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1
Q

What are the 4 types of neuropathy?

Which is most common

A

DSPN (Distal symmetric polyneuropathy) Most common

Radiculopathy

Mononeuropathy

Autonomic

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2
Q

What causes Distal Symmetric Polyneuropathy?

A

Hyperglycemia, dyslipedem and poor glucose uptake lead to changes of metabolism and cause inflammation and nerve injury

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3
Q

What are the sensory symptoms of distal symmetric polyneuropathy

A

Numbness, tingling, decreased pain and temp, burning, prickling

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4
Q

What are the motor symptoms of distal symmetric polyneuropathy

A

Impaired coordination

Foot slapping

Loss of balance

Weakness in arms/leg/toes/feet

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5
Q

What autonomic symptoms can distal symmetric polyneuropathy cause?

A

GI - dysphasia, abdominal pain, nausea, diarrhea, constipation

CV- Tachycarcia, orthostat hypotension, arrhythmia, syncope

Urinary- poor stream, difficulty voiding

Heat intolerance, excessive sweating

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6
Q

How is distal symmetric polyneuropathy diagnosed

A

Typically diagnosed w/ monofilament testing, pain testing, and vibration testing

Other tests may include electromyography, nerve conduction study, and skin biopsy

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7
Q

How is distal symmetric polyneuropathy treated?

A

Blood sugar management, keep within targeted range decided by physician

Prevent foot ulcers, falls

Prescription medications for systemic complications

Lifestyle changes are the key

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8
Q

What are the symptoms of UTI?

A

Strong urge to urinate,

Burning sensation

Frequent urinating in small amounts

Urine looks cloudy

Red or pink color

Strong smelling urine

Pain in lower abdomen

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9
Q

Where is the most common place a UTI affects?

A

Lower urinary tract: bladder + urethra

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10
Q

What bacteria most commonly causes UTI?

A

E Coli.

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11
Q

What are the risk factors of a UTI?

A

Female

Sexually active

Poor hygiene (wiping back to front)

Immunosuppressive

Catheter use

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12
Q

Complications of a UTI?

A

Repeated infection

Kidney damage

Sepsis

Delirium

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13
Q

What are possible differential diagnosis of UTI?

A

Interstitial Cystitis

Bladder Cancer

Sexually transmitted infection (chlamydia or conorrhea)

Kidney stone/kidney infection

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14
Q

What tests can rule out a UTI?

A

Nitrite and leukocyte esterase lab test:

Sensitivity : 75.74

Neurotrophic Gelitinase Associated lipocalin (NGAL)

Sensitivity: 100

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15
Q

What tests can rule in a UTI?

A

Urinary white blood cell count

Specificity: 86%

Consensus criterion with more than 2 bio markers

Specificity:

91.2%

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16
Q

What test do they use to diagnose a UTI?

What about in cases where the infection travels to the kidneys (pyelonephritis)?

A

Standard urine culture: specificity 95%, sensitivity 85%

When kidney is involved: CT Scan and renal ultrasound

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17
Q

What is cholecystitis?

A

Inflammation of the gallbladder, an organ that stores bile (essential for digesting fat)

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18
Q

What is the primary cause of cholecystitis

A

Cholelithiasis AKA gallstones

They block the bile duct and lead to infection

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19
Q

What is chronic cholecystitis

A

Recurrent episodes of acute cholecystitis leading to irritation of gall bladder wall

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20
Q

What risk factors are associated with cholecystitis

A

Female

Obese

Pregnancy

High fat/low fiber

Older

Central and South American/ Hispanic or American Indian

Diabetes

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21
Q

What is acalculous cholecystitis

A

Gall bladder inflammation w/o gall stones

Due to critical illness, severe trauma, bone marrow transplant, burns

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22
Q

Cholecystitis is commonly found w/ palpating in what quadrant? What is it called?

A

Right upper quadrant

Murphys sign

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23
Q

With cholecystitis, pain gets worse with consumption of _______ and is ________ with exercise

A

Fatty food

Not relieved with exercise

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24
Q

Other signs and symptoms of cholecystitis?

