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Differential Diagnosis > LE Differential Diagnosis & Screening > Flashcards

LE Differential Diagnosis & Screening Flashcards

1
Q

What are Constitutional Symptoms?

A

Fever, diaphoresis, sweats night or day, nausea, vomiting, diarrhea, pallor, dizziness/syncope, fatigue, weight loss, malaise, chills, pain, sleep patterns

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2
Q

Red flag signs are what the patient presents with and things you can “see”. What are some examples? (3)

A

fever, sweating, redness, etc.

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3
Q

Red flag symptoms are what the patient reports they are experiencing, what are 3 examples?

A

pain, numbness tingling, constipation, etc

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4
Q

What’s the first thing you need to figure out with new evaluations?

A

Is the patient appropriate for PT?

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5
Q

If pain is constant, what are some follow up questions you can ask? (4)

A
  1. Are you in pain at the moment?2.Is their any time that you aren’t in pain?
  2. Is their anything that makes the pain better or worse?
  3. What or when did the pain start?
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6
Q

If pain came on insidiously, what are some follow up questions to ask? (3)

A
  1. What were you doing when it started?
  2. How long ago did the pain start?3.Did you have any accident?
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7
Q

When exercising makes it worse, what are some follow up questions to ask? (2)

A
  1. Are you a regular exerciser normally?
  2. Are you in pain when you walk or do household activities?
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8
Q

What are some possible diagnoses with back pain red flags?(4)

A

Fracture, malignancy, infection, Cauda equina syndrome

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9
Q

With back pain red flags and possible diagnoses, what are the combination of signs and symptoms?

A
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10
Q

What are the lower extremity red flags?

A
  • History of cancer
  • History of renal/urologic disease (kidney stones, UTI)
  • Trauma/assault/fall
  • Femoral artery catheterization
  • History of infectious or inflammatory disease (Chron’s, ulcerative colitis, reactive arthritis, appendicitis, diverticulitis)
  • History of gynecologic condition (recent pregnancy, abortion, etc)
  • Alcoholism
  • Long-term use of immunosuppressants
  • History of heart disease (arterial insufficiency, vascular disease)
  • Anticoagulation therapy
  • AIDS
  • Hematologic disease (sickle cell anemia or hemophilia)
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11
Q

What are the common non-MSK conditions in the lower extremity?(4)

A
  • Fractures
  • Deep Venous Thrombosis
  • Peripheral Vascular Disease
  • Malignancy
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12
Q

What are the red flags for LE fracture, both in patient history and form exam?

A

recent trauma, osteoporosis, older age (>50-70), discoloration, deformity, hematomas, edema, significant pain, tuning fork test, pubic-patellar percussion, and Ottawa knee and ankle/foot rules

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13
Q

What are the Ottawa knee rules? (5)

A
  • Age 55 or older OR
  • Isolated tenderness of the patella OR
  • Tenderness of the head of the fibula OR
  • Cannot flex to 90 degrees OR
  • Unable to bear weight both immediately and in the ED for 4 steps (can’t transfer weight regardless of limping)
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14
Q

What are the Ottawa ankle/foot rules? (5)

A
  • Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus OR
  • Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus OR
  • Bony tenderness at the base of 5th metatarsal OR
  • Bony tenderness at the navicular OR
  • Inability to bear weight both immediately after injury and for 4 steps during initial evaluation
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15
Q

What are the red flags for LE DVT, both in patient history and form exam?

A

Acute infection, Cancer, Stroke, Previous DVT, Congestive heart failure, Pregnancy, Dehydration, Varicose veins, Recent major surgery, Prolonged immobility, Long air travel

Swelling, Palpation, Gait/Weight bearing (PAD), 6-minute walk test, Special tests, Wells criteria (DVT), Ankle-brachial index (PAD)

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16
Q

What are the WELLS criteria for DVT?

A

Active cancer (+1), Paralysis, paresis, precent plaster immobilization (+1), Recently bedridden for 3 days or major surgery within 12 weeks (+1), Localized tenderness along deep veins (+1), Entire leg swollen (+1), Calf swelling 3 cm asymptomatic side (+1), Pitting edema in symptomatic leg (+1), Collateral superficial veins (+1), Previous DVT (+1), Alternative diagnosis as likely or more likely than DVT (-2)

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17
Q

What are the red flags for LE peripheral artery disease (PAD), both in patient history and form exam?

