Week 2- Do Not Want To Miss Flashcards
What are (9) conditions that you DO NOT want to miss?
- 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
PART 1: MAJOR DEPRESSION
PART 1: MAJOR DEPRESSION
Early _________ and ________ are critical in regards to patients with depression.
recognition and referral
Major Depression Risk Factors. (4)
- Personal/Family Hx (first-degree family)
- Women (especially during pregnancy/postpartum)
- Hx of DM, MI, cancer, stroke, chemical dependency
- Suffering from significant loss
What questionnaire is used to screen for depression?
PHQ (-2 or -9)
- PHQ-2 Score ≥ __ should be further evaluated with PHQ-9.
- PHQ-9 Score ≥ __ indicates depression.
- ≥ 2
- ≥ 10
(SQ)
What (2) questions should all patients be asked to screen for depression?
- ) During the past month have you been feeling down, depressed, or hopeless?
- ) During the past month have you been bothered by having little interest or pleasure in doing things?
PART 2: SUICIDE RISK
PART 2: SUICIDE RISK
50-67% of people who committed suicide saw a physician within ___ weeks of the act.
4 weeks
Suicide Risk Factors. (9)
- 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
- How do you want to address suicide concern?
- What do you do if answered yes?
- Ask direct question, “Are you having thoughts of attempting to harm yourself?”
- If pt answers yes, initiate facility protocol.
PART 3: FEMORAL HEAD/NECK FRACTURES
PART 3: FEMORAL HEAD/NECK FRACTURES
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 _____.
- non-displaced, displaced
- femur and lumbar vertebrae
- femoral neck
(SQ) Femoral Head/Neck Fx Risk Factors: -\_\_\_\_\_\_\_ gender. -Involved in \_\_\_\_\_\_\_/\_\_\_\_\_\_\_ activities. -Change in training \_\_\_\_\_\_\_/\_\_\_\_\_\_. -\_\_\_\_\_\_\_\_\_ deficiencies. -\_\_\_\_\_\_\_\_\_\_ discrepancy. -Diminished muscle strength. -\_\_\_\_\_\_\_\_\_\_\_.
- Female
- Running/jumping
- program/intensity
- Nutritional
- Leg-length
- Diminished muscle strength.
- Osteoporosis.
(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?
- Yes
- Yes (usually)
- Yes
- ER and ABD
(SQ)
Non-Displaced Femoral Head/Neck Fx:
-_______ or _______ Fx
-Is onset of pain secondary to trauma?
- insufficiency or fatigue Fx
- Typically not marked by major trauma
_______ Fractures have more confusing or much less severe presentation which can result in what?
Non-displaced, can result in delayed diagnosis and/or progression to displaced Fx.
(SQ)
What is the difference between insufficiency and fatigue fractures?
- Fatigue = normal bone, abnormal stress
- Insufficiency = normal stress, abnormal bone
(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.
- Pain in groin, greater trochanter, and/or buttock
- anteromedial
- WBing
- insidious
- minor (if any)
(SQ)
What physical exam techniques would you utilize if you suspected a femoral head/neck Fx? (2)
- Patellar-Pubic Percussion
- Fulcrum Test
PART 4: CAUDA EQUINA SYNDROME
PART 4: CAUDA EQUINA SYNDROME
General:
- Carries significant risk of irreversible __________ compromise.
- May require urgent surgical intervention.
- Main causes include what?
- neurological
- disc herniation/surgery
(SQ)
Cauda Equina Syndrome Risk Factors. (5)
- low back injury, central disc herniation
- congenital/acquired spinal stenosis
- spinal fracture
- ankylosing spondylosis
- TB, Pott’s Disease
(SQ) Cauda Equina Syndrome Clinical Manifestations: -\_\_\_\_\_\_/\_\_\_\_\_\_/\_\_\_\_\_\_\_ dysfunction. -\_\_\_\_\_\_\_\_ deficits. -\_\_\_\_\_\_\_ deficits.
- urinary, bowel, sexual dysfunction
- sensory deficits (“saddle” anesthesia, LE)
- motor deficits (LE)
What is more common with Caude Equina Syndrome, urinary retention or incontinence?
Retention
PART 5: CERVICAL MYELOPATHY
PART 5: CERVICAL MYELOPATHY
(SQ)
Cervical Myelopathy Risk Factors. (3)
- Cervical spondylosis
- Spinal degeneration from neck trauma
- RA
(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
Cervical Myelopathy Cluster. (5)
- ) Gait abnormality
- ) + Hoffman
- ) + Babinski
- ) + Inverted supinator sign
- ) Age >45
Cervical Myelopathy Cluster Rule IN/OUT:
- > /=__/5 = Rule IN
- =__/5 = Rule OUT
- > /=3/5 = Rule IN
- =1/5 = Rule OUT
PART 5: ABDOMINAL AORTIC ANEURYSM
PART 5: ABDOMINAL AORTIC ANEURYSM
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)
(SQ)
AAA Risk Factors. (5)
- Age
- Male gender
- Hx of smoking
- Hx of hypercholesterol and CHD
- family Hx
(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
PART 7: DVT
PART 7: DVT
(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
(SQ) DVT Clinical Manifestation: -Ache/tightness/tenderness -General/pitting \_\_\_\_\_\_ -Prominent \_\_\_\_\_\_\_ plexus -Increased local skin \_\_\_\_\_\_\_
- general/pitting edema
- prominent superficial venous plexus
- increased skin temp
(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.
PART 8: PE
PART 8: PE
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
PE Clinical Manifestation:
- ________
- _______
- Pleuritic ________, intensified w/ deep respiration and cough.
- dyspnea
- tachypnea
- pleuritic chest pain
Wells CPR for PE:
- High Probability = >__
- Moderate Probability = __-__
- Low Probability = __-__
- High Probability = >6
- Moderate Probability = 3-6
- Low Probability = 0-2
PART 9: ATYPICAL MYOCARDIAL INFARCTION
PART 9: ATYPICAL MYOCARDIAL INFARCTION
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)
(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)
(SQ) Atypical MI Clinical Manifestation: -\_\_\_\_/\_\_\_\_\_ -\_\_\_\_\_\_ disturbance -Nausea (w/ or w/out vomiting) -Palpitations -Dizziness -Diaphoresis -Anxiety -\_\_\_\_\_ locations
- SOB/Fatigue
- Sleep disturbances
- Pain locations
(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)
