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Primary Care > Lecture 1C (differential diagnosis) > Flashcards

Lecture 1C (differential diagnosis) Flashcards

1
Q

after making sure patient is appropriate for PT, review:

  • ALL medical hx
  • history / pt interveiw
  • _____ ______
  • relevant med hx
  • review of systems
  • physical exam (vitals, anthropometric measures, scanning exams, systems/structures review)
A

functional limitations

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2
Q

sequence your exam in such a manner to allow for

A

efficient data collection
effective clinical decision

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3
Q

patient history: subjective data can help determine the following about pt’s condition
(SINSS)

A

SINSS
S- severity
I- irritability
N- nature
S- stage
S- stability

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4
Q

_____ describes PT assessment of intensity of pt’s symptoms as they relate to functional activity

  • the higher this is, the less function
A

severity

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5
Q

_____ ease with which symptoms can be provoked or stirred up

A

irritability

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6
Q

if the PT is asking these questions, they are examining patient’s irritability

A
  1. amount of activity needed to trigger pt’s symptoms
  2. severity of symptoms provoked
  3. what activity and amt before pt’s symptoms subside
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7
Q

______ describes clinician’s assessment of stage in which pt is presenting (acute-subacute, chronic) may be obtained from past/present hx

A

stage of pathology

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8
Q

acute stage
sub-acute
chronic

A

3-7 days
7+ days
3 months

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9
Q

____ describes progression of symptoms overtime

A

stability

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10
Q

if the clinician asks these questions, they are examining nature of complaint

A
  1. Hypotheses of structures responsible for producing pt’s pain
  2. Anything about the problem that may warrant caution w/ physical exam
  3. Character of presenting pt or problem (i.e. psychological, personality, ethnicity, SES factors
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11
Q

how should you start off with subjective data collection?

A

start w open-ended questions
then use close-ended questions to follow up as needed.

let pt tell you their story! but make sure you receive the info you need for exam/decision making

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12
Q

potential red flags

A
  • trauma (possible fx)
  • age (↑50 risk of cancer, AAA, fx, infection)
  • hx cancer (↑ metastasize)
  • fever, chill, night sweat (↑ fever/cancer)
  • unexplained weight loss/gain (↑cancer/infection)
  • recent infection (↑ infection)
  • immunosuppresssion (↑ infection)
  • rest/night pain (↑ cancer, AAA, infection)
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13
Q

what is the weight loss red flag?

A

loss of greater or equal to 10 Ibs in 3 months w/o explanation (indicates cancer or infection)

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14
Q

saddle anesthesia
- absence of sensation in ____ - ____ sacral nerve roots, perineal region
- what red flag is the rationale?

A

2-5
cauda equina

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15
Q

rationale of bowel and bladder dysfunction (dysuria, hematuria)

A

cauda equina or infection

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16
Q

rationale of LE neurological deficit

A

cauda equina syndrome

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17
Q

Patient centered interview model

  1. explore disease/diagnosis and effect on their lives
  2. understanding the whole person
  3. finding common ground regarding intervention and / or management
  4. advocating prevention and health promotion
  5. enhancing pt-provider relationship
  6. providing ______ expectations
A

realistic

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18
Q

based on pt’s health history, subjective interview, have a list of top _____ dx’s following subjective hx

A

top 3
then use physical exam to either prove or disprove top 3 dx

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19
Q

T/F referred pain is only non-mechanical

A

false- can be both mechanical and non-mechanical (and a patient may have both once)

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20
Q

cervical and L/R shoulder pain (including shoulder girdle region)

A
  • cardiopulmonary
  • gastrointestinal
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21
Q

thoracic spine pain

A
  • Cardiopulmonary
  • gastrointestinal
  • genitourinary (T-L junction)
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22
Q

lumbar-pelvic pain

A
  • GI
  • Urogenital
  • peripheral vascular
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23
Q

mid-humerus, femur to digits pain

A

peripheral vascular

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24
Q

inconsistent symptom pattern

A

psychologic
endocrine
neurologic
rheumatic
adverse drug reaction

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25
Q

MSK symptoms (treat)

A
  • pain fluctuates over 24 hr period
  • movement changes the pain
    (macro or microtrauma, loading vs unloading tissue)
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26
Q

non-MSK symptoms

A

referral patterns from ORGAN systems
- pain does NOT fluctuate w/ activity change or position
- dull, vague, ache pain
- insidious (no obvious MOI)

