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Differential Diagnosis > Lecture 02-Review Of Systems > Flashcards

Lecture 02-Review Of Systems Flashcards

1
Q

What are the steps of the diagnostic process?

A
  1. Identify the pt’s chief concern
  2. Identify barriers to communication
  3. Identify special concerns
  4. Create symptom timeline
  5. Create a diagnostic hypothesis list (remote + local pathology)
  6. Sort the list by epidemiology and specific case characteristics
  7. Ask specific Q’s to rule out specific conditions or pathological categories less likely
  8. Re-sort the list based on pt’s response to Q’s from step 7
  9. Perform tests to differentiate among the remaining diagnostic hypotheses
  10. Re-sort the diagnostic hypothesis list based on the pt’s response to specific tests
  11. Decide on a diagnostic impression
  12. Determine the appropriate pt disposition
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2
Q

The following describes which part of the subjective examination/diagnostic process?

  • series of checklists or questions of common symptoms relevant to major body symptoms
  • not intended to identify or rule out specific diseases
  • part of the subjective screening process (medical model for pre-examination screening)
A

The Review of Systems

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3
Q

What is the purpose fo the review of systems?

A
  • identify symptoms that may have been overlooked
  • identify symptoms related to a principle complaint
  • identify existing co-morbid conditions
  • identify occult disease
  • identify adverse drug reactions (ADR)
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4
Q

When should a PT complete a review of systems?

A
  • Pt’s medical history or health risk reveals several red flags
  • unable to determine that the source of the symptoms is mechanical
  • pt doesn’t respond appropriately to the developed POC
  • something changes during the course of the treatment making it appropriate
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5
Q

What is screened during a review of systems?

A
  • general health
  • cardiovascular system
  • pulmonary system
  • gastrointestinal system
  • genitourinary system
  • nervous system
  • integumentary
  • endocrine system
  • MSK
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6
Q

True or False: the general health screen should be completed the screen that is most often completed in clinical practice.

A

TRUE

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7
Q

When does fatigue become a red flag?

A

When

  • it interferes with the pt’s ability to carry out typical daily activities at home, work, social settings, school, or rehabilitation
  • it lasts for 2-4 wks or more
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8
Q

What is malaise and when does it become concerning?

A

Malaise = sense of uneasiness or general discomfort or an “out of sorts” feeling

  • you should ask the pt if the feeling of malaise occurred at/around the same time that the pain began OR does the pt feel it after aggravating movement/factors
  • malaise becomes concerning when there is no clear connection between it no the presenting problem
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9
Q

When does a fever become a red flag?

A
  • 99.5 F (37.5 C) > 2 wks without seeing MD

- 102 F (39 C)

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10
Q

When is weight loss/gain concerning?

A
  • if the pt has experienced unexplained weight loss/gain (5-10% of body weight) over the last 6 months
  • note; weight gain is associated with fluid retention (seen with CHF)
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11
Q

When does nausea and vomiting become a red flag?

A
  • if the physician is not aware
  • if symptoms have worsened since the pt’s last visit
  • if there is an unexplained cause
  • note; consider going back 6 months in the pt’s history to discuss incidences of nausea and/or vomiting
  • also note; headaches originating from the neurovascular system often involve nausea and vomiting while those originating from the MSK system typically do not
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12
Q

What can you ask a pt about concerning medications and experiencing dizziness/lightheadedness?

A

If the symptoms began within 4-6 wks of taking the medication(s).

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13
Q

Is a pt more likely to experience tunnel vision with lightheadedness or fatigue?

A

Fatigue

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14
Q

When does paresthesia and/or numbness become a red flag?

A

If the pt is experiencing

  • “Stocking-and-Glove” distribution
  • “Saddle” distribution
  • progressive deficits such as urinary problems (retention, incontinence) and bilateral extremity deficits or UE/LE combination
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15
Q

If a pt presents with changes in mentation, their examination should include assessment of:

A
  • level of consciousness (alertness)
  • attention (ability to focus)
  • memory (short-term vs long-term)
  • orientation (person, place, time)
  • thought process (logical and coherent)
  • judgement (evaluate alternatives and follow appropriate values while choosing a course)
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16
Q

What are the definitions of the following terms?

  • orthopnea
  • Trepopnea
  • platypnea
A
  • orthopnea = difficulty breathing when lying supine
  • Trepopnea = difficulty breathing when in side-lying on one side, but then relieved when lying on the other side
  • platypnea = difficulty when breathing upright

-note; platypnea is very rare and associated with some neurological diseases, S/P pneumonectomy

17
Q

What is syncope?

