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primary care > Lecture 1C Only By Alyssa > Flashcards

Lecture 1C Only By Alyssa Flashcards

1
Q
  • Age 50 yr
  • hx cancer
  • unexplained WL
  • failure of conservative Tx
A

back related tumor

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2
Q

constant pain not affected by position
worse at night

A

back related tumor

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3
Q

recent infection
IV drug user
concurrent immunosuppressive disorder

A

back related infection (spinal osteomyelitis)

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4
Q

hx of spinal stenosis
history of DDD

A

cauda equina

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5
Q

deep constant pain that ups with weight bearing
fever, malaise, swelling
spine rigidity, accessory mobility may be limited

A

back related infection (osteomyelitis spinal)

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6
Q

Hx of trauma( minor falls heavy lifts osteoporotic or elderly)
70 + years
long-term steroid use

A

spinal Fx

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7
Q

exquisitely tender w palpation over fx site with increased pain with WB
edema in local area

A

spinal Fx

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8
Q

abnormal width of aortic or iliac arterial pulses
presence of a bruit in central epigastric area upon auscultation

A

abdominal aneurysm

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9
Q

age 50+
bowel disturbances
unexplained WL
Hx of colon cancer in immediate family
pain unchanged by position or movement

A

colon cancer

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10
Q
  • older women (70+)
  • hip, groin, or thigh pain
  • Hx of fall from standing position
A

pathologic Fx in femoral neck

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11
Q

may have hypoactive or hyperactive bowel sounds from obstruction (later)
possible TTP of abdomen
ascites possible
metastases to liver, lung, bone, or brain

A

colon cancer

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12
Q

severe, constant pain in leg worse with movement
shortened and ER’d LE

A

pathologic fx in femoral neck

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13
Q

Hx of long-term corticosteroid use
RA, SLE, Asthma
Hx of osteonecrosis of contralateral hip
trauma

A

osteonecrosis of femoral head (aka AVN)

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14
Q

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)

A

Osteonecrosis of the femoral head (AVN)

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15
Q

5-8 yr old boys w groin, thigh, pain

A

Legg-Calve-Perthes disease

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16
Q

antalgic gait pain complaints aggravated w hip movement, especially ABD and IR in young boys

A

Legg-Calve-Perthes disease

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17
Q

overweight adolescent
Hx of a recent growth spurt

A

SCFE

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18
Q

aching in groin exacerbated w WB
involved leg held in ER
ROM limitations in IR

A

SCFE

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19
Q

60+ yr
Hx of T2DM
Hx of ischemic heart diesase
smoking
sedentary lifestyle
concurrent intermittent claudication

A

peripheral arterial occlusive disease

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20
Q

unilat cool extremity (could be bi)
prolonged capillary refill time (2+ sec)
decreased pules
prolonged vascular filling time
ankle-brachial index (ABI) <.90

A

peripheral arterial occlusive disease

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21
Q

recent surgery, malignancy, pregnancy, trauma, or leg immobilization

A

DVT

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22
Q

calf pain, edema, tenderness, warmth
calf pain intensified with standing or walking and relieved w rest
possible pallor and loss of dorsalis pedis pulse

A

DVT

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23
Q

Hx of blunt trauma, crash injury, or unaccustomed exercise

A

compartment syndrome

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24
Q
  • 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
A

compartment syndrome

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25
Q

Hx of recent infection, surgery or injection
coexisting immunosuppressive disorder

A

septic arthritis

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26
Q
  • constant aching or throbbing pain, joint swelling, tenderness, warmth
  • may have elevated body temp
A

septic arthritis

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27
Q

Hx of

  • recent skin ulceration or abrasion
  • venous insuff
  • CHF or cirrhosis
A

cellulitis

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28
Q

pain, skin swell, warmth, advancing irregular margin or erythema/reddish streaks
fever, chills, malaise and weakness

A

cellulitis

29
Q
  • Presence of risk factors: previous
    hx of CAD, HTN, smoking, DM,
    elevated blood serum cholesterol
    (>240 mg/dL)
  • Men >40 yr, women >50 yr
A

MI

30
Q
  • Chest pain
  • Pallor, sweating, dyspnea, nausea, palpitations
    (symptoms lasting >30 min & not relieved w/
    sublingual nitroglycerin)
A

