Exam 1: Week 2 Wednesday Flashcards Preview

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

Flashcards in Exam 1: Week 2 Wednesday Deck (61):

Symptoms of Systemic Disorders (6)

  1. Fever
  2. Fatigue/Malaise
  3. Abnormal sensation
  4. Weight loss
  5. Change in mentation
  6. Insidious onset


What kind of rhythm does body temperature have? (1)

Details? (3)

when is body temp cooler/warmer?

When do pt's usually run a fever?

What temperature is a concern?

Rhythm: a circadian rhythm


  1. Cooler in morning ~ 97⁰, warmer in evening ~99.3⁰
  2. Typically patients run a fever at night/afternoon
  3. Not a concern until 100-101⁰F for non-elderly


At what temp should we be concerned about an elderly person's health?

99-100 degrees F

because fear of pneumonia is greater


What can occur with increased body temperature? (2)

  1. change in mentation
  2. convulsion if above 104 - 106


Topics to explore if a person complains of fatigue (4)

  1. Fatigue all the time?
  2. What time of day?
  3. No longer able to do certain activities due to fatigue?
  4. Explore Hx or changes in:
    • work,
    • family,
    • social,
    • physical activity level,
    • stress  
    • recent illness 

Everyone gets tired at times, so we want to explore if this is unusual lethargy (a concern) or normal for the circumstances)


What is Malaise?


  • Overall Feeling of general illness
    1. Decreased energy level,
    2. decreased functional ability,
    3. decreased motivation
  • General uneasiness whose exact cause is difficult to identify



  • a good way to describe how pts with fibromyalgia or lupus feel
  • Arguably Dr. Bringman's favorite word!


What to screen if patient presents with Paresthesia, Numbness, Weakness, other Weird Sensation? (5)

  1. Sensory:
    • Dermatomes
    • Sharp/dull, 1 point/2 point discrimination, hot/cold
  2. Myotomes
    • general to specific if necessary
  3. Reflexes:
    • Lower and upper motor neurons
  4. Balance/Coordination:
    • Seated, standing, static, dynamic (balance)
    • finger to nose, heal up shin, Romberg test, etc. (coord)
  5. Proprioception-
    • Position in space (static)
    • dynamic movement replication


If patient has recent weight loss, what objective finding will alert you to explore further?

5% body weight loss or more without explanation associated or unassociated symptoms


Some things that can lead to weight gain (6)

  1. Swelling
  2. fluid retention
  3. kidney issues
  4. liver issues
  5. CHF
  6. medication (ie. steroids, hormone replacement, contraceptives, depression meds [SSRI])


Possible changes in mentation (6)

(things to assess for changes in mentation)

  1. A and O X 3 or 4 (person, place, time and event)
  2. Attention span
  3. Memory (long and/or short term)
  4. Level of Consciousnes:
    • Loss of consciousness ---- alertness
  5. Thought process
  6. Judgement (could present as decreased safety awareness)


Five pathologies a patient may see a PT for first, but need to be referred back to physician for med management and/or additional testing

(if an MD isn't already managing them)

  1. OA
  2. RA
  3. SLE (Systemic lupus erythematosus)
  4. Reactive arthritis
  5. Septic arthritis


Health History Risk Factors for RA (4)

  1. Autoimmune thyroid disorders
  2. History of fertility issues
  3. Positive family history
  4. Typically occurs after 40 years old


7 parts of RA classification system for RA

  1. Morning stiffness for greater than 1 hour
  2. Arthritis of 3 or more joints
  3. Arthritis of hands
  4. Symmetric arthritis
  5. Rheumatoid nodules
  6. Radiographic changes (Erosion, decalcification)
  7. Serum rheumatoid factor (> 5% of normals)


Health History Risk Factors for SLE (Systemic lupus erythematosus) (4)

  1. Infection (viral)
  2. Sunlight or UV light exposure
  3. Medications (hydralazine, anticonvulsants, Penicillin)
  4. Positive family history


