Week 2- Do Not Want To Miss Flashcards

1
Q

What are (9) conditions that you DO NOT want to miss?

A
  • Major depression
  • Suicide risk
  • Femoral head and neck fractures
  • Cauda equina syndrome
  • Cervical myelopathy
  • Abdominal aortic aneurysm
  • Deep venous thrombosis
  • Pulmonary embolism
  • Atypical myocardial infarction
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2
Q

PART 1: MAJOR DEPRESSION

A

PART 1: MAJOR DEPRESSION

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3
Q

Early _________ and ________ are critical in regards to patients with depression.

A

recognition and referral

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4
Q

Major Depression Risk Factors. (4)

A
  • Personal/Family Hx (first-degree family)
  • Women (especially during pregnancy/postpartum)
  • Hx of DM, MI, cancer, stroke, chemical dependency
  • Suffering from significant loss
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5
Q

What questionnaire is used to screen for depression?

A

PHQ (-2 or -9)

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6
Q
  • PHQ-2 Score ≥ __ should be further evaluated with PHQ-9.

- PHQ-9 Score ≥ __ indicates depression.

A
  • ≥ 2

- ≥ 10

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7
Q

(SQ)

What (2) questions should all patients be asked to screen 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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8
Q

PART 2: SUICIDE RISK

A

PART 2: SUICIDE RISK

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9
Q

50-67% of people who committed suicide saw a physician within ___ weeks of the act.

A

4 weeks

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10
Q

Suicide Risk Factors. (9)

A
  • Gender (males>females)
  • Widowed, divorced, living alone
  • History of psychiatric illness
  • Previous suicide attempt
  • History of chronic progressive illnesses
  • Recent significant loss
  • Unemployed
  • Sense of hopelessness
  • Family history of suicide completion or attempts
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11
Q
  • How do you want to address suicide concern?

- What do you do if answered yes?

A
  • Ask direct question, “Are you having thoughts of attempting to harm yourself?”
  • If pt answers yes, initiate facility protocol.
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12
Q

PART 3: FEMORAL HEAD/NECK FRACTURES

A

PART 3: FEMORAL HEAD/NECK FRACTURES

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13
Q

General Fx:

  • Timely referral can prevent __________ fractures from progressing to _______ fractures.
  • Osteoporosis-related fractures more commonly occur where?
  • 11% of stress fractures in athletes involve the femoral _____.
A
  • non-displaced, displaced
  • femur and lumbar vertebrae
  • femoral neck
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14
Q
(SQ)
Femoral Head/Neck Fx Risk Factors:
-\_\_\_\_\_\_\_ gender.
-Involved in \_\_\_\_\_\_\_/\_\_\_\_\_\_\_ activities.
-Change in training \_\_\_\_\_\_\_/\_\_\_\_\_\_.
-\_\_\_\_\_\_\_\_\_ deficiencies.
-\_\_\_\_\_\_\_\_\_\_ discrepancy.
-Diminished muscle strength.
-\_\_\_\_\_\_\_\_\_\_\_.
A
  • Female
  • Running/jumping
  • program/intensity
  • Nutritional
  • Leg-length
  • Diminished muscle strength.
  • Osteoporosis.
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15
Q
(SQ)
Displaced Femoral Head/Neck Fx:
-Do they have compromised WB status?
-Is onset of pain secondary to trauma?
-Do they have leg length discrepancies?
-What is a position of comfort?
A
  • Yes
  • Yes (usually)
  • Yes
  • ER and ABD
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16
Q

(SQ)
Non-Displaced Femoral Head/Neck Fx:
-_______ or _______ Fx
-Is onset of pain secondary to trauma?

A
  • insufficiency or fatigue Fx

- Typically not marked by major trauma

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17
Q

_______ Fractures have more confusing or much less severe presentation which can result in what?

A

Non-displaced, can result in delayed diagnosis and/or progression to displaced Fx.

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18
Q

(SQ)

What is the difference between insufficiency and fatigue fractures?

A
  • Fatigue = normal bone, abnormal stress

- Insufficiency = normal stress, abnormal bone

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19
Q

(SQ)
Femoral Head/Neck Fx Clinical Manifestations:
-Pain in _____, _________ and/or ________.
-Referred pain to __________ thigh may be cc.
-Provoked/relieved with _____.
-________ onset.
-Hip ROM reveals ______ pain provocation.
-Plain films often negative.

A
  • Pain in groin, greater trochanter, and/or buttock
  • anteromedial
  • WBing
  • insidious
  • minor (if any)
20
Q

(SQ)

What physical exam techniques would you utilize if you suspected a femoral head/neck Fx? (2)

A
  • Patellar-Pubic Percussion

- Fulcrum Test

21
Q

PART 4: CAUDA EQUINA SYNDROME

A

PART 4: CAUDA EQUINA SYNDROME

22
Q

General:

  • Carries significant risk of irreversible __________ compromise.
  • May require urgent surgical intervention.
  • Main causes include what?
A
  • neurological

- disc herniation/surgery

23
Q

(SQ)

Cauda Equina Syndrome Risk Factors. (5)

