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Differential Diagnosis > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is diagnosis most often based on?

A

cluster of clinical findings

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2
Q

What is the heuristic process based on?

A

clinical experience of clinician

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3
Q

What does heuristic process use to make a diagnosis?

A

clusters of s/s

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4
Q

What may the heuristic process not pick up on or ignore?

A

rare serious medical disorders

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5
Q

What is grouped and tested with heuristic process?

A

most probable hypothesis

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6
Q

Can ruled based diagnosis use pattern recognition only?

A

no

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7
Q

What do algorithms screen for?

A

non-systemic vs systemic disease

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8
Q

What disorders or diseases are investigated in hypothetic deductive process?

A

most and least probable

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9
Q

What reasoning process is fastest and which is slower?

A

hypothetic deductive process is fastest; heuristic process is slower

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10
Q

What does hypothetic deductive reasoning search for?

A

pathognomonic (hallmark) sign of disease/disorder

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11
Q

When does naturalistic or event driven reasoning occur?

A

when clinical decision is made without a reliable or valid diagnosis

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12
Q

What does the clinician do during naturalistic or event driven process?

A

switches decision making from eval of diagnostic possibilities to an eval of possible courses of action or therapeutic trials

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13
Q

Which model do experienced clinicians use?

A

heuristic

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14
Q

Which model do less experienced clinicians use?

A

hypothetic deductive approach

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15
Q

How much of the information is acquired from the interview? How much comes from the physical exam?

A

70-80%; 10%

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16
Q

What is the diagnostic hypothesis based on?

A

PMH, RF, & s/s

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17
Q

What is the diagnostic hypothesis confirmed /c?

A

physical exam, lab, & imaging tests

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18
Q

What is the purpose of ROS?

A

ID health probs that have been overlooked during the pt chief presenting hx

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19
Q

What is ROS used in conjunction /c?

A

detailed medical/surgical hx

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20
Q

What does ROS screen for?

A
  • medical conditions yet to be diagnosed: responsible/not responsible for symptoms;
  • existing clinically stable/unstable medical conditions
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21
Q

What does hypothetic deductive model rule out?

A

rare serious medical conditions

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22
Q

What is the most important part of the clinical eval?

A

the interview process

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23
Q

What are systemic syptoms?

A

involve multiple systems;

  • hematologic (SCD)
  • endocrine (hyperthyroid)
  • immune (HIV)
  • metabolic (paget’s)
  • malignances /c metastasis
  • adverse drug reaction
  • neurological (GBS)
  • CV (CHF)
  • GU: renal failure
  • Hepatic: cirrohsis
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24
Q

What are non-systemic systems?

A

<2 systems;

  • GI (appendicitis)
  • GU (kidney stones)
  • Hepatic (abcess)
  • biliary (gall bladder dis)
  • CV (MI)
  • pulmonary (bronchitis)
  • non-mech MSK (bone infection, bone cancer)
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25
Q

Systemic reviews include what?

A

psych, endocrine, hematological, neurological, immune or metabolic, and adverse drug reaction

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26
Q

If a pt has consistent symptoms assoc /c local pn, ache or soreness; what is review based on?

A

hepatic & biliary, GI, GU, CV, pulmonary

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27
Q

What are constitutional symptoms?

A

fatigue, fever/chills, loss of weight 5-10% unexplained, nausea/vomitting, insomnia/irritability, syncope, general paresthesia/numbness/weakness, dyspnea, change in mental/cognitive abilities, bowel dysfunction, urination freq changes, and sexual dysfunction

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28
Q

If there is pn on C-spine, where is the ROS focused?

A

GI &GU
CV
pulmonary

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29
Q

If there is pn on T-spine, where is the ROS focused?

A

CV
GI
GU (T-L junction)

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30
Q

If there is pn on lumbar and SI joint, where is the ROS focused?

A

GI
GU
Perivascular

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31
Q

If there is pn on UE and LE, where is the ROS focused?

