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Patient Interviewing > Clinical Reasoning Conditions > Flashcards

Clinical Reasoning Conditions Flashcards

1
Q

Non-specific neck pain “Cervicalgia”

A

-Signs/Symptoms: Diffuse, UL pain around the cervical spine; May have mild UL radiating symptoms but typically does not
-Prognosis: 2-3 days to 6 months
-Dx Criteria: NO neural, ortho or imaging useful

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2
Q

Cervical stenosis w/ myelopathy

A

-Signs/symptoms: Diffuse general neck pain with occasional sharpness near CT junction, usually. Radiating symptoms into both arms. Decreased ROM in Cspine

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3
Q

Cervical stenosis w/ myelopathy Dx Criteria

A

-Neuro tests: Motor/sensory/reflexes of the UE, Hoffman’s sign
-Orthos: Lhermitte’s sign
-Imaging/Labs: XR, MR confirmation

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4
Q

Cervical disc lesion

A

-Common signs/symptoms: Pain at base of the neck or mid cervical spine; may have radiating symptoms down arms or midback, typically UL
-Prognosis: Good, 2 days-12 weeks

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5
Q

Cervical disc lesion: Dx Criteria

A

-Neuro tests: Motor/Sensory/Reflexes of UE
-Orthos: Cervical distraction, cervical compression and ROM
-Imaging/Labs: C-Spine MR

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6
Q

Cervical radiculopathy

A

-Signs/symptoms: Radiating pain from cervical spine into UL/BL extremities. Dermatomal pattern present.
-Prognosis: Favorable (Days to weeks typically)

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7
Q

Cervical radiculopathy: Dx Criteria

A

-Neuro: Muscle/strength/reflexes in UE; 10pt discrimination test if sensory changes present
-Orthos: Spurlings test, other cervical compression tests, ROM
-Imaging/Labs: XR and MR, typically NOT helpful

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8
Q

Cervical sprain/strain (“Whiplash”)

A

-Signs/symptoms: Any event which causes sudden cervical hyperextension and flexion; Headaches, nausea & vomiting, neck pain, midback pain, visual disturbances, hearing problems, and other neurological disturbances may be present
-Prognosis: Favorable (Weeks to years)

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9
Q

Cervical sprain/strain (“Whiplash”): Dx Criteria

A

-Neuro: None
-Orthos: Cervical ROM, active and passive, cervical distraction will typically be painful
-Imaging/Labs: MR in severe cases

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10
Q

Chiari Malformations

A

-Signs/symptoms: headaches, nausea, dizziness, visual and hearing disturbances, tinnitus, neurological muscle weakness
-Prognosis: Favorable, typically surgery is warranted to resolve symptoms
-Dx Criteria: Neuro/Orthos (NONE), Imaging/labs (MR and surgical consult to determine what type)

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11
Q

Lumbar Disc Herniation

A

-Common signs and symptoms: Painful flexion and/or lateral flexion, often accompanied with varying degrees of unilateral radiculopathy.
-Prognosis: Favorable

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12
Q

Lumbar Disc Herniation Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: muscle testing of LE
(Maybe sensory)
◦ Ortho tests that may be useful: Slump tests, SLR,
Valsalva, lumbar ROM
◦ Imaging/Labs: MR, but typically not helpful.

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13
Q

Non-specific LBP

A

-ICD10 Code: M54.50
-Common signs and symptoms: Diffuse lower back pain. Unilateral or bilateral. W/wo radiculopathy.
-Prognosis: Favorable.

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14
Q

Non-Specific LBP Dx Criteria

A

NONE

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15
Q

Spondylolisthesis

A

-ICD10 Code: M43.10
-Common signs and symptoms: Patients typically pubescent age. Painful lumbar extension. Diffuse BL lower back pain, typically worse on one side compared to other.
-Prognosis: Favorable

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16
Q

Spondylolisthesis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: None
◦ Ortho tests that may be useful: Extension based tests.
◦ Imaging/Labs: XR, specifically Flex/Ext film series to rule
in/out segmental instability.

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17
Q

Cauda Equina Syndrome

A

-ICD10 Code: S34.3XXA
-Common signs and symptoms: low back pain radiating into both legs. Saddle anesthesia, numbness and weakness in LE, urinary and/or bowel incontinence.
-Prognosis: Favorable, if surgically corrected within 24-48 hours of symptom onset.