A

A sudden loss of consciousness (fainting)

18
Q

When is diaphoresis (excessive and unexplained seating) considered serious?

A

When accompanied by pain at the

  • chest
  • UE’s
  • Neck, jaw, and teeth
  • left shoulder
  • epigastium or mid-thoracic
19
Q

When is a cough considered to be “chronic”?

A
  • lf it’s duration is > 3 wks

- can be associated with asthma, pneumonia, heart failure, lung cancer

20
Q

What are some integumentary signs that can be assessed for as part of a screen of the cardiovascular system?

A
  • cold hands/feet (poor circulation)
  • open wounds (venous insufficiency, diabetes)
  • ski discoloration (venous insufficiency, diabetes, poor circulation)
  • hair loss

-note; having cold hands/feet + hair loss around the area + skin that is blue in color = concern, not just having cold hands/feet alone

21
Q

Who is most at risk of developing a thrombosis?

A

The most significant clinical risk factors for development of a thrombosis are age over 70 and previous thromboembolism.

22
Q

Where do DVTs most commonly occur in the body?

A

In the LEs

  • popliteal and thigh veins = proximal
  • tibial and calf veins = distal

-note; DVTs have the greatest occurrence in pt’s who have been recently immobilized, undergone surgery, and/or have had an MI

23
Q

What does TIM VaDeTuCoNE stand for?

A
  • Trauma
  • Inflammation
  • Metabolic
  • Vascular
  • Degenerative
  • Tumor
  • Congenital
  • Neurogenic/Psychogenic
24
Q

What are some things to assess for as part of a screen of the pulmonary system?

A
  • Dyspnea
  • Chronic cough
  • Wheezing/stridor
  • clubbing of the nails (often accompanies cyanosis)
  • edema (i.e., pulmonary hypertension)
25
Q

___ is the loss of coordinated local muscle control that affects swallowing.

___ is also know as indigestion (the body may be unable to digest fatty foods, etc.)

A
  • dysphasia: can be caused by MS, PD, stroke, etc.
  • Dyspepsia: often associated with food intolerance and can cause heartburn symptoms (fatty foods => Gall Bladder disease)
26
Q

With concern to the GI system, when is constipation considered a red flag?

A

When it occurs with a change in mental status or confusion.

27
Q

__ is urination at night at least 2-3 times, which is a common complaint in diabetes mellitus.
__ = can a a sign of infection/irritation.
___ can be caused by blockage (prostate) or can be a central cord sign (spastic bladder).

A
  • Frequency
  • Urgency
  • Retention
28
Q

The following problems concerning urination can be signs of what condition(s):

  1. dysuria (painful urination)
  2. reduced caliber or force of urination or difficulty initiating urine stream
  3. incontinence
  4. color (reddish or dark brown)
A
  1. Inflammation, infection, and/or distension
  2. Associated with obstructive disorders (enlarged prostate)
  3. Central cord sign, pelvic floor dysfunction
  4. Acute rhabdomyolysis, hydration
29
Q

The following are clinical signs that the ___ system is pathological:

  • muscle weakness and atrophy
  • fatigue
  • progressive joint degeneration
  • altered cardio respiratory function
  • changes in skin pigmentation
  • changes in body temperature
  • changes in reproductive function
  • mental changes
A

The endocrine system
-note; if the endocrine system is involved, if effects everything => changes in hormone levels will have a negative impact on homeostasis

30
Q

The following are signs of which thyroid condition:

  • multi-region joint or muscle pain
  • dry, scaly skin
  • brittle hair and nails
  • cold intolerance
  • paresthesia
  • hoarseness of voice
  • weight gain
  • fatigue
  • muscle weakness
A

Hypothyroidism

31
Q

The following are signs of which thyroid condition:

  • thin hair
  • exophtalamos (bulging eyes)
  • enlarged thyroid
  • tachycardia
  • weight loss
  • warm skin (sweaty palms)
  • hyperreflexia
A

Hyperthyroidism

32
Q

Generally, what is the difference between diabetes inspidus and diabetes mellitus?

A
  • Diabetes insipidus = irregular control of body fluids while diabetes mellitus = irregular control of blood sugars
  • recall; type 1 diabetes = pancreases produces little to no insulin while type 2 = pancreases provides little insulin or the body has developed insulin resistance

Differential Diagnosis (11 decks)

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