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Primary Care I > Module 5 > Flashcards

Module 5 Flashcards

1
Q

Confusion

A

not a disease process or disease state but rather a symptom. Confusion is an inability to think quickly or coherently
usually demonstrated by inappropriate reactions to environmental stimuli, may arise suddenly or gradually, and may be either temporary or irreversible. Stressful events, lack of sleep or food, or sensory deprivation may precipitate confusion. Age no reliable factor

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2
Q

Dementia

A

is a decline in mental functioning, affecting memory, cognition, language, and personality
persistent or more severe confusion, with or without psychomotor hyperactivity characterized by a significant time span between symptom appearance and death

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3
Q

Cognitive impairment

A

refers to a decline in at least one of the following cognitive domains: language, executive function, attention, perceptual-motor function, social cognition, learning, and memory. The disturbance must interfere with independence in everyday activities and not be better accounted for by another neurocognitive disorder

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4
Q

Treatment of dementia- pharm

A

NMDA receptor agonist (memantine) and cholinesterase inhbitors (donepezil, rivastigmine)
most useful for moderate to severe AD, combo is more effective

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5
Q

non pharm tx of dementia

A

cognitive rehab
exercise
occupational therapy

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6
Q

recommended psychotic for dementia

A

risperidone, only used for 3 months

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7
Q

delirium

A

acute, abrupt onset
confusion fluctuates throughout day
inattention
once the cause is corrected, should return to previous state of cognitive functioning

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8
Q

metabolic disturbance/ confusion

A

fluid, electrolyte and acid base imbalance may b result of metabolic problems, which can produce confusion
dehydration

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9
Q

infectious process/ confusion

A

confusion may be result of infectious process that can cause extensive tissue and organ impairment, ischemia produces cell injury

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10
Q

Dizziness

A

is the sensation of unsteadiness or feeling off balance, faintness, light-headedness, and a feeling of movement within the head. Loss of consciousness rarely occurs, but the feeling of faintness encourages the patient to lie down, which may cause the feelings to disappear
brief episodes, result of inadequate blood flow and oxygen supply to brain

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11
Q

Vertigo

A

is the false sensation of rotation or movement of the patient or the patient’s surroundings. Vertigo may result from an inner ear disease or a disturbance of the vestibular center or pathway in the central nervous system (CNS).

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12
Q

Diagnoses of dizziness- 4 categories

A

peripheral vestibular disease
systemic disorders
CNS disorders
anxiety states

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13
Q

Questions to ask regarding dizziness

A

duration
severity
nature of episodes
associated symptoms

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14
Q

physical exam dizziness

A

exam ear (r/o cerumen)
whisper test
rinne and weber
thorough neuro assessment
Hallpike maneuver

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15
Q

The Hallpike maneuver

A

is performed by rotating the patient’s head to one side and then lowering it slowly to 30 degrees below the bodyline. The patient should be observed for nystagmus during head rotation and vertical positioning.
In patients with benign vertigo, there may be rotational nystagmus and possible severe vertigo, which usually occurs in one direction. This resolves quickly and cannot be reproduced after two to three repetitions.

The clinician should suspect a central lesion when the vertical nystagmus is of a longer duration and continues with each repetition

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16
Q

peripheral vestibular disease dizziness

A

Most often the problem is located in the labyrinth of the middle ear
dizziness, nausea and vomiting, diaphoresis, difficulty with balance, vertigo, tinnitus, fluctuating hearing loss, feelings of pressure in the ear, and diplopia

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17
Q

tx vertigo

A

meclizine or promethazine most common- suppress vestibular end organ receptors, inhibit vagal response
take med x1 week, then taper down

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18
Q

diamox

A

is used to decrease edema in the labyrinth

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19
Q

vertigo exercise

A

instructed to reproduce the feelings of vertigo by placing the affected ear down, then assume a supine position and hold that position until the vertigo disappears. The vertigo may return when the patient sits up. The patient should repeat these maneuvers at least five times a day or until the vertigo no longer returns. Patients with persistent symptoms should be referred for assessment of nerve function.

