HEENT, Neuro, Musculoskeletal Diagnostic Reasoning Flashcards
Acute vesicular eruption caused by the varicella zoster virus
Herpes zoster (shingles)
Identification of herpes zoster
Vesicular morphology
Grouped configuration
Dermatomal distribution
Subjective findings of herpes
Regional neuralgia and discomfort
Burning or intense pruritic
Malaise
Skin lesions that start as macules then develop into vesicles erupt and crust over
Objective findings of herpes zoster
Vesicular lesions ina dermatomal pattern
Regional lymphadenopathy
May becomes generalized in immunocompromised pts
The types of skin cancers :
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Comprises 80% of skin cancers
Grow slowly and rarely metastasize
Basal cell carcinoma
Comprises 16% of skin cancers
They can metastasize (3-7%) risk
Squamous cell carcinoma
Comprises 4% of skin cancers
Rapidly increasing in frequency and rapidly metastasizes
Melanoma
How to identify basal cell carcinoma
Papule or nodule morphology
Solitary configuration
Face or sun exposed skin
Subj findings of basal cell carcinoma
Non healing sore on face or sun exposed areas
Objective findings of basal cell carcinoma
Waxy “pearly” papule or nodule (or shiny red) with a central induration
Border of lesions appeared rolled
May be flat, hyperpigmented, and indistinct margins
Identification of squamous cell carcinoma
Nodule morphology
Solitary configuration
Face or sun exposed skin
Subjective findings of squamous cell carcinoma
Non healing lesion that continues to grow in size
Tenderness to lesion
History of actinic keratosis
Objective findings of squamous cell carcinoma
Warty appearance to lesion
Pink-colored plaque, nodule, or Papule with eroded surface
0.5-1.5 cm in size
ABCDE screening for Moles
Asymmetry
Border
Changes in color
Diameter
Elevation, enlargement, or evolution
Common or concerning symptoms of the head
Headache
History of head injury
Common or concerning symptoms of the eyes
Visual disturbances
Spots
Flashing lights
Use of corrective lenses
Pain
Redness
Excessive tearing
Diplopia
Common or concerning symptoms of the ears
Hearing loss
Tinnitus
Vertigo
Pain
Discharge
Common or concerning symptoms of the nose
Drainage
Congestion
Sneezing
Nose bleeds
Common or concerning symptoms of the oropharynx
Sore throat
Bleeding gums
Hoarseness
Common or concerning symptoms of the neck
Swollen glands
Goiter
Historical risk factors of sinusitis
Caused by S.pneumoniae
History of allergies, asthma, smoking
Subjective findings of sinusitis
Frontal headache
Malaise
Nasal discharge
Sore throat
Sinus ear pain:pressure
Congestion
Subjective fever
Objective findings of sinusitis
Sinus pain on palpitation
Fever
Inflamed nasal mucosa
Dull or inflamed TM
cervical lymphadenopathy
Nasal discharge
Suspicion for bacterial sinusitis
Purilent discharge
Facial pain
Anosmia
Symptoms lasting longer than 7-10 days
Maxillary tooth pain
Fever
Risk factors for acute otitis media
Commonly caused by strep pneumonia h.flu, or m.catarrhalis
Common in children
Preceded by viral illness
Subjective findings of AOM
unilateral ear pain
Recent URI symptoms
Diminished hearing acuity
Irritable
Subj fever
Obj findings of AOM
children pulling at ear
Dull, bulging , inflamed , obscured cone of light, diminished mobility of tympanic membrane
fever
Symptoms of bacterial conjunctivitis
Typically presents unilaterally and spreads manually
Burning or gritty
URI symptoms or none
Mucopurulent, viscous
Usually nonpalpable preauricular lymph nodes
Symptoms of viral conjunctivitis
Typically unilateral and spreads quickly bilateral
Sensation of foreign body and/or gritty
URI s:s
Mucous-like discharge
Palpable preauricular lymph nodes
Symptoms of allergic conjunctivitis
Bilateral
No pain
Hx recurrent allergy symptoms
Water thin clear discharge
Nonpalpable preauricular lymph nodes
Risk factors of corneal abrasion
Trauma or foreign body to eye
History of dry eye
Subjective findings of corneal abrasion
