Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Comps - Mod 2 > PC 617 Modules 7,8,9 - Sheet1 > Flashcards

PC 617 Modules 7,8,9 - Sheet1 Flashcards

1
Q

Percentage of adults that report recurrent headaches

A

80-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Headaches and primary care

A

Rank as one of the 10 most common presenting problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Classifications of headaches

A

Tension, vascular, analgesic rebound, traction/inflammation (secondary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tension headaches

A

More prevalent than migraines; produce little disability and are generally effectively managed with OTC medications; rarely seen in primary care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Length of tension headaches

A

Episodic and can last 30 minutes to hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Description essentials of tension headaches

A

At least 2 of 4 - bilateral; steady and nonpulsatile; mild to moderate intensity (may prohibit but not inhibit activity); not aggravated by routine activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tension headaches and nausea

A

Should not be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tension headache and aura symptoms

A

There can be photophobia or phonophobia but not both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tension headaches and underly disease

A

Should be no evidence that accounts for the headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Migraine without aura

A

Common migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Length of migraine without aura

A

Lasts 4-12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Characteristics of migraine without aura

A

Must have 2 of the following - unilateral head pain; throbbing; moderate to severe intensity; pain aggravated by routine activity; N and/or V; photophobia and phonophobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Migraine with aura

A

Classic migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prevalence of migraine with aura

A

Occurs in approximately 15% of migraine attaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Occurrance of aura with migraine

A

Generally precede headache by less than 1 hours but may occur durring headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Characteristics of most auras

A

Most are visual, ie flashes of light, alternating geometric patterns, alterations in perception - the “Alice in Wonderland” syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Somatosensory auras

A

Consist primarily of numbness and tingling in the lips and fingers although they can occur anywhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Phases of migraines

A

Preheadache or premonitory; headache phase; and postheadache or prostdrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Preheadache or premonitory

A

Prodrome is far more common than aura; involves changes in mood or energy level (depression, euphoria, fatigue), alteration in sensory processing, changes in muscle tone, food cravings, fluid retention, yawning and a variety of other nondescript symptoms; probably reflect the chemical milieu of the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Chocolates as a trigger

A

Traditionally considered a potent migraine trigger, but research has shown it is reflected carbohydrate cravings and was a prodrome and not a trigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Importance of prodromes

A

Become important markers for the timing of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Headache phase

A

Begins mild and progresses from mild to severe over 30 minutes to several hours; can be unilateral or bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Duration of migraine with auras in children and adolescents

A

Usually less than 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Duration of migraine with auras in children and adolescents

A

Usually last 4-72 hours, but menstrual migraines may last longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Postheadache or prodrome

A

After headache is resolved, other symptoms may linger for 1-2 days - fatigue, irritability, inability to concentrate, muscle pain, and/or food intolerance are common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

4 diagnostic questions of headaches

A

1) How do your headaches interfere with your life? 2) Has there been any change in your headache pattern? 3) How do you experience headaches of any type? 4) How often do you use medication to treat headaches?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Use of a headache diary

A

Helps to identify triggers to avoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Diagnostics of headaches

A

Testing should not be done unless it will change management. If diagnosis is undertain based on H&P, may need testing to differentiate primary and secondary headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Cluster headache

A

Classification of vascular headaches - extremely severe, most often seen in men - suicide risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Anangesic rebound headache

A

Suspect with complain of daily headache - Inquire about frequency of analgesia use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Traction/inflammation (Secondary) headache

A

Diseases of the bones of the cranium. Referred pain from eyes, sinuses, teeth, TMJ, ears, and back, menigeal irrittion, temporal arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Non-pharmacological migraine management

A

AVOID triggers, relaxation techniques, accupressure, regular exercise, adequate sleep, good nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Classifications of pharmacological management of migraine

A

Abortive therapy and preventative therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Abortive therapy of migraine treatment

A

Important to use at first indication of headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Use of triptans of abortive therapy of migraine treatment

A

Separate all doses by at least 2 hours; may augment with reglan if N&V severe; pregnancy category C - contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Classifications of drugs used in abortive migraine treatment

A

Triptans, NSAIDS, narcotics, combination analgesics, ergots, corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Combination abortive drugs used in treatment of migraines

A

Excedrine migraine and fiorinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Ergots and use as abortive therapy for migraine

A

Pregnancy category X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Abortive therapy of migraine and pregnant patients

A

Generally should be counseled to avoid triggers, use non-pharmacological measures except accupressure and may take tylenol or midrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Preventative therapy for migraine headaches

