GULICK: Medical Screening Pt. 1 Systemic Pathology Flashcards
(154 cards)
1
Q
What is a RED Flag?
A
Predictor of pathology
2
Q
From exam to either Initiating PT OR REFER OUT!
A
SEE PICS
3
Q
Dx Tests Ex’s
A
X-ray, MRI, CT, US, Bone Scan, DEXA, EMG/NCV, EKG, EEG, Urine Analysis, Blood Work,
4
Q
Statistics: Sensitivity
SnNOUT==>
A
-
SnNOUT→ If the test is NEGATIVE, it is effective @ RULING OUT dysfunction
- Sn== good ScreeNing tool
5
Q
Generalized Systemic RED FLAGS!
Big picture, Key words, things that raise concern****
A
- Insidious, NO known MOI
- Sx’s out of proportion to injury
- NO change in sx’s, despite position, rest, tx
- NO pattern to sx’s; unable to reproduce sx’s
- Sx’s persist beyond expected healing time
- Recent OR Current fever, chills, night sweats, infx
- Unexplained wt loss, pallor, nausea, dizzy, vom, B&B changes (constitutional sx’s→ involve lots of systems)
6
Q
MORE Generalized Systemic RED FLAGS
A
- HA/Visual changes
- *Change in vital signs→ NEED BASELINE!!
- B/L sx’s
- Pigmentation changes, edema, rash, nail changes, weakness, numb, tingle, burning→ all Endocrine***
- Hx of Cx
- >40yo gender, ethnicity, race
- Night pain
- Progressive neurology sx’s
- Cyclic presentation
- Jt pain w/ skin lesions
7
Q
Dev’t of a Review-of-Systems Screening Tool for Ortho PT
23-Item tool correctly ID’d 100% of (+) responders
23 Questions:
A
- abnormal sensations (numb, pins, needles)?
- HAs?
- Night pain?
- Sustained morning stiffness?
- Light-headed?
- Trauma (MVA, fall)?
- Night sweats?
- Constipation?
- Easy bruising?
- Changes in vision?
- Changes in menstrual pattern?
- Balance disturbs?
- Chest pain w/ rest?
- SOB?
- MM weakness?
- Failure of conservative intervention (30d)?
- Excess sweating?
- Edema/wt gain?
- Heartbeat in abdomen when lie down?
- Cramps in legs when walk several blocks?
- Abdom pain?
- Changes in integrity of nails?
- Prolonged use of corticosteroids?→ myopathy!
8
Q
Vital Signs
A
- ALWAYS TAKE THEM!!!
- MUST establish Baseline!!!!
- Standard of Minimal Acceptable Care!!!
9
Q
Early Warning Signs of Cx
Mnemonic to use?
A
CAUTION
10
Q
Early Warning Signs of Cx
CAUTION
A
- C: Change in B&B
- A: A sore that fails to heal in 6wks
- U: Unusual bleeding or discharge
- T: Thickening/lump (breast or elsewhere)
- I: Indigestion or diff swallowing
- O: Obvious change in wart, mole, freckle
- N: Nagging cough, hoarseness, rust colored sputum
11
Q
Early Warning Signs of Cx
CAUTION
More on the O: Obvious change in wart, mole, freckle
A
ABCDE:
- A: Asymmetrical shape
- B: Border irregularities
- C: Color→ pigmentation is not uniform
- D: Diameter >6mm
- E: Evolution (change in status)
12
Q
Cx Screenings:
WHY?
A
Many Cx’s do NOT display sx’s in early stages*****
13
Q
Cx Screenings:
Many cx’s do not display sx’s in early stages!!!
Best approach?