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27
Q

most common chief complaints pts seek PT treatment for

A

LBP, shoulder and knee pain

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28
Q

non-MSK pain comes on during/after

A

eating or urinating

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29
Q

unusual descriptors for MSK disorders: VASCULAR

A

throb, pound, pulsating

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30
Q

unusual descriptors for MSK disorders: NEURO

A

sharp
lancinating
shock
burn

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31
Q

unusual descriptors for MSK disorders: VISCERAL

A

aching, squeezing, gnawing, burning, cramping

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32
Q

better to refer in cases where S&S are

A

unclear

consider how the probability of a serious condition being present shifts as you gain new info from interview and physical exam

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33
Q

if you only find 1 red flag:

A

it does NOT automatically mean serious pathology / refer

  • build a case
  • look for patterns that are NON-MSK
  • investigate further!
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34
Q

patient with history of ____ and _____ may have cauda equina

A

spinal stenosis or DDD

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35
Q

cauda equina data obtained during physical exam

  • ______ retention or incontinence
  • _______ incontinence
  • _____ ______
  • Global or progressive weakness in (UE/LE)
  • Sensory deficits (i.e. dermatomal)
  • Ankle ___, toe ___ & ankle ___ weakness
A
  • urinary
  • fecal
  • Saddle anesthesia
  • LE only
  • ankle PF/DF and toe ext
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36
Q

back related tumor: data obtained during Hx

age?
history of ?
unexplained ____ ____
failure of conservative tx

A

> 50 y/o
cancer
weight loss

37
Q

back-related tumor: data obtained during physical exam

  • constant ____ not affected by position or activity
  • worse at _____
A
  • pain
  • night
38
Q

back-related infection: data during physical exam

  • deep, constant pain that (increase/decrease) with WB
  • fever, malaise, swelling
  • spine _____, accessory mobility may be limited
A
  • increased w WB
  • rigidity
39
Q

spinal fx: data during Hx

  • Hx of ___ (including minor falls or heavy lifts for osteoporotic or elderly pts)
  • Long-term _____ use
  • Age >__ yrs
A
  • trauma
  • steroid
  • 70
40
Q

spinal fx: data during physical exam

  • Exquisitely ______ w/ palpation over fx site
  • ↑’d pain w/ ______
  • Edema in local area
A
  • tender
  • WB
41
Q

pelvis, hip, thigh region red flags

A

colon cancer
pathologic fx’s in femoral neck
osteonecrosis of femora head (AVN)
legg-cave-perthes disease
slipped capital femoral epiphysis

42
Q

leg, knee, ankle, and foot regions red flags

A
  • peripheral arterial occlusive disease
  • DVT
  • compartment syndrome
  • septic arthritis
  • cellulitis
43
Q

4 p’s for compartment syndrome

A

pallor
pulseless
paresthesia
paresis

44
Q

compartment syndrome pain is intensified with

A

stretching of the involved muscles

45
Q

pericarditis patient Hx

A
  • autoimmune disease (SLE, RA)
  • hx of MI
  • hx renal failure, open heart surgery, radiation therapy
46
Q

both unstable and stable angina have history of___, with stable angina being more common in

A

CAD; males

47
Q

where does pericarditis pain refer? how is it relieved?

A

lateral neck and either shoulder
relieved by leaning forward

48
Q

where does PE pain refer?

A

chest, shoulder, upper abdominal pain

49
Q

pleuritic pain that may be referred to shoulders

A

pulmonary embolism
pericarditis
pneumonia

50
Q

describe the pain and region for cholecystitis

A

“colicky” pain in R upper abdominal quadrant w/ accompanying R scapular pain

51
Q

symptoms of ___ worsen with ingestion of fatty foods. symptoms don’t increase with activity or rest.

A

cholecystitis

52
Q

peptic ulcer regions

A

“dull or gnawing” pain in epigastric, mid-back or supraclavicular region

localized tenderness at R epigastrium

53
Q

how are peptic ulcer sypmtoms relieved

A

w/ food

54
Q

unique symptoms of peptic ulcer

A
  • constipation, bleeding, vomiting
  • tarry colored stools
  • coffee ground emesis
55
Q

unique pyelonephritis sign is tenderness over

A

costovertebral angle (Murphy’s sign)

56
Q

T/F nephrolithiasis is gradual pain to the back or flank pain

A

false (sudden sever back or flank pain)

