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Thompson class fall 2015 > Exam 1: Week 2 Monday > Flashcards

Exam 1: Week 2 Monday Flashcards

1
Q

Some general follow up questions for differential diagnosis (10)

A
  1. Changes in Location?
  2. Intensity with certain movements or rest?
  3. Changes with posture?
  4. Constant or intermittent?
  5. Aggravating factors?
  6. Nighttime pain?
  7. Other possibilities?
  8. Alleviating factors?
  9. How Symptoms Developed? (insideous? Traumatic event? )
  10. Non-musculoskeletal activity (food intake and defecation)
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2
Q

Words used to describe visceral pain (9)

A
  1. Cramping
  2. Colicky (comes and goes without means of onset)
  3. Throbbing/aching
  4. Pressure
  5. Tightness
  6. Heaviness
  7. Weakness
  8. Severe/disabling
  9. Worst pain I have ever had
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3
Q

Words used to describe vascular disorders (3)

A
  • Throbbing
  • pounding
  • pulsating
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4
Q

Words used to describe neurologic disorders (4)

A
  • Sharp
  • lancinating
  • shocking
  • burning
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5
Q

Words used to describe visceral disorders (5)

A
  1. Aching
  2. squeezing
  3. gnawing
  4. burning
  5. cramping
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6
Q

Red Flags: Cancer (6)

A
  1. Persistent pain at night
  2. Constant pain anywhere in body
  3. Unexplained weight loss
  4. Loss of appetite
  5. Unusual lumps/growths
  6. Unwarranted fatigue
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7
Q

Red Flags: Cardiovascular (8)

A
  1. SOB
  2. Dizziness
  3. Pain/heaviness in chest
  4. Pulsating pain anywhere in body
  5. Constant/severe pain in lower leg/arm
  6. Discolored or painful feet
  7. Swelling (no history of injury)
  8. Bilateral LE edema
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8
Q

Reds Flags: Gastrointestinal/Genitourinary (5)

A
  1. Frequent/severe abdominal pain
  2. Frequent heartburn or indigestion
  3. Frequent nausea or vomiting
  4. Changes/problems with bladder function (UTI etc).
  5. Unusual menstrual irregularities
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9
Q

Red Flags: Neurological (8)

A
  1. Changes in hearing
  2. Frequent or severe headaches with no history of injury
  3. Difficulty with swallowing/speech
  4. Changes in vision
  5. Problems with balance
  6. Fainting spells (drop attacks)
  7. Sudden weakness
  8. 5 Ds

Alternate way to remember:

  • The 5 Ds
    • Dysphagia (difficulty swallowing)
    • Dysarthria (dificulty speaking)
    • Drop Attacks
    • Dizziness (also problems with balance)
    • Diploplia (double vision –> problems with vision)
  • Changes in hearing
  • Frequent or severe headaches with no history of injury
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10
Q

What are the 5 Ds

A
  1. Dizziness
  2. Dysphagia
  3. Diplopia
  4. Dysarthria
  5. Drop attacks
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11
Q

Red Flags: Miscellaneous (4)

A
  • Fever or night sweats
  • Recent severe emotional disturbances
  • Swelling/redness in any joint with no history of injury
  • Pregnancy
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12
Q

Potential differential diagnosis for Back Pain (5)

A
  1. Back Related Tumor
  2. Abdominal aneurysm
  3. Back Related infection
  4. Cauda Equina Syndrome
  5. Spinal Fracture
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13
Q

Possible signs that might make you suspect a back related tumor (4)

A
  • Age > 50
  • Hx of Cancer
  • Weight loss
  • Failure of conservative care
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14
Q

Possible signs that might make you suspect an abdominal aneurysm (2)

A
  1. PVD,
  2. Symptoms not related to movement
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15
Q

Possible signs that might make you suspect a back related infection (3)

A
  • Recent infection (UTI/skin)
  • IV drugs
  • immunosuppressive disorder
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16
Q

Possible signs that might make you suspect cauda equina (4-5)

A
  • Bowel and Bladder
  • Saddle paresthesia
  • weakness
  • myotomes/dermatomes
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17
Q

Possible signs that might make you suspect a spinal Fx (3)

A
  • Trauma
  • Age > 70
  • Prolonged use of steroids

Should ask if pt. has been screened for osteoporosis

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18
Q

Potential differential diagnosis for pain in Pelvis, Hip, and Thigh Region (5)

A
  • Colon Cancer
  • Pathological fx of femoral neck
  • Avascular necrosis
  • Legg-Calve-Perthes disease
  • Slipped Capital Femoral Ephysis
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19
Q

Possible signs that might make you suspect Colon Cancer (5)

A
  • Age >50
  • Rectal bleeding/black stool
  • Weight loss
  • Pain in pelvis, thigh, or hip unchanged by position
  • Family Hx of colon cancer,
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20
Q

Possible signs that might make you suspect a Pathological fx of femoral neck (5-7)