Health History Risk Factors for Gout (3-10)

and Three symptoms

  1. Renal disorder with increased uric acid
  2. Hx of:
    1. Leukemia,
    2. lymphoma,
    3. psoriasis,
    4. chemotherapy
    5. hypothyroidism
    6. alcohol use
    7. diuretics
  3. Positive family history

a few symptoms: Fever, malaise, tachycardia


Some symptoms of lupus (not exhaustive) (11)

  1. persistent or unusual headaches
  2. dry or puffy eyes
  3. butterfly rash over cheeks or bridge of nose
  4. blood in urine
  5. unexplained fevers
  6. fatigue
  7. fingers, toes, or tip of nose become white when cold or stressed pain and
  8. swelling of legs, joints, or feet
  9. peripheral neuropathy
  10. photosensitivity
  11. dyspnea (difficult or labored breathing)


History Risk Factors Psoriatic Arthritis (2)

  1. Psoriasis (1/3 of people with psoriasis have psoriatic arthritis)
  2. Positive family history


*autoimmune disease that presents similarly to RA


History Risk Factors Reiter’s Syndrome (3)

  1. More common in males
  2. Venereal (STIs) or dysenteric (intenstial) infection
  3. No family history


History Risk Factors for Septic Arthritis (4)

  1. Systemic corticosteroid use
  2. DM (Diabetes)
  3. Infection elsewhere in the body
  4. Direct penetrating joint trauma (injections etc)


What is Psoriatic Arthritis?

An autoimmune disease that has a similar presentation to RA. Systemic. Symptoms include fever and fatigue/


What is Reiter's Syndrome?

Reactive arthritis typically caused by a bacterial infection. Typically comes from Gonorrhea or Chlamydia.

  1. Will often have burning sensation when urinating
  2. May have conjunctivitis
  3. May have nausea/vomitting
  4. May have weightloss
  5. May deny exposure to possible VD

*Need to be referred. Need antibiotics


What is Septic Arthritis?


2 symptoms?

common population?

An intensely painful infection in a joint. Joint can become infected with germs that travel through bloodstream from another part of body.

  • Most common in Infants and older adults
  • Joint may be swollen, red and warm,
  • pt. might have a fever.


Who is most likely to have Ankylosing Spondylitis (3) How is it diagnosed? (1)

  1. Develops teens through 40s
  2. Males 2-3 more likely than females
  3. Positive family history

*Diagnosed with classification system and positive radiograph


Symptoms of Ankylosing Spondylitis (9)

  1. Radiographs will show "bamboo" spine
  2. morning stiffness > 30 min
  3. Improvement in back pain with exercise, but not with rest.
  4. Night pain during second half of night only
  5. Alternating buttock pain
  6. Fatigue
  7. weight loss
  8. fever
  9. malaise


Possible cause for single or multi-limb pain (8)

  1. Hypothyroidism
  2. Lyme disease
  3. Statin related myopathies
  4. Vascular claudication
  5. neurogenic claudication (spinal stenosis)
  6. Stress fracture
  7. DVT
  8. Compartment syndrome


Limb Pain: The difference between Neurogenic cause and Vascular Claudication when evaluating pt. after walking

Neurogenic: weakness Vascular

Claudication: unchanged


Limb Pain: The difference between Neurogenic cause and Vascular Claudication with palliative (relieving pain) factors

Neurogenic: bending over, sitting

Vascular Claudication: stopping


Limb Pain: The difference between Neurogenic cause and Vascular Claudication with provocative factors

Neurogenic: walking downhill, increased lordosis

Vascular Claudication: walking uphill, increased metabolic demand


Limb Pain: The difference between Neurogenic cause and Vascular Claudication when checking pulses

Neurogenic: present

Vascular Claudication: absent


Limb Pain: The difference between Neurogenic cause and Vascular Claudication with the "shopping cart" sign


Shopping cart sign: Shopping at grocery store and start to feel bad: if you lean over shopping cart, do symptoms go away?

If they go away it indicates a neurogenic cause.