A
Mammos, colonoscopy, pap smear & pelvic exam, prostate exam, skin exam
14
Q
Monohemispheric Brain Tumor
Clinical Tests studied
A
- Spasticity of conjugate gaze
- Platysma sign
- Forearm rolling test
- Finger rolling test
- Digit quinti sign
- Souques interosseus sign
- Pronator drifting test
- Mayer sign
- Finger tapping sign
- Digit quinti rolling sign
- Foot tapping sign
- Babinski
- Chaddock sign
15
Q
Monohemispheric Brain Tumor
6 of the tests that are great Dx TOOLS bc they have HIGH SPECIFICITY (SPPIN)
A
- Forearm rolling: Sp= 100%, PPV= 100%
- Finger rolling: Sp= 93%, PPV=92%
- Souques interosseus sign: Sp= 80%, PPV=70%
- Finger tapping: Sp= 90%, PPV= 78%
- Foot tapping: Sp= 93%, PPV=87%
- Babinksi: Sp= 100%, PPV=100%
16
Q
Cerebral Lesions
What TEST was found to be MOST EFFECTIVE for this?
A
DTRs!!!!
17
Q
DTRs
A
Cerebral Lesions!!!
18
Q
Pain Patterns
3:
A
- Dermatomes
- Myofascial Trigger Points
- Viscera
19
Q
Visceral Referral Patterns
A
- Epigastric
- RUQ, LUQ, RLQ, LLQ
- Suprapubic
20
Q
RUQ, LUQ, RLQ, LLQ Review
See Anatomy notes for mnemonic!!!!!
A
-
RUQ:
- Pylorus, Duodenum, Liver, Rt kidney and adrenal gland, Hepatic flexure of colon, Head of pancreas
-
LUQ:
- Stomach, Spleen, L. kidney and adrenal gland, Splenic flexure of colon, Body of pancreas
-
RLQ:
- Cecum, Appendix, R. ovary and fallopian tube (female), R ureter and lower kidney pole, R spermatic cord (male)
-
LLQ:
- Sigmoid colon, L. ovary and fallopian tube (female), L. ureter and lower kidney pole, L. spermatic cord (male)
21
Q
Visceral Anatomy
Say OUT LOUD where things are/what side!!!!
A
see pics
22
Q
Visceral Referral patterns!!!! know them all/label!!!!
A
see pics
Slide 40…. go back and make blank one to practice!!!!
23
Q
Purpose of Visceral Palpation
ID 3 things:
A
- Masses
- Tenderness
- Irregularities
24
Q
Systemic Patho: Cardiovascular
Risk factors for Coronary Artery Disease (CAD)
Modifiable, Non-modifiable, Contributing
A
-
Modifiable:
- Phys act, smoking, alcohol
-
CHO:
- HDL <40
- LDL >130
- Total >200
-
BP:
- SBP >140
- DBP >90
-
Non-modifiable
- Age, gender, family hx, race, post-menopausal
-
Contributing:
- Obesity
- Females: waist >88cm
- Males: waist >102cm
- stress, personality, PVD, hormones, fasting blood glu >100***
- Obesity
25
Systemic Patho: **Cardiovascular**
## Footnote
**Cardiac s/s**
* Chest pain, irreg heartbeat (palpitations), dyspnea/orthopnea, fainting/dizzy, rapid onset fatigue, peripheral edema, cold hands/feet, DEC peripheral pulse, LE claudication, Cyanotic nail beds
26
Systemic Patho: **Cardiovascular**
## Footnote
**Cardiac pain referral**
**C= Cardiac Pain**
**L= Lung Pain**
see pics!
