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clin med II - exam I > Systems Review - LQ > Flashcards

Systems Review - LQ 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 profession

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2
Q

What is a systems review NOT?

A

a dx of a non-MSK condition but recognition of suspicious non-MSK S&S

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3
Q

Are red flag S&S informative in isolation?

A

not usually - few red flag S&S in isolation are informative, look for combinations

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4
Q

Is there a consensus on which red flag S&S are most useful?

A

NO

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5
Q

What are the best tools to raise suspicion of pathology?

A

RED FLAGS

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6
Q

What are systems determined by?

A

HX and observation

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7
Q

What is the onset like for non-MSK and red flag S&S?

A

Gradual and unknown onset for many non-MSK conditions and red flag S&S with minimal to no mechanical provocation

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8
Q

What are some constitutional S&S or general health components requiring review when present?

A
  • Fever, chills, sweats- MOST often associated with systemic illness
  • Prolonged (≥2 wks.)
    > 102° may require hospitalization
  • Weight changes, particularly loss of ≥ 5% and if unexplained
  • Nausea and Vomiting (N&V)
  • Dizziness and lt. headedness
  • Fatigue- prolonged (≥ 2 wks.) and limiting
  • Weakness- limiting
  • Paresthesia’s/Numbness
  • Malaise or ill feeling- “I feel like I’m coming down with something”
  • Mentation or cognitive changes
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9
Q

What are the structures involved with the urinary system?

A

Kidneys, ureters, bladder, and urethra

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10
Q

What are the functions of the urinary system?

A
  • Filter fluid from renal blood flow
  • Remove waste
  • Retain essential substances for fluid and contents balance i.e., electrolytes, acid base balance, etc.
  • Stimulates RBC production
  • Blood pressure regulation
  • Converts Vitamin D to its active form
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11
Q

What are urinary S&S?

A
  • P! in trunk, flank, and/or pelvic regions
  • Discoloration
  • Urinary changes
    > Frequency
    > Urgency
    > Bleeding
    > Pus
  • Dysfunction
    > Flow
    > Initiation
    > Control
  • Nocturia- awake to urinate
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12
Q

What is a part of the urinary review?

A
  • most from hx
  • observation of urine unlikely
  • pain with kidney percussion
  • pain with palpation/percussion of system organs during abdominal assessment
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13
Q

What is the function of the reproductive system?

A
  • producing sex cells such as eggs/sperm and creating sex hormones with endocrine system
  • maintaining fertilized eggs for development
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14
Q

What are the S&S of the reproductive system?

A
  • pain in pelvis, LB, abdominal regions and/or sexual organs
  • dysfunction: sexual or bowel and bladder due to proximity
  • abnormal: discharge from sex organs or menstration
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15
Q

What are early and possibly unknown pregnancy indications?

A
  • polyuria (excessive urination)
  • breast tenderness
  • fatigue
  • N&V with possible weight loss
  • heartburn
  • constipation
  • abnormal vaginal discharge
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16
Q

What will we use for our reproductive review?

A
  • most from hx
  • observation unlikely
  • no other specific assessment
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17
Q

What makes up the metabolic system?

A

gut, liver, adipose tissue, pancreas, kidney, and muscle

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18
Q

What are the functions of the metabolic system?

A
  • conversion of foods and liquids into: energy for all cellular processes / building blocks for proteins, fats, and carbohydrates
  • elimination of waste
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19
Q

What is key for cellular metabolism?

A

Fluid and electrolyte balance

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20
Q

What does sodium do as an electrolyte?

A
  • maintains fluid volume and cell function for messages to and from CNS
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21
Q

What is the most frequent electrolyte disorder and contributor to neurological S&S?

A

Hyponatremia - low sodium

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22
Q

What does potassium do as an electrolyte?

A

Maintains fluid volume

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23
Q

What is the skeleton a storehouse for?

A
  • calcium
    -phosphorus
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24
Q

What does calcium do?

A

involved with bone health, muscle actions, nerve impulses, circulation, and hormone balance

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25
Q

What does phosphorus do?

A
  • majority located in our bones and teeth
  • plays a crucial role with the metabolism for the growth, maintenance and repair of all tissues
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26
Q

What does bicarbonate do as an electrolyte?

A
  • works as an acid buffer
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27
Q

What is the main reason for loss of bicarbonate?

A

Diarrhea

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28
Q

What does magnesium do as an electrolyte?

A

Mainly involved in neuromuscular functions

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29
Q

What does chloride do?

A

Regulates fluid in and out of cells

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30
Q

Are metabolic S&S varied?

