Lecture 1C Only By Alyssa Flashcards
- Age 50 yr
- hx cancer
- unexplained WL
- failure of conservative Tx
back related tumor
constant pain not affected by position
worse at night
back related tumor
recent infection
IV drug user
concurrent immunosuppressive disorder
back related infection (spinal osteomyelitis)
hx of spinal stenosis
history of DDD
cauda equina
deep constant pain that ups with weight bearing
fever, malaise, swelling
spine rigidity, accessory mobility may be limited
back related infection (osteomyelitis spinal)
Hx of trauma( minor falls heavy lifts osteoporotic or elderly)
70 + years
long-term steroid use
spinal Fx
exquisitely tender w palpation over fx site with increased pain with WB
edema in local area
spinal Fx
abnormal width of aortic or iliac arterial pulses
presence of a bruit in central epigastric area upon auscultation
abdominal aneurysm
age 50+
bowel disturbances
unexplained WL
Hx of colon cancer in immediate family
pain unchanged by position or movement
colon cancer
- older women (70+)
- hip, groin, or thigh pain
- Hx of fall from standing position
pathologic Fx in femoral neck
may have hypoactive or hyperactive bowel sounds from obstruction (later)
possible TTP of abdomen
ascites possible
metastases to liver, lung, bone, or brain
colon cancer
severe, constant pain in leg worse with movement
shortened and ER’d LE
pathologic fx in femoral neck
Hx of long-term corticosteroid use
RA, SLE, Asthma
Hx of osteonecrosis of contralateral hip
trauma
osteonecrosis of femoral head (aka AVN)
gradual onset of pain that may refer to groin, thigh, or medial knee that worsens with WB
stiff hip joint restricted (primarily in IR and Flex)
Osteonecrosis of the femoral head (AVN)
5-8 yr old boys w groin, thigh, pain
Legg-Calve-Perthes disease
antalgic gait pain complaints aggravated w hip movement, especially ABD and IR in young boys
Legg-Calve-Perthes disease
overweight adolescent
Hx of a recent growth spurt
SCFE
aching in groin exacerbated w WB
involved leg held in ER
ROM limitations in IR
SCFE
60+ yr
Hx of T2DM
Hx of ischemic heart diesase
smoking
sedentary lifestyle
concurrent intermittent claudication
peripheral arterial occlusive disease
unilat cool extremity (could be bi)
prolonged capillary refill time (2+ sec)
decreased pules
prolonged vascular filling time
ankle-brachial index (ABI) <.90
peripheral arterial occlusive disease
recent surgery, malignancy, pregnancy, trauma, or leg immobilization
DVT
calf pain, edema, tenderness, warmth
calf pain intensified with standing or walking and relieved w rest
possible pallor and loss of dorsalis pedis pulse
DVT
Hx of blunt trauma, crash injury, or unaccustomed exercise
compartment syndrome
- severe persistent leg pain that is intensified w stretch applied to involved muscles
- swelling, very tender and palpable tension/hardness of involved
- paresthesia, paresis, pallor, pulselessness
compartment syndrome
Hx of recent infection, surgery or injection
coexisting immunosuppressive disorder
septic arthritis
- constant aching or throbbing pain, joint swelling, tenderness, warmth
- may have elevated body temp
septic arthritis
Hx of
- recent skin ulceration or abrasion
- venous insuff
- CHF or cirrhosis
cellulitis
pain, skin swell, warmth, advancing irregular margin or erythema/reddish streaks
fever, chills, malaise and weakness
cellulitis
- Presence of risk factors: previous
hx of CAD, HTN, smoking, DM,
elevated blood serum cholesterol
(>240 mg/dL) - Men >40 yr, women >50 yr
MI
- Chest pain
- Pallor, sweating, dyspnea, nausea, palpitations
(symptoms lasting >30 min & not relieved w/
sublingual nitroglycerin)
MI
HX of CAD
chest pain that occurs outside of predictable pattern
not responsive to nitroglycerine
unstable angina pectoris
common in 65+
Hx of CAD
more common in men
easing chest pain that is predictable and alleviated with rest or sublingual nitroglycerin
stable angina pectoris
autoimmune disease
Hx of MI
Hx Renal Failure, open heart surgery, radiation therapy
pericarditis
sharp/stabbing chest pain that may be referred to lateral neck to shoulder
increased pain w L sidelying
relived w forward leaning while sitting
pericarditis
- Hx of, or risk factors for
developing, DVT - Immobility
- Trauma
- Cancer
PE
- Chest, shoulder or upper abdominal pain
- Dyspnea
- Tachypnea
- Tachycardia
PE
Hx of recent or concurrent
respiratory disorder (i.e.
