Lecture 1C Only By Alyssa Flashcards by Alexander Lee

Age 50 yr
hx cancer
unexplained WL
failure of conservative Tx

back related tumor

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constant pain not affected by position
worse at night

back related tumor

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recent infection
IV drug user
concurrent immunosuppressive disorder

back related infection (spinal osteomyelitis)

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hx of spinal stenosis
history of DDD

cauda equina

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

back related infection (osteomyelitis spinal)

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

spinal Fx

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

spinal Fx

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

abdominal aneurysm

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

colon cancer

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

pathologic Fx in femoral neck

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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

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

pathologic fx in femoral neck

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

osteonecrosis of femoral head (aka AVN)

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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)

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

Legg-Calve-Perthes disease

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

Legg-Calve-Perthes disease

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overweight adolescent
Hx of a recent growth spurt

SCFE

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

SCFE

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

peripheral arterial occlusive disease

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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

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

DVT

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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

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Hx of blunt trauma, crash injury, or unaccustomed exercise

compartment syndrome

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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

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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

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

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

* Chest, shoulder or upper abdominal pain * Dyspnea * Tachypnea * Tachycardia

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)

* 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