A

Leukocytosis: increased wbc count 12,000-15,000

Nausea, vomiting, bloatedness, fever

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25
Cholecystitis can refer pain where?
Right scapula/mid back
26
What tests can rule out cholecystitis?
**CT scan with IV contrast** Abdominal US Hepatobilary imilodiacetic acid scan (HIDA)
27
What tests are effective for ruling in cholecystitis
**Abdominal Palpation *RUQ*** Abdominal ultrasound HIDA scan
28
Is Murphy sign better at ruling out or ruling in Cholecystitis?
Better for ruling in
29
What is the gold standard test to diagnose Cholecystitis
**Ultrasound to visualize gallbladder** 95% of patients have gall stone Serum lipase levels rule out pancreatitis and peptic ulcers
30
What conditions are included in the differential diagnosis of cholecystitis
Appendicitis Gastritis Peptic ulcer Acute cholangitis Hiatal hernia Acute viral hepatitis Myocardial infarction
31
What causes appendicitis?
Appendix gets filled w/ something that causes it to swell Ex: mucus, stool, parasites Note: symptoms usually present within 24 hours
32
What causes appendicitis?
Stool obstruction, appendix mass or abscess, infectious agents (parasites, virus, bacteria) Common: E Coli and bacteriodes spp Note: symptoms usually present within 24 hours
33
Appendicitis causes pain in what quadrant
Lower right quadrant
34
Appendicitis is the most common abdominal surgical emergency Who is it most common in? What are the symptoms?
Males in mid 20s Pain in LRQ, Nausea, vomiting, loss of appetitive, pain increase w/ abdominal pressure, GI symptoms of gas bloating and diarrhea, Fever Sudden onset
35
What are appendicitis risk factors?
Male Family history Environmental factors - summer and air pollution Ethnic minorities - increased risk of perforation
36
Appendicitis differential diagnosis is?
Crohn’s Disease, gastroenteritis, terminal ilietis, UTI, endometriosis, ectopic pregnancy, pelvic inflammatory disease
37
What is a test used to rule out appendicitis?
**Mcburney’s test** * Sensitivity: 83% * Pressure applied in LRQ with 1 finger along a line between right ASIS and umbilicus * Positive finding: pain reproduced
38
Tests to rule in appendicitis?
**Scoring systems to predict risk**: Appendicitis Inflammatory response, Adult appendicits score, Alvarado score **Diagnostic tests**: Lab work: WBC count, C-reactive protein, procalcitonin **Imaging**: Ultrasound, CT scan (most widely used) and MRI Note: imaging cannot differentiate between a perforated and non perforated appendix
39
CT scan will show what measurements to confirm appendicitis?
Enlarged appendix over 6mm Thickened wall over 2mm Surrounding inflammation Appendicolith
40
What sphincter doesn’t close properly in acid reflux?
Lower esophageal sphincter
41
What are common signs and symptoms of acid reflux
Heart burn, regurgitation, non-cardiac chest pain, sour taste in mouth, sore throat, nausea, difficulty swallowing
42
What are the risk factors of Acid Reflux
* Female * 50+ * Pregnancy * High BMI * Smoking * Stress * Hiatal Hernia * Medication * Diet
43
What tests help rule out acid reflux?
**Esophageal pH test** Sensitivity: 78% **X-ray** Sensitivity: 82%
44
What tests can rule in acid reflux?
**Esophagoscopy** Specificity 84% Sensitivity 54% **Manometry** Sensitivity 84% Specificity 89% (this test has the highest combined metrics)
45
Acid Reflux differential diagnosis?
Cancer- GERD can look like esophageal cancer (difference is weight loss and systemic systems w/ cancer) Esophagitis - Soley inflammatory response of esophagus but not caused by acid Irritable bowel syndrome - problem w/ digestion causing intense abdominal pain Peptic ulcer disease - acid causes sores in stomach lining, not the esophagus
46
What is endometriosis?
Chronic inflammatory disease w/ the presence of endometrium-like tissue outside of uterus
47
What are the 3 types of endometriosis tissue
Peritoneal Deep Infiltrating Ovarian
