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Primary Care > Lecture 2A (review of systems) > Flashcards

Lecture 2A (review of systems) Flashcards

1
Q

if PT finds a red flag and pt provides a YES response, the following questions shoulf form basis for level of concern:

A
  1. does complaint represent something new, diff, or unusual for the pt?
  2. is there an explanation for it that would minimize concern?
  3. has pt mentioned this to physician?
  4. if physician is aware, has it become worse?
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2
Q

8 things for general health screen

A
  1. fatigue
  2. malaise
  3. fever, chills, sweats
  4. weight loss/gain
  5. nausea, vomiting
  6. dizziness, lightheadedness
  7. paresthesia, numbness, weakness
  8. change in mentation, cognitive abilities
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3
Q

what symptoms are mainly cardio?

A

palpitation
syncope
sweats
edema
cold distal extremity
skin discoloration
open wound/ulcers

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4
Q

what symptoms are both cardio and pulmonary?

A

dyspena
cough (duration, positional, productive, sputum?)
clubbing of nails
wheezing, stridor

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5
Q

in the hematologic system, PT looks for:

A

erythrocyte, leukocyte, platelet conditions
bleeding disorders

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6
Q

GI system

A
  1. swallowing difficulty
  2. indigestion, heartburn
  3. food intolerance
  4. bowel dysfunction (stool color, shape, caliber, color constipation, diarrhea, incontinence)
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7
Q

what does it mean when stool color is black, tarry, shiny, sticky? what about black, but not sticky?

A

black, tarry, shiny, sticky: upper GI bleeding
black, not sticky: ingestion of iron and bismuth salts (peptobismol), black licorice, CC cookies

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8
Q

what does it mean when stool color is light gray, pale? what about bright, blood red?

A

light gray, pale: obstructive jaundice
bright, blood red: lower GI bleeding

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9
Q

hematologic system

A

exertional dyspnea
anginal pain patterns
fatigue
pallor
lightheaded/drowsy
confused
easyily bruised/bleed
fever, chills, sweat
malaise

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10
Q

male reproductive system

A

urethral D/C
sexual dysfunction
pain during intercourse, ejaculation

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11
Q

female reproductive system

A

vaginal d/c
pain w intercourse
menstruation (dysmenorrhea and length)
# pregnancy and delivery
menopause

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12
Q

what does the color of urine mean?
dark
red
reddish

A

dark: hepatic or biliary obstructive disease, acute rhabadomylosis

red: (blood) many GI disorders

reddish: blood, ingestion of vegetable dyes, beets, use of some meds (phenazopyridine)

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13
Q

T/F nervous system: vomiting without nausea

A

true

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14
Q

endocrine system

A
  1. general health (fatigue, weight, weakness)
  2. psychologic , cognitive
  3. GI (n/v, anorexia, dysphagia, diarrhea, constipated)
  4. urogenital
  5. MSK
  6. sensory
  7. dermatologic
  8. msc
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15
Q

psychologic system

A

general health
major clinical depression
chemical dependence
abuse

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16
Q

4 chemical dependence factors

A

caffeine
ETOH
tobacco
illicit drugs

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17
Q

T/F history of a condition warrants checklist for the associated system

A

true

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18
Q

how to decide which review of symptoms checklist to use:

A

system location / patterns
PMH (if pt has it there, you should check)
follow up visits (did the symptoms get better? any new ones?
adverse drug reactions (e.g. HTN medication causes hypotension)

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19
Q

~__% of drug adverse events represent a magnification of what the drug was meant to do therapeutically

A

~80%

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20
Q

chief complaint by non-systemic specific symptoms

A
  • joint pain
  • limb
  • dizziness
  • HA
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21
Q

what is the most common cause of joint pain, affecting 30 million adults each year?

