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)