week 2: differential dx Flashcards
which systems have an inconsistent symptom pattern?
psychologic
endocrine
neurologic
rheumatic disorders
adverse drug reactions
what does a pain description of throbbing, pounding, and pulsating indicate?
vascular disorders
(ex: AAA, PVD)
what does a pain description of sharp, lancinating, shocking, and burning indicate?
neurological disorders
what does a pain description of aching, squeezing, gnawing, burning, and cramping indicate?
visceral disorders
suspected diff dx:
constant back pain not affected by mvmt
back pain worse at night
unexplained weight loss
failure of conservative treatment
back-related tumor
suspected diff dx:
spine rigidity
deep constant pain, increased with WB
fever, malaise, swelling
back-related infection (ex: spinal osteomyelitis)
suspected diff dx:
hx spinal stenosis
hx of DDD
urinary retention or incontinence
saddle anesthesia
global or progressive weakness in LEs
cauda equina syndrome
suspected diff dx:
exquisitely tender w/ palpation over site
local edema
increased back pain with WB
hx of trauma
long-term steroid use
over 70 yo
spinal fx
suspected diff dx:
back, abdominal, or groin pain
PVD or CAD
symptoms not related to mvmt
bruit in epigastric area
abdominal aneurysm
suspected diff dx:
pain unchanged by position or mvmt
age >50
unexplained weight loss
bowel disturbances
colon cancer
what are the most common places for metastasis of colon cancer?
liver, lung, bone, brain
suspected diff dx:
older female >70
hip, groin, or thigh pain
hx of fall from standing
severe, constant pain
shortened and ER’d LE
pathological fx in femoral neck
which pelvis region disease is for younger kids? older?
younger: Legg-Calve-Perthes disease
older: SCFE
suspected diff dx:
stiff hip joint
hx of long-term corticosteroid use
trauma
gradual onset of hip pain that worsens with WB
osteonecrosis of femoral head
suspected diff dx:
5-8 yo boy
groin/thigh pain
antalgic gait
pain with hip abd & IR
Legg-Calve-Perthes disease
suspected diff dx:
overweight adolescent (esp male)
recent growth spurt or trauma
aching in groin worse with WB
leg in ER
ROM limited in IR
SCFE
suspected diff dx:
>60
hx of T2DM &/or ischemic heart disease
sedentary, smoker
intermittent claudication
cool extremity
peripheral arterial occlusive disease
DVT has ____ symptoms, while compartment syndrome has ____ symptoms (intermediate/constant)
DVT: intermittent
compartment syndrome: constant
suspected diff dx:
recent surgery, malignancy, pregnancy, trauma, or leg immobilization
calf pain, edema, tenderness, warmth
pallor, loss of dorsalis pedis pulse
DVT
suspected diff dx:
blunt trauma, crush injury
severe, persistent leg pain
swelling, severe leg pain
compartment syndrome
suspected diff dx:
hx of recent infection, surgery, or injection
immunosuppressant disorder
constant aching or throbbing in joint
elevated body temperature
septic arthritis
suspected diff dx:
hx of recent skin ulceration or abrasion
hx of venous insufficiency, CHF, cirrhosis
pain, skin swelling, warmth
advancing irregular margin of erythema/reddish streak
cellulitis
suspected diff dx:
men >40, women >50 yo
chest pain, palpitations
pallor, sweating, dyspnea, nausea
hx of CAD, HTN, smoking, DM, elevated cholesterol
myocardial infarction
suspected diff dx:
hx of CAD
chest pain outside of predictable pattern
unresponsive to nitroglycerin
unstable angina pectoris
suspected diff dx:
>65 yo
hx of CAD
chest pain that occurs with predictable level of exertion
sx alleviated with nitroglycerin
stable angina pectoris
suspected diff dx:
autoimmune disease
sharp, stabbing chest pain
increased chest pain with side lying
chest pain relived with forward sitting
pericarditis
suspected diff dx:
immobility, trauma, &/or cancer
chest, shoulder, upper abdominal pain
dyspnea, tachycardia, tachypnea
PE
suspected diff dx:
hx of recurrent respiratory disorder
severe, sharp pain with inspiration
dyspnea, decreased chest wall excursion
pleurisy
suspected diff dx:
recent bout of coughing or strenuous ex
pleuritic pain
fever, chills, HA, malaise, nausea
pneumothorax
suspected diff dx:
hx of infection
pleuritic pain
fever, chills, malaise, HA, nausea
pneumonia
suspected diff dx:
sx worsen with ingestion of fatty foods
middle aged woman
colicky pain in R upper quadrant
R scapular pain
cholecystitis
suspected diff dx:
sx relieved with ingestion of food
pain in epigastrium, midback, or supraclavicular regions
tenderness at R epigastrium
tarry stool
peptic ulcer
suspected diff dx:
recent or current UTI &/or kidney stone
enlarged prostate
tenderness over costovertebral angle
pyelonephritis
where are the most common levels of spinal fx?