A
  • low back injury, central disc herniation
  • congenital/acquired spinal stenosis
  • spinal fracture
  • ankylosing spondylosis
  • TB, Pott’s Disease
24
Q
(SQ)
Cauda Equina Syndrome Clinical Manifestations:
-\_\_\_\_\_\_/\_\_\_\_\_\_/\_\_\_\_\_\_\_ dysfunction.
-\_\_\_\_\_\_\_\_ deficits.
-\_\_\_\_\_\_\_ deficits.
A
  • urinary, bowel, sexual dysfunction
  • sensory deficits (“saddle” anesthesia, LE)
  • motor deficits (LE)
25
What is more common with Caude Equina Syndrome, urinary retention or incontinence?
Retention
26
PART 5: CERVICAL MYELOPATHY
PART 5: CERVICAL MYELOPATHY
27
(SQ) | Cervical Myelopathy Risk Factors. (3)
- Cervical spondylosis - Spinal degeneration from neck trauma - RA
28
``` (SQ) Cervical Myelopathy Clinical Manifestations: -Hx -Impaired hand _________ -_____/_______ difficulties -Numbness/paresthesia (UE, possible LE) -Neck stiffness -_______ dysfunction -Physical Exam -Hand intrinsic ________ -Muscle weakness (UE and LE(proximal) -_____ signs ```
- Hx - impaired hand dexterity - gait/balance difficulties - Numbness/paresthesia (UE, possible LE) - Neck stiffness - Urinary dysfunction - Physical Exam - Hand intrinsic atrophy - Muscle weakness (UE and LE(proximal) - UMN signs
29
Cervical Myelopathy Cluster. (5)
1. ) Gait abnormality 2. ) + Hoffman 3. ) + Babinski 4. ) + Inverted supinator sign 5. ) Age >45
30
Cervical Myelopathy Cluster Rule IN/OUT: - >/=__/5 = Rule IN - =__/5 = Rule OUT
- >/=3/5 = Rule IN | - =1/5 = Rule OUT
31
PART 5: ABDOMINAL AORTIC ANEURYSM
PART 5: ABDOMINAL AORTIC ANEURYSM
32
AAA General: - Visceral causes of back pain are ________. - Most AAA occur in individuals >___ yo. - AAA defined as vessel diameter >__cm. (Risk of rupture increases as diameter approaches (__-__cm)
- uncommon - >60yo - >3cm (5-6cm)
33
(SQ) | AAA Risk Factors. (5)
- Age - Male gender - Hx of smoking - Hx of hypercholesterol and CHD - family Hx
34
(SQ) AAA Clinical Manifestation: -_________ in most. -If pain is present, most likely ______ pain. -_____, ____, ______, or _____ pain also possible. -Nonmechanical properties. -_________ onset. -May report early satiety, weight loss and nausea. -Vascular dissection must be considered with pain described as hot, searing, ripping, tearing pain.
- Asymptomatic - back pain - Abdominal, hip, groin, buttock - insidious
35
PART 7: DVT
PART 7: DVT
36
``` (SQ) DVT Risk Factors: -Previous Hx of DVT -Hx of _____, ____, ____ -Recieving chemotherapy -Major ______/________ -Immobility -Limb paralysis -Women during pregnancy -Women taking oral contraceptives/hormone replacement -Age >___ ```
- Hx of cancer, CHF, SLE - Major surgery/trauma - Age >60
37
``` (SQ) DVT Clinical Manifestation: -Ache/tightness/tenderness -General/pitting ______ -Prominent _______ plexus -Increased local skin _______ ```
- general/pitting edema - prominent superficial venous plexus - increased skin temp
38
``` (SQ) Wells CPR for DVT: -High Probability = >__ (75%) -Moderate Probability = __-__ (17%) -Low Probability = __ (3%) ``` -What probability would warrant a referral for further screening?
- High Probability = >3 - Moderate Probability = 1-2 - Low Probability = 0 -High/Moderate Probability would warrant a referral.
39
PART 8: PE
PART 8: PE
40
PE Risk Factors: - Previous Hx of __/___. - Immobility - Hx of abdominal/pelvic surgery - Total hip/knee replacement - Late-stage ________ - ____ fracture - Malignancy of pelvis or abdomen
- PE/DVT - late-stage pregnancy - LE fracture
41
PE Clinical Manifestation: - ________ - _______ - Pleuritic ________, intensified w/ deep respiration and cough.
- dyspnea - tachypnea - pleuritic chest pain
42
Wells CPR for PE: - High Probability = >__ - Moderate Probability = __-__ - Low Probability = __-__
- High Probability = >6 - Moderate Probability = 3-6 - Low Probability = 0-2
43
PART 9: ATYPICAL MYOCARDIAL INFARCTION
PART 9: ATYPICAL MYOCARDIAL INFARCTION
44
Atypical Myocardial Infarction General: - What is the typical presentation of MI? - Less typical for _____ to present with classic pattern.
- L sided chest tightness/pressure/pain w/ referral to L UE. | - women (only 50% of women have chest pain)
45
``` (SQ) Atypical MI Risk Factors (modifiable vs non): -Modifiable -Smoking/alcohol -High ______ levels -HTN -DM/Obesity -________ lifestyle -Non-modifiable -Age >__ (women), >__ (men) -_____ Hx -Ethnicity (________ highest) ```
- Modifiable - Smoking/alcohol - High cholesterol levels - HTN - DM/Obesity - sedentary lifestyle - Non-modifiable - Age >55 (women), >45 (men) - Family Hx - Ethnicity (African American highest)
46
``` (SQ) Atypical MI Clinical Manifestation: -____/_____ -______ disturbance -Nausea (w/ or w/out vomiting) -Palpitations -Dizziness -Diaphoresis -Anxiety -_____ locations ```
- SOB/Fatigue - Sleep disturbances - Pain locations
47
(SQ) | What are the pain locations associated with Atypical MI? (4)
- Upper abdominal/epigastric - Neck, jaw, and tooth - Interscapular and mid-lower thoracic - R arm pain (possible isolation to biceps)