A

perivascular

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32
Q

What two things are less crucial for immediate management?

A

risk factor and PMH

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33
Q

WHat is important to confirm MS diagnosis?

A

pain/symptom behavior

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34
Q

What two things are important when choosing b/t medical referral and medical emeregency?

A

vital signs and current systemic/visceral s/s

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35
Q

What diseases may cause death or permanent loss if not managed quickly?

A

MI, cauda equina syndrome, SC compression

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36
Q

When referring for emergency, what is more important than RF and medical hx of disease?

A

present s/s of disease

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37
Q

When is medical hx useful when referring to emergency?

A

when pt has cluster of s/s matching medical hx; same goes for when risk factors matching s/s

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38
Q

What is considered abnormal vitals?

A
  • cardiac or respiratory arrest/distress
  • overdose and RR < 6
  • HTN >160/100
  • pale /c SBP at 70
  • weak/dizzy, HR <30
  • pt in distress
  • tachycardia /c hypovolemia (Shock index >.9, HR divided by SBP; normal .5-.8)
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39
Q

When do you refer out without PT intervention?

A
  • symptoms that cant be reproduced /c MS procedures
  • not getting better in 4 weeks
  • symptoms at any jt AND suspicion of systemic condition
  • symptoms on spine, shoulders, or hips concomitant /c NON systemic visceral probs
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40
Q

When can PT intervene and refer?

A
  • jt pn and suspicion of metabolic bone disease or inflam arthritis WITH constitutional symptoms
  • pt /c MS probs and additional dis/disorder that are NOT causing symptoms
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41
Q

What is the fitzpatrick scale?

A

numerical classification used for human skin color

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42
Q

What is type 1 skin?

A

always burns, never tans

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43
Q

What is type 2 skin?

A

usually burns, tans minimally

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44
Q

What is type 3 skin?

A

sometimes mild burns, tans uniformly

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45
Q

What is type 4 skin?

A

burns minimally, always tans well (light brown)

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46
Q

What is type 5 skin?

A

very rarely burns, tans easily (brown)

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47
Q

What is type 6 skin?

A

never burns, always tans

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48
Q

What races are most to least likely to acquire malignant melanoma?

A

Whites, hispanics, american indian/alaska native, asian, black

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49
Q

What is the most common skin cancer in the USA?

A

basal cell carcinoma

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50
Q

What is basal cell carcinoma?

A

slow growing surface epithelial tumor

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51
Q

Where does basal cell carcinoma originate?

A

undifferentiated basal cells in epidermis

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52
Q

Does basal cell carcinoma invade the blood or lymph vessels?

A

no; but causes local destruction

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53
Q

What are the most common causes of basal cell carcinoma?

A

prolonged and intermittent sun exposure

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54
Q

Is basal cell carcinoma malignant or benign?

A

benign

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55
Q

Explain the appearance of basal cell carcinoma

A

pearly or ivory, rolled edges, slightly elevated, small blood vessels on surface

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56
Q

If left untreated, what could basal cell carcinoma result in?

A

destruction of local tissues (bone or cartilage)

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57
Q

What is the second most common form of skin cancer in whites?

A

squamous cell carcinoma; may be in suti (confined) or invasive (infiltrates)

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58
Q

Where do most squamous cell carcinomas occur?

A

head and neck region; 80%

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59
Q

How can squamous cell carcinoma present?

A

flat red area, as an ulcer, cutaneous horn, indurated plaque, or nodule

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60
Q

What is the most dangerous form of skin cancer?

A

malignant melanoma

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61
Q

Which type of melanoma is the most common type?

A

superficial spreading melanoma; accounts for 75% of cutaneous melanomas

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62
Q

How does superficial spreading melanoma present?

A

brown or black, raised patch, irregular border, and variable pigmentation

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63
Q

Is it true that malignant melanoma is incurable?

A

No; 100% curable if detected early

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64
Q

Would it be accurate to say that malignant melanoma is associated more with duration of sunlight exposure?