A

Can use if no more than 4 per month, used for severe headaches, use if patient does not respond well to medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Comorbid conditions and migraines

A

Consider conditions such as hypertension and epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Classes of preventive drugs and treatment of migraines

A

Beta blockers; calcium channel blockers; anticonvulsants; TCAs; SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Follow up care and migraine

A

Return to clinic every 2-4 weeks X 3 months until responding well to medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Dizziness

A

A symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Vertigo

A

A condition that causes dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Differentiation of dizziness

A

The sensation of the person spinning or the environment spinning around the person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Disequalibrium

A

A loss of balance and lack of coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Lightheadedness

A

The feeling that one is about to faint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Classifications of vestibular problems

A

Peripheral and central

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Vestibular problems

A

Imbalance in vestibular system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Peripheral vestibular problems

A

Problems of inner ear or cranial nerve VIII - most common type of vertigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Central vestibular problems

A

Includes brainstem ischemia and infarction and demylenating disease such as MS - uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Presentation of central vestibular problems

A

Typically present with vertigo in association with other brainstem deficits. May be associated with other signs and symtpoms including diplopia and focal, sensory or motor deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Nonvestibular causes of vertigo

A

Systemic viral or bacterial infection causing postural hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Classifications of nonvestibular causes of vertigo

A

Systemic, metabolic, and drug causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Metabolic causes of vertigo

A

Hypo or hyperglycemia; electrolyte disturbances; anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Drug causes of vertigo

A

Hypnotics, antihypertensives, alcohol, analgesics, tranquilizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Types of peripheral vestibular

A

Benign positional paroxysmal vertigo (BPPV); Menier’s disease; vestibular neuronitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Benign positional paroxysmal vertigo (BPPV)

A

Mot common type of vertigo - caused by free floating particular matter which moves within the semicircular canal with certain head movements; position changes cause an abrupt onset; NO tinnitus or hearing loss but may have associated N&V; a common problem in the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Diagnostic criteria of Meniere’s disease

A

2 episodes, last at least 20 minutes each; accompanied by hearing loss, tinnitus or aural fullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Characteristics of meniere’s disease

A

Vertigo unrelated to position changes, hearing loss is initially reversible but may become permanent in 75% of cases; symptoms are usually unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Vestibular neuronitis (acute labyrinthitis

A

Involves the cochlea and may cause hearing loss - caused by viral infection of the labyrinth. Frequently occurs after URI followed by vertigo. Symptoms resolve in 3-6 weeks with no sequelae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

History of dizziness and vertigo

A

Describe dizziness. Medical problems? Do episodes occur with any specific activity or movement? Associated symptoms? Describe episodes especially onset, duration, and any hearing involvement. Medications? Recent infections? Any recent head trauma? Ear surgeries?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Physical exam of dizziness and vertigo

A

General appearance. Vision exam. Ear exam including Weber and Rinne tests. Hallpike maneuver. Perform neuro and cardiovascular exams.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Weber hearing test

A

Lateralization to unaffected side with sensorineural hearing loss - Meniere’s and labyrinthitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Rinne hearing test

A

AC:BC with sensorineural loss. BC and AC are both reduced but ration remains the same.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

When will you see conductive bone loss with hearing test

A

Seen with serous otitis and otitis media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Hallpike maneuver

A

Produces intense vertigo in patients with vestibular problems. May cause mild vertigo in patients with central problems. Nystagmus with peripheral causes produces a 3-10 second delay in onset, lessens with repetition, and is in a fixed direction. Nystagmus with central causes begins immediately, does not fatigue with repetition and may be in any change of positions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Diagnostics of dizziness and vertigo

A

Lab tests identify the cause in less than 1% of patients. Audiometry - quantify hearing loss. Electronystagmography (ENG). MRI. CBC/ELECTROLYTES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Electronystagmography (ENG)

A

can be useful in diagnosing chronic peripheral disorders such as Meniere’s and persistant BPPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

MRI and diagnosis of dizziness and vertigo

A

Use if vertigo is of sudden onset and accompanied by severe headache, direction changing nystagmus or if risk factors for stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

CBC/electrolytes and diagnosis of dizziness and vertigo

A

Use if suspect anemia, diabetes, or electrolytes inbalances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Length of BPPV

A

May resolve in a few days or weeks without any treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Action tht may shorten BPPV recovery time

A

Referral for vestibular physical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Epley’s maneuver

A

Patient can be taught to do this at home, especially if recurrent (50% of patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Medical treatment for BPPV