infection, pneumonia, tumor, TB
Pleurisy
- Severe, sharp, knife-like pain w/ inspiration
- Dyspnea, ↓ chest wall excursion
pleurisy
recent bout of coughing or strenuous exercise or trauma
Pneumothorax
chest pain that ups with inspiration
difficulty ventilating or expanding chest wall
hyperresonance on percussion
decreased breath sounds
Pneumothorax
Hx of bacterial, viral, fungal or mycoplasma infection
pleuritic pain (shoulder maybe)
fever, chills, malaise, nausea
pneumonia
middle aged women
WBC elevated (12k-15k/ml)
colicky pain in R upper abdominal quadrant and scap pain
symptoms worsen with ingestion of fatty foods
not affected by increased activity or rest
cholecystitis
dull/gnawing pain or burning sensation in epigastrium, mid back, or subclav region
symptoms relieved w food
Hx infection
Hx multiple stressors, poor coping skills, persistent anxiety and depression
localized tenderness at R epigastrium
constipation, bleeding, vomiting, tarry stools, coffee-ground emesis
peptic ulcer
women
recent or coexisting UTI
kidney stone or recent one
fever, chills, malaise, HA, flank pain
enlarged prostrate
tenderness over costovertebral angle (Murphy’s sign)
pyelonephritis
residence in hot humid climates
past kidney stones
sudden, severe back or flank pain
renal colic
UTI symptoms
Nephrolithiasis (kidney stones)
Hx of fall of MVA
Hx osteoporosis
long term steroid use
70+ yrs
loss of function or mobility
midline tenderness at level
most common fx T11-L1
bruising
LE neurological deficits
evidence of increased thoracic kyphosis
spinal fx
20-64 yrs
HA
altered mental state
status
ataxia
speech deficits
sensory abnormalities
GI and N&V signs
visual changes
seizures
primary brain tumor
hx smoking, HTN, ETOH abuse
HA sudden onset
brief LOC
brain tumor signs and neurologic dysfunction
meningeal irritation, nuchal rigidity
fever, photophobia, N&V
subarachnoid hemorrhage
- Presence of risk factors: previous
hx of CAD, HTN, smoking, DM,
elevated blood serum cholesterol
(>240 mg/dL) - Men >40 yr, women >50 yr
- Chest pain
- Pallor, sweating, dyspnea, nausea, palpitations
(symptoms lasting >30 min & not relieved w/
sublingual nitroglycerin)
MI
- Major trauma such as an MVA or
fall from a height - Hx of RA or AS
- Oral contraceptive use
- Long tract neurologic signs (especially present
in >1 extremity): dizziness, nystagmus, vertigo
w/ head/neck movements/positions, clonus,
(+) Babinski’s sign
cervical ligamentous instabilities w possible cord compromise
- Paresthesias
- Pain present at rest & possibly
w/ a retrograde distribution - Muscles innervated by affected nerve can be
tender to palpate - Muscles & sensory distribution follow specific
nerve pattern
cervical and shoulder girdle peripheral entrapment neuropathies
- Hx of penetrating injury, such as stab or gunshot
- Direct blow or stretching of
nerve during a fall or MVA - Surgical hx of radical neck
dissection for tumor or cervical
lymph node biopsy - Hx of blow from a hockey stick or lacrosse stick
- Asymmetry of neck line & drooping of
shoulder - Inability to shrug shoulders
- Lack of scapular stabilization
- Weakness of shoulder abduction
spinal accessory nerve
- Pts >40 yrs w/ shoulder
dislocation - Hx of traction force or blunt
trauma to shoulder - Hx of brachial neuritis or
quadrilateral space syndrome - Weakness of shoulder abduction & flexion
- Lack of sensation of lateral aspect of upper
arm
axillary nerve
- Identified in players of many sports, including tennis, volleyball, archery, golf, gymnastics, bowling, weight lifting, soccer, hockey & rifle shooting
- Serratus anterior weakness w/ scapular winging
