Exam 1: Week 2 Monday Flashcards
Some general follow up questions for differential diagnosis (10)
- Changes in Location?
- Intensity with certain movements or rest?
- Changes with posture?
- Constant or intermittent?
- Aggravating factors?
- Nighttime pain?
- Other possibilities?
- Alleviating factors?
- How Symptoms Developed? (insideous? Traumatic event? )
- Non-musculoskeletal activity (food intake and defecation)
Words used to describe visceral pain (9)
- Cramping
- Colicky (comes and goes without means of onset)
- Throbbing/aching
- Pressure
- Tightness
- Heaviness
- Weakness
- Severe/disabling
- Worst pain I have ever had
Words used to describe vascular disorders (3)
- Throbbing
- pounding
- pulsating
Words used to describe neurologic disorders (4)
- Sharp
- lancinating
- shocking
- burning
Words used to describe visceral disorders (5)
- Aching
- squeezing
- gnawing
- burning
- cramping
Red Flags: Cancer (6)
- Persistent pain at night
- Constant pain anywhere in body
- Unexplained weight loss
- Loss of appetite
- Unusual lumps/growths
- Unwarranted fatigue
Red Flags: Cardiovascular (8)
- SOB
- Dizziness
- Pain/heaviness in chest
- Pulsating pain anywhere in body
- Constant/severe pain in lower leg/arm
- Discolored or painful feet
- Swelling (no history of injury)
- Bilateral LE edema
Reds Flags: Gastrointestinal/Genitourinary (5)
- Frequent/severe abdominal pain
- Frequent heartburn or indigestion
- Frequent nausea or vomiting
- Changes/problems with bladder function (UTI etc).
- Unusual menstrual irregularities
Red Flags: Neurological (8)
- Changes in hearing
- Frequent or severe headaches with no history of injury
- Difficulty with swallowing/speech
- Changes in vision
- Problems with balance
- Fainting spells (drop attacks)
- Sudden weakness
- 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
What are the 5 Ds
- Dizziness
- Dysphagia
- Diplopia
- Dysarthria
- Drop attacks
Red Flags: Miscellaneous (4)
- Fever or night sweats
- Recent severe emotional disturbances
- Swelling/redness in any joint with no history of injury
- Pregnancy
Potential differential diagnosis for Back Pain (5)
- Back Related Tumor
- Abdominal aneurysm
- Back Related infection
- Cauda Equina Syndrome
- Spinal Fracture
Possible signs that might make you suspect a back related tumor (4)
- Age > 50
- Hx of Cancer
- Weight loss
- Failure of conservative care
Possible signs that might make you suspect an abdominal aneurysm (2)
- PVD,
- Symptoms not related to movement
Possible signs that might make you suspect a back related infection (3)
- Recent infection (UTI/skin)
- IV drugs
- immunosuppressive disorder
Possible signs that might make you suspect cauda equina (4-5)
- Bowel and Bladder
- Saddle paresthesia
- weakness
- myotomes/dermatomes
Possible signs that might make you suspect a spinal Fx (3)
- Trauma
- Age > 70
- Prolonged use of steroids
Should ask if pt. has been screened for osteoporosis
Potential differential diagnosis for pain in Pelvis, Hip, and Thigh Region (5)
- Colon Cancer
- Pathological fx of femoral neck
- Avascular necrosis
- Legg-Calve-Perthes disease
- Slipped Capital Femoral Ephysis
Possible signs that might make you suspect Colon Cancer (5)
- Age >50
- Rectal bleeding/black stool
- Weight loss
- Pain in pelvis, thigh, or hip unchanged by position
- Family Hx of colon cancer,
Possible signs that might make you suspect a Pathological fx of femoral neck (5-7)
- Age >70 (over 50 in book)
- Fall
- severe/constant pain
- Hx of metabolic disease (such as osteoporosis or Paget’s)
- Position of leg
- ER LE
- Affected LE typically shorter than uneffected
Possible signs that might make you suspect Avascular necrosis of Femoral Head (3)
- Long term corticosteroid use
- Trauma
- Sickle Cell disease
Possible signs that might make you suspect Legg-Calve-Perthes disease (3)
- typically boys ages 5-8
- pain with WB
- limited hip internal rotation and abduction
Possible signs that might make you suspect Slipped Capital Femoral Ephysis (4)
- typically adolescent males
- may also have knee pain
- overweight
- limited hip IR
Potential differential diagnosis for pain in LE (4)
- Peripheral arterial occlusive disease
- DVT
- Compartment Syndrome
- Septic Arthritis
Possible signs that might make you suspect Peripheral arterial occlusive disease (9)
- Age >60
- Type II DM
- Heart disease
- Smoker
- Sedentary
- Intermittent claudication
- Cool extremity
- Decreased pedal pulses
- Prolonged venous filling time
Possible signs that might make you suspect DVT (5)
- Recently immobilized
- Pain worse with moving/Less with elevation
- TTP
- Warm
- Swollen
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):
- Recent trauma/unaccustomed exericse
- 6 P’s
- Pulselessness (decreased pulses)
- Pallor
- Pain
- Paresthesia
- Paralysis
- Poikilothermia (one limb cooler than the other)