57
Q

most common fx levels in the thoracic spine are

A

T11-L1

58
Q

thoracic spinal fracture evidence

A

LE neuro deficits
increased thoracic kyphosis (forward)

59
Q

meningitis patient hx

A

hx of recent bacterial or viral infection
hx of skull fx

60
Q

“worst HA of patient’s life”

A

subarachnoid hemorrhage

61
Q

positive slump sign indicates

A

meningitis

62
Q

sensor abnormality, GI signs, seizures, speech deficit, ataxia, altered mental status

A

brain tumor

63
Q

GI signs, fever, HA, photophobia, confusion, seizures, sleepiness

A

meningitis

64
Q

subarachnoid hemmorhage comes from a history of

A

smoking, ETOH abuse, and HTN

65
Q

data during physical exam for cervical ligamentous instability w possible cord compromise

A

long tract neurologic signs (esp if >1 extremity): dizziness, nystagmus, vertigo w head/neck mvmt, position, clonus, (+) babinski’s sign

66
Q

patient’s history of taking oral contraceptives,
or traumatic fall,
or RA/AS is a sign of this condition

A

cervical ligamentous instabilities w/ possible cord compromise

67
Q
  • a surgical hx of radical neck disection for tumor or cervical lymph node biopsy
  • hx of blow from hockey stick or lacrosse stick
  • penetrating injury like GSW and stab
  • direct blow or stretching of the nerve
A

spinal accessory nerve

68
Q

spinal accessory nerve shoulder exam

A
  • asymmetry of neck like / dropping of shoulder
  • inability to shrug the shoulder
  • lack of scapular stabilization
  • weak shoulder abduction
69
Q

a history of brachial neuritis or quadrilateral space syndrome

A

axillary nerve

70
Q

with axillary nerve entrapment, patient may not be able to perform?

A
  • shoulder abduction and flexion
  • and a lack of sensation of lateral aspect of upper arm
71
Q

serratus anterior weakness w/ scapular winging and a loss of scapulohumeral rhythm

A

long thoracic nerve

72
Q

this nerve is i.d. in players of many sports (tennis, volleyball, archery, golf, gymnastics, soccer, hockey, etc.)

A

long thoracic nerve

73
Q

the pain of this nerve is deep, poorly localized with pt Hx of scapula fx and involvement of the notch and blade of the scapula
Traction (pulled nerves) injury

A

suprascapular nerve

74
Q

suprascapular nerve is wasting of?

what shouler mvmt is lost w this nerve entrapped?

A

supraspinatus and infraspinaus

loss of shoulder abduction and ER

75
Q

apical lung tumor that occurs most commonly in men >50 w/ hx of smoking

A

pancoast’s tumor

76
Q

describe pancoast’s tumor progression

A

nagging-type pain in shoulder and along vertebral border of the scapula.
the pain later progresses to BURNING in nature, extending down the arm into ULNAR nerve distribution

77
Q

ALL spinal fx have this in common

A

extended steroid use

78
Q

pain in anatomic snuffbox

A

scaphoid fx

79
Q

decreased grip strength and decreased motion

A

lunate fx or dislocation

80
Q

movement into wrist extension is painful for this condition because MOI was FOOSH w/ wrist extension

A

distal radius (Colles’)

  • 40 y/o, osteoporosis, woman
81
Q

T/F FOOSH w/ pronated forearm is a radial head fracture

A

F (SUPINATED)

82
Q

patient presentation of a radial head fracture

A

can’t sup/pron forearm
elbow held against side with 70 deg flexion and slight supination

83
Q

hx of corticosteroid

A

osteonecrosis of fem head
long flexor tendon rupture

84
Q

PMH significant for RA, occlusive vascular disease, smoking, or use of beta blockers.

A

raynaud’s phenomenon

85
Q

raynaud’s phenomenon physical examination

A

hands or feet that blanch
go cynatoic
then turn red when exposed to COLD or emotional stress

numbness and tingling in hands and feet when they turn red

86
Q

hx of RA, corticosteroid use for chronic resp problems, and hx of trauma

A

long flexor tendon

87
Q

hypersensitivity with swollen or pitting edema and severe aching.
hx of truama or dislocation or surgery and when the patient takes anagesics, pain doesn’t respond

A

complex regional pain syndrome

88
Q

dorsal ulnar head subluxation after a FOOSH w/ forearm pronated

A

triangular fibrocartilaginous complex (TFCC tear)

Primary Care (6 decks)

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