A

Meclizine (antivert) can be used but is not as effective as exercises and do not suppress acute attacks. Pregnancy category B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Meniere’s disease

A

Refer to otolaryngologist for testing and management. Bed rest during an attack. Recommend decreasing sodium, caffeine, alcohol, and tobacco, but unclear benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Medication to use to treat Meniere’s disease

A

Antivert and antiemetics with severe symptoms. Diuretics may reduce severity of attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Vestibular neuronitis

A

Lie down in darkened room. Antibiotics if associated with bacterial infection. Symptoms resolve spontaneously in 3-6 weeks with no sequelea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Medication used to treat vestibular neuronitis

A

Methylprednisone. Antivert and antiemetics can be helpful during an attack but should be stopped after 3 days since continuing may slow recovery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Bell’s palsy

A

Presents with unilateral paralysis of face. Often preceded by viral infection. CN VII affected. Acute onset with maximum paralysis in 48-72 hours. May have altered taste and increased sensitivity to sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

History to obtain regarding Bell’s palsy

A

Onset and progression. History of recent infections, especially viral. Any chronic diseases. Insect bites - Bell’s palsy is a common neuropathy with Lyme’s disease. Facial trauma? Pregnancy? Occurs more frequently with pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Physical exam of Bell’s palsy

A

Head and neck. Cranial nerve assessment. Corneal light reflex may be decreased. Eyeball may roll upward when close eyelid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Diagnostics of Bell’s palsy

A

Usually not indicated. May be useful to exclude other conditions such as Lyme disease (titre) or other infection (CBC with diff)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Management of Bell’s palsp

A

Prevention of eye injury is the most important goal. Prevent exposure keratitis by protecting cornea with eye drops (methylcellulose bid and lubricant at HS). Protective eyewear. Patching at bedtime. Massage of facial muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Pharmacological therapy within first week of onset of Bell’s palsy

A

Prednisone recommended in all patients. Antiviral (Valacyclovir). Pregnancy category B - recommended for patients with severe facial paralysis. NSAIDS can be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Recovery of Bell’s palsy

A

Majority of patients recover full function in 4-6 months - 12 months at the most

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Trigeminal neuralgia

A

Affects 5th (trigeminal) cranial nerve. Most are idiopathic. Presents with recurrent episodes of intense sharp, penetrating electric like pain on one side of the fact. Frequency and duration varies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Trigger of pain of trigeminal neuralgia

A

May be triggered by cold, chewing, touch, talking or facial movements with trigger zone. Info should be elicited in history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Exam of trigeminal neuralgia

A

Physical should include exam of all cranial nerves. Neuro exam should be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Management of trigeminal neuralgia

A

Tegretal 100 mg bid, may increase to max 1200/day. Need serial blood counts and LFTs. Abrupt withdrawal should be avoided. SSRIs if person is depressed.

92
Q

Referral of treatment of trigeminal neuralgia

A

Should be referred to a neurologist for more comprehensive evaluation and initiation of treatment. Care can be managed by the PCP. Refer to neurosurgeon is limited pain relief.

93
Q

Meningitis

A

Infection that results in inflammation of the brain’s meningeal membranes. Most often caused by bacterial agent.

94
Q

Presentation of meningitis

A

Typically with high fever, headache, photophobia and neck pain and stiffness (nuchal rigidty)

95
Q

History regarding meningitis

A

Should include exposures, recent travels, food consumptions, sexual practices, drug use, history of infectious diseases, immunocompromised, systemic disorders

96
Q

Physical exam regarding meningitis

A

Temp, pulse, respiratory rate; signs of meningeal irritation - Brudinski’s and Kernig’s sign; LOC - confusion, lethargy, stupor, coma; cranial nerves - diplopia, deafness, facial weakness, pupillary abnormalities

97
Q

Brudinski’s sign

A

Hip and knee flexion with the neck flexed

98
Q

Kernig’s sign

A

Inability to fully extend the legs

99
Q

Initial diagnostics of meningitis

A

CBC - marked elevation of WBC’s; blood cultures; serum glucose; LP is indicated but will be done after referral

100
Q

Management of meningitis

A

If sign and symptoms indicate possibility of meningitis, immediate referral to a neurologist or ED is warranted

101
Q

Prevention of meningitis of unexposed individual

A

Pneumococcal and H Influenza vaccines - all ages; meningococcal vaccine - young adolescents, college freshmen and military, also high risk patients and travelers to endemic areas

102
Q

Prevention of meningitis of exposed individual

A

Meningococcal of H influenza - Rifampin or cipro; pneumococcal - none recommended

