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Differential > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Patients with visceral pain will have difficulty doing what?

A

finding a comfortable position
- deep aching, boring, gnawing, vague burning, or deep grinding

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2
Q

Patients with inflammatory pain will often do what?

A

see a quiet position w/o movement
- sitting/lying with knees bent or in a curled up/fetal position

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3
Q

What type of pain is steady, has a sudden onset, and is extremely intense? What causes it?

A

Ischemic pain
- secondary to vascular disease or from an obstruction causing strangulation of bowel tissue

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4
Q

pain from the _______ can be referred to the midback, and visa versa

A

esophagus

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5
Q

What may be altered in referred pain distribution

A

sensation

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6
Q

hyperesthesia

A

excessive sensibility to sensory stimuli of skin

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7
Q

hyperalgesia

A

excessive sensibility to painful stimuli of muscle

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8
Q

What organs refer to the shoulder?

A
  • liver
  • respiratory diaphragm
  • pericardium
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9
Q

What organs refer to the midback and scapular region?

A
  • gallbladder
  • stomach
  • pancreas
  • small intestine
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10
Q

What refers to the pelvis, flank, low back, or sacrum?

A
  • colon
  • sigmoid colon
  • appendix
  • rectum
  • ureters
  • testes
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11
Q

Dysfunction of the stomach, gallbladder, liver, pylorus, or respiratory diaphragm can cause what?

A

contraction, guarding, and splinting of the rectus abdominis and muscles superior to umbilicus

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12
Q

Dysfunction of the ileum, jejunum, appendix, cecum, colon, and rectum can cause what?

A

muscle spasm of the rectus abdominis inferior to the umbilicus

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13
Q

What are causes of dysphagia?

A

difficulty swallowing
- non-GI conditions (neuro diseases)
- achalasia - obstruction of muscles for peristalsis
- peptic esophagitis
- GERD
- Neoplasm
- certain antidepressants, antipsychotics, antihypertensive, and asthma drugs

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14
Q

What is odynophagia? What are potential causes?

A

pain during swallowing
- esophagitis
- esophageal spasm

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15
Q

GI bleeding manifest as ___________ pain with radiation to the RUQ

A

mid-thoracic back pain

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16
Q

signs of GI bleeding

A
  • coffee-ground emesis
  • bloody diarrhea
  • bright red blood
  • melena (blood in stool)
  • reddish colored stools
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17
Q

GI cancer pain S&S

A

more intense, boring, constant, unable to be relieved

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18
Q

Duodenal ulcer S&S

A

pain that could be relieved by eating

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19
Q

accompanying symptoms of arthralgia in GI disorders

A
  • fever
  • skin rash
  • nails separate from nail bed
  • conjuctivities
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20
Q

pancreatic cancer involving tail of pancreas refers to where?

A

Left shoulder

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21
Q

Kehr’s sign

A

L shoulder pain with pressure placed on the upper abdomen

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22
Q

Danforth sign

A

shoulder pain with inspiration

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23
Q

pancreatic cancer involving head of pancreas refers where?

A

Right shoulder

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24
Q

What GI issues refer to the right shoulder?

A
  • perforated duodenal or gastric ulcers that irritate diaphragm
  • pancreatic cancer involving head of pancreas
  • liver trauma
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25
Q

What GI issues refer to both shoulders?

A
  • ruptured ectopic pregnancy w/ retroperitoneal bleeding
  • accumulation of blood from a slow bleed
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26
Q

S&S of obturator or psoas abscess

A
  • hectic fever
  • night sweats
  • abdominal pain
  • back, pelvic, abdominal, hip, and/or knee pain
  • antalgic gait
  • palpable, tender mass
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27
Q

what does a + heel tap indicate?

A

obturator or psoas abscess

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28
Q

What is a red flag of a peptic ulcer?

A

new onset of shoulder/back pain for someone with a hx of peptic ulcers

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29
Q

S&S of peptic ulcer

A
  • heartburn
  • night pain
  • radiating back pain
  • R shoulder pain/lateral border of R scapula
  • blood stools
  • black, tarry stools
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30
Q

Gastric ulcer is ________ by food

A

aggravated

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31
Q

Duodenal ulcers is _______ by food

A

relieved

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32
Q

Diverticulosis vs Diverticulitis. Where is the pain for deverticulitis?