Neurogenic: present

Vascular Claudication: absent


Limb Pain: The difference between Neurogenic cause and Vascular Claudication with van Gelderen bicycle test (add extension and flexion component to use of stationary bike)

Neurogenic: no leg pain

Vascular Claudication: leg pain


Van Gelderen bicycle test: put on bicycle test, 5 min warm up; extend back while riding back, lean forward while riding bike. If symptoms go away in flexed position, then it is neurogenic. In what position do symptoms get better or worse?


Common features of pathological limb pain (9)

  1. Aching
  2. cramping
  3. weakness
  4. stiffness
  5. Often multiple limbs
  6. Symptom migration
  7. Insidious onset
  8. Non-mechanical pattern
  9. Prolonged morning stiffness> 30 min


What is the preferred spinal direction with spinal stenosis?



Primary suspects for Multi-limb complaints for spinal origin (1) and systemic origin (5)

  • Spinal origin
    1. Central cord compression
  • Systemic Disease
    1. Hypothyroidism
    2. Lyme disease
    3. Polymyalgia Rheumatica
    4. Statin drugs


Symptoms of Hypothyroidism

Review of symptoms: (7)

Systems Review: (7)

  • Review of Systems:
    1. Typically female
    2. Fatigue
    3. weight gain
    4. Cold intolerance
    5. Menstrual irregularities
    6. Hair loss
    7. Brittle nails
  • Systems Review:
    1. Bradycardia
    2. Pallor
    3. Obesity (typically no more than 20lb. gain)
    4. Proximal muscle weakness
    5. Hypo-reflexive
    6. Dry skin general
    7. myalgia if untreated


Symptoms of Lyme disease (6 always, plus 5 in late stages)


  1. Exposure to tick
  2. Fatigue,
  3. fever/chills
  4. Peripheral neuritis
  5. Erythema Migrans Rash (see picture)
  6. Migraines?

Later stages:

  1. cranial neuropathies,
  2. encephalitis,
  3. neck stiffness with cervical flexion -
  4. joint pain,
  5. muscles aches

A image thumb

Symptoms of Polymyalgia Rheumatica (8)

  1. More females than males
  2. Bilateral pain and stiffness
  3. Fatigue,
  4. weight loss,
  5. low grade fever
  6. Diffuse edema, possible pitting edema in dorsum of hands/feet
  7. worse in morning
  8. average onset is age 73

A image thumb

What is Polymyalgia Rheumatica?

an uncommon inflammatory disorder that causes muscle pain and stiffness. cause unknown


Symptoms of Statin Related Myopathy (6)

  1. Advanced age,
  2. women > men
  3. Frail health, immunosuppressed
  4. Weakness
  5. Muscle edema
  6. Generalized muscle aching/pain

A image thumb

What question should you ask if you suspect statin related myopathy?

Have you had any recent change in your medication?


4 Pathological Neck Conditions

  1. Cervical Myelopathy
  2. Neoplastic Condition
  3. Cervical Ligamentous Instability
  4. Vertebral Artery Insufficiency (5 Ds)


Symptoms of Cervical Myelopathy (8)

  1. Sensory disturbance of hands
  2. Muscle wasting of hand
  3. Unsteady gait
  4. Hoffman’s reflex (flick the finger)
  5. Hyperreflexia
  6. Bowel/Bladder issues
  7. Multi-segmental
  8. weakness/sensory changes


Symptoms of Neoplastic Condition (4)

  1. History of Cancer
  2. Unexplained weight loss
  3. Constant pain
  4. Night pain


What is Neoplastic Condition?

The word neoplasm, meaning new growth in Greek, refers to any abnormal growth, whether malignant or benign. Neoplastic disease refers to both malignant and benign growths. All types of cancer fall into the category of malignant neoplastic diseases.


Symptoms of Cervical Ligamentous Instability (3)

  1. Occipital headache/numbness
  2. Limited Cervical AROM
  3. Cervical myelopathy signs


Want to add: recent trauma [MVA], RA, Down Syndrome, another condition I can't remember)


Symptoms of Vertebral Artery Insufficiency (2-7)

  • 5 Ds:
    1. Dizziness,
    2. Drop attacks,
    3. Dysphasia,
    4. Dysarthria,
    5. Diplopia
  • Cranial Nerve signs


What special tests check for cervical instability?