103
Q

Most challenging decision regarding PCP care of chest pain

A

The determination if the presenting symptoms are life threatening, requiring immediate referral

104
Q

Common causes of non-cardiac chest pain

A

Peptic ulcer disease (PUD), GERD, costochondritis, acute anxiety

105
Q

Consideration of life-threatening conditions regarding chest pain

A

Determine there is no immediate risk of severe O2 deprivation to vital organs such as - MI, aortic dissection, PE. Most life-threatening conditions present as acute rather than chronic pain

106
Q

Symptoms of MI

A

Sudden onset not relieved by rest or nitro. associated symptoms

107
Q

Aortic dissection

A

Sudden tearing pain located in the anterior or posterior chest. May radiate to arms, legs, abdomen, or back

108
Q

Pulmonary embolism

A

Able to point to area of pain over lung; dyspnea; apprehension; hemoptysis; gripping or stabbing pain of moderate to severe intensity that may increase with deep breathing; may radiate to neck or shoulder; bed rest or other surgery are risk factors

109
Q

Known risk factors for CAD

A

Male >45; female > 55; family history of premature CAD; cigarette smoking; HTN; low HDL 130

110
Q

Patients who present with CP that should be sent to ED

A

Non-localized pain lasting > 20 minutes. Associated with diaphoresis, dyspnea, N&V, dizziness, radiation to neck, jaw, shoulder, arm.

111
Q

CP patients who present with atypical symptoms

A

Women, older adults, and diabetic patients

112
Q

Physical of patients who present with CP

A

General appearance. Vital signs. Inspect skin. Palpate chest wall. Auscultate breath sounds. Auscultate heart sounds. Examine abdomen. Examine extremities.

113
Q

Costochondritis

A

Pain with palpation over the cartilage between the sternum and ribs

114
Q

Musculoskeletal pain assessment in patient with CP

A

Can it be reproduced with movement or palpation?

115
Q

Breath sounds with patient with PE

A

Crackles may be heard over the site of PE

116
Q

Auscultation of heart sounds in patient with CP

A

A new, transient, paradoxical S2 during pain can indicate coronary ischemia. S4 indicates stressed heart which can result from MI, HTN, or CAD. Irregular rhythms are often heard during MI. Aortic diastolic murmur can occur with a dissecting aorta.

117
Q

Physical appearance with patient with CP

A

Grimacing, diaphroesis, cyanosis, pallor, tachypnea

118
Q

Vital signs in patient with CP

A

BP may be elevated with MI. Aortic dissection can have hypotension. Hyperventiltion can cause chest pain.

119
Q

Skin inspection with patient with CP

A

May have cool, pale, moist skin with acute MI, PE, or aortic dissection. Palpate entire chest wall.

120
Q

Abdominal exam of patient with CP

A

PUD, cholecystitis, pancreatitis may cause referred pain

121
Q

Extremity exam in patient with CP

A

Observe for peripheral cyanosis which can indicate hypoxia. Lower extremity edema can indicate heart failure. Absent peripheral pulses can occur with PE

122
Q

Diagnostic tests of costochondritis

A

None needed if physical exam is normal

123
Q

Treatment of costochondritis

A

Application of heat and NSAIDs

124
Q

Education regarding costochondritis

A

Condition is self-limiting. Avoid overuse and trauam. Take NSAIDs with food

125
Q

Follow up care regarding costochondritis

A

Return to clinic if symptoms worsens or no improvement

126
Q

GERD

A

If suspect give trial dose of PPI and check for improvement. If risk factors for CAD, may also do EKG and check lipids.

127
Q

Cardiac work up - Suspected post-MI in no acute distress

A

Cardiac troponins (I&T), serum cardiac enzymes (CPK), SGOT adn LDH, elevated leukocytes & ESR - non-specific indicators, EKG, and refer

128
Q

Cardiac tropinins

A

Rise within 2-4 hours post MI and remain elevated 7-10 days

129
Q

Serum cardiac enzymes (CPK)

A

Rise 4-8 hours after MI and return to normal 48-72 hours

130
Q

SGOT and LDH

A

Elevated later and not indicators of acute MI

131
Q

Neck pain and paresthesias - cervical radiculopathy

A

Caused by compression of the cervical nerve roots - radiculopathy. Most comonly affected are C6 and C7

132
Q

Radiculopathy

A

A pathologic process affecting the nerve root

133
Q

Causes of radiculopathy

A

Compressive - most common - and noncompressive etiologies

134
Q

Predominant mechanisms of compressive cervical radiculopathy

A

Cervical spondylosis and disc herniation

135
Q

Causes of noncompressive radiculopathy

A

Infectious processes (especially herpes zoster and Lyme disease), nerve root infarction, root avulsion, infiltration by tumor, infiltration by granulomatous tissue, and demyelination

136
Q

Clinical symptoms of cevical radiculopathy

A

Neck pain and radicular pain associated with numbness and paresthesias in the upper extremities; muscle spasms or fasciculations in involved myotomes; weakness, lack of coordination, changes in handwriting or strength, radiation of pain into paraspinal and scapular regions. Pain may be relieved by placing hands on top of head to relieve tension of involved nerve root.