A

Diverticulosis - colon balloons out through weakened areas in the wall

Diverticulitis - infection and inflammation that accompany a microperforation of 1 of the diverticula
- left lower abdominal or pelvic pain/tenderness

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33
Q

Diverticulitis S&S

A
  • abdominal pain often with loss of appetite, nausea, abdominal bloating
  • Lower left quadrant pain ~70% of patients
  • lower right quadrant pain - asians
  • decreased or absent bowel sounds
  • bloody stools
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34
Q

Pinch-an-inch test + test

A

pain upon release of the skin fold
- indicates appendicitis

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35
Q

What is the most common cause of acute pancreatitis?

A

gall stones

Other causes:
- chronic alcoholism
- High triglyceride blood levels
- toxicity from some other agent

36
Q

What is the most common cause of chronic pancreatitis?

A

alcohol use and smoking

37
Q

acute pancreatitis S&S

A
  • epigastric pain radiating to the back
  • abdominal distention
  • fever and sweating
  • bluish discoloration of abdomen or flanks
  • jaundice
  • Colon’s sign - bruise formed on the abdomen around umbilicus
38
Q

chronic pancreatitis S&S

A
  • epigastric pain radiating to the back
  • upper left lumbar region pain
  • clay-colored or pale stools
39
Q

Who is most likely to have pancreatic cancer?

A

men in their 7th decade (60s)

40
Q

S&S of pancreatic cancer

A
  • epigastric pain radiating to the back
  • back pain may be the only symptom
  • jaundice
  • light-colored stool
41
Q

Aggravating and relieving factors of pancreatic pain

A

Aggravating
- walking and lying supine
- alcohol, large meals
- digestive activities

Relieving
- sitting and leaning forward

42
Q

Pain from head of pancreas refers to ______ shoulder

A

right

43
Q

Pain from tail of pancreas refers to the _____ shoulder

A

left

44
Q

ulcerative colitis affects _______

A

the colon

45
Q

Crohn’s disease affects _________

A

any portion of the intestine from the mouth to the anus

46
Q

Who is most likely to develop Crohn’s disease?

A
  • between 20-29 y/o
  • parental/sibling Hx of IBD
  • smokers
47
Q

Who is more likely to develop colorectal cancer, Crohn’s disease or ulcerative colitis?

A

ulcerative colitis

48
Q

Crohn’s disease and ulcerative colitis S&S

A
  • fever
  • abdominal pain
  • rectal bleeding
  • night sweats
  • decreased appetite
  • skin lesions
  • uveitis - eye redness and swelling in whites of the eye
  • migratory arthralgias
49
Q

What is uveitis?

A

eye redness and swelling in whites of the eye
- sign of Crohn’s disease and ulcerative colitis

50
Q

IBS typically affects who

A

females > males
</= 50 y/o

51
Q

risk factors for IBS

A
  • family hx of IBS
  • emotional stress, tension or anxiety
  • food intolerance
  • Hx of physical or sexual abuse
  • severe digestive tract infection
52
Q

Who is at an increased risk for colorectal cancer?

A
  • non-hispanic AA
  • native americans and native Alaskans
  • family Hx of colorectal cancer
  • prior Hx IBD
53
Q

S&S of early stage colorectal cancer

A
  • rectal bleeding, hemorrhoids
  • abdominal, pelvic, back, or sacral pain
  • back pain that radiates down the leg
  • changes in bowel patterns
54
Q

S&S of advanced stages of colorectal cancer

A
  • constipation progressing to obstipation
  • diarrhea with copious amounts of mucus
  • N&V
  • abdominal distention
  • weight loss
  • fatigue
55
Q

What skin changes occur with liver disorders?

A
  • jaundice
  • pruritus - itchy skin
  • bruising
  • spider angiomas - red branched dilations of the superficial capillaries
  • palmar/plantar erythema
  • White nails of Terry - white hue of nails with darker redness on the distal end of nails
56
Q

What is Leukonychia and Koilonychia?

A

Leukonychia - white discoloration of the nails

Koilonychia - soft nails that look scooped out

57
Q

What nailbed changes occur with liver disorders?

A
  • Leukonychia - white discoloration of the nails
  • clubbed nails
  • Koilonychia - soft nails that look scooped out
58
Q

What are the primary pain patterns for hepatic/bilary disorders?