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20
Q

systemic disorder dizziness

A

aggravated by postural changes or exertion. Pallor, dyspnea, tachycardia, bounding pulse, weakness, hypotension, blurred vision, decreased breath sounds, headache, diaphoresis, and agitation suggest systemic problems

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21
Q

percentage of HA without cause

A

90%

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22
Q

types of primary headaches

A

tension-type headaches, migraines, and cluster headaches

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23
Q

Tension-type headache

A

, also referred to as a muscle contraction headache, presents as a mild to moderate bilateral, nonpulsating, tightening pain that is not aggravated by routine physical activity. It is usually not accompanied by nausea and vomiting or photophobia.

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24
Q

Migraine headache

A

may last for 4 to 72 hours and may or may not be precipitated by an aura. It is usually unilateral, of moderate to severe intensity with a pulsating quality, aggravated by routine physical activity, and accompanied by nausea, vomiting, and photophobia.

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25
Q

Cluster headache

A

usually occurs at night and may last from 15 to 180 minutes. There is usually severe unilateral orbital, supraorbital, and/or temporal pain that is accompanied on the same side of the face with sweating, lacrimation, nasal congestion, ptosis, rhinorrhea, eyelid edema, and/or conjunctival injection.

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26
Q

subtypes of migraine

A

with and without aura

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27
Q

aura

A

fully reversible neurologic symptoms: visual, motor, sensory, speech, brainstem, or retinal. The symptoms of an aura typically develop gradually and are usually followed by a headache. Auras are fully reversible and last 5 to 60 minutes

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28
Q

definition of migraine without aura (2 characteristics required)

A

unilateral location, pulsating quality, moderate to severe intensity, and exacerbation by physical activity. In addition, at least one of the following must be present: nausea or vomiting, photophobia, or phonophobia

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29
Q

chronic migraine definition

A

15 migraine days each month, for at least 3 months

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30
Q

women are _____x more likely to be affected by migraines

A

2-3

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31
Q

most common type of headache

A

tension, age peaks between 30-38

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32
Q

second mots common type of headache

A

migraine
African americans, non whites 2x likely to have migraines

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33
Q

foods that are known migraine triggers

A

sodium nitrate
alcohol
tyramine
phenylethylamine
caffeine

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34
Q

most painful type of headaches

A

cluster

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35
Q

temporal arteritis or GCA

A

Associated symptoms include scalp allodynia, jaw claudication, and concurrent polymyalgia rheumatica. Other symptoms are local swelling; tenderness and pulselessness of the temporal artery; and systemic symptoms of fever, anorexia, weight loss, and chills. Systemic markers of inflammation also are present. Prompt diagnosis is important since temporal arteritis can cause permanent vision loss if left untreated.

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36
Q

thunderclap headache

A

abrupt and severe, sudden onset headache that reaches maximal intensity in under 1 minute. This type of headache requires emergent evaluation since it is often caused by a subarachnoid hemorrhage

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37
Q

Arterial dissection,

A

characterized by cephalic pain or headache of sudden onset, often preceding transient ischemic attack (TIA) or stroke symptoms. Carotid or vertebral artery dissection causes acute unilateral neck pain that is sudden and often radiates to the ipsilateral face or eye. The headache is related to cervical manipulation, sustained exertion, or trauma. Recognition and proper treatment are important since arterial dissections can lead to stroke

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38
Q

Increased intracranial pressure

A

causes headaches that worsen with lying flat, bending over, or with the Valsalva maneuver. There may be an associated cranial nerve VI palsy, pulsatile tinnitus, or transient visual obscuration, including a graying out of vision, typically with position changes. Funduscopic examination reveals papilledema.

