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PT 6014: Internal Medicine > Module 1B: Student Differential Diagnosis > Flashcards

Module 1B: Student Differential Diagnosis Flashcards

1
Q

What are some of the challenges of the acute care environment for patients?

A

Physical, psychological, emotional challenges
- change of routine
- lack of privacy/independence
- pain
- potential lifestyle change
- medical crisis
- critical illness/long-term illness
- lack of control
- confusion, fear, anger

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2
Q

What are some of the challenges of the acute care environment for the PT?

A

Physical, psychological, emotional challenges
- Pt refusal (too tired, bad mood)
- high turnover (working w/ lots of new Pts)

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3
Q

To minimize infection risk, you should always _______

A

Wash your hands

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4
Q

In most hospitals, a code red indicates a _______

A

Fire

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5
Q

In most hospitals, a code blue indicates a _______

A

Cardiac/respiratory arrest or a medical emergency

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6
Q

Needles should never be _______

A

reused, discarded in trash, or recapped*

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7
Q

Before leaving a Pt, make sure they have a _______ and the _______ are up

A

call light; top rails*

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8
Q

Leave assistive devices such as walkers in the Pt’s _______

A

reach

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9
Q

An _______ is one of the most common adverse events in acute care and accounts for increased lengths of stay, cost, morbidity, and mortality

A

infection

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10
Q

What are some factors that can increase a Pt’s chance of falling?
AKA What are some fall risks?

A
  • Prior falls
  • Age
  • Polypharmacy (use of multi. drugs at same time)
  • Use of diuretics or antihypertensive medications
  • Bowel and bladder incontinence (lack of bowel/bladder control)
  • Visual acuity (dim lights make it hard to see)
  • Presence of lines and tubes (can get tangled)
  • Med. conditions such as neuropathy
  • Dementia, memory impairment, confusion
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11
Q

When are restraints used?

A

For Pts who are at risk of injuring themselves or others

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12
Q

Are all restraints physical restraints?

A

No, there are also chemical and environmental restraints such as sedating medication and bed rails

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13
Q

What are some Do’s of restraints?

A
  • DO tie w/ a slip-knot
  • DO tie to an immovable object
  • DO rmr to re-tie after PT
  • DO notify the team if you feel the Pt is excessively retrained, and vice-versa
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14
Q

What are some Don’ts of restraints?

A
  • DON’T tie too tight
  • DON’T leave restraint “tails” hanging during PT
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15
Q

Orders for restraints must be re-written every ___ hrs

A

24

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16
Q

What are some examples of restraints?

A
  • ankle/wrist ties (P)
  • vest ties (P)
  • netted beds (E)
  • medications (C)
  • all bed rails in the raised position (E)
  • gait belt (P)
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17
Q

What is orthostatic hypotension, as a cardiac effect of prolonged bed rest?

A

Sitting or lying down leads to LBP
Pt is constantly lying down during bed rest

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18
Q

What is thromboembolism, as a hematologic effect of prolonged bed rest?

A

Blood clot obstructs a blood vessel, causing blood to remain stuck in an area
No movement → may make it more diff. for blood to circulate
PT Imp: ankle/heel pumps may help blood flow w/ minimal mvmt

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19
Q

What is ventilation-perfusion mismatch, as a respiratory effect of prolonged bed rest?

A

Lung receives O2 w/o blood flow, or blood flow w/o O2
Occurs when an airway is obstructed

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20
Q

What is bowel motility, as a gastrointestinal (GI) effect of prolonged bed rest?

A

No physical movement → no bowel movement in the body
PT Imp: As soon as Pt gets up, they will need to go #2

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21
Q

What is muscle weakness, as a musculoskeletal effect of prolonged bed rest?

A

Loss of muscle strength/tone, possible atrophy
Pt needs movement to keep strength
PT Imp: Pt may be weaker than they look

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22
Q

What is risk of contracture, as a musculoskeletal effect of prolonged bed rest?

A

Joints get stiff w/o movement
Muscles don’t want to relax after being stretched in the same position for a long time

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23
Q

What is reduced pain threshold, as a neurologic effect of prolonged bed rest?

A

Pt becomes more sensitive to a stimulus that wasn’t painful before
PT Imp: be gentle, Pt is more sensitive to pain

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24
Q

What is pressure ulcer formation, as an integumentary effect of prolonged bed rest?

