Exam 1: Week 2 Monday Flashcards Preview

Thompson class fall 2015 > Exam 1: Week 2 Monday > Flashcards

Flashcards in Exam 1: Week 2 Monday Deck (69):
1

Some general follow up questions for differential diagnosis (10)

  1. Changes in Location?
  2. Intensity with certain movements or rest?
  3. Changes with posture?
  4. Constant or intermittent?
  5. Aggravating factors?
  6. Nighttime pain?
  7. Other possibilities?
  8. Alleviating factors?
  9. How Symptoms Developed? (insideous? Traumatic event? )
  10. Non-musculoskeletal activity (food intake and defecation)

2

Words used to describe visceral pain (9)

  1. Cramping
  2. Colicky (comes and goes without means of onset)
  3. Throbbing/aching
  4. Pressure
  5. Tightness
  6. Heaviness
  7. Weakness
  8. Severe/disabling
  9. Worst pain I have ever had

3

Words used to describe vascular disorders (3)

  • Throbbing
  • pounding
  • pulsating

4

Words used to describe neurologic disorders (4)

  • Sharp
  • lancinating
  • shocking
  • burning

5

Words used to describe visceral disorders (5)

  1. Aching
  2. squeezing
  3. gnawing
  4. burning
  5. cramping

6

Red Flags: Cancer (6)

  1. Persistent pain at night
  2. Constant pain anywhere in body
  3. Unexplained weight loss
  4. Loss of appetite
  5. Unusual lumps/growths
  6. Unwarranted fatigue

7

Red Flags: Cardiovascular (8)

  1. SOB
  2. Dizziness
  3. Pain/heaviness in chest
  4. Pulsating pain anywhere in body
  5. Constant/severe pain in lower leg/arm
  6. Discolored or painful feet
  7. Swelling (no history of injury)
  8. Bilateral LE edema

8

Reds Flags: Gastrointestinal/Genitourinary (5)

  1. Frequent/severe abdominal pain
  2. Frequent heartburn or indigestion
  3. Frequent nausea or vomiting
  4. Changes/problems with bladder function (UTI etc).
  5. Unusual menstrual irregularities

9

Red Flags: Neurological (8)

  1. Changes in hearing
  2. Frequent or severe headaches with no history of injury
  3. Difficulty with swallowing/speech
  4. Changes in vision
  5. Problems with balance
  6. Fainting spells (drop attacks)
  7. Sudden weakness
  8. 5 Ds

 

Alternate way to remember:

  • The 5 Ds
    • Dysphagia (difficulty swallowing)
    • Dysarthria (dificulty speaking)
    • Drop Attacks
    • Dizziness (also problems with balance)
    • Diploplia (double vision --> problems with vision)
  • Changes in hearing
  • Frequent or severe headaches with no history of injury

10

What are the 5 Ds

  1. Dizziness
  2. Dysphagia
  3. Diplopia
  4. Dysarthria
  5. Drop attacks

11

Red Flags: Miscellaneous (4)

  • Fever or night sweats
  • Recent severe emotional disturbances
  • Swelling/redness in any joint with no history of injury
  • Pregnancy

12

Potential differential diagnosis for Back Pain (5)

  1. Back Related Tumor
  2. Abdominal aneurysm
  3. Back Related infection
  4. Cauda Equina Syndrome
  5. Spinal Fracture

13

Possible signs that might make you suspect a back related tumor (4)

  • Age > 50
  • Hx of Cancer
  • Weight loss
  • Failure of conservative care

14

Possible signs that might make you suspect an abdominal aneurysm (2)

  1. PVD,
  2. Symptoms not related to movement

15

Possible signs that might make you suspect a back related infection (3)

  • Recent infection (UTI/skin)
  • IV drugs
  • immunosuppressive disorder

16

Possible signs that might make you suspect cauda equina (4-5)

  • Bowel and Bladder
  • Saddle paresthesia
  • weakness
  • myotomes/dermatomes

17

Possible signs that might make you suspect a spinal Fx (3)

  • Trauma
  • Age > 70
  • Prolonged use of steroids

Should ask if pt. has been screened for osteoporosis

18

Potential differential diagnosis for pain in Pelvis, Hip, and Thigh Region (5)

  • Colon Cancer
  • Pathological fx of femoral neck
  • Avascular necrosis
  • Legg-Calve-Perthes disease
  • Slipped Capital Femoral Ephysis

19

Possible signs that might make you suspect Colon Cancer (5)

  • Age >50
  • Rectal bleeding/black stool
  • Weight loss
  • Pain in pelvis, thigh, or hip unchanged by position
  • Family Hx of colon cancer,

20

Possible signs that might make you suspect a Pathological fx of femoral neck (5-7)

  1. Age >70 (over 50 in book)
  2. Fall
  3. severe/constant pain
  4. Hx of metabolic disease (such as osteoporosis or Paget's)

  5. Position of leg

    • ER LE
    • Affected LE typically shorter than uneffected 

21

Possible signs that might make you suspect Avascular necrosis of Femoral Head (3)

  • Long term corticosteroid use
  • Trauma
  • Sickle Cell disease

22

Possible signs that might make you suspect Legg-Calve-Perthes disease (3)