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18
Q

Cauda Equina Syndrome Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: muscle, sensory and
reflexes of LE will be abnormal.
◦ Ortho tests that may be useful: SLR, Slump, and LE nerve tension tests.
◦ Imaging/Labs: MRI confirmation is needed.

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19
Q

Lumbar central canal stenosis

A

-ICD10 Code: M48.06
-Common signs and symptoms: Pain (unilateral or bilateral) radiating from the low back to below buttocks, pain relieved with sitting, pain reduced when leaning forward and pain increased with extension typically. -Prognosis: Favorable

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20
Q

Lumbar central canal stenosis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: muscle, sensory and
reflexes may be abnormal, but no always. Heel toe walk may be abnormal.
◦ Ortho tests that may be useful: Extension based tests
such as Kemps, ROM extension etc.
◦ Imaging/Labs: XR, MR to confirm, although oftentimes
structural changes are seen on MRI with patients that are
asymptomatic.

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21
Q

Lumbar IVF Stenosis

A

-ICD10 Code: M99.76
-Common signs and symptoms: Diffuse low back pain with radiating symptoms typically only unilaterally and within a dermatomal pattern.
-Prognosis: Favorable

22
Q

Lumbar IVF Stenosis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: muscle, strength
and reflexes may be abnormal pending severity.
◦ Ortho tests that may be useful: Kemp’s and all
other extension based orthos.
◦ Imaging/Labs: XR screen and then MRI confirmation.

23
Q

Sacroilitis

A

-ICD10 Code: M46.1
-Common signs and symptoms: Typically unilateral buttock pain and midline lower lumbar pain. Up to 50% of cases can have radiation to the lower extremity, upper lumbar area, to the groin, and/or the lower abdomen. -Prognosis:Favorable, 2-4 weeks typically

24
Q

Sacroilitis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: None
◦ Ortho tests that may be useful: SI joint
cluster/Lasletts cluster.
◦ Imaging/Labs: HLA-B27 if infection
seems possible.

25
Q

Ankylosing Spondylitis

A

-ICD10 Code: M45.9
-Common signs and symptoms: pain and stiffness througout midback and lower back with hyperkyphotic Tspine. Possible difficulty taking a deep breath, visual changes due to uveitis, unexplained fatigue, weight loss, possible bowel changes.
-Prognosis: Varied. No cure, but medication is available to
manage symptoms and possibly slow disease progression.

26
Q

Ankylosing Spondylitis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: None
◦ Ortho tests that may be useful: None
◦ Imaging/Labs: +ve HLA-B27 blood marker, XR can be used as a screen, MRI to confirm.

27
Q

Scoliosis

A

-ICD10 Code: M41.9
-Common signs and symptoms: Severe AIS may lead to abnormalities including a shaver back, lopsided shoulder, and thoracic malformation and even affect the cardiopulmonary function and irreversible damage to nerves
-Prognosis: Fair to good. Needs to be managed approprietly through puberty and adolescent growth spurt.

28
Q

Scoliosis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: None
◦ Ortho tests that may be useful: Adams test, postural
observation.
◦ Imaging/Labs: Xray to confirm

29
Q

Costochondritis

A

-ICD10 Code: M94.0
-Common signs and symptoms: Caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions, typical signs and symptoms include chest pain and or rib pain.
-Prognosis: Good, weeks to months.

30
Q

Costochondritis Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: Diagnosis by rule out. CN II-XII
◦ Ortho tests that may be useful: Thorough heart and lung exam.
◦ Imaging/Labs: None

31
Q

Thoracic Outlet Syndrome

A

-ICD10 Code: G54.0
-Common signs and symptoms: pain, numbness, tingling due to a peripheral nerve entrapment in the hand, arm and neck region.
-Prognosis: Good. Weeks to months.

32
Q

____ of TOS cases are neurogenic in nature. ___ are venous, and only___ are arterial.

A

95%, 4%, 1%

33
Q

TOS Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: possible myeotome or sensory changes.
◦ Ortho tests that may be useful: elevated arm stress test (EAST) aka Roos test, upper limb tension test (ULTT), and Adson’s test.
◦ Imaging/Labs: XR for congenital TOS only

34
Q

Pain in thoracic spine

A

-ICD10 Code: M54.6
-Common signs and symptoms: pain in midback and shoulders. Insidious onset gradually. Worse with slouching better with sitting up straight or exercise.
-Prognosis: Good. Days to weeks.