A

YES

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31
Q

What can it mean if the S&S dont match a specific system and seem widespread?

A

Possibly a metabolic condition because altered metabolism can affect multiple systems

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32
Q

What are the overall S&S of the metabolic system due to?

A

Fluid and electrolyte imbalances, altered pH

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33
Q

What is fluid and electrolyte imbalance most commonly due to?

A

Conditions involving fluid loss and dehydration

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34
Q

What are some conditions involving fluid loss and dehydration?

A
  • Diabetes
  • Kidney dysfunction- regulates MOST electrolytes followed by intestines, bone, and parathyroid gland
  • Malignancy
  • Alcoholism/liver disease
  • Medication side affects e.g., diuretic
  • HTN
  • Burns
  • Surgery
  • Diarrhea
  • N&V
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35
Q

What can fluid and electrolyte imbalance do to skin?

A
  • loss of skin elasticity
  • altered temperature
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36
Q

What can fluid and electrolyte imbalance do to the neuromuscular system?

A
  • weakness
  • fatigue
  • twitching
  • cramping
  • tetany
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37
Q

What can fluid and electrolyte imbalance do regarding CNS involvement?

A
  • memory impairment
  • depression
  • delusions/hallucinations
  • seizures
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38
Q

What can fluid and electrolyte imbalance do regarding cardiovascular changes?

A
  • tachycardia
  • postural hypotension
  • altered respirations
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39
Q

What is the ideal pH?

A

Between 7.35 - 7.45
“narrow window”

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40
Q

What do the lungs do for pH regulation?

A
  • balance the acidic CO2 with the neutral O2
  • work with the circulatory system to provide O2 and remove waste products of metabolism
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41
Q

What do the kidneys do for pH regulation?

A
  • remove acids and keep bases
42
Q

What can aging result in regarding pH regulation?

A
  • decreased respiration so less gas exchange
  • oxidation where oxygen molecules lose electrons and steal them from other electrolytes and cells
43
Q

What are the 4 acid-base classes?

A
  1. respiratory acidosis
  2. respiratory alkalosis
  3. metabolic acidosis
  4. metabolic alkalosis
44
Q

What type of altered pH can cause confusion and fatigue S&S?

A

ALL classes

45
Q

What is respiratory acidosis?

A

Lowered ph

46
Q

What can respiratory acidosis cause?

A

Hypoventilaiton and an accumulation of acidic CO2 may occur along with:
- aging
- pulmonary conditions
- drugs that suppress respiration like opioids/muscle relaxers
- sleep apnea

47
Q

WHAT IS RESPIRATORY ALKALOSIS?

A

higher pH - hyperventilation leading to a loss of acidic CO2

48
Q

What can respiratory alkalosis occur with?

A
  • pulmonary conditions
  • anxiety
  • hypoxemia disorders such as anaemia / anxiety (hyperventilate trying to get more O2 in)
49
Q

What are S&S of respiratory alkalosis?

A
  • shortness of breath is the ONLY sign
  • otherwise highly variable
50
Q

What is metabolic acidosis? (KNOW THIS)

A

MOST common acid base abnormality
- accumulation of acidic H+ ions

51
Q

What is metabolic acidosis most commonly due to?

A
  • build up of ketone bodies or acids : diabetes
  • also can be due to diarrhea/ dehydration leading to greater acid concentration
  • kidney conditions that hold onto too many acids
52
Q

What are S&S of metabolic acidosis?

A
  • rapid deep breaths with a fruity smell, from ketone bodies, trying to get rid of CO2 acids

> diabetes cardinal S&S
- dry mouth
- extreme thirst (polydipsia)
- decreased skin turgor
- blurry vision
- weakness / fatigue

53
Q

What is metabolic alkalosis?

A
  • higher pH
    Accumulation of bicarbonate base
54
Q

What can metabolic alkalosis & accumulation of bicarbonate be caused by?

A
  • vomiting by loss of stomach acids
  • kidney disorders or medications that keep too many bases
  • excessive antacid, laxative, or diuretic medications
  • diarrhea
55
Q

What are S&S of metabolic alkalosis?

A
  • headache
  • neuromuscular excitability ( paresthesias/numbness, twitching and cramping, particularly in feet and hands, seizures)
  • muscle alterations due to associated lowering of CA2+ (skeletal weakness, cardiac arrhythmias)
56
Q

What is a part of our metabolic review?

