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MI Differential Diagnosis > Screening in Pt interview > Flashcards

Screening in Pt interview Flashcards

1
Q

what are 2 essentially questions to include when screening a pt for depression?

A
  1. During the past month have you been feeling down, depressed, or hopeless?
  2. During the past month have you been bothered by having little interest or pleasure in doing things?
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2
Q

list prominent signs that someone may have an eating disorder

A
  1. discoloration or staining of the teeth from contact with stomach acid
  2. broken blood vessels in eyes from vomiting
  3. dry skin and hair; brittle nails; hair loss and growth of downy hair all over the body (lanugo), including the face
  4. tooth marks, scratches, scars or calluses on the backs of hands from inducing vomiting (Russell’s sign)
  5. Weight loss/gain
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3
Q

other less prominent signs that someone may have an eating disorder

A
  1. irregular or absent menstrual periods
  2. inability to tolerate cold
  3. reports of heartburn, abdominal bloating or gas, constipation or dirrhea
  4. bradycardia or low BP
  5. enlarged parotid gland from repeated contact with vomit
  6. skeletal myopathy and weakness
  7. chronic fatigue
  8. dehydration or rebound water retention (pitting edema)
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4
Q

behavioral S/S of an eating disorder

A
  1. preoccupation w/weight, food, calories, fat, grams, dieting clothing, size, body shape
  2. mood swings
  3. frequent comments about being far or overweight despite looking very thin
  4. excessive exercise to burn off calories
  5. use of diuretics or other meds to induce urination, bowel movements or vomiting
  6. binging and purging
  7. food restriction
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5
Q

why is it important that PT’s screen for smoking?

A
  1. Tobacco use causes vasoconstriction and delayed wound healing
  2. smoking has been linked with disc degernation and acute lumbar/cervical disc herniation
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6
Q

performance-based tests for fall risk pts

A
  1. functional reach test
  2. BERG balance scale
  3. TUG
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7
Q

scales for balance confidence/fear of falling in pts that are fall risk

A
  1. Activities-specific balance confidence scale (ABC)
  2. Falls efficacy scale (FES)
  3. Survey of activities and fear of falling in the elderly (SAFE)
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8
Q

List warning signs of elder abuse

A
  1. multiple trips to the ER
  2. depression
  3. “falls”/fractures
  4. bruising/suspicious sores
  5. malnutrition/weight loss
  6. pressure ulcers
  7. changing MDs/therapists often
  8. confusion attributed to dementia
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9
Q

common MSK side-effects associated with antibiotics

A
  1. skin reactions
  2. noninflammatory joint pain
  3. tendinopathy/tendon rupture
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10
Q

common MSK side-effects associated with NSAIDs

A
  1. back and shoulder pain
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11
Q

common MSK side-effects associated with statins

A

myalgia

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12
Q

S/S of NSAID complications relating to GI

A
  1. indigestion/heartburn/epigastric or abdominal pain
  2. esophagitis, dysphagia, odynophagia
  3. nausea
  4. unexplained fatigue lasting more than 1-2 weeks
  5. ulcers, perforations, bleeding
  6. melena
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13
Q

S/S of NSAID complications relating to MSK

A
  1. increased symptoms after taking the med
  2. symptoms linked with ingestion of food
  3. midthoracic back, shoulder or scapular pain
  4. muscle weakness
  5. restless leg syndrome
  6. paresthesia
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14
Q

2 questions should be asked to screen for suicide risk

A
  1. are you having thoughts of attempting to harm yourself?
  2. do you have a plan in place?
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15
Q

compare and contrast fatigue and insufficiency fractures

A
  • insufficiency fracture → abnormal bone with normal stress
    • associated with osteoporosis
  • fatigue fracture → abnormal stress on normal bone
    • associated with overload
    • stress fractures
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16
Q

List risk factors for femoral head and neck fractures

A
  1. female gender
    • hormones
    • menstrual irregularities
  2. involvement in running, jumping and marchign activities
  3. change in training program or routine
  4. nutritional deficiencies
  5. LLD
  6. diminished muscle strength
  7. osteoporosis
17
Q

Describe clinical manifestations of femoral head and neck fractures

A
  1. pain in groin, greater trochanter and/or buttock
  2. referred pain to anteromedial thigh may be chief complaint
  3. provoked with increased WBing
  4. relieved with reduced WBing
  5. insidious onset
  6. Hip ROM reveals minor if any pain provocation
  7. Plain films often negative
18
Q

what physical exam techniques would you utilize if you suspect a femoral head or neck fracture?

A
  1. Fulcrum Test
  2. Patellar-Pubic Percussion test
19
Q

list the risk factors for CES

A
  1. low back injury, central disc herniation
  2. congenital or acquired spinal stenosis
  3. spinal fracture
  4. anklyosing spondylitis
  5. TB, Pott’s disease
20
Q

describe the clinical manifestation of CES

A
  1. urinary dysfunction
    • retention, incontinence
  2. bowel dysfunction
    • incontinence, loss of anal tone
  3. sexual dysfunction
    • reduced sensation during intercourse, impotence
  4. sensory deficits
    • perineum and “saddle” regions
    • LEs
  5. motor deficits
    • lower limbs (multiple spinal level weakness
21
Q

list risk factors for cervical myelopathy

A
  1. cervical spondylosis
  2. spinal degeneration from neck trauma (MVA, sports injury)
  3. RA
22
Q

describe the clinical manifestations of cervical myelopathy (history)

A
  1. impaired hand dexterity
  2. gait, balance difficulties (legs weak, stiff)
  3. numbness, paresthesia-extremities (upper and possibly lower)
  4. neck stiffness
  5. urinary dysfunction
    • retention and possible urgency and frequency
23
Q

describe the clinical manifestations of cervical myelopathy (physical exam)

A
  1. hand-intrinsic atrophy
  2. muscle weakness
    • often triceps and hand intrinsic
    • proximal muscles of LE
  3. UMN signs
24
Q

Cook cluster for cervical myelopathy

A
  1. Gait abnormality
  2. +Hoffman’s Test
  3. Inverted Supinator sign
  4. +Babinski test
  5. age >45 years
25
Q

how do you interpert Cook’s cluster

A
  • 1/5 present = ability to rule out myelopathy (sensitivity 0.94)
  • 3/5 present = ability to rule in myelopathy (specificity 0.99)
26
Q

list the risk factors for abominal aortic aneursym (AAA)

A
  1. age
  2. male gender
  3. history of smoking
  4. history of hyper cholesterol and coronary heart disease
  5. family history of AAA
27
Q

describe the clinical manifestation of AAA

A
  1. asymptomatic in most
  2. if pain present, most likely back pain
  3. abdominal, hip, groin or buttock pain also possible
  4. nonmechanical properties
  5. insidious onset
  6. may report early satiety, weight loss and nausea
  7. vascular dissection must be considered with pain
28
Q

list risk factors for DVT

A
  1. previous history of DVT
  2. history of cancer
  3. history of CHF
  4. history of SLE
  5. recieving chemo
  6. major surgery
  7. major trauma
  8. immobility
  9. limb paralysis
  10. women during pregnancy
  11. women taking oral contraceptives, hormone replacement therapy
  12. age >60 years
29
Q

describe the clinical manifestations of DVT

A
  1. ache, tightness, tenderness
  2. general edema
  3. pitting edema
  4. prominent superficial venosu plexus
  5. increased local skin temp
30
Q

how to interpret the Wells Clinical Prediction rule for DVT

A
  1. high probability if score > 3 (75%)
  2. moderate if score 1-2 (17%)
  3. low if score is 0 (3%)
31
Q

list the risk factors for PE

A
  1. previous history of PE
  2. history of DVT
  3. immobility
  4. history of abdominal, pelvic surgery
  5. total hip, knee replacement
  6. late-stage pregnancy
  7. lower limb fractures
  8. malignancy of pelvis or abdomen
32
Q

describe the clinical manifestations of PE

A
  1. dyspnea
  2. tachypnea
  3. pleuritic chest pain, intensified w/deep respiration and cough
  4. persistent cough
  5. apprehension, anxiety
  6. tachycardia
  7. palpitations
33
Q

T/F: it is typical for women to present with the classic symptoms of an MI

A

FALSE

less typical for women than men

only 50% of women experience chest pain

thus cardiac death leading cause of death in women all ages

34
Q

modifiable risk factors of an atypical MI

A
  1. cigarette smoking
  2. high cholesterol levels
  3. HTN
  4. DM
  5. Obesity
  6. Sedentary lifestyle
  7. Excessive alcohol consumption
35
Q

Nonmodifiable risk factors for an atypical MI

A
  1. age > 55 in women
  2. age > 45 in men
  3. family history
  4. ethnicity
    • highest in AA
36
Q

describe the clinical manifestation of an atypical MI

A
  1. SOB
  2. Fatigue
  3. Sleep disturbance
  4. Nausea (with or without vomiting)
  5. Palpitations
  6. Dizziness
  7. Diaphoresis
  8. Anxiety
  9. Pain
37
Q

pain locations for an atypical MI

A
  1. upper abdominal/epigastric
  2. neck, jaw and tooth
  3. interscapular and mid to lower thoracic
  4. R arm pain (possibly isolated in biceps)

MI Differential Diagnosis (16 decks)

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