T11-L1
suspected diff dx:
sudden severe back or flank pain
renal colic
symptoms of UTI
fever, malaise, nausea, vomiting
nephrolithiasis (kidney stone)
suspected diff dx:
hx of fall, MVA, osteoporosis
long-term steroid use
age >70
midline tenderness
LE neuro signs
increased thoracic kyphosis
spinal fx
suspected diff dx:
hx of infection, skull fracture
+ slump sign
HA, fever, nausea, vomiting
photophobia, confusion
seizures, sleepiness
meningitis
suspected diff dx:
age 24-64 yo
HA, altered mental status
ataxia, speech deficits
sensory abnormalities
visual changes, seizures
primary brain tumor
suspected diff dx:
hx of smoking, HTN, alcohol abuse
sudden onset HA
bries LOC
brain tumor signs
meningeal irritation signs
subarachnoid hemorrhage
suspected diff dx:
major trauma
hx RA or AS
oral contraceptive use
+ Babinski sign
dizziness, nystagmus, vertigo, clonus
cervical ligamentous instability with possible cord compromise
suspected diff dx:
paresthesias
retrograde distribution of pain
UE muscle tender to palpation
cervical & shoulder girdle entrapment neuropathies
suspected diff dx:
men >50 w/ smoking hx
nagging pain in shoulder & scapula
nagging pain –> burning in ulnar n. distr.
Pancoast’s tumor
(superior sulcus long tumor)
suspected diff dx:
asymmetry of neck line
inability to shrug shoulder
lack scapular stabilizers
weak shoulder abduction
spinal accessory nerve disorder
suspected diff dx:
>40 with shoulder dislocation
weak shoulder abduction & flexion
lack sensation in lateral aspect of up arm
axillary nerve disorder
suspected diff dx:
serratus anterior weakness
loss of scapulohumeral rhythm
long thoracic nerve disorder
suspected diff dx:
deep, poorly localized pain
weak shoulder abduction and ER
hx of scapula fracture
suprascapular nerve disorder
suspected diff dx:
FOOSH with forearm supinated
elbow held at side
radial head fx
suspected diff dx:
FOOSH w/ forceful wrist extension
>40
distal radius fx (Colles’)
(most common)
suspected diff dx:
pain in anatomical snuff box
scaphoid fx
suspected diff dx:
FOOSH
diffuse synovitis
lunate fx or dislocation
suspected diff dx:
FOOSH w/ forearm pronated
ulnar-sided wrist pain
TFCC tear
suspected diff dx:
recent skin puncture, insect bite
presence of abcess
purulent tenosynovitis
signs of o=inflammation
space infection of hand
suspected diff dx:
hx RA, trauma, corticosteroid use
hand/wrist tenderness, swelling, muscle spasms, hematoma
long flexor tendon rupture
suspected diff dx:
hx RA, smoking, beta blocker use
hands or feet blanch & turn red when exposed to cold or emotional stress
Raynaud’s disease
suspected diff dx:
hypersensitivity
pain doesn’t respond to analgesics
swelling (pitting edema), warm
aching, stinging, cutting, burning pain
pain not typical to injury
complex regional pain syndrome
