Misc Flashcards
DDx - shoulder pain + distinguishing features
Shoulder dislocation (glenohumeral joint) - fall on outstretched arm, hold arm in slight abduction and external rotation, pain/restricted ROM
Rotator cuff impingement or tear - pain and weakness with abduction or external rotation, possible impingement signs; unable to abduct or flex, significant weakness on IR/ER, non-specific pain, may refer down arm
Humeral fracture - tenderness over upper/middle arm, s/p fall, if distal, possible radial nerve palsy (wrist drop, loss of thumb extension), if proximal, possible axillary nerve injury (deltoid sensory loss)
Adhesive capsulitis - shoulder stiffness, but only mild pain with movement
Osteoarthritis
Osteoporosis
Elder abuse
DDx - knee pain + distinguish
- ACL
- Non-contact twisting mechanism, forced hyperextension, or impact to extended knee
- Anterior drawer and Lachman tests - PCL
- Posteriorly directed force on a flexed knee (dashboard injury, etc.)
- Positive posterior drawer test - MCL
- Positive valgus stress test - LCL
- Positive varus stress test - Meniscal tears
- Acute twisting injury or degenerative tear in elderly patients
- Joint line tenderness
- Positive McMurray test
- Clicking or locking
DDx - low back pain
- Lumbar muscle strain
- Disc herniation
- Lumbar spinal stenosis
- Metastatic cancer (prostate, etc.)
- Tumor in vertebral canal
- Compression fracture
- Multiple myeloma
- Malingering
- Ankylosing spondylitis
- Epidural abscess
- Osteomyelitis
DDx - calf pain
DVT Cellulitis Myositis Rupture of Baker's cyst Hematoma Spasm due to injury or sprain
DDx - heel pain
Plantar fasciitis Calcaneal stress fracture Achilles tendinitis Retrocalcaneal bursitis Tarsal tunnel syndrome Foreign body Ankle sprain
Work-up - shoulder pain
XR shoulder and arm
MRI shoulder
DEXA
Work-up - low back pain
Rectal exam XR - lower spine MRI - lower spine [PSA] CBC, Calcium BUN/Cr SPEP/UPEP
Work-up - calf pain
Doppler U/S of lower extremities D-Dimer PT/INR, pTT CBC with diff CPK and myoglobin CT venography MRI
Work-up - heel pain
XR - right ankle
Bone scan
MRI
DDx - dysphagia
Esophageal cancer (solids -> liquids) Achalasia (both solids and liquids) Esophagitis (pain with swallowing) Systemic sclerosis (CREST) GERD (cough at night, hoarseness, sore throat) Zenker diverticulum Pill-induced esophagitis MV stenosis
DDx - hoaresness
Laryngitis Laryngeal cancer Vocal cord polyps/nodules Hypothyroidism MV stenosis
Ddx - hearing loss
Conductive (younger): otosclerosis, OM +/- effusion, cerumen impaction, external auditory canal atresia
Sensorineural (older): Meniere disease, acoustic neuroma, noise-induced hearing loss, internal ear infections, presbycusis
DDx - neck pain
Spinal disc herniation Cervical fracture Neck muscle strain OA (compression of nerves) Cervical spondylosis
Work-up - neck-pain
MRI - C-spine (if any neuro symptoms)
XR - C-spine
Work-up - hearing loss
Audiometry Tympanography Brain stem auditory evoked potentials CT-head VDRL/RPR (r/o Meniere)