A
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18
Q

What areas or structures should be considered as a sources of symptoms? (4)

A

(1) joints under areas of symptoms
(2) structures which may refer to area
(3) contractile structures in the area
(4) other structures

19
Q

What are specific questions to ask with hip pain?

A
  1. Point to the area of pain.
  2. Do you have pain at rest?3.Trauma, injury, or falls?
  3. Pain worse with sitting or standing or walking?
  4. Do you still have a menstral cycle/any changes?
  5. Any bowel or bladder changes? Any change in urinary frequency?
  6. When was your last physical?8.Any snapping, popping, clicking, locking?
  7. Does the pain travel below the hip/knee? Any back or buttock pain?
20
Q

What are some different diagnoses with hip and groin pain?

A

Groin pain in adults most commonly comes from hip osteoarthritis
Femoral acetabular impingement syndrome
Hip Pointer
Upper lumbar radiculopathy
Labral tear
Meralgia Paresthetica (lateral femoral cutaneous neuropathy)
Piriformis Syndrome
Iliopsoas tendinopathy, iliopsoas bursitis, rectus femoris tendinopathy
Tendinopathies (deep hip rotators, hamstrings, quadriceps)
Fracture (traumatic, insufficiency, pathologic)
Femoral head AVN (avascular necrosis)
Transient bone marrow edema syndrome (femoral head)
Metastatic disease (femoral head, pelvis), multiple myeloma, lymphoma, primary osseous tumors
Septic arthritis
Retroperitoneal hematoma (often affecting iliopsoas muscle belly), Inguinal hernia or viscerally-referred pain (including pelvic tumors)
Vascular (femoral arterial aneurysm)
Reiter’s syndrome
Pelvic inflammatory disease (Chron’s disease, Appendicitis, etc.) Lumbar plexopathy (inflammatory, diabetic, secondary to retroperitoneal hematoma)
Femoral neuropathy
Kidney stones
Thrombosis
Iliopsoas abscess
Cauda Equina
Slipped Capital Femoral Epiphysis
Transient osteoporosis
Legg-Calve Perthes disease
Developmental dysplasia (congenital hip dislocation)

21
Q

Refer to slide #32 in “Medical Screening LE” for review of systems questions in all systems!!!!

A

DO IT!

22
Q

What are the non-MSK causes of hip pain (cancer)?

A
  • Mets to femur or pelvis
  • Bone tumors
  • Osteoid osteoma (benign)• Chondosarcoma (~25%)
  • Giant cell tumor
  • Ewing’s sarcoma
  • Vascular
23
Q

What are vascular causes of hip pain?

A
  • Abdominal aortic aneurysm
  • Groin pain may be present due to pressure on structures
  • Arterial Insufficiency
  • Hemophilia

GI bleeding (large intestine, iliopsoas m.) (See hip pain)

24
Q

What are Etiologic factors associated with osteonecrosis?(Traumatic and Nontraumatic)

A

Femoral Neck Fracture, dislocation or fracture-disclocation, minor trauma

Glucocorticoid administration, rarely hypersecretion of cortisol, alcohol use, sickle cell hemoglobinopathies, Caisson (dysbarism) disease, systemic, lupus erythematosus, pancreatitis, pregnancy, hyperlipidemia, radiation, organ transplantation, Intravascular coagulation, thrombophlebitis, Cigarette smoking, hypouricemia/gout, human immunodeficiency virus infection, idiopathic

25
Q

Arterial insufficiency is atherosclerosis in peripheral arteries (Ages 40-60+) and can be a cause of hip and leg pain, what are some signs and symptoms?

A

Worse with physical activity and improved with reset (bicycle test)

26
Q

Infectious/ inflammatory hip pain can be caused by inflammatory diseases, what are some examples? (7)

A
  • Abdominal or peritoneal inflammation (Psoas Abscess)• Anklyosing Spondylitis
  • Crohn’s disease
  • Appendicitis
  • Inflammatory arthritis
  • Septic hip
  • Tuberculosis
27
Q

What are metabolic causes of hip and leg pain?

A

Osteoporosis
Hip fracture, post-menopausal women
Transient osteoporosis during pregnancy: progressive hip pain, last trimester, aggravated by WB’ing
Osteomalacia
Paget’s disease
Diabetes mellitus

28
Q

What are some specific questions to ask with knee pain?