## Footnote
**HIGH Sn==\> good **_S_**cree**_N_**ing test!**
27
Heart Sounds
## Footnote
**APT-M 2245**
see pics
28
Systemic Patho: **Cardiovascular**
## Footnote
**Frank's Sign**
* 45\* angle crease in earlobe
* **Risk of heart disease**
29
Palpation of Aorta
## Footnote
**Instructions in Pics**
**_Red Flag:_**
Aortic pulse width \>3cm; Back pain w/ palpation; Bruit on auscultation
## Footnote
**NOTE: screening men or women \>80yo NOT recommended\***
30
Systemic Patho: **Pulmonary**
## Footnote
**S/S**
* Sharp, localized pain
* Fever, chills
* **Sx's aggravated by cold air or exertion**
* INC pain→ **recumbent,** DEC pain→ **lying on involved side**
* Cough w/ or w/out blood
* Sputum
* SOB/DOE
31
Systemic Patho: **Pulmonary**
## Footnote
**INC pain in \_\_\_\_\_\_**
**DEC pain in \_\_\_\_\_**
INC pain→ recumbent
DEC pain→ lying on _involved side_
32
Systemic Patho: **Pulmonary**
## Footnote
**More S/S**
* Crackles, wheezes, pleural friction rub on auscultation
* **Clubbing of nails**
* Pain w/ deep inhale
* DEC O2sats
* **Weak/rapid pulse w/ DEC BP==\> _Pneumothorax_**
33
Systemic Patho: **Pulmonary**
## Footnote
**Pancoast Tumor referral pattern**
See pics (highlighted dark gray area)
34
Systemic Patho: **Pulmonary**
## Footnote
**Auscultation**
see pics and note lobes
35
Systemic Patho: **Pulmonary**
## Footnote
**Sputum**
**ALL FIRST in table**
see table
36
Systemic Patho: **Pulmonary**
**Sputum**
**Presentation:** White
**Possible Patho:**
Bronchitis, CF
37
Systemic Patho: **Pulmonary**
**Sputum**
**Presentation:** Rusty
**Possible Patho:** PNA
38
Systemic Patho: **Pulmonary**
**Sputum**
**Presentation:** Hemoptysis (bloody)
**Possible Patho:** PNA, acute bronchitis, lung Cx, TB
39
Systemic Patho: **Pulmonary**
**Sputum**
**Presentation:** Stringy mucous
**Possible Patho:** After Asthma attack
40
Systemic Patho: **Pulmonary**
## Footnote
**Integumentary System we think _3 things:_**
Skin←→Hair←→Nails
41
Integumentary Screen:
## Footnote
**Includes ALL of the following:**
* Color
* Integrity
* Temperature
* Moisture
* Texture
* Mobility
* Shape & Size
* Hair
* Nails
42
Integumentary Screen:
## Footnote
**Color**
* Yellow→ jaundice
* Red→ irritation, pressure
43
Integumentary Screen:
## Footnote
**Integrity**
* Wounds
* Ulcers
44
Integumentary Screen:
## Footnote
**Temperature**
* Palpate w/ **dorsum of hand**
* Cold vs Warm
45
Integumentary Screen:
## Footnote
**Moisture**
* DRY→ **arterial insuff., absent sweating**
* WET→ **venous insuff.**
46
Integumentary Screen:
## Footnote
**Texture**
Smooth & Soft vs.
Thick or leathery
47
Integumentary Screen:
**Mobility**
* **Turgor=** “tenting” of dorsal hand= **dehydration**
* skin stays up when pulled on
* **Stemmer Sign= inability to lift skin**= fibrotic or lymphedema
48
Integumentary Screen:
## Footnote
**Shape & Size**
**Edema→** pitting
**Stretched or shiny**
49
Integumentary Screen:
## Footnote
**Hair**
Decd or absent
50
Integumentary Screen:
## Footnote
**Nails**
Capillary refill\*
Beau's, Spoon, Clubbing
51
Systemic Patho: **Pulmonary**
## Footnote
**Integumentary Screen:**
**Beau's Lines**
* **\*ASK:** “Tell me about illness 1-2mos ago”
* **Temporary arrest of nail growth due to _systemic insult, fever, infx, renal/hepatic px_**
* \***Appears 1-2mos AFTER _systemic problem_**
52
Systemic Patho: **Pulmonary**
## Footnote
**Clubbing aka**
Chronic hypoxemia
* Respiratory/CV patho, thyroid, ulcerative colitis, cirrhosis, Cx
53
Malignant Melanoma we are looking for ______ in the nails
Streaks
54
Systemic Patho: **Gastro-Intestinal**
## Footnote
**Cologuard (talked about in class)**
Just know its a **GI screening** checking for **blood in stool as an indicator of Cx**
55
Systemic Patho: **Gastro-Intestinal**
## Footnote
**GI anatomy**
Know sides of everything!!!!