137
Q

Reflexes in patients affected with cervical radiculopathy

A

Reflexes are typically reduced with involvement of C5, C6, or C7, but there are no standard reflexes that reflect the distribution of C8 and T1

138
Q

Major aim of neurologic exam in patient with neck pain and paresthesias

A

To look for evidence of weakness and sensory disturbance in myotomal and dermatomal patterns

139
Q

Clinical exam of patient with neck pain and paresthesias

A

Evaluate ROM of neck and extremities, Spurling’s maneuver, abduction relief test, palpate for tendeness, muscle spasm, or lymphadenopathy, assess sensory and motor functions, DTRs

140
Q

Spurlings maneuver

A

Highly specificity for the prsence of cervical radiculopathy, but its sensitivity is low to moderate. Positive test - if limb pain or paresthesias are produced test should be stopped. Production of neck pain alone is nonspecific and constitutes a negative test.

141
Q

Caution with Spurling’s maneuver

A

Never perform in patients who may have instability o the C-spine (RA, cervical malformations, or metastatic disease, since it may cause further injury to the spine). Should not be performed when associated cervical myelopathy is suspected.

142
Q

Abduction relief test

A

Patient is asked to lift the symptmatic arm above the head, resing hand on top of head. If test is positive, the patient has a decrease or disappearance of radicular symptoms.

143
Q

Diagnostics of neck pain and paresthesias

A

Based on history and clinical findings. neuroimaging and electrodiagnostic testing, MRI, EMG, plain radiographs

144
Q

When neuroimaging and electrodiagnostic testing is indicated

A

Persistent symptoms that do not resolve with 4-6 weeks of conservative therapy. Significant neurologic findings or localizing symptoms are present, including myotomal weakness or myelopathy

145
Q

MRI and diagnosis of neck pain and paresthesias

A

Most currently the study of choice in most patients for the initial neuroimaging eval of the C-spine

146
Q

EMG and diagnosis of neck pain and paresthesias

A

Usually confirms radiculopathy and frequently reveals a myotomal pattern of denervation. Nerve conduction studies alone are not sensitive for radiculopathy. Symptoms should be present for more than 3 weeks when use this test

147
Q

Plain radiographs in use of neck pain and paresthesias diagnosis

A

They are rarely diagnostic in setting on non-traumatic cervical radiculopathy

148
Q

Differential diagnoses of neck pain and paresthesias

A

Adhesive capsulitis, demylenating conditions, myocardial ischemia, peripheral nerve entrapment, rotator cuff disease, thoracid outlet syndrome

149
Q

Conservative treatment of neck pain and paresthesias

A

NSAIDs, avoidance of provocative activities, add a short course of oral prednisone if pain severe. Once pain is tolerable, initiate physical therapy with exercise and gradual mobilization.

150
Q

Treatment for patients with severe or disabling pain related to neck pain and paresthesias

A

If conservative treatment has failed and if no progressive worsening of neurologic deficits, recommend use of epidural steroid injections rather than surgery

151
Q

Surgical candidates of neck pain and paresthesias

A

Symptoms and signs of cervical radiculopathy. Cervical nerve root compression by MRI or CT myelography. Persistence of radicular pain despite non-surgical therapy for at least 6-12 weeks, or progressive motor weakness that imapirs function

152
Q

Cervical strain

A

A common condition that is usually self-limited. It is a muscle injury.

153
Q

Sprain

A

Ligamentous stretching-type injury

154
Q

Whiplash

A

Ligament is torn, usually C7

155
Q

Clinical symptoms of cervical strain or sprain

A

May occur after trauma or may be spontaneous. Report of non-radicular, non-focal pain, noted anywhere from the base of the skill to cervicothoracid junction. Pain worse with motion and may accompanied by paraspinal spasm. Occipital headaches may occur early and may persist longer than pain. May report increased irritability, fatigue, sleep disturbances, and difficulty concentrating.