A

OA

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22
Q

T/F PTs should be primary care providers for OA

A

True

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23
Q

criteria for inflammatory back pain - historical symptoms

A

morning stiffness >30 min
improve w exercise, NOT with rest
awaken during 2nd half of night
alternating buttock pain
inclusion criteria: <50 yr of age and minimum of 3 months LBP

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24
Q

criteria for inflammatory back pain - expert opinion

A

insidious
improve with exercise, NOT with rest
pain at night
age 40 yr or younger

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25
Q

pain symptoms of ankylosing spondylitis vs non-specific LBP

A

AS: symptoms increase w/ rest, decrease w/ activity

LBP: vary but can decrease w/ rest or position changes
(may refer to hip)

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26
Q

ankylosing spondylitis vs nonspecific LBP: type of arthritis

A

AS: autoimmune in the spine (+ family)

LBP: degenerative

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27
Q

which one is more rare? AS or LBP?

A

AS

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28
Q

age groups and gender ratio: AS vs LBP

A

AS: <40 yrs; 3-1 male-female
LPB: 35-55 yrs; 1-1

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29
Q

is there non-joint conditions for AS? what about LBP?

A

AS: uveitis, IBS

LBP: n/a

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30
Q

what are the classification criteria for RA?

A
  1. morning stiffness ≥1 hour
  2. arthritis of ≥3 joints
  3. arthritis of hand joints
  4. symmetric arthritis
  5. rehumatoid nodules
  6. serum rheumatoid factor
  7. radiographic changes
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31
Q

how many weeks must criteria be present for RA?

A

≥ 6 weeks

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32
Q

describe the main difference between RA and SLE and stiffness

A

RA: severe post-rest stiffness >60 min

SLE: moderate post-rest stiffness >60 min

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33
Q

describe the main difference between RA and SLE causes

A

RA: autoimmune thyroid disorder
SLE: infection, sunlight or UV exposure, meds

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34
Q

T/F males are more likely to experience SLE or RA,
particularly African American males > caucasian have SLE

A

F (female)

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35
Q

what’s the peak onset of RA? SLE?

A

RA: 20-50 y/o

SLE: 15-40 y/o

36
Q

describe symptoms intensify and relief for SLE and RA

A

Sx increase with rest and intense activity
Sx decrease with short rest, mild activity

for BOTH
ALSO for PSORATIC ARTHRITIS, REACTIVE ARTHRITIS (REITER’S SYNDROME)

37
Q

gout is _____
psoratic arthitis is ____

A

sudden esp at night
insidious

38
Q

gender predilection: gout vs psoriatic arthritis

A

gout: male > female
PA: n/a

39
Q

peak onset for gout? psoriatic arthritis?

A

gout: male is 5th decade, female is 6th decade

PA: 2nd and 3rd decade

40
Q

what causes gout? Psoriatic arthritis?

A

Gout: renal disorder (increased uric acid), leukemia, lymphoma, psoriasis, chemo, hypothyroidism, HTN, ETOH, diuretics, salicylates

PA: psoriasis

41
Q

postrest stiffness: gout vs psoriasis arthritis- which one is it more evident?

A

gout: n/a

PA: moderate post-rest stiffness

42
Q

which one has more evidence of night pain: gout or psoriasis arthritis?

A

gout

43
Q

progression: gout vs psoriasis arthritis

A

gout: rapid

PA: slow or rapid

44
Q

T/F gout sx is tenderness at affected joint

A

F (psoriasis arthritis)

45
Q

Symptom aggravation and relief for gout

A

sx increase with WB and joint use

sx: less pain w rest but unrelenting

46
Q

septic arthritis presents more like___

A

gout

47
Q

reactive arthritis (reiter’s syndrome) peak onset is

A

3rd decade - acute

48
Q

gender predilection: reactive arthritis vs septic arthritis

A

reactive: males
septic: n/a

49
Q

symptom aggravaiton and relief: reactive and septic arthritis

A

reactive: sx increase w: rest, intense activity and decrease w short rest, mild activity

septic: sx increase with WB joint use,
and pain goes away with rest but is unrelenting

50
Q

what causes reactive arthritis (reiter’s syndrome)?

A

venereal or dysenteric disease

51
Q

what causes septic arthritis?

A

systemic corticosteroid use, DM, infection elsewhere, direct penetrating joint trauma

52
Q

night is more evident in which condition? reactive arthritis or septic arthritis?