56
Systemic Patho: **Gastro-Intestinal**
## Footnote
**Rebound Tenderness test aka**
Blumberg!!!!
57
Systemic Patho: **Gastro-Intestinal**
## Footnote
**Rebound tenderness aka Blumberg Sign**
**_Red Flag:_**
* **(+)=** pain on release
* **(-)=** no pain
**NOTE: tells us _something_ is going on, will not tell you _what_**
See pics for instructions
58
Liver and Gallbladder pain referral pattern
## Footnote
**Li= Liver**
**GB= Gall Bladder**
see pics
59
Systemic Patho: **Hepatic (liver)**
## Footnote
**FACTS**
* ****_R_**UQ pain**
* **Referred pain to T-spine** (scapula, R shoulder, R upper trap, R subscap region)
* Wt change
* Ascites/LE edema (see pics for distended stomach)
* White (not pink) fingernails
* Cold hands/feet
60
Systemic Patho: **Hepatic**
## Footnote
**Talk about Referred pain**
* **Referred pain to T-spine\*\***
* Scapula, R shoulder, R upper trap, R subscap region
61
Systemic Patho: **Hepatic**
## Footnote
**Weight change**
**talk more about this**
* Weight change: lots of **fluid OR**
* **Gain→** fluid
* **Loss→** muscle mass
62
Systemic Patho: **Hepatic**
## Footnote
**More Facts**
* **Jaundice** (BIG one for liver)/Bruising; Yellow sclera (eyes)
* CTS sx's→ **B/L**
* Intermittent pruritus (itching)
* Weakness & fatigue
* **Dark urine/Clay-colored stools**
* Brain fog
* Chronic fatigue
63
Systemic Patho: **Hepatic**
## Footnote
**Asterixis aka**
Liver flap or Flapping Tremor @ wrist or hips (exactly what it sounds like!!!)
## Footnote
**see slide 65 and watch videos again!!!**
64
Systemic Patho: **Hepatic**
## Footnote
**Asterixis aka Liver flap**
* **Flapping TREMOR @ wrist or hips**
* Has to do w/ **ammonia lvls**
* No sig. correlation bw number of flaps & MELD scores
65
Liver palpation
RIGHT side, HOOKLYING\*\*\*\*
\*can go from front OR scoop from behind
66
Gallbladder Palpation
**_Red Flag_:**
Sudden pain & abdominal muscle tensing that **ceases inspiration** is suggestive of **gall bladder pathology; Pain also INC w/ FB**
67
**Murphys Sign**
Palpating on RIGHT side (scooping from behind) either **Liver or Gallbladder (tough to do one and not other)**
**_Red Flag or (+) Test:_**
Sharp pain OR unable to complete inspiration
## Footnote
**Sn= 97%= good SCREENING tool!**
68
Gall Bladder Patho:
## Footnote
**Risk Factors===== what rule should you remember about Gallbladder patho????**
8 F's!!!!!
69
Gall Bladder Patho
## Footnote
**Risk Factors== 8 F's\*\*\***
* **8 F's:**
* **F**emale, **F**air, **F**ertile (inc likelihood during pregnancy), **F**latulent, **F**amily hx, **F**atty foods (bring on sx's), **F**at (overwt.), **F**orty
70
**8 F's for Gallbladder patho**
Female, Fair, Fertile, Flatulent, Family hx, Fatty foods, Fat, Forty
71
Spleen side
LEFT!!!!