48
What is the etiology of endometriosis?
No known cause Theories: Black-flow Hormonal/immune Systemic issues
49
What are the symptoms of endometriosis?
Chronic pelvic pain Heavy bleeding during periods Trouble getting pregnant Bloating or nausea Fatigue Depression or anxiety Can be asymptomatic
50
How can you rule out endometriosis? How to rule it in?
Rule out: clinical history Rule in: Pelvic exam
51
What conditions can present like endometriosis (differential diagnosis)
Cervical stenosis Anovulation MSK cause (of pelvic muscles) Neoplasms
52
Diagnostic tests for endometriosis?
**Laparoscopy** (gold standard) Ultrasound MRI Lab work
53
What are the symptoms of a DVT?
Swelling, warmth, redness, aches, pains
54
Risk factors of DVT?
Obesity, hospitalization, surgery, immobility, cancer, travel
55
Test to rule in a DVT?
Wells criteria, constans
56
Tests to rule out a DVT?
D- Dimer Doppler ultrasound
57
What conditions can be included in a differential diagnosis for DVT
Lymphedema Lipedema Gout Thrombophlebitis Cellulitis
58
What virus causes herpes zoster?
Varicella zoster virus First appears as chicken pox and then reoccurs as shingles later
59
Where does herpes zoster remain dormant within the body
In sensory dorsal root ganglion
60
Where does herpes zoster rash appear?
Along a single dermatomal pattern, sometimes can affect adjacent 2-3 dermatomes
61
What are the signs and symptoms of herpes zoster
Pain itching swelling Stripe of blisters along dermatome (can occur on body or face) Can include fever, headache, chills, upset stomach
62
How does herpes zoster spread?
Spreads through **droplets** or **skin blister contact** (infected surfaces or direct contact)
63
What can trigger reactivation of herpes zoster as shingles
Age, stress, immunocompromised Note: risk factors: female, family history, previous chicken pox
64
What is a common complication of herpes zoster that can cause prolonged pain?
Post-herpetic neuralgia
65
What are potential differential diagnosis concerning herpes zoster
**Contact dermatitis**- red itchy rash **Impetigo** - red sores or blisters typically not defined by a dermatome **Cellulitis**- red swollen area **Eczema herpitcum** - rapid onset of vesicular lesions only on patients w/ pre-existing eczema
66
What is the gold standard for diagnosing Herpes zoster
**PCR-VZV**. Polymerase chain reaction varicella-zoster virus (gold standard) Sensitivity - 95-100%. Specificity 91-100%
67
How else is herpes zoster identified besides PCR-VZV which is the diagnostic gold standard
**Clinician screen** - sensitivity 100% specificity 70% **DFA (Direct fluorescent antibody)** - Diagnostic. Sensitivity 87%, Specificity 93%
68
What is a groin hernia? What are the 2 categories?
Bowel or abdominal tissue bulges out of weakspot in muscles 2 categories: Inguinal or Femoral
69
Signs and symptoms of abdominal hernia?
**Visible bulge** that goes away when lying supine and applying mild pressure -increase pain or bulge with activity or cough Discomfort that can progress to intense **pain** if not treated **Burning** sensation that may **radiate** down leg **More obstruction = more symptoms**
70
What are the possible etiology of abdominal hernia?
Congenital - CT abnormality seen with Marfan syndrome or Ehler-Danilo’s syndrome Vs Acquired - increase intra-abdominal pressure from obesity, COPD, straining, pregnancy
71
What are the possible differential diagnosis of groin hernia
Lymphedema Femoral artery aneurism Psoas abscess Sebaceous cyst Undescended testicle Epididymitis Hydrocele
72
What diagnostic tests can rule out a hernia?
**Herniography** - involve injecting contrast media into hernial sac (sensitivity 91%, specificity 83% **Computed tomography**
73
What tests can rule in a groin hernia?
**Ultrasonography** **MRI** - with valsalva maneuver (MRI will be considered if suspected hernia inspite of negative ultrasound findings
74