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39
Q

Encephalitis

A

is associated with a new-onset generalized headache, accompanied by confusion, altered level of consciousness, focal neurologic signs, or seizures. Signs of infection and meningismus may be present. Changes associated with these conditions can be detected with lumbar puncture (LP) and brain imaging

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40
Q

skull structures sensitive to pain

A

meninges, arteries, skull

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41
Q

Pain signals are transmitted from most structures in the head by branches of the

A

trigeminal nerve

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42
Q

It is thought that an abnormal reduction in serotonergic activity in the ________is a part of the hypersensitization in primary headache syndromes

A

thalamus

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43
Q

events of migraine

A

prodrome- hours to days before headache (drowsiness, depression, euphoria)
Unilateral headache- increased sensitivity

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44
Q

cluster headache duration

A

2-3 months, 1-2x/year

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45
Q

family hx-migraine

A

associated with 40% patients

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46
Q

typical migraine without aura

A

often unilateral
2-72 hours
pulsating
inhibiting daily activity
n/v, photo and phonophobia

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47
Q

typical migraine with aura

A

aura develops over minutes, lasts less than hour
visual symptoms most common

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48
Q

migraines and menses

A

migraines often occur after ovulation and before/during menstruation

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49
Q

for women who experience aura

A

use of any combined hormonal contraception is contraindicated= d/t 3x increase in risk of stroke

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50
Q

physical findings with subarachnoid hemorrhage

A

visual blurring
diploplia
fever
alteration of consciousness
nuchal rigidity

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51
Q

A symptom specific to temporal arteritis is

A

“claudication” of the muscles of mastication

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52
Q

A computed tomography (CT) scan or an magnetic resonance imaging (MRI) study is recommended if the patient’s headache

A

pattern is atypical, has changed in pattern or character, or is accompanied by seizures, personality changes, or an abnormal neurologic finding

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53
Q

labs for headache pt

A

CBC
CMP
UA

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54
Q

GCA labs

A

ESR strongly elevated
CRP elevated
biopsy of temporal artery is gold standard

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55
Q

HA red flags

A
  • Progressive or fundamental change in headache that worsens over time
  • Patient states, “This is the worst headache of my life!”
  • New-onset headaches before the age of 5 or after age 50
  • Persistent headache precipitated by a Valsalva maneuver, exertion, or sex
  • Fever, acute glaucoma, hypertension, myalgias, weight loss, or scalp tenderness
  • Neurologic signs and symptoms: confusion, altered level of consciousness, changes in memory, papilledema, sensory deficits, reflex asymmetry, or gait disturbances
  • Headache with syncope or seizures
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56
Q

Tension type headache tx

A

NSAID, cool compresses, stress reduction
Not more than 2x/week

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57
Q

migraine tx- non pharm

A

ID and eliminate triggers
maintain strict sleep schedule
regular exercise
deep breathing, massage, hot/cold therapy

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58
Q

migraine tx- pharm

A

triptan , NSAID

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59
Q

cluster ha tx

A

SQ sumatriptan
intranasal zolmitriptan
O2

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60
Q

Paresthesia

A

is an abnormal sensation described as numbness or tingling, cramping, or pain without a known stimulus, felt along peripheral nerve pathways.

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61
Q

Paresis

A

is weakness

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62
Q

Tremors

A

are rhythmic involuntary muscle movements that result from alternate contraction and relaxation of opposing muscle groups. They are typically evident in patients with cerebellar or extrapyramidal disorders

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63
Q

resting tremor

A

occurs in a relaxed and supported extremity and ends with purposeful movement

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64
Q

intentional tremor

A

occurs when the patient attempts voluntary movement.

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65
Q

Musculoskeletal problems

A

most common cause of disability in workers
* Typically self limiting, however must r/o musculoskeletal emergencies
* Diagnosis dependent on patient’s self reporting symptoms

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66
Q

Categories of musculoskeletal complaints

A

o Acute or chronic
o Articular or nonarticular
o Inflammatory or non inflammatory
o Localized or systemic

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67
Q

articular complaints

A

involve synovium, synovial fluid, articular cartilage, intra articular ligaments, joint capsule
o Deep/diffuse pain, limited ROM on active and passive movement, swelling,crepitation, instability, locking, deformity
o Based on number of involved joints (monoarticular, periarticular, polyarticular)