72
Spleen palpation and **pain referral**
## Footnote
**Sp= splenic pain**
**E= Esophageal pain**
see pics
73
Patho **HERE** can result in **Esophageal pain**
Spleen
74
Spleen can refer pain to
Esophagus
75
Kehr's Sign is for the
Spleen
76
Kehr's Sign for **Spleen**
* Pt supine→ raise foot of bed (**Trendelenberg)**
* **Kehr's Sign** occurs **30mins AFTER spleen injury & can take _days_ to subside**
* **_Red Flag:_** Presence of **blood** or other irritant in the **peritoneal cavity** will result in **severe L shoulder pain** a few mins AFTER LEs elevated\*\*\*
77
Systemic Patho: **Gastro-Intestinal**
## Footnote
**S/S**
* Sx's influenced by **eating, swallowing→ Generic**
* Epigastric pain w/ radiation to the back
* Blood or **dark, tarry stool**
* Fecal incont/urgency, diarrhea/constipation
* Nausea, vom, bloating
* Wt loss, loss of appetite
* **(+) Blumberg (rebound tenderness) Sign**
78
**Gastro-Intestinal pain referral patterns**
**Ga= Gastric pain**
**Duo= Duodenum pain**
**J= Jejunum pain**
**I= Ileum pain**
**Ce= Cecum pain**
**S= Sigmoid colon pain**
see pics
79
Bowel Changes
## Footnote
**KNOW CHART**
see pics
80
Bowel Changes
**Presentation:** Melena (black, tarry)
**Possible patho:** Upper GI bleed (loss of \>150-200 ml of blood)
81
Bowel Changes
**Presentation:** Blood-red
**Possible patho:** Colon-rectal tumor, colon diverticulitis, hemorrhoids
82
Bowel Changes
**Presentation:** Silvery\*
**Possible patho:** Pancreatic Cx
83
Bowel Changes
**Presentation:** Pencil-thin, ribbon stools
**Possible patho:** Distal colon/anal cx
84
**Role of Appendix**
Houses **GOOD** **bacteria**
85
When you see **McBurney's Point think…..**
RIGHT SIDE
APPENDIX spot
86
McBurney's Point for **Appendix**
* SUPINE→ ID pt ⅓ distance bw **ASIS & Umbilicus**
* **apply vertical pressure to this point**
* **_Red Flag_: (+) test is INC abdom. pain**
87
RLQ Pain
## Footnote
**McBurney's Pt. test**
\***MOST discriminating feature of pts hx**
**Sn & Sp= ~80%**
+LR= 3.18
-LR= .5
88
RLQ Pain aka **McBurney's Point Test for appendix**
## Footnote
**Further explanation**
Read, be familiar
89
2 “Stretch” Signs for **Appendicitis**
1. Psoas Sign (go into hip EXT)
2. Obturator Sign (go into hip IR)
90
Psoas Sign for **Appendicitis**
* In L. S/L, hyperEXT R LE
* **_Red Flag_: (+) test= INC abdom pain**
91
Anatomic Basis for **Psoas Sign for Appendicitis**
see pics
92
Obturator Sign for\_\_\_\_\_\_\_
Appendix!!!!
