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General Approach Flashcards

1
Q

What should you never fail to do?

A

exam the area of patient complaint

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2
Q

what can happen if a diagnostic error is made?

A

many times, it is inconsequential

others can result in substantial harm

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3
Q

ROWS

A

rule out worst case senarios

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4
Q

differential dx

A

process that involves the use of clinical signs and symptoms, physical exam, a knowledge of pathology and mechanisms of injury, provocative and motion tests, palpation, labratory and diagnostic imaging

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5
Q

common conditions of bone

A 
tumors (primary or metastatic)
osteochondrosis/apophysitis
fracture
osteopenia/osteoporosis
osteomyelitis
congenital anomalies and variants
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6
Q

common conditions of soft tissue and musccle

A 
strain or rupture
trigger points
atrophy
myositis ossificans
muscular dystrophy
rhabdomyositis
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7
Q

tendinitis

A

inflammation

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8
Q

tendonosis

A

intra-tendon degeneration

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9
Q

paratendonitis

A

inflammed paratendon

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10
Q

common ligament conditions

A

sprain or rupture

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11
Q

common bursa conditions

A

bursitis

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12
Q

common fascial conditions

A

myofascitis

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13
Q

common joint conditions

A

arthritis
subluxation/fixation
joint mice
dislocation/subluxation

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14
Q

what should you rule out with acute traumatic pain?

A

fracture
dislocation
instability
neutral, vasculara injury

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15
Q

what should you rule out with nontraumatic pain?

A

tumors
inflammatory arthridities
infections
visceral referral

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16
Q

how do you clarify the type of complaint?

A

is there trauma?
is there a history of overuse?
is the onset insidious?

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17
Q

what should you ask if the injury was traumatic?

A

what was the mechanism of injury

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18
Q

what should you ask if the injury is overuse?

A

what is the repetitive motion and what is the positional status of the patient

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19
Q

what should you ask if the injury is insidious?

A

is there fever, lymphadenopathy, multiple areas affected, local signs of inflammation, deformity, associated weakness, numbness, tingining, neurologic dysfunction?

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20
Q

18 questions

A 
when did it start?
gradual or sudden?
anything cause or contribute to it?
ever had this before?
point to area of complaint?
does it radiate/travel?
symptoms in other parts of the body?
how would you rate the pain?
is it costant, come and go?
getting better, worse, staying the same
anything that makes it better?
anything that makes it worse?
any change in bodily functions?
affected daily activities?
tried store bought or at home remedies?
seen anyone else for this?
anything else you want me to know?
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21
Q

evaluation

A 
always examine area of complaint
visualization
palpation
AROM, PROM, resisted ROM
orthopedic and neurologic exam
radiographs
specialized imaging
labs
manage, co-manage, emergent referal
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22
Q

orthopedic exams are to?

A

reproduce complaints
reveal laxity
demonstrate weakness
demonstrate restriction

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23
Q

what questions should you ask if you want to do radiographs?

A

are there red flags
is patient high or low risk?
combine history, clinical presentation

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24
Q

if someone has had pain for more than 6 weeks, what are the ddx?