A

Skin & soft tissue press against hard surfaces for a while → reduces blood supply to that area → forms bedsores/pressure sores
PT Imp: be careful around red areas of skin (skin check)

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25
Q

Critical Illness Polyneuropathy (CIP) is commonly seen in Pts w/…

A

sepsis, respiratory failure, or multisystem organ failure

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26
Q

What are symptoms (Sx) of Critical Illness Polyneuropathy (CIP)?

A
  • distal extremity weakness
  • muscle wasting
  • sensory loss
  • paresthesia
  • decreased deep tendon reflexes (DTR)
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27
Q

The etiology of CIP is unknown but it’s possibly related to…

A

medication, elevated glucose levels, nutritional, or toxic factors

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28
Q

Critical Illness Myopathy (CIM) is also known as _______

A

Acute steroid myopathy

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29
Q

What are symptoms (Sx) of Critical Illness Myopathy (CIM)?

A
  • diffuse quadriparesis (mostly aff. LG proximal muscles)
  • respiratory muscle weakness
  • decreased deep tendon reflexes (DTR)
  • sensation remains intact
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30
Q

What is the etiology of CIM?

A

thought to be a result of high-dose corticosteroids and a neuromuscular (NM) blockade

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31
Q

What are the 4 factors of CIP & CIM pathogenesis (development)?

A

Microvascular alterations
Metabolic alterations
Electrical alterations
Bioenergetic failure

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32
Q

What are factors of microvascular alterations, leading to the development of CIP & CIM?

A
  • vasodilation (blood vessels widen)
  • inc. permeability
  • endoneurial edema (exc. accumulation of fluid in interstitial connective tissue of a peripheral nerve)
  • hypoxemia* (lack of O2 in blood)
  • extravasation (leakage of blood, lymph, or fluid from a tube into tissue)
  • cytokine production (T cell, macrophage)
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33
Q

What are factors of metabolic alterations, leading to the development of CIP & CIM?

A
  • hyperglycemia* (high blood glucose)
  • hormone imbalance
  • hypoalbuminemia (low albumin prod. → fluid can’t remain in blood vessels)
  • amino acid deficiency (lack of protein)
  • activation of proteolytic pathways (break down proteins)
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34
Q

What are factors of electrical alterations, leading to the development of CIP & CIM?

A
  • ion channel dysfunction
  • cell depolarization
  • cell inexcitability (can’t generate action potential)
  • altered Ca2+ homeostasis
  • changes in excitation-contraction coupling* (rhythm can be thrown off)
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35
Q

What are factors of bioenergetic failure, leading to the development of CIP & CIM?

A
  • antioxidant depletion (lose protection against free radicals)
  • reactive O2 species (ROS) increase
  • mitochondrial dysfunction (can affect other diseases)
  • apoptosis* (death of cell)
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36
Q

What is the difference b/t diagnosis (Dx) vs. prognosis (Px)?

A

Dx is the label/explanation given for relevant signs & symptoms
Px is how well a PT thinks a Pt will do based on age, motivation, etc.

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37
Q

What is Px used for?

A

Prepares Pt mentally (how well they’ll do, how long it’ll take, difficulty of PT)
Convinces insurance that PT will benefit the Pt (or not)

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38
Q

What is differential diagnosis?

A

Determination of which disease (out of 2 or more) a client is suffering from
Compare/contrast findings
Provides diff. options

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39
Q

What is the difference b/t signs vs. symptoms?

A

Signs are observed (skin color, edema, postural findings, atrophy, HR, BP, temp, O2 sats)
Symptoms are reported by the Pt (pain, discomfort, numbness, dizziness, tingling, fatigue, ringing in ears)

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40
Q

How should you structure an evaluation?

A

Chart Review if avail. (usually avail. in acute care)
Subjective interview
Objective examination
Assessment
Plan

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41
Q

What is included in a Medical Chart Review?

A
  • corner stamp (age/birth date, name, attending MD, admit date, medical record #)
  • advanced directives (DNR status is usually written written on outside of chart)
  • physician’s report (Hx and physical, Dx, PMH, HPI)
  • surgery notes (date, complications, restrictions, how well they think post-op will go)
  • medications
  • orders (orders for PT, restrictions like weight bearing/fluid/dietary)
  • imaging (radiology)
  • discharge planning (family support, living situation, insurance)
  • lab results
  • other disciplines (PT/OT/ST)
  • nursing notes (admit eval, vitals, medication, daily routine/visitor, diet, bowel/bladder)
  • progress notes
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42
Q

What does a “red” chart indicate?