A

no; more associated with intensity of sunlight exposure

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65
Q

What does ABCDE stand for?

A 
A- asymetry
B- border
C- color
D- diameter
E- evolution/elevation
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66
Q

Regarding asymetry, what type is suspicious?

A

unequal or asymmetric

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67
Q

When is the border of skin lesion thought to be more cancerous?

A

if its irregular or indistinct

68
Q

When is color suspicious?

A

when there is more than one

69
Q

At what diameter is a skin lesion suspicious?

A

> 6 mm

70
Q

Regarding elevation and evolution when should it become suspicious?

A

if the mole is elevated or raised; and if the progress is quick

71
Q

What are the major features (3) for referral of skin screens?

A

change in size
change in color
change in shape

72
Q

What are the minor features (4) for refferal of skin screens?

A

7 mm or more in any direction, inflammation, oozing, or bleeding

73
Q

If the pt scores 3 or more points on the 7 point screening scale when should he/she see a dermatologist?

A

within 2 weeks

74
Q

If the pt scores 1 or 2 points how long can he/she wait to see a dermatologist?

A

3 or 4 weeks

75
Q

What are the stipulations for immediate referral of skin lesions?

A

any of the major and minor PLUS;

  • abnormal vitals
  • constitutional symptoms
  • signs of metastases (lungs, brain, bone, lymph nodes, liver)
76
Q

What are screening tools for psych and behavioral disorders?

A
  • depression, anxiety, stress scales
  • geriatric depression scale
  • somatoform screening tool
  • personality disorders screening tools
  • Domestic violence scale
  • FAB questionnaire
  • Work APGAR
77
Q

What gender is depression most common in?

A

females; 2:1

78
Q

What are symptoms of depression?

A
  • inability to feel pleasure (anhedonia)
  • low self esteem/guilt/worry
  • sleep probs
  • appetite
  • weight changes
  • hopelessness
  • suicidality
  • fatigue
  • cognitive impairments
  • psychomotor retardation
79
Q

What are the top 3 disorders assoc. /c depression?

A
  1. stroke
  2. MI
  3. PD
80
Q

If depressive consequences are not treated, do you think PT intervention will be as effective?

A

no, outcome will be worse

81
Q

What is the best treatment for depression?

A

medication combined /c therapy

82
Q

What gender is more likely to suffer from anxiety?

A

females; 2x more likely

83
Q

What are the physical signs of anxiety?

A

high BP, increased HR, increased sweating, tremors

84
Q

What is fear and panic more associated /c?

A

anxiety

85
Q

What are the types of anxiety disorders?

A
  • PTSD
  • phobias (simple and social)
  • OCD
  • panic disorder
  • medically induced
  • substance induced
86
Q

What are symptoms of anxiety?

A

fear, sleep probs, uncontrollable thoughts, intrusive thoughts, flashbacks, avoidant behavior, ritualistic/compulsive behavior, mood changes

87
Q

What is the most common treatment for anxiety?

A

benzodiazepines

88
Q

What does DASS screen for?

A

depression, anxiety, stress

89
Q

If a pt scores > 7 in any of the DASS sub-scales, what must be done?

A

pt must be referred out

90
Q

What are somatoform disorders?

A

pt expresses emotional problems through physical symptoms; no mechanical s/s noted

91
Q

Patients with somatoform disorders will typically do what?

A

call in sick, “whine”, try to make PT feel incompetent

92
Q

What are the six types of somatoform disorders?

A
  1. somatization
  2. undifferentiated hypochondriac
  3. somatoform pain disorder
  4. body dysmorphic disorder (amputee)
  5. conversion disorder (rare)
93
Q

What are somatic pain disorders?

A

pt worries about pain constantly, this may delay appropriate care to psych disorders

94
Q

What is a dysmorphic disorder?

A

preoccupied /c a body part due to specific reason (burnt, scar, amputation, bone deformity)

95
Q

When screening for somatoform disorders, how many positive findings on the questionnaire result in referral to a psychologist?