A

septic arthritis

53
Q

which pain levels are worse? reactive arthritis or septic?

A

reactive: mod - severe pain
septic: excruciating pain

54
Q

describe the progression of septic arthritis and reactive arthritis

A

septic: rapid

reactive: slow or rapid

55
Q

which symptoms are more sever? septic or reactive arthritis?

A

septic arthritis

56
Q

review of system findings: OA

A

N/A

57
Q

review of system findings: SLE

A
  • skin rash (MALAR most common)
  • fever, fatigue, malaise
  • photosensitive
  • dyspnea, cough
  • peripheral neuropathy
58
Q

review of system findings: Gout

A
  • fever, malaise
  • tachycardia
59
Q

review of system findings: psoriatic arthritis

A
  • fever, fatigue, malaise
  • psoriasis (integumentary)
60
Q

review of system findings: reactive arthritis (reiter’s syndrome)

A
  • urethritis
  • conjunctivitis
  • N, V, D
  • weight loss
61
Q

review of system findings: septic arthritis

A

fever, chills, malaise

62
Q

gout is the only one that has

A

tachycardia

63
Q

which two conditions have weight loss as a side effect?

A

ankylosing spondylitis
reactive arthritis

64
Q

fever, fatigue, malaise

A

psoriatic arthritis, SLE

65
Q

chief complaint of limb (non-joint) pain

A

calf/thigh
antalgic gait
difficulty walking

66
Q

limb pain (non-joint) is pattern of____symptoms

A

non-mechanical

67
Q

what are conditions associated w/ limb pain NOT managed by PTs?

A
  • hypothyroidism
  • lyme disease
  • polymyalgia rhematica
  • statin-induced myopathy
68
Q

dizziness

A

impairment in spatial perception and stability

69
Q

vertigo

A

sensation of spinning

70
Q

T/F dizziness is rare in children and more common in adults. incidence will increase by 10% every 5 yr in age

A

True

71
Q

what pathologic condition should be considered when evaluating dizziness?

A

serious pathologic neck condition (treating may resolve dizziness)

72
Q

most common complaints in medicine

A

dizziness (17-30%), vertigo (2-10%)

73
Q

serious pathologic neck conditions

A
  • vertebral artery insufficiency (VAI)
  • upper cervical ligamentous instability
  • cervical myelopathy
  • neoplastic condition
  • inflammatory or systemic disease
74
Q

5 D’s of VAI

A
  • drop attack
  • dizziness or lightheadedness related to neck mvmt
  • dysphasia
  • dysarthria
  • diplopia
75
Q

3 N’s of VAI

A
  • nausea
  • numbness
  • nystagmus
76
Q

VBI S&S are markers for an impending?

A

CVA

77
Q

what type of HA is caused by upper cervical ligamentous instability

A

occipital HA and numbness

78
Q

signs and symptoms of upper cervical ligamentous instability

A

sx: limited cervical AROM all directions
sign: of cervical myelopathy

79
Q

vertigo

A

sensation of spinning caused by asymmetrical involvement of vestibular system

80
Q

disequilibrium

A

dizziness, imbalance, unsteady W/O vertigo
- degenerative changes in brain and body

80
Q

non-specific dizziness

A
  • panic/anxiety
  • cervicogenic
81
Q

pre-syncope

A
  • vascular compromise to the cerebellum
  • CV disease
  • non CV causes: hypoglycemia, medicaitons
82
Q

most to least common types of HA

A

tension
cervicogenic (secondary)
migraine
cluster

83
Q

the MOST severe type of HA

A

cluster
come in clusters at least every other day for 8 days

(migraine is just severe)

84
Q

TBI red flags

A

double vsn
severe or worsening HA
seizure / convulsion
LOC
deteriorating consciousness
vomiting
agitation / combative

85
Q

high risk sites for stress reaction and stress fx injuries

A

femoral neck
anterior cortex of tibia
medial malleolus
tarsal navicular
base of 2nd and 5th metatarsal
talus
patella

Primary Care (6 decks)

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