systems review - Exam 1 Flashcards
What is the purpose of a systems review?
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
what is the best tools to raise suspicion of pathology?
RED flags
How is a systems review determined?
from the initial history and observation of the patient
ex: symptoms w/ aerobic exertion indicate cardiovascular and respiratory systems
What two factors weigh in when determining level of concern?
- evidence (red flags)
2. clinical profile (urgency, progression, co-morbidities, etc)
what are some constitutional symptoms requiring systems review?
fever, chills, sweats weight changes N&V dizziness fatigue weakness paresthesias malaise cognitive changes
How do you get referred pain?
some muscles share innervations which then share symptoms
what are S&S of infections?
malaise (most common early symptom) fever, chills, sweats N&V enlarged/tender lymph nodes redness, heat, swelling specific system S&S
what are systemic S&S in older adults?
more subtle & atypical
mentation changes subnormal body temp bradycardia tachypnea fatigue lethargy decreased appetite
what are you palpating for in infections?
lymph nodes - > 2 cm diameter, firm, immobile, tender
heat
swelling
abdominal quadrant assessment
what are standard vital signs?
temperature
heart rate
blood pressure
respiratory rate
what is the function of the immune system?
defends the body against harmful substances, pathogens, and cells or non-selfs from internal and external threats
common S&S to most auto-immune conditions but not exhaustive
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
Cancer S&S
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
describe abnormal lymph nodes of someone with cancer
> 2 cm
firm
immobile
non-tender due to limited inflammation with typical slow growth of most cancer
What are the functions of the integumentary system?
protects underlying structures insulator regulates temperature assists with fluid balance synthesis of vitamin D sensory detection of stimuli
Integumentary system S&S
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
what are the ABCDE of melanoma skin cancer?
Asymmetry border - not well defined or irregular color - multiple shades diameter - larger than pencil eraser evolution - change over time
what is Cafe au Lait?
aka coffee stain
indicate underlying genetic problem
mostly benign but a concern if multiple spots
what are hair skin marks like?
patch, especially on spine - underlying genetic problem
loss may indicate impaired circulation
what are the discolorations as an integumentary S&S?
cyanosis - possible impaired circulation/oxygenation
redness/red streaks - may indicate acute inflammation, stage I pressure ulcer, infection or allergic reaction
bruising - recent injury
what are the two types of hot S&S in integumentary system?
localized - acute or local inflammation
generalized - fever, chills, sweats with infection or cancer
what are you looking for in an integumentary review?
Hx and observation S&S palpation - swelling - heat - skin mobility
what are you looking for in an infection review?
hx and obsercation S&S
palpation
standard vital signs
what are you looking for in an immune review?
hx and observation S&S
temperature
palpation of lymph nodes
what are you looking for in a cancer review?
hx and observation S&S
palpation of lymph nodes
temperature
what is the function of the endocrine system?
sends messages throughout the body by hormones
where does the endocrine system meet the nervous system?
hypothalamus-pituitary interface
what is the hypothalamus?
main integrative center of endocrine and autonomic nervous system functions by hormonal and neural pathways
endocrine S&S
depends on affected gland - hyper or hypoactive, creating hormonal changes
may affect multiple symptoms
why could you mistake an endocrine S&S as MSK problem?
can initially present as msk problem that regresses in response to hormonal changes or is not progressing
neuromusculoskeletal endocrine system S&S
presence of some MSK conditions (RA, OA, CTS, osteoporosis) persistent muscle weakness, atrophy, P! fatigue stiffness joint P!
what are some systemic endocrine S&S?
growth alterations polydipsia/polyuria changes in mentation, hair, skin, body fat, elevated vitals heart palpitations increased perspiration deep rapid breathing fluid imbalance
what are you looking for in an endocrine review?
hx and observation S&S
selective tension testing and/or MMT
standard vital signs
what is the function of the cardiovascular system?
coordination with respiratory and nervous system
oxygenated blood through arterial system
deoxygenated blood carried by venous system
what is the primary reason for cardiovascular S&S?
insufficiency of heart and vessels
cardiovascular S&S
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
describe P! in chest symptom for cardiovascular
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
peripheral vascular S&S
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
what are you looking for in a cardiovascular review?
hx and observation S&S vitals ankle-brachial index - LE systolic BP/UE systolic BP - > .9 can be used for prediction
what is the function of the lymphatic system?
develops embryologically from venous system
primary reason for lymphatic S&S
fluid build up and pressure
lymphatic S&S
P! in local area full, heavy, tight sensation impaired ROM paresthesias increased extremity size weight gain swollen lymph nodes
what are additional S&S in advanced lymphatic cases?
skin breakdown/wounds
infections –> infection S&S
head and neck edema interferes with speech, swallowing, breathing
what are you looking for in a lymphatic review?
hx and observation S&S ROM girth measures palpation of lymph nodes temperature
what is the function of the respiratory system?
coordination with cardiovascular, nervous and immune systems to facilitate gas exchange
nutrients and O2 to tissues, CO2 and waste from tissues
respiratory S&S
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
what are you looking for in a respiratory review?
hx and observation S&S
vitals
breath sounds with stethoscope
percussions
function of GI system
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
GI S&S
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
what are you looking for in GI review?
hx and observation S&S
abdominal quadrant assessment
function of hepatic system
filter and remove things
plays a role in nearly every bodily system
houses immune system cells - largest number of phagocytic cells
what are most hepatic S&S due to?
increased bilirubin
hepatic S&S
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
what is asterixis?
paresthesia’s from ammonia build up and inability to maintain wrist ext with shd flx
what are you looking for in a hepatic review?
hx and observation S&S
abdominal quadrant assessment
neurological tests
what is the function of the nervous system?
sensory processing
involuntary and voluntary responses
controlling, regulatory and communicating bodily system
LMN parts
cranial nerves
anterior gray column of spinal cord
cauda equina
spinal nerves and distal to terminal nerves
UMN parts
above anterior horn of spinal cord
brain and most of spinal cord
neurological S&S - superficial abdominal reflex
light strokes in each abdominal quandrant
WNL = umbilicus moves in direction of stroke
hypoactive = decreased or lack of umbilical movement
neurological S&S
N&V
dizziness
visual or auditory dysfunction
what are you looking for in a neurological review?
hx and observation
neurological tests specific to region (dermatomes, DTR, myotomes, etc)