MI

31
Q

HX of CAD
chest pain that occurs outside of predictable pattern
not responsive to nitroglycerine

A

unstable angina pectoris

32
Q

common in 65+
Hx of CAD
more common in men
easing chest pain that is predictable and alleviated with rest or sublingual nitroglycerin

A

stable angina pectoris

33
Q

autoimmune disease
Hx of MI
Hx Renal Failure, open heart surgery, radiation therapy

A

pericarditis

34
Q

sharp/stabbing chest pain that may be referred to lateral neck to shoulder
increased pain w L sidelying
relived w forward leaning while sitting

A

pericarditis

35
Q
  • Hx of, or risk factors for
    developing, DVT
  • Immobility
  • Trauma
  • Cancer
A

PE

36
Q
  • Chest, shoulder or upper abdominal pain
  • Dyspnea
  • Tachypnea
  • Tachycardia
A

PE

37
Q

Hx of recent or concurrent
respiratory disorder (i.e.
infection, pneumonia, tumor, TB

A

Pleurisy

38
Q
  • Severe, sharp, knife-like pain w/ inspiration
  • Dyspnea, ↓ chest wall excursion
A

pleurisy

39
Q

recent bout of coughing or strenuous exercise or trauma

A

Pneumothorax

40
Q

chest pain that ups with inspiration
difficulty ventilating or expanding chest wall
hyperresonance on percussion
decreased breath sounds

A

Pneumothorax

41
Q

Hx of bacterial, viral, fungal or mycoplasma infection
pleuritic pain (shoulder maybe)
fever, chills, malaise, nausea

A

pneumonia

42
Q

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

A

cholecystitis

43
Q

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

A

peptic ulcer

44
Q

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)

A

pyelonephritis

45
Q

residence in hot humid climates
past kidney stones
sudden, severe back or flank pain
renal colic
UTI symptoms

A

Nephrolithiasis (kidney stones)

46
Q

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

A

spinal fx

47
Q

20-64 yrs
HA
altered mental state
status
ataxia
speech deficits
sensory abnormalities
GI and N&V signs
visual changes
seizures

A

primary brain tumor

48
Q

hx smoking, HTN, ETOH abuse
HA sudden onset
brief LOC
brain tumor signs and neurologic dysfunction
meningeal irritation, nuchal rigidity
fever, photophobia, N&V

A

subarachnoid hemorrhage

49
Q
  • 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)
A

MI

50
Q
  • 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
A

cervical ligamentous instabilities w possible cord compromise

51
Q
  • 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
A

cervical and shoulder girdle peripheral entrapment neuropathies

52
Q
  • 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
A

spinal accessory nerve

53
Q
  • 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
A

axillary nerve

54
Q
  • 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
A

long thoracic nerve

55
Q
  • 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
A

suprascapular nerve

56
Q
  • 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
A

pancoast’s tumor (superior sulcus lung tumor)

57
Q

recent fall
Hx osteoporosis
extended use of steroids
respiratory problem
pathologies of bone modeling
pain, tenderness, swelling, ecchymosis

A

Fx’s

58
Q

FOOSH w forceful wrist extension
40+ yr women
women > men
Hx osteoporosis
wrist held in neutral
wrist swelling
wrist ext painful

A

distal radius (Colles’) Fx

59
Q

FOOSH
wrist swelling
wrist held in neutral
pain in anatomical snuff box

A

scaphoid fx

60
Q

FOOSH
diffuse synovitis
generalized wrist swelling
decreased motion
decreased grip strength

A

lunate fx or dislocation

61
Q
  • 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
A

TFCC tear

62
Q
  • 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
A

space infection of the hand

63
Q
  • 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
A

long flexor tendon rupture

64
Q
  • 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
A

Raynaud’s Phenomenon or disease

65
Q
  • 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
A

complex regional pain syndrome (formerly known as reflex sympathetic dystrophy)

66
Q

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

A

radial head Fx

67
Q

Hx of recent bacterial or viral infection
Hx of skull fx
+ slump sign
HA
fever
GI signs
N&V
photophobia
confusion
seizures
sleepiness

A

meningitis

68
Q

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

A

abdominal aneurysm

69
Q

urinary retention or incontinence
fecal incontinence
saddle anesthesia
global or progressive weakness in LE
sensory deficits
ankle DF, toe Ext, ankle PF weakness

A

cauda equina

primary care (10 decks)

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