35
Q

Pain in thoracic spine Dx Criteria

A

NONE

36
Q

Cluster Headache

A

-ICD10 Code: G44.001
-Common signs and symptoms: headaches cause excruciating, unilateral periorbital or temporal pain, with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion).
-Prognosis: 1-3 episodes a month is considered chronic. Episodic cluster headaches can happen and then go into remission for months to years. Managed with medication, but no cure at this moment.

37
Q

Who do cluster headaches affect more?

A

Predominantly effecting males more than females.

38
Q

Cluster Headache Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: CN II-XII, MSRs
◦ Ortho tests that may be useful: None
◦ Imaging/Labs: None

39
Q

Tension-type headache

A

-ICD10 Code: G44.209
Common signs and symptoms: headache causes mild generalized pain (usually viselike) without the incapacity, nausea, or photophobia associated with migraine. Pain pattern typically consists of a band across the forehead, as if the person is wearing a hat that is too tight.
-Prognosis: Can be episodic, or chronic. Typically, last anywhere between 30 mins to several days.

40
Q

Tension-type headache: Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: MSRs to rule out cerebrovascular accident. (CVA)
◦ Ortho tests that may be useful: None
◦ Imaging/Labs: None

41
Q

Cervicogenic Headache

A

-ICD10 Code: G44.86
-Common signs and symptoms: a unilateral headache associated with evidence of cervical involvement through provocation of pain by movement of the neck or by pressing the neck; concurrent pain in the neck, shoulder, and arm; and reduced range of motion of the neck, with or without other features.
-Prognosis: Good. Days to weeks.

42
Q

Cervicogenic Headache: Dx Criteria

A

NONE

43
Q

Migrane w/ Aura

A

-ICD10 Code: G43.11
-Common signs and symptoms: an episodic primary headache disorder. Pain is often unilateral, throbbing, worse with exertion, and accompanied by symptoms such as nausea and sensitivity to light, sound, or odors.
-Prognosis: Symptoms typically last 4 to 72 hours and may be severe. Managed with medication. No cure.

44
Q

Auras occur in about ____ of patients, usually just before but sometimes after the headache.

A

25%

45
Q

Migrane w/ Aura: Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: CN II-XII and MSRs to rule out CVA
◦ Ortho tests that may be useful: None
◦ Imaging/Labs: None

46
Q

Migrane w/o Aura

A

-ICD10 Code: G43.01
-Common signs and symptoms: They present with the same symptoms, but it is important to differentiate the aura.
-Prognosis: Symptoms typically last 4 to 72 hours and may be severe. Managed with medication. No cure.

47
Q

Migraine with aura is associated with an increased risk of ___________, whereas no increased risk is associated with migraine without aura.

A

ischemic stroke

48
Q

Migraine w/o Aura: Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: CN II-XII, MSRs.
◦ Ortho tests that may be useful: None
◦ Imaging/Labs: None

49
Q

Occipital Neuraglia

A

-ICD10 Code:
-Common signs and symptoms: involves shooting, shocking, throbbing, burning, or aching pain and headache that generally starts at the base of the head and spreads along the scalp on one or both sides of the head. It involves the occipital nerves, which run from the area where the spinal column meets the neck, up to the scalp at the back of the head into the eye(s).
-Prognosis: Good. May become chronic. Can last days to weeks or intermittently for years.

50
Q

Occipital Neuraglia: Dx Criteria

A

Dx criteria:
◦ Neuro tests that may be useful: CN II-XII, MSRs for rule out of CVA
◦ Ortho tests that may be useful: None
◦ Imaging/Labs: None

51
Q

Hormone Headache

A

-ICD10 Code: G43.81
-Common signs and symptoms: Migraine is most likely to develop in either the 2 days leading up to a period or the first 3 days during a period. This is because of the natural drop in estrogen levels at these times.
-Prognosis: Recurrent until perimenopause, where symptoms tend to minimize or completely resolve.

52
Q

Hormone Headache: Dx Criteria

A

NONE

Patient Interviewing (5 decks)

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