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S7- Differential Diagnosis > Week 2- Do Not Want To Miss > Flashcards

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
Q

What is more common with Caude Equina Syndrome, urinary retention or incontinence?

A

Retention

26
Q

PART 5: CERVICAL MYELOPATHY

A

PART 5: CERVICAL MYELOPATHY

27
Q

(SQ)

Cervical Myelopathy Risk Factors. (3)

A
  • Cervical spondylosis
  • Spinal degeneration from neck trauma
  • RA
28
Q 
(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
A
  • 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
Q

Cervical Myelopathy Cluster. (5)

A
  1. ) Gait abnormality
  2. ) + Hoffman
  3. ) + Babinski
  4. ) + Inverted supinator sign
  5. ) Age >45
30
Q

Cervical Myelopathy Cluster Rule IN/OUT:

  • > /=__/5 = Rule IN
  • =__/5 = Rule OUT
A
  • > /=3/5 = Rule IN

- =1/5 = Rule OUT

31
Q

PART 5: ABDOMINAL AORTIC ANEURYSM

A

PART 5: ABDOMINAL AORTIC ANEURYSM

32
Q

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)
A
  • uncommon
  • > 60yo
  • > 3cm (5-6cm)
33
Q

(SQ)

AAA Risk Factors. (5)

A
  • Age
  • Male gender
  • Hx of smoking
  • Hx of hypercholesterol and CHD
  • family Hx
34
Q

(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.

A
  • Asymptomatic
  • back pain
  • Abdominal, hip, groin, buttock
  • insidious
35
Q

PART 7: DVT

A

PART 7: DVT

36
Q 
(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 >\_\_\_
A
  • Hx of cancer, CHF, SLE
  • Major surgery/trauma
  • Age >60
37
Q 
(SQ)
DVT Clinical Manifestation:
-Ache/tightness/tenderness
-General/pitting \_\_\_\_\_\_
-Prominent \_\_\_\_\_\_\_ plexus
-Increased local skin \_\_\_\_\_\_\_
A
  • general/pitting edema
  • prominent superficial venous plexus
  • increased skin temp
38
Q 
(SQ)
Wells CPR for DVT:
-High Probability = >\_\_ (75%)
-Moderate Probability = \_\_-\_\_ (17%)
-Low Probability = \_\_ (3%)

-What probability would warrant a referral for further screening?

A
  • High Probability = >3
  • Moderate Probability = 1-2
  • Low Probability = 0

-High/Moderate Probability would warrant a referral.

39
Q

PART 8: PE

A

PART 8: PE

40
Q

PE Risk Factors:

  • Previous Hx of __/___.
  • Immobility
  • Hx of abdominal/pelvic surgery
  • Total hip/knee replacement
  • Late-stage ________
  • ____ fracture
  • Malignancy of pelvis or abdomen
A
  • PE/DVT
  • late-stage pregnancy
  • LE fracture
41
Q

PE Clinical Manifestation:

  • ________
  • _______
  • Pleuritic ________, intensified w/ deep respiration and cough.
A
  • dyspnea
  • tachypnea
  • pleuritic chest pain
42
Q

Wells CPR for PE:

  • High Probability = >__
  • Moderate Probability = __-__
  • Low Probability = __-__
A
  • High Probability = >6
  • Moderate Probability = 3-6
  • Low Probability = 0-2
43
Q

PART 9: ATYPICAL MYOCARDIAL INFARCTION

A

PART 9: ATYPICAL MYOCARDIAL INFARCTION

44
Q

Atypical Myocardial Infarction General:

  • What is the typical presentation of MI?
  • Less typical for _____ to present with classic pattern.
A
  • L sided chest tightness/pressure/pain w/ referral to L UE.

- women (only 50% of women have chest pain)

45
Q 
(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)
A
  • 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
Q 
(SQ)
Atypical MI Clinical Manifestation:
-\_\_\_\_/\_\_\_\_\_
-\_\_\_\_\_\_ disturbance
-Nausea (w/ or w/out vomiting)
-Palpitations
-Dizziness
-Diaphoresis
-Anxiety
-\_\_\_\_\_ locations
A
  • SOB/Fatigue
  • Sleep disturbances
  • Pain locations
47
Q

(SQ)

What are the pain locations associated with Atypical MI? (4)

A
  • Upper abdominal/epigastric
  • Neck, jaw, and tooth
  • Interscapular and mid-lower thoracic
  • R arm pain (possible isolation to biceps)

S7- Differential Diagnosis (15 decks)

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