Sharp-Purser test

Alar ligament test


Categories of Dizziness (4)

  1. Vertigo and nystagmus: sensation of spinning
  2. Dysequilibrium: unsteadiness or imbalance without vertigo
  3. Presyncope: near fainting; lightheadedness
  4. Non-specific Psychophysiologic: multifactorial


Symptoms of Vertigo and nystagmus (7)

  1. sensation of spinning
  2. Diaphoresis (sweating)
  3. pallor
  4. nausea and vomiting
  5. fullness in ears
  6. tinnitus
  7. hearing loss


Symptoms of Dysequilibrium (What is it? and what does it affect? [6])

Unsteadiness or imbalance without vertigo


  1. somatosensory
  2. visual,
  3. cerebellum,
  4. aging brain
  5. Muscle weakness
  6. Lack of corrective ROM Reaction time


Symptoms of Presyncope (9) (including what presyncope is)

  1. near fainting; lightheadedness
  2. Woozy
  3. blurred vision
  4. nausea/vomiting
  5. diaphoresis
  6. pallor
  7. HA
  8. giddiness
  9. paresthesia


Possible systems/causes of a person experiencing presyncope (5)

  1. Cardiovascular
  2. metabolic
  3. vasovagal
  4. medication
  5. stress induced


Symptoms or pt. description of Non-specific Psychophysiologic dizziness (3)

  1. Floating, rocking, or swimming sensations
  2. removed from the body
  3. giddiness


Possible reasons a person may experience non-specific psychophysiologic dizziness (6)

  1. Anxiety
  2. motion sickness
  3. pain disorders
  4. personality disorders
  5. depression
  6. agoraphobia


Possible Causes of Dizziness in Infants/Toddlers (4)

Appropriate Action by Provider (1)

Differential Diagnosis:

  1. BPPV and Vestibular Migraine (50%)
    • Headache,
    • fever,
    • nausea/vomiting
  2. Vestibular Neuritis
  3. Brainstem or Cerebellar tumor
  4. TBI
    • Children 0-4 y/o high risk for TBI

Action by Provider

  • Given prevalence of brain tumor in children-MRI may be warranted.


Possible Causes of Dizziness in Children and Adolescents  - with percentages if you want (7)

Action by Provider: (3)


Differential Diagnosis

  1. Vertiginous migraine (39%)
  2. BPPV (15%)
  3. Vestibular neuritis-ear infection (14%)
  4. Anxiety (13%)
  5. Orthostatic Hypotension (9%)
  6. Concussion (3%)
  7. Seizure, Syncope, Non-specific (2%)

Action by Provider

  1. Laboratory tests
  2. Electroencephalography
  3. MRI


Possible Causes of Dizziness in Adults (3)

Action by Provider: (2)

Differential Diagnosis

  1. Vestibular neuritis (labyrinthitis)
  2. BPPV
  3. PresyncopalConditions

Action by Provider

  1. Ear infection with acute dizziness warrants ENT referral
  2. Attempt to differentiate between central and peripheral vestibular conditions


Possible Causes of Dizziness in Older Adults >65 (2)

Action by Provider: (1)

Differential Diagnosis

  1. BPPV
  2. Presyncopal (orthostatic hypotension, arrhythmias, ect..)

Action by Provider

  1. Must rule out presyncopal conditions (orthostatic hypotension, vascular disease, arrhythmia) in this age group b/c it could be life threatening.


Name the 4 most common reasons for physical therapy

  1. Back pain
  2. Neck pain
  3. Knee pain
  4. Shoulder pain


Health History Risk Factors for OA (4)

  1. Joint infection,
  2. trauma,
  3. over use
  4. lifestyle

*No family history involvement (in contrast to RA)


What is "shopping cart sign"?

Shopping cart sign: Shopping at grocery store and start to feel bad: if you lean over shopping cart, do symptoms go away?

If symptoms go away, it is indicative of a neurogenic cause of leg pain