Stretch the **R. ERs into IR**
93
Obturator Sign for **Appendicitis**
* In SUPINE, raise pts **R LE w/ knee in flexion**
* Rotate RLE into **IR @ hip**
* **_Red Flag:_ (+) test is INC abdominal pain**
94
Anatomic basis for **Obturator Sign for Appendicitis**
see pics
95
Systemic Patho: **Renal**
## Footnote
**FACTS**
* **(+) Percussion over kidneys\*\*\***
* Fever, chills
* Dull aching pain aggravated by prolonged sitting
* Blood in urine\*\* (**hematuria)**
* Cloudy/foul smelling urine
* Painful/freq urination
* Pain constant (stones)
* Back pain @ lvl of kidneys\*\* (costovertebral angle tender)
* Skin hypERsensitivity
* HTN
* Bleeding tendencies; ecchymosis
* HA
* Pruritus (itchy)
96
Systemic Patho: **Renal**
## Footnote
**Renal pain patterns**
**K=kidney pain**
**T=testes pain**
**Pr=prostate pain**
**U=ureter pain**
**B=bladder pain**
see pics
97
Right Kidney palpation
see pics
98
Kidney Percussion
see pics
## Footnote
**NOTE: make sure you just _REACH_ hand over when doing opp side!!!!**
**½ way bw last rib and iliac crest \*\*\***
99
Urinary Changes
## Footnote
**KNOW CHART!!!**
see pics
100
Urinary Changes
**Presentation:** Red
**Possible Patho:** Glomerulonephritis, TB, trauma, lupus, renal cystic disease
101
Urinary Changes
**Presentation:** Orange/Brown
**Possible Patho:** Dehydration, INC bilirubin
102
Urinary Changes
**Presentation:** Milky/Casts
**Possible Patho:** Infx\*
103
Urinary Changes
**Presentation:** DEC Flow
**Possible Patho:** Obstruction, UTI, Prostate hypERplasia
104
Urinary Changes
**Presentation:** Fruity Odor
**Possible Patho:** Ketosis
105
Incontinence
**QoL Issue**
* Embarrassment; decd socialization
* burden of care, risk of falls, cost
106
Incontinence
## Footnote
**Characteristics**
* 40% from 60-80yo
* 36% after 3+ children
* 26% w/ BMI \>25
* 26% diuretics
* 18% after hysterectomy (prostate)
107
Incontinence
## Footnote
**Meds**
* **Diuretics→** INC freq/urge
* **Ca+ channel blockers→** INC retention
* **Antidepressants→** Cause INcomplete emptying
108
Prostate
## Footnote
**Facts**
* **Men \>50yo w/ LBP or suprapubic pain**
* Diff starting/stopping urine flow
* Change in freq; DEC urine flow
* Nocturia, **hematuria**
* Incont/dribbling
* Sexual dysf.
* **PSA (Prostate-specific antigen) lvl \>4 ng/ml**
* **BPH**
* Easily confused w/ Prostate cx bc PSA lvls inc in BOTH
109
Gynecological S/S
* **Cyclic pain → “comes and goes” and WHEN specifically?**
* Abnorm bleeding
* Nausea, vom
* Vaginal discharge
* Chronic constipation
* LOW BP (blood loss)
* Missed or irreg. periods
* Pain w/ cough/intercourse
110
Evan's Sign **MOST COMMON in \_\_\_\_\_\_\_\_\_**
Cervical Cx !!!!
111
Cervical Cx and MOST COMMON sign associated w/ this????
Evans' Sign
112
Evans' Sign
## Footnote
**MOST COMMON in Cervical Cx\*\*\***
* AKA **“Hot Foot Syndrome”**
* Sx's→ warm, dry foot
* **Etiology→** Sympathetic disruption from **lumbosacral plexus via tumors** or other **lesions (vasodilation w/ loss of perspiration)**
113
Evans' Sign aka
Hot Foot Syndrome
## Footnote
**MOST COMMON IN CERVICAL Cx \*\*\***
114
Location of 9 **Endocrine Glands**
## Footnote
**and more info on Endocrine system**
* \*Hair, skin, nails
* Sets our “meter”
* **Homeostasis regulation**
**WATCH!!!**
115
Endocrine S/S
* Joint pain, muscle pain, parasthesia, dry, scaly skin, constipation, fatigue, dyspnea
* Brittle nails/hair, heat/cold intolerance (remember thermostat), wt change, periorbital edema, hoarseness, polydipsia/polyuria (thirsty, abnorm lg amts urine)
116
Vitamin Deficiencies
## Footnote
**Sunshine Vitamin= Vitamin D**
* **Recommended exposure:** 10-15mins few times a week\*\*\*
* **Food:**
* 6.5lbs mushrooms
* 150 egg yolks
* 3.75 lbs salmon
* 30 servings fortified cereal
* \>2lbs sardines
* 30 cups fortified OJ
117
Vitamin D Insuff.
