Differential Diagnosis Flashcards
(46 cards)
About ____% of LBP related to non-MSK issue
2
Why do we care/need to differentiate between systemic and MSK related LBP as PTs?
- direct access providers
- limited exam is completed by PCP
- pt had multiple complaints at PC visit and not enough time to address them
- pt reports new symptoms during PT visit
- symptoms may have progressed since PCP visit
T or F: MSK pain has gradual onset and gets worse over time
F, systemic does
T or F: MSK pain has identifiable agg and easing factors
T, systemic does not
T or F: MSK pain wakes pt up at night and they can’t do anything to fix it
F, systemic does
stabbing, throbbing, deep, and aching are all used to describe what type of pain?
non-msk
Red flag
serious pathology, refer out
yellow flag
beliefs and pain behavior
orange flag
- psychiatric
- depression, anxiety
*be careful what you ask/document
blue flags
work related, boss, tasks
black flags
system issues like insurance, legislation for workers comp, overly helpful or unhelpful family
What are some examples of red flags
- age and onset (over 50&traumatic)
- history of cancer
- fever, chills, night sweats
- unexplained weightloss (10lbs in 3 months)
- recent infection or immunosuppression
- resting pain, non-positional night pain
- saddle anesthesia
- bowel/bladder dysfunction
how should you document red flag screening
red flags aren’t helpful in isolation but be sure to document negative results so you can have defensible documentation
If pts say yes to constitutional symptoms what should you do? what if they say no?
send them to PCP if yes;
if no then document the negative
remember you have to address the symptoms you document
why is it important to ask about constitutional symmptoms?
they can indicate systemic disease
what are some examples of constitutional symptoms
- fever, diaphoresis, night sweats
- nausea, vomiting, diarrhea
- pallor, dizziness, syncope
- fatigue, weight loss
what is a Kehr’s sign
- classic symptom of a ruptured spleen
- referred pain from the phrenic nerve (which was irritated from a splenic injury)
what are the nerve roots for the diaphragm
C3-5, “keeps you alive”
How do you test for a Kehr’s sign
patient in supine, left upper quadrant palpation. if this creates left shoulder pain then it’s a positive Kehr’s sign (spleen injury)
right shoulder pain could be referred from what?
gall bladder or liver
T or F: most abdominal aortic aneurysms are asymptomatic
T
majority in 65 years or older and relatively frequent COD in elderly
what is the number one risk factor for an abdominal aortic aneurysm
smoking
AAA is 4 times more common in _____-
men
Mid back pain radiating to shoulder combined with nausea, vomiting, and diaphoresis could indicate what?
MI