- Loss of scapulohumeral rhythm
long thoracic nerve
- Deep, poorly localized pain
- Hx of fx of scapula w/ involvement of the notch & blade of scapula
- Traction injury mechanism
- Direct compression of suprascapular nerve at level of scapular notch or at
spinoglenoid notch bc of a ganglion cyst or hypertrophied transverse scapular or spinoglenoid ligament - Presentation similar to RC tear bc of wasting of supraspinatus & infraspinatus
muscles * Loss of strength in shoulder abd & ER
suprascapular nerve
- Men >50 yrs w/ hx of cigarette smoking
- Nagging-type pain in shoulder & along vertebral border of scapula
- Pain that has progressed from nagging to burning in nature, often extending down the arm & into ulnar nerve distribution
pancoast’s tumor (superior sulcus lung tumor)
recent fall
Hx osteoporosis
extended use of steroids
respiratory problem
pathologies of bone modeling
pain, tenderness, swelling, ecchymosis
Fx’s
FOOSH w forceful wrist extension
40+ yr women
women > men
Hx osteoporosis
wrist held in neutral
wrist swelling
wrist ext painful
distal radius (Colles’) Fx
FOOSH
wrist swelling
wrist held in neutral
pain in anatomical snuff box
scaphoid fx
FOOSH
diffuse synovitis
generalized wrist swelling
decreased motion
decreased grip strength
lunate fx or dislocation
- Traumatic fall after slipping or tripping on outstretched hand w/ forearm pronated
- Commonly associated w/ Colles’ fx
- Ulnar-sided wrist pain
- Tenderness & clicking w/ wrist
movement (passive ulnar deviation) - Weakness w/ grip strength
- Dorsal ulnar head subluxation
TFCC tear
- Recent puncture of skin
- Recent insect bite
- Presence of an abscess
- Purulent tenosynovitis of tendons that go through a space
- Typical signs of inflammation: swelling in palm, dorsum of hand or fingertips
- Pain, tenderness, warmth, erythema
- Signs of long-standing infection: high fever, chills, weakness, malaise
space infection of the hand
- Hx of RA
- Hx of corticosteroid use for
chronic respiratory problems - Hx of trauma
- Grade I & II muscle tear: local tenderness, swelling, muscle spasms, hematoma, pain w/
motion & w/ passive stretch - Grade III muscle rupture: total loss of motion & palpable defect in muscle, swelling, tenderness, ecchymosis of overlying skin
long flexor tendon rupture
- PMH significant for RA,
occlusive vascular disease,
smoking or use of beta blockers - Hands or feet that blanch, go cyanotic & then turn red when exposed to cold or emotional stress
- Pain & tingling in hands & feet when they turn red
Raynaud’s Phenomenon or disease
- Trauma including fx, dislocation
or surgery - Pain does not respond to
typical analgesics - Severe aching, stinging, cutting or boring
pain that is not typical of injury - Hypersensitivity
- Area swollen (pitting edema), warm &
erythematous
complex regional pain syndrome (formerly known as reflex sympathetic dystrophy)
FOOSH with supination of forearm
antero-lateral pain and tenderness at elbow
inability to sup/pronate forearm
elbow held against side w 70 deg of flexion and slightly supinated
radial head Fx
Hx of recent bacterial or viral infection
Hx of skull fx
+ slump sign
HA
fever
GI signs
N&V
photophobia
confusion
seizures
sleepiness
meningitis
back, abdominal or groin pain
presence of PVD or CAD and associated risk factors (50+ yr, smokes, HTN, DM)
symptoms not related to movement stresses associated with somatic LBP
abdominal aneurysm
urinary retention or incontinence
fecal incontinence
saddle anesthesia
global or progressive weakness in LE
sensory deficits
ankle DF, toe Ext, ankle PF weakness
cauda equina