Scratchy
Pain
Foreign body sensation
Severe photophobia
Excessive tearing
Visual disturbances
Objective findings of corneal abrasion
Redness with cilliary flush
Decreased visual acuity
Types of primary headaches
Tension
Migraine
Cluster
Causes of secondary headaches
Increased ICP
uncontrolled HTN
intracranial bleeding
Stroke
Malignancy
Risk factors for headaches
History of prior episodes
Exposure to triggers:
Stress
Sleep alterations
Food
Alcohol
Perfumes
Subjective findings for tension headaches
No fam history
Pressing, nonpulsatile
Wraps around the head
Duration of pain 30min-7 days
Subjective findings of migraine headache
Family history 70-90%
Pulsating quality
Unilateral
Pain duration 4-72 hours
Symptoms include N/V, photophobia or phonophobia
Subjective findings for cluster headaches
Fam history in 20%
Steady intense pain
Unilateral, intense pain behind eye
Duration 15min-3 hours
Pain onset 1 hour into sleep
S/s- lacrimation, conjunctival injection, congestion, ptosis
Subjective findings of migraines with aura
Feeling of dread or anxiety, fatigue, nervousness, excitement, GI, visual or olfactory alteration
Dysfunction of cerebral or brain stem dysfunction
Symptoms last >1 hour consider seizure
Consider diagnostic of headache is these s/s present (red flags)
Systemic symptoms or secondary headache risk factors
Neurological s/s
Onset - how it started
Onset- age
Previous headache history
Headache S(snoop) symptoms
Systemic symptoms :
Fever
Unexplained weight loss
Secondary headache risk factors
Malignancy
Pregnancy
HIV
anti coagulation
Hypertension
Traumatic injury
Alcoholism
Headache N (snoop) symptoms
Neuro symptoms:
New focal deficits
Nuchal rigidity
Uncontrolled HTN
papilledmea
Cranial nerve dysfunction
Abnormal motor dysfunction
Signs of stroke
Headache o (snoop) symptoms
Sudden abrupt or split second onset
Headache onset with exertion, sexual activity coughing or sneezing
Headache O (snoop) symptoms (age)
> 50
<5
Headache P (snoop) symptoms
Any change in previous headache presentation (increase frequency, severity, time without headache)
Change in clinical features of headache
(Prolonged aura, new systemic symptoms)
Historical risk factors of OA
Increase age
History of wear and tear to joints
History of joint injury
Effects hips, knees, hands, feet
Subjective findings of OA
Pain and stiffness in joints (asymmetrical)
Worsens with rest
Improved with moderate movement or activity
When to consider RA over OA
If complaint is symmetrical and or involves 3 or more metacarpophalangeal joints
Objective findings of OA
Bouchards nodes
Herbedens nodes
Joint effusion
Clicking on ROM
Historic risk factors of carpal tunnel syndrome
History of overuse or repetitive movements
Frequent computer use or painting
Subjective findings or carpal tunnel syndrome
Symptoms usually involve anterior wrist, first 3 digits, medial palm
Pain, paresthesia, weakness
Pain typically at night
Phalen’s sign
Pain, paresthesia, or numbness with wrists flexed for 60 seconds
Tinel’s sign
Pain, paresthesia, or numbness with tapping over the transverse carpal ligament
Examples of low back pain
Muscle, ligament, tendon strain
Discogenic disorders
Herniated disc
Apophyseal joint arthritis
Spinal stenosis
Spondylolysis
Scoliosis
Historical risk factors of mechanical low back pain
History of overuse and repetitive movements
New physical activity or unusual exertion
Subjective findings of mechanical low back pain
Pain in buttocks, back, thigh
Pain relieved when laying supine
Objective findings of mechanical back pain
Paravertebral spasms or tenderness
Scoliosis
Loss of natural lumbar lordosis
No neuro signs or radiculopatgy
Common or concerning symptoms of the skin hair and nails
Hair loss, rashes, moles, changes in nails
Health history, questions for the skin hair and nails
Have you noticed any changes in your skin or hair?
Have you noticed any moles that changed in size color shape or sensation?
Have you noticed any new moles?