A
  1. Age >70 (over 50 in book)
  2. Fall
  3. severe/constant pain
  4. Hx of metabolic disease (such as osteoporosis or Paget’s)
  5. Position of leg
    • ER LE
    • Affected LE typically shorter than uneffected
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21
Q

Possible signs that might make you suspect Avascular necrosis of Femoral Head (3)

A
  • Long term corticosteroid use
  • Trauma
  • Sickle Cell disease
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22
Q

Possible signs that might make you suspect Legg-Calve-Perthes disease (3)

A
  • typically boys ages 5-8
  • pain with WB
  • limited hip internal rotation and abduction
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23
Q

Possible signs that might make you suspect Slipped Capital Femoral Ephysis (4)

A
  • typically adolescent males
  • may also have knee pain
  • overweight
  • limited hip IR
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24
Q

Potential differential diagnosis for pain in LE (4)

A
  • Peripheral arterial occlusive disease
  • DVT
  • Compartment Syndrome
  • Septic Arthritis
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25
Possible signs that might make you suspect Peripheral arterial occlusive disease (9)
1. Age \>60 2. Type II DM 3. Heart disease 4. Smoker 5. Sedentary 6. Intermittent claudication 7. Cool extremity 8. Decreased pedal pulses 9. Prolonged venous filling time
26
Possible signs that might make you suspect DVT (5)
1. Recently immobilized 2. Pain worse with moving/Less with elevation 3. TTP 4. Warm 5. Swollen
27
Possible signs that might make you suspect Compartment Syndrome (4-7)
* Recent trauma/unaccustomed exercise * Paresthesias * Decreased pulses * 6 P's Alternate way to remember (spoiler for 6 Ps): 1. Recent trauma/unaccustomed exericse 2. 6 P's 1. Pulselessness (decreased pulses) 2. Pallor 3. Pain 4. Paresthesia 5. Paralysis 6. Poikilothermia (one limb cooler than the other)
28
Possible signs that might make you suspect Septic Arthritis (5)
1. Recent infection/ surgery/injection 2. Constant aching/throbbing pain 3. Tenderness 4. Warmth 5. Immunosuppressive disorder
29
If you suspect DVT, what tool should you use?
Wells criteria for DVT
30
What are the 6 Ps
1. Pain 2. Paresthesia 3. Pallor 4. Pulselessness 5. Paralysis 6. Poikilothermia (differing temperatures between the affected limb and the uninjured limb)
31
Potential differential diagnosis for pain in Head, Face, and TMJ (4)
* Vertebrobasilar Insufficiency (VBI) * Meningitis * Primary brain tumor * Subarachnoid Hemorrhage
32
Possible signs that might make you suspect Vertebrobasilar Insufficiency (VBI) (7)
1. Dizziness 2. Vertigo 3. Visual Disturbances 4. Headaches 5. Nausea 6. Loss of Consciousness 7. Apprehension with CAROM (cervical active range of motion)
33
Possible signs that might make you suspect Meningitis (7)
1. Positive slump sign 2. Headache 3. Fever 4. GI distress 5. Photophobia 6. Confusion 7. Seizures
34
Possible signs that might make you suspect a primary brain tumor (7)
1. Ataxia 2. Speech deficits 3. Headache (possibly neck pain) 4. Visual changes 5. GI distress 6. Altered mental status 7. Seizures
35
Possible signs that might make you suspect a Subarachnoid Hemorrhage (4)
* Severe headache-sudden onset * Brief loss of consciousness * Brain tumor signs * Meningeal irritation
36
Potential differential diagnosis for pain in C-Spine and shoulder (2)
* Myocardial Infarction * Pancoast tumor
37
Possible signs that might make you suspect a Myocardial Infarction (7)
1. Chest pain 2. pallor 3. nausea or palpitations 4. Presence of Risk Factors 5. Men age \> 40 6. Women age \> 50 7. Symptoms \> 30 min-not relieved by nitroglycerin
38
Possible signs that might make you suspect a Pancoast tumor (4)
* Men over 50 y/o with history of smoking * Nagging pain-shoulder and vertebral edge of scapula * Progresses to burning pain in ulnar nerve distribution * Insideous onset of pain
39
Potential differential diagnosis for pain in elbow, wrist, or hand (2)
Raynaud phenomenon/ disease Complex Regional Pain Syndrome
40
What is a pancoast tumor?
malignant tumor in upper apices of a lung; tumor grows in thoracic inlet pulmonary symptoms are rare can develop a burning pain down arm along ulnar distribution
41
Possible signs that might make you suspect Raynaud phenomenon/ disease (3)
* Hands/feet blanch, go cyanotic (blue), then red with cold or emotional distress * Pain in hands/feet with redness * PMH of RA, occlusive vascular disease, smoking, or use of beta-blockers
42
Possible signs that might make you suspect Complex Regional Pain Syndrome (6)
1. Trauma 2. Severe aching/stinging pain not typical of injury 3. Pitting edema 4. Erythema 5. Warm 6. Pain doesn’t respond to analgesics
