sensitization

A

Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input

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21
Q

peripheral sensitization

A

Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields

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22
Q

Waddell’s signs
TENDERNESS

A

Superficial- the client’s skin is tender to light pinch over a wide area of lumbar skin; unable to localize to one structure.

Nonanatomic- deep tenderness felt over a wide area, not localized to one structure; crosses multiple somatic boundaries.

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23
Q

Waddell’s signs
SIMULATION TEST

A

Axial loading- light vertical loading over client’s skull in the standing position reproduces lumbar (not cervical) spine pain.

Acetabular rotation- lumbosacral pain from upper trunk rotation, back pain reported when the pelvis and shoulders are passively rotated in the same plane as the client stands, considered a positive test if pain is reported within the first 30 degrees.

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24
Q

Waddell’s signs
DISTRACTION TESTS

A

Straight-leg-raise (SLR) discrepancy- marked improvement of SLR when client is distracted compared with formal testing; different response to SLR in supine (worse) compared with sitting (better) when both tests should have the same result in the presence of organic pathology.

Double leg raise- when both legs are raised after straight leg raising, the organic response would be a greater degree of double leg raising; clients with a nonorganic component demonstrate less double leg raise compared with the single leg raise.

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25
Q

Waddell’s signs
OVERREACTION

A

Disproportionate verbalization, facial expression, muscle tension, and tremor, collapsing, or sweating.

Client may exhibit any of the following behaviors during the physical
examination: guarding, bracing, rubbing, sighing, clenching teeth, or grimacing.

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26
Q

Waddell’s signs
REGIONAL DISTURBANCES

A

Weakness- cogwheeling or giving way of many muscle groups that cannot be explained on a neurologic basis.

Sensory disturbance- diminished sensation fitting a “stocking” rather than a dermatomal pattern.

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27
Q

5 pain sources

A

cutaneous
somatic
visceral
neuropathic
referred

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28
Q

CAGE questionnaire

A

C: Have you ever thought you should cut down on 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 (a drink or two) in the morning?

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29
Q

strategies for refinement

A

Insight/ awareness
Metacognition
Consider alternatives
Simulation
Decrease reliance on memory
Cognitive forcing strategies
Minimize time pressures
Accountability
Feedback

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30
Q

no fault errors

A

most people would not have gotten it correct
tough situation

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31
Q

system errors

A

technical failures (poor reading or visualization or glitch in technology)
organizational failures (PT overbooked, overstressed)

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32
Q

cognitive errors

A

what we can address and refine

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33
Q

aggregate bias

A

predisposition to thinking population is special compared to others for that general presentation

34
Q

anchoring

A

make a decision too early without thinking through the rest of the results

35
Q

commission and omission biases

A

commission– force something in (if I don’t do anything, the patient will get worse)

omission– stay away (I better not do anything or I will make the patient worse)

36
Q

confirmation bias

A

if you develop a hypothesis during a differential, you will pay attention to everything that supports the dx and ignore the rest

seeks to confirm suspicion

37
Q

outcome bias

A

predisposed to a certain condition because you know there is a better prognosis // tendency to think pt will have a better outcome

(tight pec minor as opposed to cervical rib for thoracic outlet syndrome)

38
Q

overconfidence bias

A

extraordinary belief in yourself

39
Q

premature closure

A

do not finish eliminating or just confirm one thing

common in new clinicians

40
Q

search satisfying

A

as soon as you find something consistent with one dx, you zone into that and not consider other possibilities

41
Q

emotional based practice

A

emotionally attached to a procedure or dx that you do not use contrary procedures

42
Q

base-rate neglect

A

ignores how common or uncommon something is

43
Q

playing the odds

A

leaning towards the more common things because they are more likely

44
Q

faulty causation

A

putting too many links in a chain

trying to assign a cause and effect relationship where there might not be one

45
Q

ascertainment bias

A

stereotyping populations or demographics

(older people and OA)

46
Q

availability bias

A

not considering clinical patterns and jumping to something at the top of your mind

47
Q

representativeness restraint

A

script is almost there, may be too broad// overrepresentation

48
Q

3 key CV risk factors:

A

hypertension, high cholesterol, smoking

49
Q

Palpitations

A

Presence of irregular heartbeat
Common descriptors: bump, pound, jump, flop, flutter, racing sensation of the heart

Palpations lasting for hours with pain, shortness of breath, fainting or severe lightheadedness require medical evaluation
Medical referral if observed with a family Hx of unexplained sudden death

50
Q

Dyspnea

A

Breathlessness or SOB
Could also be secondary to pulmonary pathology, fever, certain meds, allergies, poor physical conditioning, obesity
Severity corresponds with severity of disease progression

Medical referral if patient:
Cannot climb a single flight of stairs without feeling moderately to severely winded
Reports waking at night or observes SOB when lying down (either obesity or more serious concern)

51
Q

Cardiac Syncope

A

fainting due to reduced O2 delivery to brain
Observed with arrhythmias, orthostatic hypotension, poor ventricular function, coronary artery disease, vertebral artery insufficiency

Syncope without warning of lightheadedness, dizziness, or nausea requires referral

52
Q

Fatigue

A

If provoked by minimal exertion, may have a cardiac origin
Associated SxS common: dyspnea, chest pain, palpitations, headache

Monitor closely if fatigue exceeds normal expectations during or after exercise

53
Q

Cough

A

Possible cause: Left ventricular dysfunction from mitral valve dysfunction when aggravated by exercise, metabolic stress, supine position, or paroxysmal nocturnal dyspnea
Hacking cough with significant frothy, bloody sputum