## Footnote
**Factors:**
* How MUCH skin exposed
* UV index:
* \>/= 3 bw 10:30-12:00 req's 50-75% of skin exposed
* \<3 means INCd risk of UVA rays w/out benefit of UVB
* Early morning & evening sunlight provides only UVA rays while mid-day has UVB
* Darker skin req's INCd exposure
118
Vitamin D Insuff.
## Footnote
**Clarifying Info:**
* When exposed to sunlight, you produce a **mechanism to repair DNA which LOWERS risk of Cx**
* **It is the _sunburning_ that is the culprit for causing skin Cx**
**\*NOTE:** Vitamin D and Ca++ are **“threshold nutrients” i.e.** Deficiencies are bad, BUT **once you reach adequate amt, higher doses are NOT beneficial**
119
Vitamin D. Insuff.
## Footnote
**MORE**
* LOW **serum lvls of Vitamin D** are associated w/ **clinically sig. sx's of _Depression_**
* Ex. Healthy women followed x1mo
* \>⅓ had depressive sx's
* ~½ had vitamin D insuff.
* **Depressive sx's were predicted by vitamin D lvls**
120
Trinity College in Dublin
**LOWER lvl of Vitamin D, the HIGHER # of COVID-19 infx's & the GREATER mortality \*\*\***
121
Adding 4000 IU of Vitamin D to anagesic regimens in pts w/ MSK pain
Adding 4000 IU of Vit. D may lead to **faster decline of consecutive VAS scores & a DEC in lvls of inflammatory & pain related cytokines**
122
Vit. D Supplementation
## Footnote
**Breakdown**
1. ~10% of our Vit. D comes from food
2. Body only makes Vitamin D3 (cholecalciferol)
3. Abate **jt pain, mm cramps, illness, fatigue**
4. Enhance **bone health**
123
Headaches
## Footnote
**KNOW CHART!!!**
SEE PICS
124
Headaches
**Type of Pain:** Severe & Intense
**Possible Etiology:** Meningitis, aneurysm, brain tumor
125
Headaches
**Type of Pain:** Throbbing/Pulsating
**Possible Etiology:** Migraine, fever, HTN, aortic insuff.
126
Headaches
**Type of Pain:** Temporal
**Possible Etiology:** Eye or ear px, migraine, **w/ visual changes→ temporal arteritis**
127
Headaches
**Type of Pain:** Occipital
**Possible Etiology: Herniated disk\***, eye strain, HTN
128
Headaches
**Type of Pain:** Parietal
**Possible Etiology:** Meningitis, constipation, tumor
129
Structured Migraine Interview
**Sn= 87% (good SCREENING tool)**
60% migraine sufferers not aware they had migraine\*
1. Have you ever had recurrent HAs?
2. Have you ever had mod-severe HA accompanied by nausea and/or vom?
3. Have you ever had mod-severe HA accompanied by hypersensitivity to sound or light?
4. Have you ever had visual disturbs lasting 5-60mins f/b HA?
1. **NOTE: if answers to ALL Q1-Q4 are “NO” then finish here\*\*\***
5. Typically what kind of HA do you get?
6. Typ are your HAs mild, mod, severe?
7. What makes HAs worse?
8. What do you do to relieve HAs?
9. Typ how long HAs last?
10. Have you been given a medical explanation and/or dx for recurrent HAs?
130
Visual Changes
## Footnote
**KNOW CHART!!!!**
SEE PICS
131
Visual Changes
**Presentation:** Spots
**Possible Patho:** Impending retinal detachment, fertility drugs
132
Visual Changes
**Presentation:** Floating spots
**Possible Patho:** Diabetic retinopathy
133
Visual Changes
**Presentation:** Flashes
**Possible patho:** Migraine, retinal detachment
134
Visual Changes
**Presentation:** Loss of Peripheral vision, haloes around lights
**Possible Patho:** Glaucoma (Ocular HTN)
135
Visual Changes
**Presentation:** Cloudy or Fuzzy vision
**Possible Patho:** Cataracts
136
Amsler Grid for\_\_\_\_\_\_\_
Visual Changes!!!!