156
Q

Exam of cervical strain or sprain

A

Tenderness in paraspinous muscles, trapexii, sternocleidomastoid muscles, spinous processes, interspinous ligaments, and/or the medial border of the scapula. Limited ROm common. Pain often noted in extremes of motion. Neuro exam is usually normal.

157
Q

Diagnostics of cervical strain or sprain

A

AP and lateral and open mouth (odontoid) radiographs are necessary if patient has history of trauma or if the patient is elderly

158
Q

Differential diagnoses of cervical strain or sprains

A

Cervical disk herniation; cervical spine tumor or infection; dislocation of subluxation of spine; inflammatory condition of C-spine (RA); spinal fracture; symptom amplification/secondary gain

159
Q

Treatment of cervical strain or sprain

A

Mild to moderate axial pain improves in 2-3 weeks. Posture modification, especially in sleep. Home exercise. Tylenol or NSAIDs and mild opioid analgesics short term. TCAs at bedtime for pts with chronic pain and sleep problems. Muscle relaxant at night for pts with severe muscle spasm. Cervical collars. Physical therapy. No c-spine traction or massage for neck pain. TENS units, medical branch blocks.

160
Q

Prevelance of low back pain

A

2nd most common reason for clinician visits. 84% of adults suffer. Most common cause of disability. By age 50, 80-90% of population have evidence of DDD.

161
Q

Risk factors for the onset of back pain

A

Smoking, obesity, older age, female gender, physical strenuous work, sedentary work, psychologically strenuous work, low education level, Worker’s comp insurance, job dissatisfaction and psychological factors such as somatization disorder, anxiety, and depression

162
Q

Subjective data of low back pain

A

Sudden onset of back pain after an event or injury; information needed - OLDCART, any associated neuro deficits, med/surg history, current meds; allergies

163
Q

Clinical symptoms of low back pain

A

Low back pain, pain often radiates to buttocks and posterior thighs, may have difficulty standing erect or may need frequent position changes

164
Q

Clinical exam of low back pain

A

Inspection, palpation, straight leg raises, range of motion, sensory and motor function, DTRs, abdominal exam

165
Q

Inspection of low back pain

A

Reveal anatomic abnormalities such as scoliosis (lateral spinal curvature) or kyphosis (spinal curvature with posterior convexity)

166
Q

Palpation of low back pain

A

Assess vertebral or soft tissue tenderness. Vertebral tenderness is not a specific finding for spinal infection

167
Q

Straight leg raises

A

May be useful to help confirm radiculopathy. Done with pt supine. Examiner raises the pt’s extended leg with ankle dirsiflexed, being careful that the pt is not actively helping in lifting. Considered positive when the sciatics is reproduced between 10-60 degrees of elevation

168
Q

“Red flags” for a potentially serious underlying cause for low back pain

A

Trauma, unexplained weight loss, age >50, female, unesplained fever, immunosuppression, diabetes, history of cancer, IV drug use, prolonged use of corticosteroids, osterporosis, age >70, focal neurologic deficits with progressive or disabling symptoms, duration longer than 6 weeks, prior surgery

169
Q

Management of low back pain

A

Usually self-limiting; 90% resolve in 1-6 weeks. Tylenol, NSAIDS, muscle relaxants. Activity as tolerated. Bed rest no longer than 2 days. Walk. Weight loss. Physical activity. Exercise 30 min per day. No smoking. Return to clinic in 2 weeks if problems persist or sooner if worsen

170
Q

Assessment of shoulder pain

A

Inspection, range of motion of elbow, palpation, rotator cuff testing, stability testing

171
Q

Rotator cuff testing

A

Positive or negative drop arm test, empty can test, push off test, Hawkin’s test, Neer’s test

172
Q

Cervical testing regarding shoulder pain

A

Positive or negative Spurling’s test

173
Q

General shoulder clinical pearls

A

Acute shoulder pain often seek treatment following trauma. Diagnosis made by observation, gentle palpation, and x-ray

174
Q

Shoulder pain unrelated to trauma

A

Must distinguish between extrinsic and intrinsic causes. Rule out potentially dangerous extrinsic causes, then move on to more common patterns of shoulder pain.