43
Potential differential diagnosis for pain in thoracic spine and ribs (12)
1. myocardial infarction 2. Stable Angina Pectoris 3. Unstable Angina Pectoris 4. Pericarditis 5. Pleurisy 6. Pulmonary Embolus 7. Pneumonia 8. Pneumothorax 9. •Cholecystitis 10. peptic ulcer 11. •Pyelonephritis 12. •Nephrolithiasis (kidney stones)
44
Possible signs that might make you suspect Stable Angina Pectoris (2)
Chest pain with predictable level of exertion relieved by nitroglycerin \*should always bring nitro to clinic with them
45
Possible signs that might make you suspect Unstable Angina Pectoris (2)
Chest pain outside of predictable pattern not responsive to nitroglycerin
46
Possible signs that might make you suspect Pericarditis (3)
* Sharp stabbing pain-referred to lateral neck or shoulder * Increased pain with L sidelying * Relieved with forward leaning posture
47
Possible signs that might make you suspect Pleurisy (3)
* Sharp stabbing pain with inspiration * Dyspnea * History of respiratory disorder
48
Possible signs that might make you suspect a Pulmonary Embolus (3)
* Chest, Shoulder, or upper abdominal pain * Dyspnea * History of DVT risk factors
49
Possible signs that might make you suspect Pneumonia (7)
1. Pleuritic pain may be referred to shoulder 2. Fever 3. chills 4. HA 5. malaise 6. nausea 7. Productive cough
50
Possible signs that might make you suspect Pneumothorax (7)
1. Chest pain increased with inspiration 2. Difficult to expand rib cage 3. Recent coughing 4. strenuous exercise 5. trauma 6. Hyperresonance upon percussion 7. Decreased breath sounds
51
Organs in the Right upper quarter (5)
1. Liver 2. Gall bladder 3. duodenum 4. head of pancreas 5. hepatic flexure of colon
52
Organs in Left upper quarter (7)
1. Stomach 2. spleen 3. L lobe of liver 4. body of pancreas 5. L kidney 6. adrenal gland 7. splenic flexure of colon, part of transverse and descending colon
53
Organs of Right lower quarter (6)
1. Cecum 2. Appendix 3. Ascending colon 4. R ovary 5. R fallopian tube 6. R ureter
54
Organs of Left lower quarter (5)
1. Descending colon 2. sigmoid colon 3. L ovary 4. L fallopian tube 5. L uterine tube
55
Want to see a picture of the quaters?
56
Possible signs that might make you suspect Cholecystitis (4)
1. •Colicky pain in RUQ with 2. R scapular pain 3. •Worsen with ingestion of fatty foods 4. •No change with activity/rest
57
Possible signs that might make you suspect a peptic ulcer (4)
1. •Dull gnawing pain/burning in epigastrium, midback, or supraclavicular region 2. •TTP in R epigastrium 3. •Symptoms relieved with food 4. •Constipation, bleeding, vomiting
58
Possible signs that might make you suspect Pyelonephritis (3)
* UTI * Enlarged prostate * History of kidney stones
59
Possible signs you might susect Nephrolithiasis (5)
1. •Sudden, severe back or flank pain 2. •Chills, fever, nausea 3. •Renal colic 4. •Symptoms of UTI 5. •History of kidney stone
60
What is Nephrolithiasis?
kidney stones
61
Common causes of abdominal pain in upper right quarter (5)
1. Duodenal ulcer 2. Hepatitis 3. Hepatomegaly 4. Lower Lobe Pneumonia 5. Cholecystis (gall bladder)
62
Common causes of abdominal pain in lower right quarter (9)
1. Appendicitis 2. Salpingitis-Infection of uterine lining, 3. Ovarian cyst 4. Ruptured ectopic pregnancy 5. Renal/ureteral stone 6. Strangulated hernia 7. Diverticulitis 8. Regional ileitis 9. Perforated cecum
63
Common causes of abdominal pain in upper left quarter (5)
1. Ruptured Spleen 2. Gastric ulcer 3. Aortic aneurysm 4. Perforated colon 5. Lower lobe pneumonia
64
Common causes of abdominal pain in lower left quadrant (9)
1. Sigmoid diverticulitis 2. Salpingitis-Infection of uterine lining 3. Ovarian cyst 4. Ovarian abscess 5. Renal/ureteral stone 6. Strangulated hernia 7. Diverticulitis 8. Regional ileitis 9. Ulcerative Colitis
65
What is McBurney's Point and what is the associated condition?
Associated Condition: Appendicitis Description: Rebound tenderness in RLQ and sharp pain when palpated
66
What is Murphy sign and what is the associated condition?
Associated condition: Cholecystitis Description: Abrupt cessation of inspiration upon palpation of the gall bladder in RUQ
67
What is Romberg-Howship Sign and what is the associated condition?
Associated Condition: Strangulated obturator hernia Description: Pain down the medial aspect of thigh to the knees
68
What is Kehr Sign and what is the associated condition?
Associated condition: Spleen rupture, renal calculi, or ectopic pregnancy. Also blood in peritoneum (from case study in G&S) Description: Abdominal pain radiating to the L shoulder
69

Thompson class fall 2015 (12 decks)

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