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Clinical Applications I > Focused Histories of Common Complaints > Flashcards

Focused Histories of Common Complaints Flashcards

1
Q

If someone presents with chest pain, what cardiovascular ddx should be considered?

A

TAA
Paricarditis
MVP
Ischemic: ACS, AS, SV, Hypertensive emergency, anemia

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2
Q

If someone presents with chest pain, what pulmonary ddx should be considered?

A

PE
Pneumothorax
PNA
Pleuritis

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3
Q

If someone presents with chest pain, what GI ddx should be considered?

A

Esophogeal spasm
PUD
Pancreatitis

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4
Q

If someone presents with chest pain, what MSK ddx should be considered?

A

Costochondritis
Zoster
Sternoclavicular arthritis

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5
Q

If someone presents with chest pain, what psychogenic ddx should be considered?

A

Anxiety disorders
Depression
Somatiform

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6
Q

What are the red flags of chest pain?

A

Diffuse retro sternal pressure

Radiation to arms or jaw

Associated diaphoresis, SOB, nausea, syncope

Lasting longer than several minutes

Occurring with exertion

Pleuritic pain with SOB, tachycardia
-Suggests PE (especially with risk factors)

Severe tearing or ripping pain, neuro sxs
-Suggest TAA

Sharp pleuritic with relief leaning forward
-Suggestive of pericarditis

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7
Q

What must you do if someone presents with chest pain?

A

Determine serious from less serious.

Know pre-test probabilities for various etiologies.

Question patient with specific questions to narrow the ddx (LOCATES and PMH).

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8
Q

What are the red flags of chest pain?

A

Diffuse retro sternal pressure.

Radiation into arms or jaw.

Associated diaphoresis, SOB, nausea, syncope.

Lasting longer than several minutes.

Occuring with exertion.

Pleuritic pain with SOB, tachycardia (suggests PE especially with risk factors).

Severe tearing or ripping pain, neurological symptoms (suggests TAA).

Sharp pleuritic pain with relief when leaning forward (suggestive of pericarditis).

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9
Q

What factors lead away from a serious cardiogenic cause?

A

Very brief localized pain.

Positional pain.

Pleuritic pain - no risk factors for PE.

Radiation below umbilicus.

Reproducible by palpation (MSK).

Association with eating.

No additional CP symptoms.

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10
Q

What type of questions should be used for someone presenting with chest pain?

A

Questions that drive the pre-test probabilities of suspected causes

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11
Q

What are the red flags of headache?

A 
SNOOP
Systemic symptoms (constitutional symptoms - fever, wt loss)

Systemic disease (HIV, malignancy)

Neurologic signs

Onset sudden

Over 40

Previous HA – this worse, different, first

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12
Q

What are the primary ddx for headache?

A

Tension
Migraine
Cluster headache

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13
Q

What are the secondary ddx for headache?

A 
Viral HA
Medications
TMJ
Sinusitis
Cervicogenic
Glaucoma
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14
Q

What are the serious ddx for headache according to the American Headache Society?

A

Subarachnoid hemorrhage

Brain tumor or abscess

Meningitis

Carbon monoxide (CO) poisoning

Trauma

Stroke

Hypertensive emergency > encephalitis

Epidural or subdural hemorrhage

Pseudotumor cerebri

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15
Q

What are some historical red flags?

A

Visual loss, ataxia, aphasia, hemiparesis

Confusion

Seizures

Previous neurosurgery

Thunder clap

“Worst headache of life!”

Progressive over months

Awakening from sleep

Neck stiffness

Onset with exertion or cough - subarachnoid

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16
Q

The longer a headache the more likely it is to be _____.

A

benign

17
Q

What does a characteristic “aura” preceding the headache make more probable?

A

migraine

18
Q

Does a new headache raise concern?

A

yes

19
Q

What should one consider if a headache is instantaneous and severe?

A

SAH

20
Q

What does a headache lasting 1-4 days over an eye indicate?

A

cluster headache

21
Q

What does a “band” like tightness indicate in a headache?

A

tension headache

22
Q

What doe piercing or sharp headaches indicate?

A

cluster headaches or trigeminal neuralgia

23
Q

What does a headache increasing in severity over weeks indicate?

A

tumor

24
Q

What should be performed at minimum in someone who presents with chest pain?

A

ECG

25
Q

What should be done for patients at high risk presenting with chest pain?

A

admit

stress testing

angio

test biomarkers

26
Q

What should be done for patients at medium risk presenting with chest pain?

A

observation

biomarkers

27
Q

What should be done for patients at low risk presenting with chest pain?

A

single set of biomarkers, f/u

28
Q

What are the red flags of low back pain?

A

Urinary retention

Saddle anesthesia

Constitutional symptoms (fever) with or without evidence of primary infection (skin, GI, GU)

Age over 50

History of cancer or immunosuppression

Motor weakness

Lack of distal pulses

History or IVDU or invasive lines

Late: loss of bowel control

29
Q

Who will experience low back pain?

A

70% of people

30
Q

True or False: Low back pain is an uncommon reason for someone to visit PCP.

A

False - Low back pain is a very common reason to visit PCP.

31
Q

What can the presence of red flags with low back pain indicate?

A

Cauda equina syndrome

Tumor (primary or metastatic)

Epidural abscess / Osteomyelitis

Myelopathy

AAA

32
Q

What does low back pain without red flags indicate?

A

Spinal stenosis

Lumbosacral strain/sprain

Ankylosing spondylitis

Abdominal pathology (pancreatitis, gallbladder)

Herniated disk

Degenerative disk disease

33
Q

How do you compile a ddx in abdominal pain?

A

Use location of the pain and the symptoms to decide what organs are in that vicinity.

34
Q

What are the important questions to ask for abdominal pain?

A

L – where is it (quadrant)

O – other symptoms (nausea, vomiting, blood, other systems)

C – crampy, burning, tearing

Aggravating Factors – eating, lying, movement

T – continuous, intermittent, progressive

E – recent surgery, antibiotics, STD, pregnancy

S – worse at onset, worse and now better

35
Q

What are the red flags of dyspnea?

A

Edema

Hemoptysis

Anemia

36
Q

What is the severe ddx for testicular pain in a young male?

A

Testicular torsion

37
Q

What does syncope with loss of bowel and bladder control indicate?

A

Seizure

38
Q

What does syncope with exertion indicate?

A

Cardiogenic causes

Clinical Applications I (7 decks)

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