54
Q

Cyanosis

A

Bluish discoloration of lips and nailbeds due to inadequate blood-oxygen levels

55
Q

Edema

A

> /= 3 lb. weight gain or gradual, continuous gain over several days with swelling in ankles, abdomen and hands is a red flag for HF

Even more so with presence of SOB, fatigue and dizziness
Possible associated SxS: jugular vein distension & cyanosis

56
Q

Claudication

A

leg pain that occurs with PVD
Pitting edema & leg pain commonly accompany with vascular disease

Immediate MD consult if abrupt onset of ischemic rest pain or sudden worsening of intermittent claudication requires immediate referral

57
Q

side effects of statins

A

Unexplained fever, nausea, vomiting

58
Q

s/sx of liver impairment

A

Dark urine
Asterixis (liver flap)
Bilateral carpal tunnel syndrome
Palmar erythema (liver palms)
Spider angioma
Changes in nail beds, skin color
Ascites

59
Q

MSK commonly mimics

A

Angina
MI
Pericarditis
Dissecting aortic aneurysm

60
Q

atherosclerosis

A

hardening of arteries

61
Q

thrombus

A

when a clot forms on plaque that is built up on artery walls

62
Q

spasm

A

sudden constriction of coronary artery

63
Q

symptoms of coronary artery disease are commonly not observed until the artery ____

A

artery narrows by 75%

64
Q

angina

A

acute pain in the chest
imbalance between cardiac workload and O2 supply to heart muscle tissue

65
Q

Chronic stable angina

A

Occurs at a predictable level of physical or emotional stress
Responds quickly to rest or nitroglycerin
No pain at rest & location/ duration/ intensity/ frequency of chest pain consistent over time

66
Q

Unstable angina

A

Abrupt change in the intensity & frequency of symptoms or decreased threshold of stimulus

Most common trigger: bursting of a cholesterol-filled plaque in lining of coronary artery

Clot forms & partially blocks blood flow
Duration > the usual 1 to 5 minutes (may last for up to 20-30 minutes)
Pain or discomfort unrelieved by rest or nitroglycerin = risk for MI
Immediate MD assessment necessary

67
Q

resting angina

A

Chest pain that occurs at rest in the supine position

68
Q

nocturnal angina

A

Can wake a person from sleep with the same sensation experienced during exertion

69
Q

atypical angina

A

Abnormal SxS with physical or emotional exertion (toothache or earache)
Subsides with rest or nitroglycerin

70
Q

angina s/sx

A

Gripping, vise-like feeling of pain or pressure behind the sternum
Pain that may radiate to the neck, jaw, back, shoulder, or arms (most often the left arm in men)
Toothache
Burning indigestion
Dyspnea; exercise intolerance
Nausea
Belching

71
Q

heartburn s/sx

A

Frequent use of antacids to relieve symptoms
Heartburn wakes the client up at night
Acidic or bitter taste in the mouth
Burning sensation in the chest
Discomfort after eating spicy foods
Abdominal bloating and gas
Dysphagia

72
Q

signs of cardiac arrest

A

Sudden loss of responsiveness (no response to gentle shaking)
No normal breathing (patient doesn’t take a normal breath when observed for several seconds)
No signs of circulation
No movement or coughing

73
Q

myocardial infarction S/sx

A

Prolonged or severe substernal chest pain or squeezing pressure
Pain radiating down one or both arms and/or up to the throat, neck, back, jaw, shoulders, or arms
Nausea or indigestion
Angina >/= 30 min
Angina unrelieved by rest, nitroglycerin, or antacids
Pain of infarct unrelieved by rest or position change
Nausea
Sudden dimness or loss of vision or speech
Pallor
Diaphoresis
SOB
Weakness, numbness, and feelings of faintness

74
Q

pericarditis

A

inflammation of the pericardium

if fluid accumulates in the pericardial sac, it may prevent the heart from expanding

75
Q

pericarditis s/sx

A

Substernal pain
Dysphagia
Pain relieved by:
Leaning forward or sitting upright
Holding the breath
Pain aggravated by:
Movement associated with deep breathing
Trunk movements
Lying down
Fever, chills, weakness
Cough
Lower extremity edema

76
Q

right ventricular failure s/sx

A

Increased fatigue
Dependent edema (usually beginning in the ankles)
Pitting edema
Edema in the sacral area or the back of the thighs
Right upper quadrant pain
Cyanosis of nail beds

77
Q

left ventricular failure s/sx

A

Fatigue and dyspnea after mild physical exertion or exercise
Persistent spasmodic cough, especially when lying down, when fluid moves from the extremities to the lungs
Paroxysmal nocturnal dyspnea
Orthopnea
Tachycardia
Fatigue and muscle weakness
Edema and weight gain
Irritability/restlessness
Decreased renal function or frequent urination at night

78
Q

diastolic heart failure s/sx

A

Fatigue and dyspnea after mild physical exertion or exercise
Orthopnea
Edema and weight gain
Jugular vein distention

79
Q

risk factors of aneurysm

A

Hx smoking
Known congenital heart disease
Sx to repair/ replace aortic valve before age of 70 years
Recent infection
Atherosclerosis
Predisposing genetic conditions
Active older adults

80
Q

ruptured aneurysm s/sx

A

Sudden, severe chest pain with a tearing sensation
Pain may extend to the neck, shoulders, between the scapulae, low back, or abdomen
Pain is not relieved by a change in position
Pain may be described as “tearing” or “ripping”
Pulsating abdominal mass
Other signs: cold, pulseless lower extremities, BP changes (more than 10 mm Hg difference in diastolic BP between arms; systolic BP less than 100 mm Hg)
Pulse rate more than 100 bpm
Ecchymoses in the flank and perianal area
Light-headedness and nausea

81
Q
A

Differential Dx (2 decks)

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