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Differential Diagnosis > Exam II > Flashcards

Exam II Flashcards

1
Q

what are the 3 most common primary headaches?

A

(1) migraine
(2) tension-type
(3) cluster headaches

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2
Q

what are the two types of migraines?

A

(1) with aura

(2) without aura

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3
Q

what demographics are migraines most common in? (3)

A

(1) females (3x more than males)
(2) 20-40 y/o
(3) hereditary (typically)

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4
Q

when a person is having a migraine are they able to work and function normally?

A

no; it’s a debilitating throbbing and intense pain

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5
Q

do migraines typically present unilaterally or bilaterally?

A

unilaterally (70% of cases)

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6
Q

what type of medications typically relieve migraine paine?

A

vasoconstrictors

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7
Q

how long do migraine headaches typically last?

A

4-72 hours

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8
Q

does physical activity or exercise make migraines better or worse?

A

worse

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9
Q

what are a couple common symptoms of migraine headaches?

A

(1) nausea or vomitting

(2) photophobia or phonophobia

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10
Q

what is the clinical prediction rule for migraines? what are the likelihood ratios?

A

(1) pulsating
(2) lasts 4-72 hours
(3) unilateral
(4) nausea
(5) headache prohibitive (can’t perform ADLs)
4/5 = likelihood 24
3/5 = likelihood 3.5

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11
Q

what is aura? what are the symptoms associated with aura? (6)

A

neurological s/s that precede a migraine

1) visual / auditory (most common
(2) sensory
(3) speech / language
(4) motor
(5) brainstem
(6) retinal

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12
Q

how long does an aura typically last? what if the s/s of an aura last longer than the expected time?

A

5-20 minutes, 60 minutes MAX; any longer is a red flag for a referral to the emergency room (CN damage)

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13
Q

what are the four stages of a migraine?

A

(1) prodome: symptoms that precede migraines (hours or a day before)
(2) aura: CNS disturbances
(3) attack
(4) postdome: exhaustion, drowsiness, light headedness

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14
Q

what can trigger a migraine?

A

(1) hormones (most common 30% of all cases)
(2) stress
(3) neck pain (10% of all cases)
(4) food / alcohol (red wine, cheese, processed meat, etc.)
(5) missing meals
(6) medications that cause vasodilation
(7) not getting enough sleep / fatigue

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15
Q

what is the most common type of primary headache?

A

tension-type headache

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16
Q

what are the 3 types of tension type headaches? how are they distinguished from one another?

A

(1) episodic (<12 per year)
(2) frequent (>12 per year)
(3) chronic (>= 180 per year)

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17
Q

do tension type headaches typically present unilaterally or bilaterally? are the prohibitive headaches?

A

bilaterally; typically not prohibitive (less intense than migraines; non-pulsating)

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18
Q

does physical activity or exercise aggravate tension type headaches?

A

no

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19
Q

what is commonly associated with tension type headaches?

A

pericranial tenderness (trigger points within the muscles of the head and neck)

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20
Q

where are the most common locations for trigger points seen in tension type headaches? (4)

A

(1) suboccipital muscles (65% of patients)
(2) upper traps
(3) SCOM
(4) temporalis muscles

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21
Q

what demographics are cluster head aches most common in? (3)

A

(1) males more than females

(2) 40 to 60 y/o

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22
Q

how do cluster headaches present?

A

(1) pulsating, burning pain

2) 1 to 4 times per day (15-180 minutes each

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23
Q

do cluster headaches typically present unilaterally or bilaterally?

A

unilaterally

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24
Q

what type of drugs help alleviate cluster headaches?

A

vasoconstrictors

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25
Q

what are some features of cluster headaches that aren’t typically observed with other primary headaches?

A

(1) facial sweating
(2) nasal congestion
(3) ptosis, miosis, lacrimination
(4) become agitated (as opposed to lying down like migraine headaches)

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26
Q

is an exercise headache considered primary or secondary? what causes this type of headache?

A

(1) primary

2) during physical exertion or exercise (not to be confused with HTN headache

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27
Q

is a cough headache considered primary or secondary? what causes this type of headache?

A

(1) primary

(2) brought on by coughing or the valsalva maneuver

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28
Q

is a sexual activity headache considered primary or secondary? what causes this type of headache?

A

(1) primary

2) caused by sexual activity, which is worse close to orgasm (not to be confused with exercise headache

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29
Q

what is the most common type of secondary headache?

A

cervicogenic headache

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30
Q

what are the signs and symptoms of a cervicogenic headache?

A

(1) headache precipitated by neck pain (MOST IMPORTANT)
(2) restricted neck ROM
(3) ipsilateral neck, shoulder, or arm pain in a vague non-radicular manner

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31
Q

do cervicogenic headaches typically present unilaterally or bilaterally?

A

unilaterally

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32
Q

what special test can be used to screen for cervicogenic headaches? how is the test administered?

A

flexion rotation test
(2) if rotation is reduced by 20% (10-15 degrees) on one side, with or without reproducing symptoms, it’s positive for cervicogenic headaches

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33
Q

how do headaches associated with TMJ disorders present? how are they treated?

A

(1) headaches will present with classic TMJ signs and symptoms
(2) management of eTMJ disorders

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34
Q

how do headaches with eye problems typically present?

A

(1) bilateral
(2) worse in afternoon
(3) non-prohibitive
(4) sensitivity to light and discomfort around eyes

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35
Q

what demographics do headaches associated with glaucoma typically affect?

A

(1) rare before age 40

(2) women more than men

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36
Q

if a patient presents with an acute headache associated with glaucoma, what should be done with this patient?

A

immediate medical referral

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37
Q

do headaches associated with glaucoma typically present unilaterally or bilaterally?

A

unilaterally

38
Q

what are some signs and symptoms associated with a headache secondary to brain neoplasm and high ICP?

A

(1) affects the whole head
(2) CN VI impairment is common
(3) visual deficits
(4) headache is worse with increased intra-cranial pressure (laying down, vasalva, bending head forward, etc.)
(5) langue, speech, mental, balance problems

39
Q

what are some signs and symptoms associated with a headache secondary to a brain aneurysm?

A

(1) thunderclap headache (unilateral)
(2) retro-orbital pain
(3) CN II and CN III dysfucntion

40
Q

what percentage of patients with an unruptured cerebral aneurysm present with headaches?

A

18%

41
Q

are headaches a common presentation with ischemic brain infarcts?

A

not commonly; hemorrhagic strokes are

42
Q

what percentage of ruptured cerebral aneurysms are fatal?

A

50% (the other 50% often end up being disabled)

43
Q

what demographics do headaches associated with temporal arteritis typically affect?

A

(1) >50 y/o

(2) males more than females

44
Q

why is temporal arteritis considered a medical emergency?

A

occlusion of blood flow can cause blindness or dementia

45
Q

what are some signs and symptoms associated with rhinosinusitis?

A

(1) pain between eyes that worsens with neck flexion
(2) relieved by taking sinus medications
(3) pain in upper teeth, jaw, ear
(4) may have inflamed lymph node

46
Q

how do headaches associated with meningitis and encephalitis present?

A

(1) bilaterally
(2) headache increases to extremely severe
(3) nausea / vomiting
(4) photophobia
(5) pain with neck flexion
(6) affects elderly, children, and depressed immune systems

47
Q

what headaches will vascoconstrictors improve their symptoms? (2)

A

(1) migraines

(2) cluster headaches

48
Q

what is the difference between primary and secondary cancer?

A

(1) primary: original site (organ or tissue) where malignant cells appeared
(2) secondary: site where metastasis occurred

49
Q

what are the stages of cancer?

A 
Stage 0: carcinoma (early form)
Stage 1: localized
Stage 2: early locally advanced
Stage 3: late locally advanced
Stage 4: Metastasized
50
Q

where does cancer fall on a list of top causes of death in the US?

A

2nd (22%)

51
Q

does cancer affect men or women more?

A

men (44%)

women (38%)

52
Q

what is the survival rate for cancer?

A

50% survival rate after 5 years

53
Q

what are the top 3 most prevalent cancers in males?

A

(1) prostate
(2) lungs
(3) colon / rectum

54
Q

what are the top 3 most prevalent cancers in females?

A

(1) breast
(2) lungs
(3) colon / rectum

55
Q

what type of cancer kills the most men and women?

A

lung

56
Q

what is one of the most important risk factors for cancer?

A

age >50

57
Q

what are common signs and symptoms associated with cancer?

A

(1) constitutional s/s (fever, weight loss, fatigue)

2) paraneoplastic syndrome (due to immune response to cancer

58
Q

what are the 7 early warning signs of cancer?

A

CAUTION

(1) Change in bladder or bowel habits
(2) A non-healing sore
(3) Unusual bleeding or discharge
(4) Thickening in breast or lymph node
(5) Indigestion (or dysphagia)
(6) Obvious changes in mole or wart
(7) Nagging cough

59
Q

what are some early signs of cancer that PTs should be aware of? (3)

A

(1) change in vital signs
(2) change in DTRs
(3) proximal muscle weakness

60
Q

what can be said about pain and cancer?

A

(1) pain is RARELY a warning sign of cancer; 60-80% of patients with cancer have pain AFTER diagnosis is made
(2) night pain that doesn’t change with motion or altered positions is a red flag

61
Q

what type of cancer has the highest mortality rate? why is this thought to occur?

A

(1) lung cancer

(2) lungs are the most common site for metastasis of all cancers

62
Q

after the lungs, what is the second most common site for cancer to metastasize to?

A

liver

63
Q

why does pancreatic cancer present much like liver cancer?

A

pancreatic cancer is often very silent, so signs and symptoms of cancer aren’t noticed until it has already metastasized to the liver

64
Q

what is one way to differentiate between liver and pancreatic cancer?

A

liver cancer will present with pain in the right UQ and right shoulder, while pancreatic cancer will present with pain in the left UQ and left shoulder

65
Q

after the lung and liver, what is the third most common site for cancer to metastasize to?

A

the musculoskeletal system

66
Q

what are the most common sites that tumors originate and metastasize to bone?

A

Lead Kettle (PbKTL)

(1) Prostate
(2) Breast
(3) Kidney
(4) Thyroid
(5) Lungs

67
Q

what percentage of patients die from MSK metastasis?

A

70%

68
Q

what are common manifestations of MSK cancer?

A

(1) 70% metastasize to the vertebrae
(2) proximal muscle weakness
(3) changes in DTRs
(4) cauda equina syndrome
(5) local bone tenderness
(6) flapping tremor

69
Q

what is the most common primary cancer that affects the spine?

A

multiple myeloma

70
Q

what is the clinical prediction rule for ruling out cancer of the lumbar spine (low back pain)?

A

100% sensitivity if 4/4 are negative

(1) age >50 y/o
(2) unexplained weight loss
(3) medical history of malignancy
(4) PT intervention doesn’t change symptoms within 4 weeks

71
Q

where in the brain does most cancer metastasize to?

A

cerebrum

72
Q

when are seizures are warning sign for cancer?

A

new seizure in patients older than 35 y/o

73
Q

what are classic signs of lymphoma?

A

lymph node enlargement; greater than the size of a pea, and often stuck to skin, bone, or muscle

74
Q

is leukemia more prevalent in adults or children?

A

children (accounts for 30% of all cancers in children)

75
Q

what are signs and symptoms of leukemia?

A

(1) anemia
(2) poor healing
(3) recurrent infections
(4) dyspnea
(5) abdominal and bone pain
(6) visible bruises

76
Q

what are the top 5 locations cancer metastasizes?

A

(1) lungs
(2) liver
(3) MS system
(4) CNS (brain)
(5) lymph nodes

77
Q

what demographics is multiple myeloma most prevalent in?

A

(1) 60-70 y/o
(2) african american
(3) males

78
Q

how does multiple myeloma present?

A

(1) constitutional s/s
(2) anemia and thrombocytopenia (similar to aplastic anemia)
(3) fracture of the spine
(4) recurrent infections

79
Q

what is the most common site of metastasis for prostate cancer?

A

bone

80
Q

what are early signs and symptoms of prostate cancer? (2)

A

(1) starting and stopping urine stream; decreased force

(2) blood in urine or semen

81
Q

what demographics is breast cancer most prevalent in?

A

(1) caucasian
(2) females
(3) 45-70 y/o

82
Q

what are ways to help prevent colorectal cancer or detect it early?

A

(1) colonoscopy

(2) tests for fecal blood

83
Q

what are early warning signs and symptoms of colorectal cancer

A

(1) rectal bleeding
(2) hemorrhoids
(3) LBP with radiation to LEs

84
Q

what are early warning signs of kidney cancer?

A

blood in the urine (or none at all)

85
Q

is thyroid cancer more prevalent in males or females?

A

3x more prevalent in females

86
Q

how does paraneoplastic syndrome typically present?

A

systemic presentation with constitutional signs and symptoms

87
Q

what condition is associated with endocrine paraneoplastic syndrome?

A

hypercalcemia

88
Q

how does hypercalcemia present? (there’s a mnemonic) (6)

A

(1) stones: kidney stones
(2) bones: bone pain and fx
(3) groans: GI
(4) thrones: polyuria, constipation
(5) overtones: headaches, lethargy, CNS
(6) marathones: CV system

89
Q

what are some symptoms associated with hyponatremia?

A

(1) decreased cognition
(2) HA
(3) nausea
(4) balance problems
(5) seizures

90
Q

what are signs that may point to a person having cancer? (8)

A

(1) age >50
(2) previous hx of Ca
(3) female with shoulder pain
(4) intense night pain
(5) DTR impairments
(6) intense pain relieved by aspirin
(7) symptoms don’t match injury or signs
(8) proximal weakness

91
Q

when is an immediate referral required for a patient with enlarged lymph nodes?

A

when a patient has a previous history of cancer

Differential Diagnosis (2 decks)

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