175
Q

Poorly localized shoulder pain

A

Often describes extrinsic cause

176
Q

Trauma of shoulder and pain

A

Acute symptoms with history of recent trauma are usually due to acromioclavicul separation, glenohumeral dislocation, fracture, or rotator cuff tear

177
Q

Anteriolateral shoulder pain

A

Aggravated by reaching overhead is common. Often associated with impingement syndrome and various stages of rotator cuff tendinopathy

178
Q

Adhesive capsulitis (frozen shoulder)

A

Most likely diagnosis when pain is accompanied by stiffness and a significant loss of movement in both active and passive motion of shoulder

179
Q

Cervical nerve root impingement and shoulder pain

A

Can produce sharp pain radiating from the neck into the posterior shoulder area and arm

180
Q

Bursitis of the olecranon (swelling)

A

Most common complaint of elbow swelling. Warmth and redness and rapid swelling indicate trauma, sepsis, or gout. Ability to extend and flex elbow completely excludes an intraarticular process as cause of elbow pain

181
Q

Medical epicondylitis - golfer’s elbow - pain

A

2nd most common elbow complaint. Frequently arises from medical epicondyle or ulner nerve as it travels through the cubital tunnel. Pain is well localized and aggravated by actions that contract the wrist flexors, such as lifting or repetitious use of forearm and wrist

182
Q

Lateral epicondylitis - tennis elbow - pain

A

Most common elbow complaint. Source may be due to joint injury or referred shoulder or neck pain. Pain typically well localized and aggravated by activity that contracts the wrist extensors, including repetitious use of forearm and wrist and shaking hands

183
Q

Differential diagnoses of olecranon bursitis

A

Fracture of olecranon process of ulna and gouty tophus or RA

184
Q

Treatment of small mass and mild symptoms with olecranon bursitis

A

Bursitis should be left alone or treated symptomatically with activity modification and possible NSAIDs. Wear elbow pain and avoid hyperflexion against hard surfaces

185
Q

Treatment of more symptomatic bursitis with olecranon bursitis

A

Undergo aspiration followed by gram stain and culture of fluid. If no indication of sepsis, compression bandage. Reassess in 2-7 days

186
Q

Treatment of septic bursitis with olecranon bursitis

A

Requires organ-specific antibiotics based on C&S of aspirate and decompression either by surgical drainage or daily aspiration

187
Q

Carpal tunnel syndrome

A

Entrapment of median nerve at wrist. Most common compression neuropathy in upper extremity. Most common in middle-aged or pregnant women. Can occur in adjacent flexor tendon repetitive overuse, RA, tumors, pregnancy, diabetes, and thyroid dysfunction

188
Q

Clinical symptoms of carpal tunnel syndrome

A

Vague aching that radiates into the thenar area. Aching can extend into shoulder. Pain typically accompanied by paresthesias or numbness in thumb through radial half of ring finger. Symptoms worse at night. Dropping objects, can’t open jars or twist lids

189
Q

Exam of carpal tunnel syndrome

A

Inspect for sensation in fingers, swelling, redness, nodules, deformity, muscle atrophy, active ROM, tenderness. Phalen’s sign is most useful clinical test. Tinel’s sign.

190
Q

Diagnostic tests of carpal tunnel syndrome

A

X-rays of limited ROM. Electrophysiologic testing can be used for confirmation

191
Q

Treatment of mild to moderate carpal tunnel syndrome

A

Splinting, glucocorticoid injections, referral to occupational therapy, nocturnal wrist splinting, bone mobilization and yoga

192
Q

Failure of conservative treatment of carpal tunnel syndrome

A

Duration of symptoms >10 months, age >50, constant paresthesias, positive Phalen’s sign <30 seconds, prolonged motor and sensory latencies. Surgery most effective - decompression

193
Q

Osteoarthritis

A

Results from multiple factors, including joint integrity, genetics, local inflammation, mechanical forces, and cellular and biochemical processes. Most common in pts over 40. Principal symtpom is pain exacerbated by activity and relieved by rest

194
Q

Additional symptoms of osteoarthritis

A

Stiffness, which typically resolvesin the morning less than 30 minutes after awakening; recurrenceof stiffness that may occur with inactivity is termed gelling

195
Q

Exam of osteoarthritis

A

Tenderness to palpation, absence of inflammation, crepitus; bony enlargement; decreased ROM; malalighment

196
Q

Places osteoarthritis typically affects

A

Fingers, knees, hips, and spine. Rarely affects elbows, wrists, and ankle.

197
Q

Rheumatoid arthritis

A

Chronic, systemic, inflammatory disorder of unknown etiology that primarily involves joints. Typically symmetrical. Usually progresses from periphery to more proximal joints with significant disability within 10-20 years

198
Q

Clinical characteristics of rheumatoid arthritis

A

Morening stiffness for at least 1 hr; swelling of 3 or more joints for 6 weeks; swelling of wrist, metacarpophalangeal, or proximal interphalangeal joints; symmetric joint swelling; elevated sed rate; rheumatoid subcutaneous nodules

199
Q

Hip pain

A

A careful history and physical exam can determine etiology of hip pain. Character and location is the key element in establishing the diagnosis.