A
  • hx
  • observation of:
  • muscle twitching / tetany
  • altered respiration
  • memory loss
  • incoordination
  • dry mouth
  • fruity breath
  • resisted and/or manual muscle testing: wide spread weakness
  • neuro tests: possibly wide spread altered sensations
  • abdominal assessment
  • standard vital signs (HR, hypotension, RR)
  • palpation of skin for mobility and temperatures
57
Q

What are we looking at with our abdominal assessment as a part of our metabolic review?

A

pain with palpation and percussion of:
- liver
- pancreas
- kidney

58
Q

What are the standard vital signs we should look at with metabolic review?

A
  • irregular heart rate
  • postural hypotension
  • altered respiratory reate
59
Q

What are we palpating for with our metabolic review?

A
  • loss of skin mobility
  • extreme skin temperature
60
Q

What are the PT implications of the metabolic system?

A
  • adequate hydration: (likely more than just water, such as electrolyte drinks)(
  • ensure efficient respiration
  • increase antioxidant foods (veggies and fruits)
61
Q

What type of referral is metabolic system?

A

URGENT

62
Q

What are infection S&S?

A

may be local and less asymptomatic but more concerned about systemic and greater S&S affecting multiple systems
- malaise
- fever, chills, sweats
- N&V
- enlarged and likely tender lymph nodes
- redness ( maybe lymphangitis or streaks towards lymph nodes), access, head, and/or swelling
- specific infected system S&S as well

63
Q

What is a part of our infection review?

A
  • hx
  • observation: redness / swelling
  • palpation: abnormal lymph nodes (> 2 cm diameter, firm, tender due to rapid onset of inflammation with infection), heat, swelling, possible pain with abdominal quadrant assessment of involved structure
  • standard vital signs: high temp
64
Q

What are some systemic S&S in the older adult that can be subtle and atypical with infection?

A
  • mentation changes
  • subnormal body temp
  • bradycardia or tachycardia
  • tachypnea
  • fatigue
  • lethargy (lack of energy)
  • decreased appetite
65
Q

What are some S&S of an autoimmune condition?

A

Gradual onset
- GI S&S due to majority of immune cells in gut
- constitutional S&S
- inflammation (persistent with possible acute bouts, local or systemic)
- myalgia/arthralgia
- swollen lymph nodes (tender if acute, non-tender with chronicity), may be immobile if fibrotic)
- typically affect > 1 part of the body
- skin and weight changes
- emotional changes

66
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

67
Q

What is a part of the immune review?

A
  • hx
  • observation of: persistent swelling and possibly pitting edema, skin changes
  • vital signs: high temp
  • palpation: swollen and tender lymph nodes, muscle and joint TTP
68
Q

What are S&S of cancer?

A

Gradual onset
- asymptomatic in early stages and may affect multiple systems
- pain: local and referred (progressive, esp at nigh and likely at a similar time after falling asleep due to metabolic activity, often invariable with position of movement, may become constant)
- N&V
- loss of appetite
- unexpained weight loss of ≥ 5-10% over a 3-6 month period
- fever, chills, sweats (night) - even in absence of infection due to increased circulating white blood cells or production pyrogen agent)
- swollen and NON tender lymph nodes, possibly hard and immobile due to fibrosis
- unusual malaise and fatigue
- secondary infections due to lowered immunity

69
Q

What is a part of our cancer review?

A
  • hx (hx of cancer?)
  • palpation of lymph nodes (> 2 cm , firm, immobile and NON-tender due to limited inflammation with typical slow growth of most cancers)
  • vital signs: high temp?
70
Q

What are S&S of the cardiovascular system?

A

Gradual or sudden onset
- family hx of heart attack prior to age 60
- pain in chest (angina), with/without upper thorax, neck, UE, and/or face due to shared innervation from C4-T4; L UE more common, UE pain is in ulnar nerve distribution medially into little finger, esp upon exertion
- heart palpitations
- nausea
- sweating
- SOB/wheezing
- dizziness/light headedness, fainting (syncope)
- fatigue, particularly with minimal exertion

71
Q

What makes up the cardiovascular system?

A

Heart and blood vessels

72
Q

What are the functions of the cardiovascular system?

A
  • in coordination with respiratory and nervous system
  • circulate oxygenated blood through the arterial system to cells throughout the body
  • deoxygenated blood carried by venous system to lungs for reoxygenation
73
Q

What are S&S of the cardiovascular system due to?

A
  • insufficiency of heart and vessels
74
Q

What other systems can the cardiovascular system influence?

A

Respiratory and lymphatic systems

75
Q

What is a part of the cardiovascular review?

A
  • hx
  • observation of: SOB, wheezing, sweating
  • abnormal vital signs: HR, RR, BP
  • abnormal heart or vessel sounds with stethoscope aka auscultations
76
Q

What are the S&S of the respiratory system?

