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Presentation Handouts Flashcards

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
Q

Cholecystitis can refer pain where?

A

Right scapula/mid back

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26
Q

What tests can rule out cholecystitis?

A

CT scan with IV contrast

Abdominal US

Hepatobilary imilodiacetic acid scan (HIDA)

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27
Q

What tests are effective for ruling in cholecystitis

A

Abdominal Palpation RUQ

Abdominal ultrasound

HIDA scan

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28
Q

Is Murphy sign better at ruling out or ruling in Cholecystitis?

A

Better for ruling in

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29
Q

What is the gold standard test to diagnose Cholecystitis

A

Ultrasound to visualize gallbladder

95% of patients have gall stone

Serum lipase levels rule out pancreatitis and peptic ulcers

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30
Q

What conditions are included in the differential diagnosis of cholecystitis

A

Appendicitis

Gastritis

Peptic ulcer

Acute cholangitis

Hiatal hernia

Acute viral hepatitis

Myocardial infarction

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31
Q

What causes appendicitis?

A

Appendix gets filled w/ something that causes it to swell

Ex: mucus, stool, parasites

Note: symptoms usually present within 24 hours

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32
Q

What causes appendicitis?

A

Stool obstruction, appendix mass or abscess, infectious agents (parasites, virus, bacteria)
Common: E Coli and bacteriodes spp

Note: symptoms usually present within 24 hours

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33
Q

Appendicitis causes pain in what quadrant

A

Lower right quadrant

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34
Q

Appendicitis is the most common abdominal surgical emergency

Who is it most common in?

What are the symptoms?

A

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

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35
Q

What are appendicitis risk factors?

A

Male
Family history
Environmental factors - summer and air pollution
Ethnic minorities - increased risk of perforation

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36
Q

Appendicitis differential diagnosis is?

A

Crohn’s Disease, gastroenteritis, terminal ilietis, UTI, endometriosis, ectopic pregnancy, pelvic inflammatory disease

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37
Q

What is a test used to rule out appendicitis?

A

Mcburney’s test

  • Sensitivity: 83%
  • Pressure applied in LRQ with 1 finger along a line between right ASIS and umbilicus
  • Positive finding: pain reproduced
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38
Q

Tests to rule in appendicitis?

A

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

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39
Q

CT scan will show what measurements to confirm appendicitis?

A

Enlarged appendix over 6mm

Thickened wall over 2mm

Surrounding inflammation

Appendicolith

40
Q

What sphincter doesn’t close properly in acid reflux?

A

Lower esophageal sphincter

41
Q

What are common signs and symptoms of acid reflux

A

Heart burn, regurgitation, non-cardiac chest pain, sour taste in mouth, sore throat, nausea, difficulty swallowing

42
Q

What are the risk factors of Acid Reflux

A
  • Female
  • 50+
  • Pregnancy
  • High BMI
  • Smoking
  • Stress
  • Hiatal Hernia
  • Medication
  • Diet
43
Q

What tests help rule out acid reflux?

A

Esophageal pH test
Sensitivity: 78%

X-ray
Sensitivity: 82%

44
Q

What tests can rule in acid reflux?

A

Esophagoscopy
Specificity 84% Sensitivity 54%

Manometry
Sensitivity 84% Specificity 89% (this test has the highest combined metrics)

45
Q

Acid Reflux differential diagnosis?

A

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
Q

What is endometriosis?

A

Chronic inflammatory disease w/ the presence of endometrium-like tissue outside of uterus

47
Q

What are the 3 types of endometriosis tissue

A

Peritoneal

Deep Infiltrating

Ovarian

48
Q

What is the etiology of endometriosis?

A

No known cause

Theories:

Black-flow

Hormonal/immune

Systemic issues

49
Q

What are the symptoms of endometriosis?

A

Chronic pelvic pain

Heavy bleeding during periods

Trouble getting pregnant

Bloating or nausea

Fatigue

Depression or anxiety

Can be asymptomatic

50
Q

How can you rule out endometriosis?

How to rule it in?

A

Rule out: clinical history

Rule in: Pelvic exam

51
Q

What conditions can present like endometriosis (differential diagnosis)

A

Cervical stenosis

Anovulation

MSK cause (of pelvic muscles)

Neoplasms

52
Q

Diagnostic tests for endometriosis?

A

Laparoscopy (gold standard)

Ultrasound

MRI

Lab work

53
Q

What are the symptoms of a DVT?

A

Swelling, warmth, redness, aches, pains

54
Q

Risk factors of DVT?

A

Obesity, hospitalization, surgery, immobility, cancer, travel

55
Q

Test to rule in a DVT?

A

Wells criteria, constans

56
Q

Tests to rule out a DVT?

A

D- Dimer

Doppler ultrasound

57
Q

What conditions can be included in a differential diagnosis for DVT

A

Lymphedema

Lipedema

Gout

Thrombophlebitis

Cellulitis

58
Q

What virus causes herpes zoster?

A

Varicella zoster virus

First appears as chicken pox and then reoccurs as shingles later

59
Q

Where does herpes zoster remain dormant within the body

A

In sensory dorsal root ganglion

60
Q

Where does herpes zoster rash appear?

A

Along a single dermatomal pattern, sometimes can affect adjacent 2-3 dermatomes

61
Q

What are the signs and symptoms of herpes zoster

A

Pain itching swelling

Stripe of blisters along dermatome (can occur on body or face)

Can include fever, headache, chills, upset stomach

62
Q

How does herpes zoster spread?