200
Q

Increased hip pain with or after use

A

Increased pain after weight-bearing movement that improves at rest is the hallmark of a structural joint problem, particularly osteoarthritis

201
Q

Constant hip pain, especially at night

A

Suggests an infectious, inflammatory, or neoplastic process

202
Q

Diagnostic tests of hip pain

A

Plain x-ray should be performed to exclude fracture with moderate to severe hip pain. MRI may be necessary when history, physical, or plain x-rays are inconclusive

203
Q

Management of hip pain related to DJD

A

Tylenol, NSAIDS, glucosamine with or without chondroitin, capsaicin

204
Q

Management of hip pain related to bursitis

A

Avoid triggers that aggravate, moist heat application, ROM exercises, NSAIDs

205
Q

Knee pain

A

Most complaints related to exercise or sports. Most common is a meniscus tear

206
Q

Physical exam of knee

A

Most common is tenderness over medial or lateral joint line, limited ROM due to pain or effusion, positive McMurry sign

207
Q

Diagnosis of meniscus tear

A

Trauma or effusion - x-ray. Chronic conditions - x-ray and while weight-bearing. Definitive diagnostic test - MRI

208
Q

Management of meniscus tear

A

If no mechanical problem - RICE, crutches, improve strength. With trauma - refer

209
Q

1st degree ankle sprain

A

Mild stretching of ligament with microscopic tears. Mild swelling and tenderness. No joint instability. Can bear weight and ambulate

210
Q

2nd degree ankle sprain

A

More severe injury with incomplete tear. Moderate pain, swelling, tenderness, and ecchymosis. mild to moderate joint instability with restriction of ROM. Weight-bearing and ambulation are painful

211
Q

3rd degree ankle sprain

A

Involves a complete tear. Severe pain, swelling, tenderness, and ecchymosis. Significant medical instability and loss of function. No weight-bearing or ambulation

212
Q

Exam of ankle sprains

A

How did injury occur? Assess ROM. Diagnostic - x-ray

213
Q

Management of ankle sprains

A

Goal - prevent chronic pain and instability. Limit inflammation and swelling and maintain ROM. Early treatment RICE for 2-3 days. NSAIDs

214
Q

Fibromyalgia

A

Chronic, generalized musculoskeletal pain. Mostly women. Diagnosis relies on history, reseach-supported tender point criteria. Altered central pain processing.

215
Q

Pathophysiology of fibromyalgia

A

Elevated CSF substance P; altered pain inhibitory mediators serotonin, norepi; dysregulated response to HPA axis

216
Q

Criteria for diagnosis of fibromyalgia

A

Pain in the axial skeleton and all 4 quadrants for 3 or more months. Excessive tenderness to 4 kg of point pressure in 11 of 18 specific muscle tendon sites

217
Q

Subjective data of fibromyalgia

A

Pain from sources that do not usually cause pain. If painful to others, then exaggerated to patient. Pain worsens with repetition of stimulus. Pain and stiffness uniform throughout the day.

218
Q

Associated symptoms of fibromyalgia

A

Sleep disturbances, fatigue, diminished cognitive function, lightheadedness, dizziness, palpitations

219
Q

Co-morbidities of fibromyalgia

A

Depression, anxiety, chronic fatigue syndrome, migraine, IBS, restless leg, TMJ dysfunction, female urethral syndrome

220
Q

Physical exam of fibromyalgia

A

Complete exam. Look for signs of inflammation and palpation of tender points

221
Q

Diagnostics of fibromyalgia

A

No specific test. Diagnosis made on history and physical findings

222
Q

Management of fibromyalgia

A

Education. Information. Fibromyalgia impace questionnaire at baseline ad with each chane in treatment

223
Q

Non-pharmacoligic treatment of fibromyalgia

A

Exercise - aerobic. Cognitive behavioral therapy. Strength training, acupuncture, hypnotherapy, biofeedback, medicinal baths

224
Q

Pharmacological treatment of fibromyalgia

A

NSAIDs, TCAs at night to improve sleep. Cyclobenzaprine. FDA approved drugs - alpha-2deltoid ligand pregabalin (Lyrica). SNRI (Cymbalta and milnacipran)

225
Q

Use of opioids to treat fibromyalgia

A

Chronic use will cause neuroadaptive changes that maintain or enhance central sensitivity to pain

Comps - Mod 2 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions