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Clin Med > systems review - Exam 1 > Flashcards

systems review - Exam 1 Flashcards

1
Q

What is the purpose of a systems review?

A

Identify suspicious non-MSK or Red flag S&S that require referral to another healthcare professional

  • NOT a diagnosis of non-MSK S&S
  • look for combinations of S&S
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2
Q

what is the best tools to raise suspicion of pathology?

A

RED flags

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3
Q

How is a systems review determined?

A

from the initial history and observation of the patient

ex: symptoms w/ aerobic exertion indicate cardiovascular and respiratory systems

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4
Q

What two factors weigh in when determining level of concern?

A
  1. evidence (red flags)

2. clinical profile (urgency, progression, co-morbidities, etc)

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5
Q

what are some constitutional symptoms requiring systems review?

A 
fever, chills, sweats
weight changes
N&V
dizziness
fatigue
weakness
paresthesias
malaise
cognitive changes
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6
Q

How do you get referred pain?

A

some muscles share innervations which then share symptoms

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7
Q

what are S&S of infections?

A 
malaise (most common early symptom)
fever, chills, sweats
N&V
enlarged/tender lymph nodes
redness, heat, swelling
specific system S&S
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8
Q

what are systemic S&S in older adults?

A

more subtle & atypical

mentation changes
subnormal body temp
bradycardia
tachypnea
fatigue
lethargy
decreased appetite
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9
Q

what are you palpating for in infections?

A

lymph nodes - > 2 cm diameter, firm, immobile, tender
heat
swelling
abdominal quadrant assessment

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10
Q

what are standard vital signs?

A

temperature
heart rate
blood pressure
respiratory rate

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11
Q

what is the function of the immune system?

A

defends the body against harmful substances, pathogens, and cells or non-selfs from internal and external threats

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12
Q

common S&S to most auto-immune conditions but not exhaustive

A 
GI p!
inflammation - local or systemic
myalgia
skin and weight changes
swollen lymph nodes - tender with acuity, non tender if chronic 
fatigue
fever - immune system kicks in 
typically affect >1 part of body
emotional changes
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13
Q

Cancer S&S

A

Hx of cancer
P! - local and referred - especially at night
N&V
loss of appetite
unexplained weight loss
fever, chills, sweats - even in absence of infection
swollen and non-tender lymph nodes - hard & immobile due to fibrosis
unusual malaise and fatigue
secondary infections due to lowered immunity

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14
Q

describe abnormal lymph nodes of someone with cancer

A

> 2 cm
firm
immobile
non-tender due to limited inflammation with typical slow growth of most cancer

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15
Q

What are the functions of the integumentary system?

A 
protects underlying structures
insulator
regulates temperature
assists with fluid balance
synthesis of vitamin D
sensory detection of stimuli
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16
Q

Integumentary system S&S

A 
itchy/dry/rough texture
- impaired circulation/oxygenation
- associated with many conditions
hives/rash
callus - excessive friction
blisters - increased friction
edema
- local: in one area
- generalized: all over
change in nail appearance - yellow
skin markings
discoloration
ulceration/wound
limited mobility - scar adhesion or inflammation
scars - past injury/surgery
varicose veins - venous congestion
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17
Q

what are the ABCDE of melanoma skin cancer?

A 
Asymmetry
border - not well defined or irregular
color - multiple shades
diameter - larger than pencil eraser
evolution - change over time
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18
Q

what is Cafe au Lait?

A

aka coffee stain

indicate underlying genetic problem
mostly benign but a concern if multiple spots

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19
Q

what are hair skin marks like?

A

patch, especially on spine - underlying genetic problem

loss may indicate impaired circulation

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20
Q

what are the discolorations as an integumentary S&S?

A

cyanosis - possible impaired circulation/oxygenation
redness/red streaks - may indicate acute inflammation, stage I pressure ulcer, infection or allergic reaction
bruising - recent injury

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21
Q

what are the two types of hot S&S in integumentary system?

A

localized - acute or local inflammation

generalized - fever, chills, sweats with infection or cancer

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22
Q

what are you looking for in an integumentary review?

A 
Hx and observation S&S
palpation
- swelling
- heat
- skin mobility
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23
Q

what are you looking for in an infection review?

A

hx and obsercation S&S
palpation
standard vital signs

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24
Q

what are you looking for in an immune review?

A

hx and observation S&S
temperature
palpation of lymph nodes

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25
Q

what are you looking for in a cancer review?

A

hx and observation S&S
palpation of lymph nodes
temperature

26
Q

what is the function of the endocrine system?

A

sends messages throughout the body by hormones

27
Q

where does the endocrine system meet the nervous system?

A

hypothalamus-pituitary interface

28
Q

what is the hypothalamus?

A

main integrative center of endocrine and autonomic nervous system functions by hormonal and neural pathways

29
Q

endocrine S&S

A

depends on affected gland - hyper or hypoactive, creating hormonal changes
may affect multiple symptoms

30
Q

why could you mistake an endocrine S&S as MSK problem?

A

can initially present as msk problem that regresses in response to hormonal changes or is not progressing

31
Q

neuromusculoskeletal endocrine system S&S

A 
presence of some MSK conditions (RA, OA, CTS, osteoporosis)
persistent muscle weakness, atrophy, P!
fatigue
stiffness
joint P!
32
Q

what are some systemic endocrine S&S?

A 
growth alterations
polydipsia/polyuria
changes in mentation, hair, skin, body fat, elevated vitals
heart palpitations
increased perspiration
deep rapid breathing
fluid imbalance
33
Q

what are you looking for in an endocrine review?

A

hx and observation S&S
selective tension testing and/or MMT
standard vital signs

34
Q

what is the function of the cardiovascular system?

A

coordination with respiratory and nervous system

oxygenated blood through arterial system
deoxygenated blood carried by venous system

35
Q

what is the primary reason for cardiovascular S&S?

A

insufficiency of heart and vessels

36
Q

cardiovascular S&S

A 
family hx of heart attack before 60
P! in chest
heart palpitations
nausea
sweating
SOB/wheezing
dizziness
fatigue w/ minimal exertion
cough
cyanosis with coldness
37
Q

describe P! in chest symptom for cardiovascular

A

P! can be with or without upper thorax, neck, UE and/or face due to shared C4-T4 innervation

L UE more common
UE pain - ulnar n. distribution medially into little finger
especially on exertion

38
Q

peripheral vascular S&S

A

LE edema including weight gain indicates impaired R ventricle
P! in LE due to claudication, w/ activity and area may lose color or become cold
diminished pulses

39
Q

what are you looking for in a cardiovascular review?

A 
hx and observation S&S
vitals
ankle-brachial index
- LE systolic BP/UE systolic BP
- > .9 can be used for prediction
40
Q

what is the function of the lymphatic system?

A

develops embryologically from venous system

41
Q

primary reason for lymphatic S&S

A

fluid build up and pressure

42
Q

lymphatic S&S

A 
P! in local area
full, heavy, tight sensation
impaired ROM
paresthesias
increased extremity size
weight gain
swollen lymph nodes
43
Q

what are additional S&S in advanced lymphatic cases?

A

skin breakdown/wounds
infections –> infection S&S
head and neck edema interferes with speech, swallowing, breathing

44
Q

what are you looking for in a lymphatic review?

A 
hx and observation S&S
ROM
girth measures
palpation of lymph nodes
temperature
45
Q

what is the function of the respiratory system?

A

coordination with cardiovascular, nervous and immune systems to facilitate gas exchange

nutrients and O2 to tissues, CO2 and waste from tissues

46
Q

respiratory S&S

A 
P! in neck, thoracic regions
Thorax P! - T2-4 shared innervation
cyanosis
digital clubbing - circulatory issues
SOB, wheezing, altered breathing patterns
cough
decreased breath sounds
hyper resonance with percussion
47
Q

what are you looking for in a respiratory review?

A

hx and observation S&S
vitals
breath sounds with stethoscope
percussions

48
Q

function of GI system

A 
digestion - stomach and SI
absorption - stomach & SI
excretion - LI, colon, rectum
protection - 70-80% immune cells in gut
assisted by hepatic system
emotional physiological connection for gut health
49
Q

GI S&S

A

P! in neck, trunk, pelvic, shoulder regions - shared innervation
dysphagia
N&V
food aversion/intolerances
indigestion or heartburn
full feeling
bowel dysfunction - color, shape, constipation, incontinence

50
Q

what are you looking for in GI review?

A

hx and observation S&S

abdominal quadrant assessment

51
Q

function of hepatic system

A

filter and remove things
plays a role in nearly every bodily system
houses immune system cells - largest number of phagocytic cells

52
Q

what are most hepatic S&S due to?

A

increased bilirubin

53
Q

hepatic S&S

A

P! in R upper abdominal and/or thoracic quadrant and/or R upper shoulder
GI S&S
skin changes - jaundice, bruising, palmar erythema, spider angioma
dark urine
discolored stools
neurological involvement due to increased neurotoxin build up of ammonia/bile - confusion, sleep disturbances, asterixis
hepatic osteohystrophy - metabolic bone disease due to suppression of bile flow

54
Q

what is asterixis?

A

paresthesia’s from ammonia build up and inability to maintain wrist ext with shd flx

55
Q

what are you looking for in a hepatic review?

A

hx and observation S&S
abdominal quadrant assessment
neurological tests

56
Q

what is the function of the nervous system?

A

sensory processing
involuntary and voluntary responses
controlling, regulatory and communicating bodily system

57
Q

LMN parts

A

cranial nerves
anterior gray column of spinal cord
cauda equina
spinal nerves and distal to terminal nerves

58
Q

UMN parts

A

above anterior horn of spinal cord

brain and most of spinal cord

59
Q

neurological S&S - superficial abdominal reflex

A

light strokes in each abdominal quandrant
WNL = umbilicus moves in direction of stroke
hypoactive = decreased or lack of umbilical movement

60
Q

neurological S&S

A

N&V
dizziness
visual or auditory dysfunction

61
Q

what are you looking for in a neurological review?

A

hx and observation

neurological tests specific to region (dermatomes, DTR, myotomes, etc)

Clin Med (7 decks)

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