A

Spreads through droplets or skin blister contact (infected surfaces or direct contact)

63
Q

What can trigger reactivation of herpes zoster as shingles

A

Age, stress, immunocompromised

Note: risk factors: female, family history, previous chicken pox

64
Q

What is a common complication of herpes zoster that can cause prolonged pain?

A

Post-herpetic neuralgia

65
Q

What are potential differential diagnosis concerning herpes zoster

A

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
Q

What is the gold standard for diagnosing Herpes zoster

A

PCR-VZV. Polymerase chain reaction varicella-zoster virus (gold standard)
Sensitivity - 95-100%. Specificity 91-100%

67
Q

How else is herpes zoster identified besides PCR-VZV which is the diagnostic gold standard

A

Clinician screen - sensitivity 100% specificity 70%

DFA (Direct fluorescent antibody) - Diagnostic. Sensitivity 87%, Specificity 93%

68
Q

What is a groin hernia?

What are the 2 categories?

A

Bowel or abdominal tissue bulges out of weakspot in muscles

2 categories: Inguinal or Femoral

69
Q

Signs and symptoms of abdominal hernia?

A

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
Q

What are the possible etiology of abdominal hernia?

A

Congenital - CT abnormality seen with Marfan syndrome or Ehler-Danilo’s syndrome

Vs

Acquired - increase intra-abdominal pressure from obesity, COPD, straining, pregnancy

71
Q

What are the possible differential diagnosis of groin hernia

A

Lymphedema

Femoral artery aneurism

Psoas abscess

Sebaceous cyst

Undescended testicle

Epididymitis

Hydrocele

72
Q

What diagnostic tests can rule out a hernia?

A

Herniography - involve injecting contrast media into hernial sac (sensitivity 91%, specificity 83%

Computed tomography

73
Q

What tests can rule in a groin hernia?

A

Ultrasonography

MRI - with valsalva maneuver (MRI will be considered if suspected hernia inspite of negative ultrasound findings

74
Q

What bacteria commonly causes Osteomyelitis

A

Staphylococcus

75
Q

What mechanisms of injury can cause osteomyelitis

A

Trauma to bone, insertion of joint prosthesis, surgery where bone is involved

76
Q

What are the risk factors of osteomyelitis

A

Age

Obesity

Chronic hypoxia

Diabetes Mellitus

Alchohol abuse

Local systemic immunodeficiency

Malignant disease

Liver or kidney failure

77
Q

What are the signs and symptoms of osteomyelitis

A

Pain/tenderness/swelling/redness

Warmth in the area

Fever

Difficulty weight bearing/moivng

New limp

Stiff back (in vertebrae)

78
Q

What conditions are included in the differential diagnosis of osteomyelitis

A

Fracture/gout/bursitis

Arthritis

Metastatic bone disease

Charcot arthropathy

Sickle cell vaso-occlusive pain crises

Sapho syndrome

Avascular necrosis

79
Q

What diagnostic imaging is good for osteomyelitis?

A

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
Q

What is the best special test to diagnose osteomyelitis

A

Probe to bone

Test preformed by inserted metal probe into wound
Positive finding: hard gritty feeling

Sensitivity: 87% Specificity 83%

81
Q

What are the symptoms of Cord Compression/UMN disorders

A

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
Q

What are possible etiology of cord compression/UMN disease

A

Spondylitis, tumors, spinal epidural abscess, inflammatory conditions

Myelopathy, disc disease,

Adults 55+ cervical sponylosis is the predominant cause of

83
Q

Differential diagnosis of cord compression/UMN syndrome

A

SCI, Spinal cord syndormes, Degen disc disease, spondylosis, osteoporosis, transverse myelitis, ALS, GBS, meningitis

84
Q

What are tests to rule in UMN/cord compression

A

MRI

Screens: gait deviation, Hoffman sign, inverted supinator sign, Babinski sign, being 45+

85
Q

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 - ?

A

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
Q

What imaging test is most effective for finding cervical myelopathy

A

MRI

87
Q

What makes TSH?

What is TSH?

A

Pituitary

Thyroid stimulating hormone (turns on the thyroid)

88
Q

What is low in all cases of hypothyroidism? TSH or T4

A

T4

Because T4 is what the thyroid makes, if the thyroid isn’t working you have low T4

89
Q

What are the 2 steps to diagnosing hypothyroidism

A
  1. Check TSH levels
  2. if TSH is high then check T4
  3. High TSH + low T4 = hypothyroidism
90
Q

Why does hypothyroidism usually have high TSH

A

Because the body is making extra TSH to try to get the thyroid working

91
Q

What are the causes of Primary hypothyroidism?

A

Hashimoto

Iodine deficiency

Radiation therapy to head and neck

Thyroidectomy

Medication induced

92
Q

What are the causes of Secondary Hypothyroidism?

A
  • Pituitary tumor
  • Sheehans syndrome
93
Q

What are the signs and symptoms of hypothyroidism

A

Fatigue
Lethargy
Cold intolerance
Change in voice
dry skin
Heavy or irregular periods
Slowed heart rate

94
Q

What are the signs and symptoms of severe hypothyroidism

A

Myxedema coma

Altered mental status

Hypothermia

Progressive lethargy

Bradycardia

95
Q

high TSH + normal T3+T4 = _______ hypothyroidism

High TSH + low T4 = _____

A

Subclinical

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primary care (10 decks)

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