  • typically boys ages 5-8
  • pain with WB
  • limited hip internal rotation and abduction

23

Possible signs that might make you suspect Slipped Capital Femoral Ephysis (4)

  • typically adolescent males
  • may also have knee pain
  • overweight
  • limited hip IR

24

Potential differential diagnosis for pain in LE (4)

  • Peripheral arterial occlusive disease
  • DVT
  • Compartment Syndrome
  • Septic Arthritis

25

Possible signs that might make you suspect Peripheral arterial occlusive disease (9)

  1. Age >60
  2. Type II DM
  3. Heart disease
  4. Smoker
  5. Sedentary
  6. Intermittent claudication
  7. Cool extremity
  8. Decreased pedal pulses
  9. Prolonged venous filling time

26

Possible signs that might make you suspect DVT (5)

  1. Recently immobilized
  2. Pain worse with moving/Less with elevation
  3. TTP
  4. Warm
  5. Swollen

27

Possible signs that might make you suspect Compartment Syndrome (4-7)

  • Recent trauma/unaccustomed exercise
  • Paresthesias 
  • Decreased pulses
  • 6 P's

 

 

Alternate way to remember (spoiler for 6 Ps):

  1. Recent trauma/unaccustomed exericse
  2. 6 P's
    1. Pulselessness (decreased pulses)
    2. Pallor
    3. Pain
    4. Paresthesia
    5. Paralysis
    6. Poikilothermia (one limb cooler than the other)

28

Possible signs that might make you suspect Septic Arthritis (5)

  1. Recent infection/ surgery/injection
  2. Constant aching/throbbing pain
  3. Tenderness
  4. Warmth
  5. Immunosuppressive disorder

29

If you suspect DVT, what tool should you use?

Wells criteria for DVT

30

What are the 6 Ps

  1. Pain
  2. Paresthesia
  3. Pallor
  4. Pulselessness
  5. Paralysis
  6. Poikilothermia (differing temperatures between the affected limb and the uninjured limb)

31

Potential differential diagnosis for pain in Head, Face, and TMJ (4)

  • Vertebrobasilar Insufficiency (VBI)
  • Meningitis
  • Primary brain tumor
  • Subarachnoid Hemorrhage

32

Possible signs that might make you suspect Vertebrobasilar Insufficiency (VBI) (7)

  1. Dizziness
  2. Vertigo
  3. Visual Disturbances
  4. Headaches
  5. Nausea
  6. Loss of Consciousness
  7. Apprehension with CAROM (cervical active range of motion)

33

Possible signs that might make you suspect Meningitis (7)

  1. Positive slump sign
  2. Headache
  3. Fever 
  4. GI distress
  5. Photophobia
  6. Confusion
  7. Seizures

34

Possible signs that might make you suspect a primary brain tumor (7)

  1. Ataxia
  2. Speech deficits
  3. Headache (possibly neck pain)
  4. Visual changes
  5. GI distress
  6. Altered mental status
  7. Seizures

35

Possible signs that might make you suspect a Subarachnoid Hemorrhage (4)

  • Severe headache-sudden onset
  • Brief loss of consciousness
  • Brain tumor signs
  • Meningeal irritation

36

Potential differential diagnosis for pain in C-Spine and shoulder (2)

  • Myocardial Infarction
  • Pancoast tumor

37

Possible signs that might make you suspect a Myocardial Infarction (7)

  1. Chest pain
  2. pallor
  3. nausea or palpitations
  4. Presence of Risk Factors
  5. Men age > 40
  6. Women age > 50
  7. Symptoms > 30 min-not relieved by nitroglycerin

38

Possible signs that might make you suspect a Pancoast tumor (4)

  • Men over 50 y/o with history of smoking
  • Nagging pain-shoulder and vertebral edge of scapula
  • Progresses to burning pain in ulnar nerve distribution
  • Insideous onset of pain

39

Potential differential diagnosis for pain in elbow, wrist, or hand (2)

Raynaud phenomenon/ disease

Complex Regional Pain Syndrome

40

What is a pancoast tumor?

malignant tumor in upper apices of a lung; tumor grows in thoracic inlet pulmonary symptoms are rare can develop a burning pain down arm along ulnar distribution

41

Possible signs that might make you suspect Raynaud phenomenon/ disease (3)

  • Hands/feet blanch, go cyanotic (blue), then red with cold or emotional distress
  • Pain in hands/feet with redness
  • PMH of RA, occlusive vascular disease, smoking, or use of beta-blockers

42

Possible signs that might make you suspect Complex Regional Pain Syndrome (6)

  1. Trauma
  2. Severe aching/stinging pain not typical of injury
  3. Pitting edema
  4. Erythema
  5. Warm
  6. Pain doesn’t respond to analgesics 

43

Potential differential diagnosis for pain in thoracic spine and ribs (12)

  1. myocardial infarction
  2. Stable Angina Pectoris
  3. Unstable Angina Pectoris
  4. Pericarditis
  5. Pleurisy
  6. Pulmonary Embolus
  7. Pneumonia
  8. Pneumothorax
  9. •Cholecystitis
  10. peptic ulcer
  11. •Pyelonephritis
  12. •Nephrolithiasis (kidney stones)