A

3 or 4

96
Q

How many personality disorders are there?

A

12

97
Q

Personality disorder grouping

A
  • eccentric (no chronic pn or exaggeration of symptoms)
  • Dramatic (symptoms exaggerated)
  • anxious (excuses, “persistant pain”)
  • self defeating (dont keep appointments, DC)
98
Q

What gender attempts suicide more?

A

females; 3x more

99
Q

What gender completes suicide more?

A

males; 4x more

100
Q

What are s/s of skin disease?

A
  1. pruritis (itching)
  2. urticaria (hives)
  3. rash
  4. blisters (vesicle or bulla)
  5. xeroderma (excessive dry skin)
101
Q

What should you inspect for during a skin exam?

A

color, texture, turgor (elasticity), moisture, lesions, hair distribution, and warmth

102
Q

What could pallor mean when examining the skin?

A

iron def. anemia

103
Q

Yellow skin coloring could mean what?

A

jaundice, carotenemia, or hemolysis

104
Q

Red skin coloring could mean what?

A

erythroderma

105
Q

What is assoc. /c acute rheumatologic disease?

A

lupus erythematosus

106
Q

What is assoc. /c chronic rheumatologic disease?

A

discoid lesions

107
Q

What is systemic sclerosis?

A

diffuse CT disease that causes fibrosis of skin, jts, blood vessels, and internal organs

108
Q

What is the first manifestation of systemic sclerosis?

A

raynaud phenomenon

109
Q

What is the common areas pt /c lyme disease will present /c pain?

A

knee or shoulder most common

110
Q

What does herpes zoster (shingles) mimic?

A

radiculopathy in t spine

111
Q

Iron deficiency anemia is caused by what?

A
  • blood loss (only RBC’s)

- increased iron demand

112
Q

Anemia caused by inflammatory response is caused by what?

A
  • chronic infection/disease
  • cancer
  • RA
  • Lupus
113
Q

Aplastic anemia results in what?

A

low RBC, WBC, and platelet count

114
Q

What are typical symptoms of aplastic anemia?

A

fatigue and bruising

115
Q

What causes renal insufficiency?

A

not having enough erythropoieten

116
Q

What causes megaloblastic anemia?

A

lack of B12 or folate

117
Q

What are s/s of mild/slow anemia?

A

fatigue, SOB, palpitations

118
Q

What are s/s of severe/rapid anemia?

A
  • Hgb < 7.5 gm/dL

- at rest: SOB, palpitations, faint upon rising, pale (conjunctivae, mucous membranes, and nail beds), chest pn

119
Q

What is anemia based on?

A

blood tests (RBC shape/size, CBC, WBC, PT, PTT)

120
Q

Findings for megaloblastic anemia?

A
  • GI (smooth, red tender tongue; diarrhea)

- B12 (numbness in extremeties, unsteady gait, motor weakness, decreased vibration/position sense, dimentia)

121
Q

What is the first sign /c aplastic anemia?

A
  • bleeding is often first sign
122
Q

What are the 2 classifications of hemolytic anemia?

A

sickle cell anemia and thalassemias

123
Q

What causes hemolytic anemia?

A

increased rate of RBD destruction

124
Q

What causes sickle cell anemia?

A

synthesis of structurally abnormal hemoglobin

125
Q

What causes thalassemia?

A

decreased synthesis of structurally normal hemoglobin

126
Q

Which form of sickle cell anemia is “best”?

A

heterozygous form; 60% of Hgb is normal

127
Q

Which form of sickle cell anemia will result in an enlarged spleen and why?

A

homozygotes; due to excessive recycling of RBC and WBC

128
Q

What are symptoms of mild/minor thalassemia (heterozygotes)?

A

mild anemia or asymptomatic

129
Q

What are symptoms of major or beta (homozygotes) thalassemia?

A
  • mod-severe fatigue & weakness

- short life span

130
Q

What is normal Hgb count in men? Women?

