8.22 Symptom Investigation 4 (Red Flags)

Question 1

What is an objective test that can be used to help dx PVD?

Answer 1

reactive hyperemia test

Question 2

What is the test procedure for the reactive hyperemia test?

Answer 2

• pt supine, hold leg up in SLR at 45˚
• lower after 1-3 minutes
• looking for how long it takes blood to return to the leg

Question 3

reactive hyperemia test: normal

Answer 3

3-5 seconds

Question 4

reactive hyperemia test: PVD

Answer 4

anything over 20 seconds

Question 5

sensitivity/specificity of Wells criteria for DVT

Answer 5

between 85 and 95%

Question 6

What are the 5 P’s of compartment syndrome?

Answer 6

• pain
• palpable tenderness
• paresis
• paresthesia
• pulselessness

Question 7

How does VBI often present?

Answer 7

severe HA ~15 hours prior

Question 8

In addition to symptoms in the shoulder, where else may s/s of an MI manifest?

Answer 8

arm - typically left, but sometimes right

Question 9

For pts who have a hx of heart disease or heart attack, what should they always have with them at therapy?

Answer 9

nitroglycerin

Question 10

Where do Pancoast tumors grow?

Answer 10

apex of the lung (no initial lung symptoms)

Question 11

Pancoast tumor: after affecting the ulnar distribution, what is affected?

Answer 11

subclavian vein

Question 12

Pancoast tumors and referral

Answer 12

• refer if they have risk factors and haven’t seen improvement over 2-3 visits
• often misdiagnosed 8 months to 2 years
• makes the difference between metastatis and not

Question 13

What are the t-spine and rib red flags?

Answer 13

• MI
• stable angina pectoris
• unstable angina pectoris
• pericarditis
• pleurisy
• pulmonary embolus
• pneumonia
• pneumothorax

Question 14

Stable angina pectoris: what will you see?

Answer 14

• chest pain with predictable level of exertion

- relieved by nitroglycerin

Question 15

stable angina pectoris: controlling

Answer 15

• not as much damage to the heart

- can be controlled easier than unstable angina

Question 16

unstable angina pectoris

Answer 16

• chest pain outside of predictable pattern

- not responsive to nitroglycerin

Question 17

What is the precursor to an MI?

Answer 17

unstable angina pectoris

Question 18

What should you do if a patient experiences chest pain?

Answer 18

• refer if they aren’t being medically managed

- don’t get them to the level of exertion that induces angina

Question 19

What is pericarditis?

Answer 19

• inflammation of the pericardium

- sharp, stabbing pain referred to lateral neck or shoulder

Question 20

What increases pain with pericarditis?

Answer 20

L sidelying (more pressure on the heart)

Question 21

What relieves pain with pericarditis

Answer 21

forward leaning posture

Question 22

What is pleurisy?

Answer 22

• inflammation of the lining of the lung
• sharp, stabbing pain with inspiration
• dyspnea

Question 23

Who gets pleurisy?

Answer 23

hx of a respiratory disorder

Question 24

Where can pleurisy refer pain to?

Answer 24

shoulder region

Question 25

What are s/s indicative of a pulmonary embolus?

Answer 25

- chest, shoulder, or upper abdominal pain | - dyspnea

Question 26

Pts with a hx of ___ are at risk for a PE

Answer 26

DVT

Question 27

Where is pleuritic pain often referred?

Answer 27

shoulder

Question 28

What are s/s of pneumonia?

Answer 28

- fever, chills - HA - malaise - nausea - productive cough

Question 29

What are some things that would make you think pneumothorax?

Answer 29

- chest pain with inspiration - difficult to expand rib cage - recent trauma, coughing, strenuous exercise

Question 30

What will you hear with a pneumothorax?

Answer 30

- hyperresonance with percussion | - decreased breath sounds