A
  • pain in neck and/or upper shoulder regions
  • thorax pain due to shared T2-4 innovation: possibly exacerbated by
    > deep inspiration
    > coughing
    > motion in UE and/or trunk
  • cyanosis
  • digital clubbing
  • SOB, wheezing, and/or altered breathing patterns
  • cough
  • decreased breath sounds and possible pleural rub of lungs together with respiration
  • hyper resonance with percussion
77
Q

What makes up the respiratory system?

A

nose, mouth, pharynx, airways, lungs, and diaphragm

78
Q

What are the functions of the respiratory system?

A

In coordination with cardiovascular, nervous, and immune systems to facilitate gas exchange:
- nutrients and oxygen to tissues
- removed carbon dioxide and waste from tissues

79
Q

What is a part of our respiratory review?

A
  • hx
  • observation: cyanosis, digital clubbing, SOB, cough
  • vital signs: altered respiration rate
  • decreased breath sounds and pleural rub with stethoscope aka auscultations
  • hyperresonance with percussions
80
Q

What are some S&S of the GI system?

A
  • pain in neck, trunk (thoracic, lumbar, and abdominal), pelvic, and / or shoulder regions due to multiple levels of shared innervations
  • dysphagia (swallowing difficulties)
  • N&V
  • food aversion / intolerances
  • indigestion and/or heartburn
  • full feeling
  • bowel dysfunction ( color, shape, constipation, incontinence or lack of control)
81
Q

What makes up the GI system?

A

Mouth, esophagus, stomach, intestines, to colon and rectum

82
Q

What are the functions of the GI system?

A
  • digestion - stomach and small intestines
  • absorption - stomach and small intestines
  • excretion - large intestines, colon, and rectum
  • protection: all major categories of immune cells in the gut, 70-80% of bodies immune cells in gut
  • assisted by hepatic system
  • also an emotional physiological connection for gut health
83
Q

What is a part of the gastrointestinal review?

A
  • primarily hx
  • observation of difficulty swallowing, swelling/bloating in abdominal quadrants
  • abdominal quadrant: auscultation (altered sounds), palpation for tenderness, percussion for abdominal sounds
84
Q

What makes up the nervous system?

A
  • central (brain/spinal cord) and peripheral (somatic/autonomic) nervous systems
85
Q

What are the functions of the nervous system?

A
  • sensory processing
  • involuntary and voluntary responses and actions
  • maintaining system homeostasis, particularly with endocrine system
  • MAJOR controlling, regulatory, and communicating bodily systems
86
Q

Where does the endocrine system meet the nervous system?

A

At the hypothalamus - pituitary interface

87
Q

What is the hypothalamus?

A

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

88
Q

What are some LMN structures?

A
  • cranial nerves
  • anterior grey column of spinal cord
  • cauda equina
  • spinal nerves to terminal nerve branches
89
Q

What are some UMN structures?

A
  • above anterior horn of spinal cord
  • brain and MOST of spinal cord
90
Q

What are some LMN S&S?

A
  • decreased or flaccid muscle tone
  • incontinence or leakage of bowel and bladder
  • single segment dermatome/paresthesias
  • single segment of hypoactive for DTRs
  • single segment of fatiguing weakness for myotomes
  • possible sexual dysfunction
91
Q

What are some UMN S&S?

A
  • increased or spastic muscle tone
  • spastic/retentive bowel and bladder
  • multi-segmental diminished dermatomes/paresthesias
  • multiple segmental hyperactivity for DTRs
  • multi-segmental weakness for myotomes
92
Q

Which motor neuron will have mentation changes?

A

UMN

93
Q

Which motor neuron will have superficial reflexes be altered?

A

UMN - hypoactive

94
Q

Which motor neuron will have speech, swallowing, and vision changes

A

UMN

95
Q

Which motor neuron will have positive dural mobility?

A

LMN, UMN if acute, not if gradual

96
Q

What does it mean if the umbilicus moves in the direction of the stroke in the abdominal quadrant?

A

WNL

97
Q

What does it mean if the umbilicus does not move with light strokes applied in each of the abdominal quadrants around the umbilicus?

A

hypoactive

98
Q

What are some other S&S that may occur with either LMN or UMN conditions?

A
  • N&V
  • dizziness
  • visual or auditory dysfunction
99
Q

What can the WORST HA ever be?

A

impending stroke

100
Q

What is a part of the neurological review?

A

hx and observation plus assessments

clin med II - exam I (4 decks)

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