A

13-17 mg/dL; 12-16 mg/dL

131
Q

What is polycythemia the result of?

A

increased Hgb and HCT count

132
Q

What is primary polycythemia?

A

disorder of bone marrow causing excessive proliferation of RBC; viscosity increases

133
Q

What is secondary polycythemia caused by?

A

increased erythropoietin

134
Q

What are physical findings for polycythemia?

A

large spleen, fulness and redness of face, high BP

135
Q

What is nadir? What is the pt at risk for?

A

lowest point white blood count reaches; at risk for acquiring infection

136
Q

Name some symptoms of platelet disorders.

A

multiple petechia (skin or gums), severe bruising, jt swelling, and hematomas

137
Q

What are the two types of hemophilia?

A

hereditary and acquired

138
Q

What would the clinical presentation of platelet disorders look like?

A

bleeding in superficial sites (skin, mucous membranes, gums, menstrual, GI)

139
Q

Describe the clinical presentation of clotting factor deficiencies

A

deep tissue bleeding (bleeding into mm, jt, and body cavities)

140
Q

For hemophilia to be diagnosed, what is considered to be normal and abnormal?

A

PT will be normal; PTT will be abnormal

141
Q

When hemophilia and MS problems are present, what is going to be the most common finding?

A

hemarthrosis

142
Q

Which tissue is the second most common site for bleeding /c hemophilia and MS problems?

A

muscle; capsular pattern will be present

143
Q

With mild hemophilia, what will the pt present with?

A

fatigue and jt bleeding

144
Q

With severe hemophilia, what will the pt present like?

A

vital signs will be affected

145
Q

What are CARDINAL symptoms of cardiac disease?

A
  • chest, neck, arm pn/discomfort
  • palpitations
  • dyspnea
  • paroxysmal nocturnal dyspnea
  • syncope
  • fatigue
  • cough
  • cyanosis
146
Q

What are most common symptoms of CV conditions?

A

edema and leg pain

147
Q

Where are symptoms of angina presented in women? Men?

A

women: more central
men: neck & arm

148
Q

What is angina in females associated with?

A

microvascular disease

149
Q

What is angina in males associated /c?

A

CAD

150
Q

What are the 3 types of angina?

A

stable (classic/effort), unstable (crescendo), and variant (prinzmetal)

151
Q

What is angina described as?

A

pressure, squeezing, or tightness in chest

152
Q

What may occur /c angina?

A

SOB, weakness, light-headedness, and sweating

153
Q

What is the most notable symptom of MI?

A

sudden sensation of pressure (crushing)

154
Q

Where could MI pain radiate?

A

arms, throat, neck, and back

155
Q

What symptoms accompany MI?

A

pain (30 min - hours), pallor, SOB, profuse sweating

156
Q

What is orthopnea?

A

breathlessness during recumbency

157
Q

How is orthopnea relieved?

A

sitting upright

158
Q

What causes cardiac syncope?

A

reduced oxygen to brain

159
Q

What causes vasovagal syncope?

A

strong parasympathetic response leading to vasodilation

160
Q

What are statins used for?

A

lowering cholesterol in pt /c CAD

161
Q

What is the most common myotoxic event assoc. /c statins?

A

myalgia

162
Q

What is rhabdomyolysis?

A

assoc. /c impaired renal and liver function

163
Q

What are side effects of statins?

A
  • myalgia
  • mm aches/pn
  • unexplained fever
  • nausea
  • vomiting and dark urine
  • rhabdomyolysis
  • symptomatic myopathy
164
Q

What is symptomatic myopathy?

A

mm soreness, pn, weakness, dyspnea

165
Q

What is myositis?

A

elevated CK level

166
Q

S/S of liver impairment?

A
  • dark urine
  • asterixis (liver flap)
  • bilateral CTS
  • palmar erythema (liver palms)
  • spider angiomas
  • nail bed changes
  • ascites

Differential Diagnosis (1 decks)

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