What bacteria commonly causes Osteomyelitis
Staphylococcus
75
What mechanisms of injury can cause osteomyelitis
Trauma to bone, insertion of joint prosthesis, surgery where bone is involved
76
What are the risk factors of osteomyelitis
Age **Obesity** Chronic hypoxia **Diabetes** Mellitus **Alchohol** abuse Local systemic **immunodeficiency** **Malignant** disease **Liver or kidney failure**
77
What are the signs and symptoms of osteomyelitis
Pain/tenderness/swelling/redness Warmth in the area Fever Difficulty weight bearing/moivng New limp Stiff back (in vertebrae)
78
What conditions are included in the differential diagnosis of osteomyelitis
Fracture/gout/bursitis Arthritis Metastatic bone disease Charcot arthropathy Sickle cell vaso-occlusive pain crises Sapho syndrome Avascular necrosis
79
What diagnostic imaging is good for osteomyelitis?
**Plain film radiography** - initial imagine to rule out other pathologies (Sensitivity 14-54, Specificty 68-70) **MRI**- highly accurate (Sensitivity 98-80, Specificty 60-90) **Leukocyte scintigaphy** - indicates infiltration of inflammatory cells (Sensitivity 61-84%, Specificity 60-68%) **Positron Emisison Tomography** -can reliably diagnose Osteomyelitis while ruling out differential diagnosis (Sensitivity 96% Specificty 91%)
80
What is the best special test to diagnose osteomyelitis
Probe to bone Test preformed by inserted metal probe into wound Positive finding: hard gritty feeling Sensitivity: 87% Specificity 83%
81
What are the symptoms of Cord Compression/UMN disorders
Neck and back pain Impaired sensation or weakness Bowel and bladder dysfunction Foot drop, decreased coordination Loss of sexual ability Hypereflexia, spasticity, abnormal reflexes,
82
What are possible etiology of cord compression/UMN disease
Spondylitis, tumors, spinal epidural abscess, inflammatory conditions Myelopathy, disc disease, Adults 55+ cervical sponylosis is the predominant cause of
83
Differential diagnosis of cord compression/UMN syndrome
SCI, Spinal cord syndormes, Degen disc disease, spondylosis, osteoporosis, transverse myelitis, ALS, GBS, meningitis
84
What are tests to rule in UMN/cord compression
MRI Screens: gait deviation, Hoffman sign, inverted supinator sign, Babinski sign, being 45+
85
What diagnostic tests can help rule out differential diagnosis of cord compression/UMN Fx and bone spurs - ? Cervical spondylosis - ? Stroke, SCI, Tumor, DDD - ? Meningitis, TM/MS, ALS, GBS - ? ALS or MS, or GBS - ?
Fx and bone spurs - x ray Cervical spondylosis - CT Stroke, SCI, Tumor, DDD - MRI Meningitis, TM/MS, ALS, GBS - spinal tap ALS MS or GBS - EMG or NCV
86
What imaging test is most effective for finding cervical myelopathy
MRI
87
What makes TSH? What is TSH?
Pituitary Thyroid stimulating hormone (turns on the thyroid)
88
What is low in all cases of hypothyroidism? TSH or T4
T4 Because T4 is what the thyroid makes, if the thyroid isn’t working you have low T4
89
What are the 2 steps to diagnosing hypothyroidism
1. Check TSH levels 2. if TSH is high then check T4 3. High TSH + low T4 = hypothyroidism
90
Why does hypothyroidism usually have high TSH
Because the body is making extra TSH to try to get the thyroid working
91
What are the causes of Primary hypothyroidism?
**Hashimoto** **Iodine deficiency** Radiation therapy to head and neck **Thyroidectomy** Medication induced
92
What are the causes of Secondary Hypothyroidism?
* Pituitary tumor * Sheehans syndrome
93
What are the signs and symptoms of hypothyroidism
Fatigue Lethargy Cold intolerance Change in voice dry skin Heavy or irregular periods Slowed heart rate
94
What are the signs and symptoms of severe hypothyroidism
Myxedema coma Altered mental status Hypothermia Progressive lethargy Bradycardia
95
high TSH + normal T3+T4 = _______ hypothyroidism High TSH + low T4 = _____
Subclinical Overt

primary care (10 decks)

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