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68
Q

non-articular complaints

A

involve extra articular ligaments, tendons, bursae, fascia, bone, nerve, skin
o Focal vs widespread

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69
Q

inflammatory muscle complaints

A

infectious or idiopathic
o Four signs of inflammation: erythema, warmth, pain swelling

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70
Q

non inflammatory musculoskeletal complaint

A
  • Non inflammatory- r/t trauma, ineffective repair, neoplasm
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71
Q

when inspecting joint pain always compare

A

symmetry and sides

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72
Q

Pain over greater trochanter indicative of

A

hip trochanteric bursitis

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73
Q

hand numbness that awakens pt at night indicative of

A

carpal tunnel syndrome

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74
Q

Bony enlargement of distal interphalangeal joints indicative of

A

osteoarthritis

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75
Q

soft tissue swelling indicative of

A

rheumatoid arthritis

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76
Q

Two key portions of physical exam of musculoskeletal

A

ask pt to rise from chair without holding on
have pt walk

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77
Q

Lab tests for musculoskeletal complaints

A

CBC- r/o anemia, leukopenia
ESR, CRP
Rheumatoid factor
ANA
Lyme
Uric acid

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78
Q

Imaging for musculoskeletal complaints

A

Indicated when exam can’t localize structure causing symptoms, after significant trauma, loss of joint function, pain continues after conservative management, fracture or infection suspected, hx of malignancy

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79
Q

Acute Musculoskeletal Injury

A
  • Acute pain of less than 6 weeks
  • Damage to muscles, tendons, ligaments, nerves, bursae- most common are spasm, strain, sprain
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80
Q

Spasm

A

o - persistent, painful, reversible contracture of striated muscle

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81
Q

Strain

A

o - muscle injury caused by excessive tensile stress placed on muscle- results in stiffness, decreased function
“pulled muscle”, usually no redness/swelling, ROM may be limited

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82
Q

Sprain

A

o - stretching/tearing of ligaments when joint forced beyond normal anatomical range
often have hx of sudden fall/injury
o Redness/bruising over affected joint, active and passive ROM limited, pain when moving

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83
Q

1st degree sprain

A
    • stretching of ligamentous fibers
84
Q

2nd degree sprain

A
    • tear of part of ligament, pain and swelling
85
Q

3rd degree sprain

A
    • complete ligamentous separation
86
Q

Acute muscle injury tx

A
  • PRICE- protect, rest, ice, compress, elevate
  • Most are self-limiting, improve within 2 weeks
  • PT- heat and cold. Cold x48 hours, then heat
  • Pain relief- NSAIDs. NO opoids
87
Q

Muscle Cramps

A
  • Sudden, involuntary, painful contractions of muscle that lasts several seconds- minutes
  • Hyper-excitability of motor neurons supplying muscle
  • In pregnancy and children- tend to be at rest, benign
  • Leg pain/cramps in adults precipitated by exercise- peripheral vascular disease
88
Q

Radiculopathy

A
    • caused by compression/injury of spinal nerve roots d/t spondylosis or disc hernation
      o Weakness, numbness, tingling typically occur along distribution of affected nerve root
      o Common: L3-L5, L5-S1
89
Q

Brachial plexus injury-

A

severe burning upper arm/shoulder pain that radiates down arm, followed by weakness. Pt holds arm at affected side

90
Q

Thoracic outlet syndrome

A
    • compression of brachial plexus and/or subclavian vessels as they exit narrow space between shoulder and first rib
      o Women age 20-50 most common
91
Q

Peripheral polyneuropathy

A
    • “stocking glove” paresthesia, diminished DTR. Diabetes is common cause
92
Q

Myofascial Pain

A
  • Type of muscle pain that is caused by development of “trigger points” within muscle
  • Trigger point- area of local irritation that when activated causes referred pain
93
Q

myofascial pain tx

A

ID and eliminate aggravating factors. Trigger point injections, dry needling, massage therapy, tizanidine
* Muscle relaxers- avoid with etoh, dry mouth

94
Q

Neck pain

A
  • Causes- generally structural in nature
  • Risk factor- stress, sedentary occupation, improper biomechanics
  • Watch for pain that begins gradually and improves with rest
  • Evaluate ROM
  • Spurlings maneuver to assess nerve root compression
  • Palpate neck- check for tenderness, spams, lymphadenopathy
  • Labs- EXR, RF or ANA if systemic
95
Q

Spondylosis

A
    • degenerative changes, may cause osteophytes. Normal result of aging
96
Q

Back Pain

A
  • Causes: lumbar strain/sprain, nerve impingement, nerve compression, radic, fractures
  • Fractures often result of trauma
  • Inspect spine, lower extremities, gait. Palpate area of concern
  • Inspect while standing, sitting with knees/hips at 90 degrees and lying in prone position
  • Evaluate lower extremities for sensation. Can they walk on heels/toes?
  • Straight leg test- pt supine, grab heel of leg and raise, assess for pain
97
Q

Ankylosing spondylitis-

A
  • inflammatory back pain in absence of RF with elevations in CRP
    back pain/stiffness over several months, relief with exercise
98
Q

Cauda equina

A
    • saddle numbness, loss of bowel/bladder. **Med emergency
99
Q

Dissecting aortic aneurysm

A
    • sudden onset severe low back pain, not relieved with rest. **Med emergency
100
Q

Gallstone back pain

A
    • pain after fatty meal, radiates around trunk to right scapula
101
Q

herniated disc back pina

A

years of recurrent low back pain

102
Q

infection back pain

A

pain even at rest, fever, diabetes

103
Q

prostatitis back pain

A

constant low back pain, urinary hesitancy, change in sexual frequency

104
Q

stenosis back pain

A

gradual onset, mimics intermittent claudication but pain is in butt, thigh or calf, pain relieved when sitting, leaning forward

105
Q

Should pain

A
  • Most commonly causes by local process
  • Often caused by precipitating injury
  • Instability often occurs in younger adults
  • Inspection first for color, swelling, edema, symmetry. Then palpation. Then active/passive ROM
106
Q

Apley scratch test

A
    • reach behind head and touch superior aspect of opposite scapula
107
Q

shoulder pain with abduction

A

supraspinatus tendinitis, subacromial bursitis

108
Q

shoulder pain with active motion

A

muscle and bursae involvment

109
Q

shoulder pain with passive motion

A

involve tendons, bursae

110
Q

acute anterior dislocation of shoulder

A

pain is severe, ROM limited

111
Q

Frozen shoulder

A

o - global loss of passive and active ROM

112
Q

elbow pain

A
  • Normally because of overuse
  • Most common lateral epicondylitis of humerus (tennis elbow)
    o Associated with repeated extension of wrist and pronation/supination of forearm against resistance
    o Pain in elbow that radiates to forearm, pain/weakness with gripping objects (coffee cup sign)
    Rest, ice, NSAID, PT
113
Q

Medial epicondylitis

A
  • “golfers elbow”
  • Result of overuse or strain of muscle group used in wrist flexion
  • Tenderness/pain over medial epicondyle and exacerbated by wrist flexion
114
Q

Allen’s test

A
    • compress radial and ulnar artery and arterial arch
115
Q

Phalen’s maneuver-

A
  • maintain forced flexion of the wrist for 1 min
116
Q

Tinel’s sign

A
    • percuss median nerve at wrist, check for tingling
117
Q

Finkelstein’s test-

A
  • have pt touch thumb into palm and make a fist, check for pain
118
Q

Hip pain

A
  • Discomfort within or around hip, subject to stress from ambulation and weight bearing
  • Pain in/around hip often felt in groin or the buttock, can be referred to thigh or knee
  • Presence of stiffness- question degenerative disease
  • Fracture of femoral head results in external rotation and flexion, shortened leg
  • Check gait if possible, check passive ROM, assess femoral/pedal pulses, DTR
119
Q

Knee pain

A
  • Relatively weak joint, suspectable to many injuries
  • Often result of overzealous exercise, fractures
120
Q

Meniscal injury

A
    • often with twisting injury with foot planted on ground and locking, localized pain/tenderness
121
Q

Ligamentous injury

A
    • acute pain, instability, swelling
122
Q

Patellofemoral dysfunction

A
    • continuum of disorders including chrondomalacia patellae and patellofemoral arthralgia (overuse syndrome). Pain occurs when climbing stairs or standing after sitting
123
Q

Bursitis/tendinitis

A
    • secondary to overuse, often bilateral. Pain worse with rising, at night
124
Q

Bulge sign

A
    • pt supine, massage medial knee toward head, then stroke lateral aspect of knee toward medial aspect. Positive if flatulence occurs over medial aspect
125
Q

McMurray test

A
    • flex knee, hold position while externally rotating foot, then extend knee
126
Q

Anterior drawer test

A
    • stabilize tibia, grasp hindfoot and pull forward
127
Q

Fairbank test

A
    • pt seat with quads relaxed, put knee in extension, displace patella laterally and flex knee to 30 degrees. Watch for pain, apprehension
128
Q

Posterior impingement syndrome

A
    • seen in ballet dancers, pain/swelling of posterior ankle and worsens with plantar flexion
129
Q

Achilles tendon rupture-

A
  • pain, inability to walk normally. Side effect of fluoroquinolones
130
Q

Thompson’s test

A
    • pt lies prone, bend knee so leg is vertical, squeeze calf, should create plantar flexion
131
Q

Neuroma

A

o causes tenderness in 3rd and 4th intermetatarsal space with radiation into toes

132
Q

Bunion (hallus vagus)

A

o - deformity of the first metatarsal joint with lateral drift of toe. Painful swelling

133
Q

Midfoot problems

A

*
o Result of flat foot, likely to produce pain/stiffness in midfoot region, tenderness to palpation

134
Q

plantar fasciitis

A

o - pain worse in morning, subcalcaneal pain that radiates to arch in foot when walking

135
Q

Achilles tendinitis

A

o - pain at or proximal to insertion of tendon into calcaneus

136
Q

“Whiplash”

A

describes an acceleration–deceleration of the neck with rapid flexion–extension and is a common sequela of motor vehicle accidents. Despite no apparent instability, these injuries may cause prolonged disability, probably related to a combination of relatively severe ligamentous/muscle injury with nonorganic overlay.

137
Q

the most common cause of neck pain

A

Mechanical disorders of the cervical spine are

138
Q

The highest prevalence (10%)of cervical pain is among

A

persons aged 45 to 64 years

139
Q

occupations at risk of developing mechanical neck pain

A

Workers who do repetitive tasks with their upper extremities and prolonged sitting with their head in a flexed position are ; these include machine operators, carpenters, office workers, dentists, and keyboard operators

140
Q

Cervical sprain

A

is a clinical condition describing a non-radiating discomfort or pain in the neck area associated with a concomitant loss of neck motion and stiffness

141
Q

Whiplash injuries are most commonly caused by

A

rear-end motor vehicle collisions (MVCs) when the driver of a stationary car is struck from behind by another vehicle

142
Q

cervical sprain subjective presentation

A

pain in middle to lower part of posterior neck
headache
pain that worsens with motion, spasm
if from MVC- does not appear until 12-14 hours after collison

143
Q

cervical sprain objective presentation

A

decreased ROM in neck, poor quality of movement
negative Spurling sign
tenderness to palpation to cspine

144
Q

Spurling’s sign

A

(radicular pain reproduced when the examiner exerts downward pressure on the vertex while tilting the head toward the symptomatic side)

145
Q

when to order imaging cpsine sprain

A

neuro deficits
XR obtained in all instances

146
Q

Cervical disc herniation presents with

A

associated radicular pain and neurologic findings.

147
Q

Cervical spine tumor is accompanied by

A

a history of night pain and weight loss.

148
Q

cervical spine infection is accompanied by

A

fever, sweats, and chills. Consider if the patient has a history of IV drug use.

149
Q

Malingering is accompanied by

A

exaggerated symptomatology and evidence of secondary gain.

150
Q

Cervical sprain tx

A

reassurance, decrease in activity
NSAIDs
muscle relaxers
PT
cervical traction

151
Q

Spondylosis

A

(also called degenerative arthritis) is a blanket term for a group of chronic degenerative processes that affect the vertebrae and facet joints and cause pain, stiffness, and disability

152
Q

Patho of cervical sponylosis

A

Changes in the intervertebral discs caused by aging include a loss of water and elasticity, which can make the disc vulnerable to injury and surrounding ligaments less able to support the surrounding structures

153
Q

cervical spondylosis subjective presentation

A

neck stiffness, mild ache with activity
trouble turning neck

154
Q

cervical spondylosis diagnostic test

A

MRI

155
Q

if symptoms of cervical sponylosis are bilateral

A

consider disc herniation

156
Q

Acute low back pain (ALBP) is pain that

A

persists for less than 6 weeks.

157
Q

Chronic low back pain (CLBP) is defined as

A

pain lasting longer than 3 months; symptoms are typically recurrent and episodic but may be unremitting.

158
Q

ALBP occurs most frequently in adults in between ages

A

20 and 50 years

159
Q

CLBP typically is seen between

A

the third and sixth decades of life, or even older for women.

160
Q

women report more LBP after

A

age 60, most likely due to osteoporosis; these women are at risk for vertebral compression fracture. In addition, a woman’s likelihood of experiencing LBP is increased after two or more pregnancies

161
Q

There are two categories of risk factors that influence LBP

A

: occupational and patient related

162
Q

occupations with associated increased risk of LBP

A

require hard labor and heavy exertion, exposure to prolonged vibration (riding)
pts who view occupations as boring

163
Q

most frequent cause of lost workdays in the United States

A

LBP

164
Q

low back pain subjective presentation

A

localized discomfort shortly after lumbar tissue mechanically stressed
difficulty standing erect, change position frequently
pain radiates into butt, posterior thigh

165
Q

he hallmark symptom of CLBP

A

is recurrent LBP that often radiates to one or both buttocks
aggravated by activities

166
Q

objective presentation of LBP

A

diffuse tenderness of low back
ROM reduced, elicits pain

167
Q

LBP is a diagnosis of

A

exclusion

168
Q

non pharm LBP tx

A

exercise
CBT
heat
massage
rest has little to no effect on resolution of LBP!!

169
Q

LBP pharm tx

A

acetaminophen, NSAIDS, muscle relaxers

170
Q

The first episode of back pain is usually

A

the briefest and least severe

171
Q

The most common cause of radicular pain to the lower extremities is a

A

herniated lumbar intervertebral disc

172
Q

Disc herniation occurs most commonly at the

A

L4 to L5 or L5 to S1 levels with subsequent irritation of the L5 and S1 nerve root.

173
Q

hallmark sign of disc herniation

A

radicular symptoms

174
Q

subjective clinical presentation lumbar spine disc herniation

A

insidious severe pain, exaggerated by sitting walking coughing
pain radiates down butt
unilateral radic

175
Q

objective lumbar spine disc herniation presentation

A

patients list to one side when standing
reproduced back pain with supine straight leg raising limited to less than 45 degrees of leg elevation

176
Q

lumbar spinal stenosis

A

most frequently results from enlarging osteophytes at facet joints

177
Q

sign of lumbar stenosis

A

short term relief by leaning forward

178
Q

lumbar spine stenosis tx

A

NSAIDs
B12
PT or exercise, biking
epidural steroid injection

179
Q

Cauda equina syndrome incomplete (I)

A

perianal/saddle anesthesia without urinary incontinence or retention with CES-I

180
Q

cauda equina retention (R)

A

fully developed urinary retention or incontinence with CES-R

181
Q

vertebral fracture

A

cspine most common- c2, c5/6/7
associated with osteoporosis, injuries
midlevel back pain, associated with movement
XR, CT, MRI

182
Q

vertebral fracture tx

A

pain relief- opioids, tramadol
maintain function- bedrest
prevention
quality of life
f/u in 1 week

183
Q

Bursitis

A

, or inflammation of a bursa, is a common cause of painful musculoskeletal syndromes. Bursae are sacs filled with synovial fluid, located between muscles, tendons, and bony prominences.
more common in men, pts younger than 35

184
Q

the most common cause of bursitis

A

Trauma in the form of repetitive motion injury is probably

185
Q

bursitis clinical presentation- subjective

A

pain, swelling, warmth
if deep bursa- pain with activity or direct pressure

186
Q

bursitis objective presentation

A

induration, erythema, effusion

187
Q

bursitis management

A

XR
avoidance of activities, moist heat/ice to affected area every 4 hours x15 min
NSAID
steroid, oral or injection

188
Q

Tendinitis

A

is the inflammation of a tendon, which usually occurs at its point of insertion into bone or at the point of muscular origin

189
Q

tendinitis risk factors

A

overtraining with athletes
repetitive motion with job
vibration, cold environment

190
Q

tendinitis subjective presentation

A

pain, swelling over localized area of tendon
pain worse with motion
squeaking or rubbing

191
Q

tendinitis objective presentation

A

swelling minimal
pain worsens when stretches involved tendons

192
Q

tendinitis tx

A

PRICE
compression
rest 1-2 days
PT
NSAIDs
steroid

193
Q

most common cause of peripheral nerve compression

A

CTS

194
Q

CTS

A

most common 40-60, affects females more than males
increased risk with occupations that require repeated flexion

195
Q

CTS subjective & objective

A

aching sensation, nighttime awakening with pain/numbness in medial thumb and medial portion of 4th digit
thenar eminence atrophied

196
Q

De Quervain’s tenosynovitis

A

pain at base of thumb, more common in middle aged women
pt complains of pain while turning key
Finkelstein’s test is confirmation test

197
Q

ganglion cyst

A

caused by frequent strains and contusions, results in joint inflammation
asymptomatic
tx: aspiration, sx

198
Q

trigger finger

A

can affect any digit, mostly affects middle or ring
snapping/locking, severe pain
tenderness in palm, palpable nodule sometimes
TX: local anesthetic, corticosteroid injection

199
Q

Dupuytren’s contracture

A

AKA viking disease
affects palmar tissue between skin and distal palm/fingers
Progressive condition, refer to ortho for tx

200
Q

adhesive capsulitis

A

frozen shoulder
Risk factor: DM type 1
Tight, painful shoulder joint that has limited ROM
TX: moist heat, NSAIDs, PT

201
Q

rotator cuff syndrome

A

lateral arm pain, radiating from shoulder to elbow, night pain, difficulty sleeping, atrophy
palpation elicits tenderness, crepitus
TX: resting, NSAIDs, stretching

202
Q

calcific tendinitis

A

degenerative process accompanied by a local deposit of calcium that develops in the rotator cuff.
tender, severe localized pain
XR shows deposit

203
Q

rotator cuff tear

A

occur spontaneously after age 50
lateral deltoid pain, weakness
empty can test-examiner places his or her fingers on the outstretched arm near the hand and applies pressure to assess if the patient can maintain position against resistance.
TX: icing, NSAIDs, PT, avoiding overhead activities

204
Q

Greater trochanteric pain syndrome

A

is a combination of both gluteal (buttock) tendon injuries (tendinopathy) and bursitis (inflammation of the bursa) surrounding the hip joint.\
characterized by chronic, intermittent, aching pain over the lateral aspect of the hip, and some patients report numbness in the upper thigh. Pain will increase with movement, especially external rotation and abduction
TX: NSAID, steroid injection

205
Q

most common fracture adult

A

hip fracture
externally rotated and shortened injured leg

Primary Care I (7 decks)

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