44

Possible signs that might make you suspect Stable Angina Pectoris (2)

Chest pain with predictable level of exertion relieved by nitroglycerin

*should always bring nitro to clinic with them

45

Possible signs that might make you suspect Unstable Angina Pectoris (2)

Chest pain outside of predictable pattern

not responsive to nitroglycerin

46

Possible signs that might make you suspect Pericarditis (3)

  • Sharp stabbing pain-referred to lateral neck or shoulder
  • Increased pain with L sidelying
  • Relieved with forward leaning posture

47

Possible signs that might make you suspect Pleurisy (3)

  • Sharp stabbing pain with inspiration
  • Dyspnea
  • History of respiratory disorder

48

Possible signs that might make you suspect a Pulmonary Embolus (3)

  • Chest, Shoulder, or upper abdominal pain
  • Dyspnea
  • History of DVT risk factors

49

Possible signs that might make you suspect Pneumonia (7)

  1. Pleuritic pain may be referred to shoulder
  2. Fever
  3. chills
  4. HA
  5. malaise
  6. nausea
  7. Productive cough

50

Possible signs that might make you suspect Pneumothorax (7)

  1. Chest pain increased with inspiration
  2. Difficult to expand rib cage
  3. Recent coughing
  4. strenuous exercise
  5. trauma
  6. Hyperresonance upon percussion
  7. Decreased breath sounds

51

Organs in the Right upper quarter (5)

  1. Liver 
  2. Gall bladder
  3. duodenum
  4. head of pancreas
  5. hepatic flexure of colon

52

Organs in Left upper quarter (7)

  1. Stomach
  2. spleen
  3. L lobe of liver
  4. body of pancreas
  5. L kidney
  6. adrenal gland
  7. splenic flexure of colon, part of transverse and descending colon

53

Organs of Right lower quarter (6)

  1. Cecum
  2. Appendix
  3. Ascending colon
  4. R ovary
  5. R fallopian tube
  6. R ureter

54

Organs of Left lower quarter (5)

  1. Descending colon
  2. sigmoid colon
  3. L ovary
  4. L fallopian tube
  5. L uterine tube

55

Want to see a picture of the quaters? 

A image thumb
56

Possible signs that might make you suspect Cholecystitis (4)

 

  1. •Colicky pain in RUQ with
  2. R scapular pain
  3. •Worsen with ingestion of fatty foods
  4. •No change with activity/rest
     

57

Possible signs that might make you suspect a peptic ulcer (4)

 

  1. •Dull gnawing pain/burning in epigastrium, midback, or supraclavicular region
  2. •TTP in R epigastrium
  3. •Symptoms relieved with food
  4. •Constipation, bleeding, vomiting

58

Possible signs that might make you suspect Pyelonephritis (3)


•UTI
•Enlarged prostate
•History of kidney stones
 

59

Possible signs you might susect Nephrolithiasis (5)

 

  1. •Sudden, severe back or flank pain
  2. •Chills, fever, nausea
  3. •Renal colic
  4. •Symptoms of UTI
  5. •History of kidney stone
     

60

What is Nephrolithiasis?

kidney stones

61

Common causes of abdominal pain in upper right quarter (5)

  1. Duodenal ulcer
  2. Hepatitis
  3. Hepatomegaly
  4. Lower Lobe Pneumonia
  5. Cholecystis (gall bladder)

62

Common causes of abdominal pain in lower right quarter (9)

  1. Appendicitis
  2. Salpingitis-Infection of uterine lining,
  3. Ovarian cyst
  4. Ruptured ectopic pregnancy
  5. Renal/ureteral stone
  6. Strangulated hernia
  7. Diverticulitis
  8. Regional ileitis
  9. Perforated cecum

63

Common causes of abdominal pain in upper left quarter (5)

  1. Ruptured Spleen
  2. Gastric ulcer
  3. Aortic aneurysm
  4. Perforated colon
  5. Lower lobe pneumonia

64

Common causes of abdominal pain in lower left quadrant (9)

  1. Sigmoid diverticulitis
  2. Salpingitis-Infection of uterine lining
  3. Ovarian cyst
  4. Ovarian abscess
  5. Renal/ureteral stone
  6. Strangulated hernia
  7. Diverticulitis
  8. Regional ileitis
  9. Ulcerative Colitis

65

What is McBurney's Point and what is the associated condition?

Associated Condition: Appendicitis

Description: Rebound tenderness in RLQ and sharp pain when palpated

66

What is Murphy sign and what is the associated condition?

Associated condition: Cholecystitis

Description: Abrupt cessation of inspiration upon palpation of the gall bladder in RUQ

67

What is Romberg-Howship Sign and what is the associated condition?

Associated Condition: Strangulated obturator hernia

Description: Pain down the medial aspect of thigh to the knees

68

What is Kehr Sign and what is the associated condition?

Associated condition: Spleen rupture, renal calculi, or ectopic pregnancy. Also blood in peritoneum (from case study in G&S)

Description: Abdominal pain radiating to the L shoulder

69