A

tumor, infection, rheumatologic disorder

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25
if someone is less than 18, what are the ddx of low back pain?
congenital defect, tumor, infection, spondylolysis, spondylolisthesis
26
if someone is above 50, what are the ddx of LBP?
tumor, intra abdominal process, infection
27
if there is major trauma, or minor trauma in elderly, what is usually the cause?
fracture
28
recent genitourinary or gastrointestingal procedure usually indicates?
infection
29
night pain usually indicates what DDX?
tumor, infection
30
unremitting pain, even when supine indicates what ddx?
tumor, infection, AAA, nephrolithiasis
31
pain worsened by coughing, sitting or valsalva maneuver indicades what ddx?
herniated disc
32
pain related below knee indicates what?
herniated disc, NR compression below L3
33
incontinence, saddle anesthesia, severe or rapidly progressive neurologic deficit indicates what ddx?
cauda equina syndrome, spineal cord compression
34
red flags
``` significant trauma suspicion of cancer, infection chronic corticosteroid use drug or alcohol abuse history of surgery to involved area neurotumor deficits scoliosis labratory abnormalities medicolegal requirements (not best reaon) unresponsive to conservative care for >1 month ```
35
when should you generally refer/refer or comanage?
refer- fractures/dislocations, infections, tumors (orthopedic management) refer/comanage- RA, CT disorders
36
if problem is instability w/o ligament rupture?
stabilize the joint through appropriate exercise program using brace if necessary
37
if problem is weakness?
strengthen associated muscles
38
those who want to return to ADLs, dowhat?
functionally retrain
39
what do you do for articular dysfucntion?
manipulation/mobilization
40
WIRS pain
``` weakness instability restricted movement surface complaints pain ```
41
weakness
may be due to pain inhibition, muscle strain or neurologic interruption
42
instability
maybe due to damaged ligaments, muscles or inherent looseness
43
restricted motion
due to pain, muscle spasm, soft tissue contracture, joint mice, fracture or soft tissue swelling/effusion
44
surface complaints
skin lesions, cuts/abrasions, swelling, patient subjective sense of numbness of paresthesia
45
pain is..
non specific and cause usually will be revealed by combinging a history of trauma, overuse, or insidious onset with associated complains and exam findings
46
nociceptive pain
caused by stimulation of peripheral nerve fibers
47
neuropathic pain
damage or disease affecting nervous system
48
psychogenic pain
mental, emotional, behavioral factors
49
phantom pain
type of neuropathic pain
50
scleratogenous sources
nondermatomal pattern, with no hard neurological findings, refers primarily to facet and disc generated pain
51
referred pain
historical screening is helpful in revealing a visceral complain, referral zones
52
bone pain
deep pain, commonly worse at night, trauma may require xrays, overuse suggestie of stress fracture and may require xrays and maybe specialized imaging as needed
53
nociceptive pain represents the normal response to..?
noxious insult or injury of tissues such as skin, muscles, visceral organs, joints, tendons or bones
54
examples of nociceptive pain
somatic | visceral
55
somatic nociceptive pain
musculoskeletal (joint of myofascial), cutaneous, well localized
56
visceral nociceptive pain
hollow organs and smooth muscle, usually referred
57
neuropathic pain is initiated by?
primary lesion or disease in the somatosensory nervous system
58
sensory abnormalities for neuropathic pain
deficits perceived as numbness to hypersensitivity and to paresthesias
59
examples of neuropathic pain
``` diabetic neuropathy postherpetic neuralgia spinal cord injury pain phantom limp pain post stroke central pain ```
60
what should you consider if the msuculoskeletal pain doesn't have an obvious mechanical or taumatic cause?
search for myofascial disorders, arthridites, phychological factors, CT disorders, cancer, infection
61
sharp pain on motion
joint
62
contant pain
joint or nerve
63
burning/hot pain
nerve
64
sharp no motion
nerve
65
stabing
nerve
66
tingling/numbness
nerve
67
cramping/knot/spasm
muscle
68
dull ache
muscle
69
deep burning, dull pain
bone/ligament
70
pinpoint pain over paraspinal tissue
MTRP
71
crawling sensation
myofascial pain
72
throbbing
vascular
73
well localized
peripheral
74
diffuse
central
75
what structures can you directly palpate to test?
ligaments (stress), tendons (stretch), muscles (contraction)
76
how do you test nerves?
tapping, compression, muscle testing, deep tendon reflexes, sensory testing
77
decreased ROM can be caused by?
``` subluxation muscle spasm/strain ligament sprain arthritic conditions obesity ```
78
how can you tell between contracile and non-contractile tissue?
PROM | AROM
79
contractile tissue
painful with stretch or mid range contraction | AROM not painful, painful PROM non contractile tissue involved
80
pain on AROM
muscle or ligament
81
pain on PROM
ligament, bursa, capsule
82
bone pain
deep and worse at niht

Diff Dx (17 decks)

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