A

There are new orders that the nsg staff needs immediately
Keep the chart close to the charge nurse

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43
Q

What does a “yellow” chart indicate?

A

Orders have been read once but still needs to be noted by a 2nd nurse
May be able to take the chart, but ask first
If not flagged, you may take the chart to the charting area

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44
Q

Can you copy chart materials without permission?

A

Never, due to HIPAA guidelines
PT can’t even release chart materials to Pts directly, they must go through a process

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45
Q

What is in the History (Hx) portion of SOAP notes?

A
  • date of surgery
  • social info
  • MD diagnosis
  • prior Dx illness/conditions
  • restrictions (weight-bearing)
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46
Q

What is in the Subjective portion of SOAP notes?

A

During eval:
- Pt profile (age, occupation, hobbies, gender, ethnicity)
- Pt comments/concerns
- Pt goals**
- body chart (localize Sx, pain, numbness, tingling, referred/radiating pain)
- Hx of present illness (sudden/gradual)
- past Hx
- Tx that worked (medication, past Tx)
- 24 hr behavior (pain in AM/PM, constant/changing)
- pain level

During Tx:
- pain level before/after Tx
- ex. difficulty level

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47
Q

What is in the Objective portion of SOAP notes?

A

During eval:
- Vital signs (BP, O2)

During Tx:
- names of ex. performed
- reps/duration of ex. performed
- resistance levels of ex.
- assist. level needed
- modalities/Tx used

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48
Q

What is in the Assessment portion of SOAP notes?

A

During eval:
- Pt’s major problem (ex: LB pain, radicular neuropathy)
- Differential diagnoses

During Tx:
- Pt progress/status
- Pt goals

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49
Q

What is in the Plan portion of SOAP notes?

A

During eval:
- tests, procedures, consultations (if needed)
- Pt education, pharmacology (if needed)
- plans for follow-up visit

During Tx:
- duration of Tx (3 d/wk, 12 wks)
- type of Tx needed (traction, cryoTx, modalities)

50
Q

What are some PROs of asking open-ended questions?

A

Allows Pt to control and direct interview
Likely to uncover imp. info

51
Q

What are some examples of open-ended questions?

A

Tell me why you are here.
What makes your pain worse?
How did you sleep last night?

52
Q

What are some CONs of asking closed-ended questions?

A

Pt responses may be limited
Can be impersonal
Limits info you get from Pt

53
Q

What are some examples of closed-ended questions?

A

Is the pain worse in the AM or PM?
Are you under any stress?
Did you sleep well last night?

54
Q

First, how do you interpret a Pt’s Hx?

A
  • identify info not likely contributing to the problem
  • identify 1st/2nd problems
  • identify info that’s inconsistent w/ the presenting complaint
  • generate a “working hypothesis” (general idea of what you think may be the problem)
  • determine whether PT will help or if it’s outside your scope of practice (referral)
55
Q

After interpreting a Pt’s Hx, what do you do?

A

Make a plan
Rule in/out your hypothesis of Pt’s problem
Only test what you need to

56
Q

What are the 6 vital signs?

A

Blood pressure
Temperature
Pulse (HR)
Respiration
Pain
Gait speed

57
Q

What are “Red flags”?

A

Signs/Sx that should make you consider referring the Pt back to their physician

58
Q

What type of red flag is this problem?

Anginal (chest) pain not relieved in 10-20 min

A

Emergency Department

59
Q

What type of red flag is this problem?

Pt w/ angina who has nausea, vomiting, or profuse sweating

A

Emergency Department

60
Q

What type of red flag is this problem?

Diabetic (or any) Pt who is confused, lethargic, or has changes in mental alertness and function

A

Emergency Department

61
Q

What type of red flag is this problem?

Onset of incontinence or saddle anesthesia

Incontinence: loss of bowel/bladder control
Saddle anesthesia: sudden numbness in groin/thigh area

A

Emergency Department

62
Q

What type of red flag is this problem?

Anaphylactic shock Sx (hives, asthma, tachycardia, hypotension, anxiety, nausea, vomiting)

A

Emergency Department

63
Q

What type of red flag is this problem?

Heart palpitations

A

Emergency Department

64
Q

What type of red flag is this problem?

Difficulty swallowing/urination

A

Emergency Department

65
Q

What type of red flag is this problem?

Unexplained exc. perspiration

A

Emergency Department

66
Q

When is a red flag a maybe emergency/maybe referral?

A

If the Sx is not normal for the Pt, but depends on if the situation could lead to the Sx or not
ex: dizziness if dehydrated, faintness if tired, high HR if Pt had intense ex.

  • constant/intense pain
  • dizziness/faintness
  • problems w/ vision
  • temporary/no relief w/ rest/change in position
  • Sx that present bilaterally (edema, numbness, weakness)
  • abdominal edema (ascites) - sign of liver disease
67
Q

What type of red flag is this problem?

Blood in urine

A

Refer back to MD

68
Q

What type of red flag is this problem?

Fever, nausea, vomiting, night pain, night sweats, pain w/ urination

A

Refer back to MD

69
Q

What type of red flag is this problem?

Unusual menstrual Hx

A

Refer back to MD

70
Q

What type of red flag is this problem?

Cyclical patterns of Sx (good → bad → good → bad)

A

Refer back to MD

71
Q

What type of red flag is this problem?

Unexplained weight loss/gain

A

Refer back to MD

72
Q

What type of red flag is this problem?

Disproportionate pain relief w/ aspirin (CA Pts)

A

Refer back to MD

73
Q

What type of red flag is this problem?

Clubbing (hands)

A

Refer back to MD
Sign of chronic O2 deprivation
ex: COPD

74
Q

What type of red flag is this problem?

Peripheral edema

A

Refer back to MD
Sign of heart failure

75
Q

What type of red flag is this problem?

Pain described as knifelike, boring (drilling), deep visceral (organ) pain

A

Refer back to MD

76
Q

What type of red flag is this problem?

Pain doesn’t fit the neuromuscular (NM) pattern

A

Refer back to MD

77
Q

What are the goals of a PT assessment?

A

Integrate subjective and objective exams

78
Q

If your findings make sense after a PT assessment, what do you do?

A

Plan your Tx

79
Q

If your findings don’t make sense after a PT assessment, what do you do?

A

Further review the S and O
Confer w/ a colleague
Refer Pt for a medical consultation

80
Q

If a Pt responded to Tx for a musculoskeletal problem after intervention, your intervention could’ve either…

A

Been effective, or Pt just got better despite the intervention

81
Q

If a Pt didn’t respond to Tx for a musculoskeletal problem after intervention, your intervention could’ve either…

A

Have been the wrong intervention, or the problem wasn’t amenable to intervention

82
Q

If a Pt doesn’t have a musculoskeletal problem, PT will…

A

be inappropriate
so, PT should refer Pt elsewhere
Tx may only temporarily work or worsen the problem

83
Q

If a Pt has a combination of musculoskeletal and non-musculoskeletal problems, PT…

A

may be appropriate and some Sx may improve
but, PT should still refer Pt elsewhere for Sx that PT doesn’t improve

84
Q

What is deep somatic pain caused by?
Name examples

A

Injury/disease to bone, muscle, tendon, ligament etc.
ex: arthritis, bone fracture

85
Q

How can deep somatic pain be described by Pts?

A

Dull or achy, can be sharp
Not always well-localized

86
Q

Is deep somatic pain usually well-localized?

A

It’s not always well-localized
~ if pain is deep, it’s hard to pinpoint

87
Q

What is superficial somatic pain caused by?
Name examples

A

Injury/disease of skin
ex: sprained ankle, bee sting

88
Q

How can superficial somatic pain be described by Pts?

A

Sharp, burning, throbbing

89
Q

Is superficial somatic pain usually well-localized?

A

It’s often well-localized
~pain on skin is easy to pinpoint

90
Q

What is visceral pain caused by?
Name examples

A

Injury/disease of 1 or more organs (heart, liver, pancreas, GI)
Receptors are partic. sensitive to stretching, hypoxia (lack of O2 in tissues), or visceral inflammation
ex: angina, bowel distension (tummy bloating/swelling), pancreatitis, menstrual cramps

91
Q

How can visceral pain be described by Pts?

A

Dull, aching, throbbing, pressured sensation

92
Q

Is visceral pain usually well-localized?

A

It’s often poorly localized
Incl. referred pain
~ pain in organs is hard to pinpoint

93
Q

Visceral pain may be assoc. w/ autonomic Sx such as…

A

sweating, nausea, BP/HR changes

94
Q

What is neuropathic pain caused by?
Name examples

A

Injury/disease of the PNS/CNS
May have assoc. evidence of nerve damage (sensory impairment and/or weakness)
ex: neuropathy, phantom pain, irritated nerve root

95
Q

How can neuropathic pain be described by Pts?

A

Burning, shooting, tingling, electric shock
Incl. radiating pain

96
Q

What is viscerosomatic pain?

A

Organ pain is felt in the muscle (referred pain)
ex: Acute appendicitis → abdominal muscle rigidity & pain
MI → pain in L arm

97
Q

What is somatovisceral pain?

A

Muscle pain is felt in the organ (referred pain)
ex: palpating a trigger point → nausea/vomiting/pain

98
Q

What is somatoemotional pain?

A

Occurs when emotional/psychological distress causes physical pain, and vice-versa
ex: Pt w/ worker’s comp has back pain → feels uncertain about returning to work

99
Q

What is referred pain?

A

Pain that is felt at a site diff. from its origin
ex: CAD → pain in L arm

Common w/ visceral pain (viscerosomatic, somatovisceral)
Can also be from trigger points (somatovisceral)

100
Q

Why does referred pain occur?

A

Sensory nerves from diff. parts of the body share common pathways in the spinal cord

101
Q

Acute nerve root irritation tends to be _______, _______, and _______

A

burning; shooting; constant

102
Q

Chronic nerve root pain tends to be _______ or _______, and causes _______ _______

A

annoying; nagging
radiating pain

103
Q

What is radiating pain?

A

Pain that is felt at the origin site and spreads to a different site, depending on the corresponding spinal nerve root(s)
ex: radicular pain from a herniated disc

104
Q

What are the 3 patterns of radiating pain?

A

Dermatome (area of skin supplied by 1 spinal nerve root)
Scleratome (area of bone supplied by 1 spinal nerve root)
Myotome (area of muscle supplied by 1 spinal nerve root)

105
Q

Muscle pain worsens with…

A

contraction/stretch of the muscle, and use of muscle, bone, tendon, bursa

106
Q

Muscle pain can be caused by _______

A

ischemia, the lack of blood flow and O2

107
Q

_______ brings relief to muscle pain

A

Rest

108
Q

If a Pt awakens at night due to joint pain, what could be the cause?

A

Bone disease or neoplasm (new and abn. growth of tissue; sign of CA)

109
Q

What is claudication?

A

Muscle pain caused by lack of blood flow/O2 during exercise, typ. walking

110
Q

Crampy calf pain while walking can be explained by _______, and often indicates _______ _______ _______

A

claudication; peripheral artery disease (PAD)

111
Q

Cardiac pain increase when there is an _______ demand on the heart
Name some examples of demands

A

increased
ex: exertion, cold weather, emotional distress

112
Q

Cardiac pain typ. _______ w/ rest

A

decreases

113
Q

As symptoms progress, pain may be…

A

present w/o an increase in activity

114
Q

What is arterial pain caused by?

A

Inflammation of an artery
ex: migraine headaches

115
Q

Arterial pain increases with increased _______ _______ _______

A

systolic blood pressure, b/c it increases pressure on an artery
Typ. described as “throbbing”
ex: bend over, fever

116
Q

Pleural pain in the thoracic cavity correlates with _______ movements

A

respiratory

117
Q

Pleural pain is typ. worse at the _______ _______ _______

A

end of inspiration

118
Q

Pain at rest may be due to _______ from vascular disease, or _______

A

ischemia (lack of O2); neoplasm (new & abn. growth of tissue)

119
Q

If pain is worse at night, wakes Pt up from sleep, and Pt can’t go back to sleep, what is the possible cause?

A

Neoplasm (new & abn. growth of tissue)

120
Q

What are the 5 Ps of pain at rest?

A

Pain (disproportionate)
Pallor (loss of color)
Pulselessness
Paresthesia (numbness)
Paralysis

121
Q

If the 5 Ps of pain at rest are present, what do you do?

A

Go to ER
Think acute arterial occlusion (sudden blockage of a peripheral artery → interrupts blood flow)

122
Q

What are the cardinal cancer warning signs?
(CAUTION)

A

C hanges in bowel/bladder (sudden incontinence)
A sore that doesn’t heal
U nusual bleeding/discharge
T hickening or lump in breast/elsewhere
I nexplicable pain
O bvious change in wart/mole
N agging cough/hoarseness

Also proximal muscle weakness, change in deep tendon reflexes (DTR), persistent bone pain (esp. at PM)

PT 6014: Internal Medicine (2 decks)

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