137
Things the **_Eye_ Can Show you**
## Footnote
**ALL FIRST**
* PD
* DM
* HTN
* Autoimmune disorders
* High CHO
* Thyroid dis.
138
Things the **_Eye_ Can Show you**
## Footnote
**Parkinson Disease**
**Thinning** of walls of the **retina**
139
Things the **_Eye_ Can Show you**
## Footnote
**DM**
Capillary **leaks (**retinopathy)
140
Things the **_Eye_ Can Show you**
## Footnote
**HTN**
Blood vessel **kinks/tears**
141
Things the **_Eye_ Can Show you**
## Footnote
**Autoimmune disorders**
**Inflammation (Lupus)**
142
Things the **_Eye_ Can Show you**
## Footnote
**High CHO**
**Yellowish cornea** OR **plaques in blood vessels of retina**
143
Things the **_Eye_ Can Show you**
## Footnote
**Thyroid Dis.**
Bulging of eyes **(Graves Disease)**
144
Substance Abuse can include\_\_\_\_\_\_\_\_
Tobacco, Caffeine, Alcohol, Food
145
Risks of Patho assocd w/ **Tobacco**
* Cerebrovascular Dis.
* Tobacco amblyopia
* COPD, PVD, Ischemic heart disease
* Peptic Ulcer
* Small babies; obstetric or fertility probs
* Impaired insulin absorption\*\*\*
* INC risk of Cx→ mouth, lung, bladder, kidney, breast, cervix
* Poor recovery from LBP, Sx
* Premature aging\*\*\*
146
Risks of Patho assocd w/ **Caffeine**
* INC blood fats, INC BP
* **Stimulates CNS→** tremors, irritability, nervousness
* Irreg heart beat
* INC Urinary Ca++, Mg++ losses (DEC bone mineralization)
* INC stomach acid secretion
* Disrupted sleep patterns→ anxiety & depression
* INC sx's of PMS\*\*\*
147
Coffee Perks???
* Reg coffee drinkers live longer (2-3cups/day)
* 3 cups caffeinated **reduced risk Alzheimer's & dementia\*\***
* Several cups w/ **post-exercise meal**==== faster muscle recovery\*\*\*
148
**Caffeine use in Sport**
**\>/= 3mg per kg of bw ==\> Ergogenic effect\*\*\***
149
Excess Caffeine??
\>350 mg/day
150
Caffeine Content
FYI but COOOOOOOOL and good to know
151
Risks of Patho assocd w/ **Alcohol**
* Alcoholic dementia
* Subdural hematoma **from falls**
* Convulsions **from w/drawal**
* Delirium tremens
* Cardiomyopathy\*\*
* HTN
* Hepatic cirrhosis
* Pancreatitis
* Dupuytren's contracture \*\*
* Myopathy
* Peripheral Neuropathy\*\*
152
Alcohol Use Disorders ID Test: Interview Version
whqlibdoc.who.int/hq/2001/WHO\_MSD\_MSB\_01.6a.pdf
153
Fetal Alcohol Syndrome (FAS)
Common Signs
see pics
154
Risks of Pathology assocd w/ **Obesity**
* **Arteriosclerosis & HTN**
* CVA & MI
* Sleep apnea
* HypOventilation & exertional breathlesness
* Gallstones\*\*
* DM
* GERD
* OA
* Abdominal striae & varicose veins
* Impaired fertility
* **Dependent** edema