A
  • mid-epigastrium or RUQ of the abdomen
59
Q

liver disease referred pain patterns

A
  • thoracic spine
  • right upper trapezius and shoulder
60
Q

gallbladder referred pain patterns

A
  • right upper trapezius and shoulder
  • right interscapular area
  • right subscapular area
61
Q

Neuro symptoms of liver disease

A
  • confusion
  • hyperractive reflexes
  • asterixis - liver flap in hands
  • peripheral nerve dysfunction
62
Q

What color will stool and urine be with liver disease?

A
  • light-colored (almost white) stools
  • during the color of tea or cola
63
Q

What is white nails of Terry? What does it indicate?

A
  • white hue of nails with darker redness on the distal ends of nails
  • indicates liver disease
64
Q

red flag of hepatitis

A
  • joint or muscle pain that is disproportionate to the physical findings
  • the presence of palmar tendinitis in someone with RA
  • positive risk factors for hepatitis
65
Q

risk factors for hepatitis

A
  • IV drug use
  • acupuncture
  • tattos/piercings
  • recent operation
  • liver transplant recipient
  • health care worker
  • unprotected sex
  • severe alcoholism
66
Q

S&S of hepatitis

A
  • extreme fatigue
  • fever
  • right upper abdominal pain
  • clay-colored stools
  • dark urine
  • jaundice
  • alteration in senses of taste and smell
  • low-grade fever
67
Q

S&S of HBV

A
  • jaundice
  • arthralgia
  • rash
  • fever
68
Q

What is considered chronic hepatitis?

A

Illness associated with prolonged (>6 months) inflammation of the liver

69
Q

S&S of chronic hepatitis

A
  • fatigue
  • jaundice
  • abdominal pain
  • anorexia
  • arthralgia
  • fever
  • ascites
70
Q

What is Wilson’s disease? What are symptoms that a patient may have?

A
  • biliary excretion of copper is impaired
  • may have mild to severe neurologic involvement
71
Q

What is hematochromatosis? What does it cause?

A
  • autosomal recessive defect of iron absorption
  • causes liver failure
72
Q

What joints are typically involved in hematochromatosis?

A
  • 2nd and 3rd (point and middle finger) MCP joints commonly involved first, then knees/hips/shoulders/low back
73
Q

What is the most common hepatotoxic agent?

A

acetaminophen

74
Q

S&S of drug-induced hepatitis

A
  • jaundice
  • dark urine
  • clay-colored stools
  • fever, rash, arthralgias, epigastric or RUQ pain
75
Q

S&S of cirrhosis

A
  • mild RUQ pain
  • GI symptoms
  • weight loss
  • ease of fatigue (w/ mild exertion)
  • fever
76
Q

integument S&S of cirrhosis

A
  • poor tissue turger
  • spider angiomas
  • palmar erythema
77
Q

S&S of portal HTN

A
  • ascitis
  • esophageal varices
  • hemorrhoids
  • splenomegaly
78
Q

S&S of hemorrhage associated w/ esophageal varices

A
  • pallor
  • tachycardia
  • cooling of the skin
  • hypotension
79
Q

What is kernicterus?

A

A type of brain damage from toxic levels of bilirubin in the blood

80
Q

What is the most common cause of a liver abscess?

A

biliary tract disease

81
Q

S&S of liver abscess

A
  • right abdominal pain
  • right shoulder pain
  • fever, chills, malaise
  • diaphoresis
  • anemia
  • tender liver
  • jaundice
82
Q

cholelithiasis risk factors

A
  • increased age
  • women > men before 60 y/o
  • elevated estrogen levels
  • obesity
  • DM
  • liver disease
  • rapid weight loss or fasting
  • statins
  • genetics/family hx
83
Q

symptom of biliary colic cholelithiasis

A

right upper abdominal pain that comes and goes in waves

84
Q

S&S of cholelithiasis

A
  • chills, low grade fever
  • jaundice
  • tenderness over the gallbladder
  • tenderness over 10th rib
  • RUQ and epigastrium severe pain
  • right shoulder and between the scapulae

chronic = pain may radiate to midback between the scapulae

85
Q

Primary Biliary Cirrhosis S&S

A
  • pruritus - itchy skin
  • dry eyes and mouth
  • jaundice
  • ascites
  • RUQ pain
  • osteoporosis
  • burning, pins and needles, prickling of the eyes

Differential (5 decks)

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