A
  1. Where specifically….one finger point.
  2. Any trauma, falls, injury?3.Snapping/popping/clicking?4.Swelling? When?
  3. Sensation? Numbness/Tingling/Weakness (N/T/W)?
  4. Giveaway or locking?7.Unilateral/bilateral?
29
Q

What are common MSK causes of anterior knee pain?

A

Patellofemoral pain syndrome
Patellar tendinitis/tendinopathy
Patellar dislocation/subluxation
Osteoarthritis
Myofascial pain (eg, quadriceps strain, myalgia)
Ligament sprain (anterior/posterior cruciate ligaments)
Fracture (tibial plateau, femur [distal or proximal], patella)

30
Q

What are some less common causes of anterior knee pain?

A

Avascular necrosis
Referred pain from hip joint (osteoarthritis, fracture)
Radiculopathy (L2 through L4)
Osteochondral Dissecans
Metastatic disease, multiple myeloma, primary osseous tumor (eg, chondrosarcoma)
Prepatellar bursitis
Pes anserine bursitis/tendinitis
Contusion (muscle or bone)
Instability (eg, genu recurvatum, Ehlers-Danlos syndrome)
Proximal tibiofibular joint pathology (osteoarthritis, ganglion cyst)
Pigmented villonodular synovitis (PVNS)
Synovial plica syndrome
Septic arthritis (Gonorrhea, Staphylococcus, Streptococcus)
Rheumatoid arthritis
Crystalline arthritis (gout, CPPD)
Hemarthrosis
Hyperparathyroidism
Neuropathy (femoral, obturator)
Lumbar plexopathy
Shingles
Charcot arthropathy
Transient bone marrow edema syndrome
Osgood-Schlatter disease

31
Q

What are common causes of medial knee pain?

A

Ligament sprain (medial collateral ligament)
Medial meniscal disease (tear, degeneration, parameniscal cyst)
Osteoarthritis
Pes anserine bursitis/tendinitis
Fracture (tibial plateau, femur [distal or proximal], patella)

32
Q

What are less common causes of medial knee pain?

A

Plica syndrome
Avascular necrosis
Referred pain from hip joint (osteoarthritis, fracture)
Radiculopathy (L2 through L4)
Osteochondral defect
Metastatic disease, multiple myeloma, primary osseous tumor (eg, chondrosarcoma)
Pes anserine bursitis
Myofascial pain (eg, quadriceps strain, myalgia)
Contusion (muscle or bone)
Instability (eg, genu recurvatum, Ehlers-Danlos syndrome)
Proximal tibiofibular joint pathology (osteoarthritis, ganglion cyst)
Pigmented villonodular synovitis (PVNS)
Synovial plica syndrome
Septic arthritis (Gonorrhea, Staphylococcus, Streptococcus)
Rheumatoid arthritis
Crystalline arthritis (gout, CPPD)
Hemarthrosis
Hyperparathyroidism
Neuropathy (femoral, obturator)
Lumbar plexopathy
Shingles
Charcot arthropathy
Transient bone marrow edema syndrome
Osgood-Schlatter disease

33
Q

What are common causes of lateral knee pain?

A

Ligament sprain (lateral collateral ligament)
Lateral meniscal injury
Iliotibial band syndrome
Osteoarthritis
Fracture (proximal fibula, tibial plateau, femur [distal or proximal], patella)
Neuropathy
Patellofemoral pain syndrome

34
Q

What are less common causes of lateral knee pain?

A

Patellar dislocation/subluxation
Avascular necrosis
Referred pain from hip joint (osteoarthritis, fracture)
Radiculopathy (L2 through L4)
Osteochondral defect
Metastatic disease, multiple myeloma, primary osseous tumor (eg, chondrosarcoma)
Iliotibial band syndrome
Popliteal cyst (Baker’s cyst)
Tendinitis (distal hamstring, popliteus, patellar)
Prepatellar bursitis
Myofascial pain (eg, quadriceps strain, myalgia)
Contusion (muscle or bone)
Instability (eg, genu recurvatum, Ehlers-Danlos syndrome)
Proximal tibiofibular joint pathology (osteoarthritis, ganglion cyst)
Pigmented villonodular synovitis (PVNS)
Synovial plica syndrome
Septic arthritis (Gonorrhea, Staphylococcus, Streptococcus)
Rheumatoid arthritis
Crystalline arthritis (gout, CPPD)
Hemarthrosis
Hyperparathyroidism
Neuropathy (femoral, obturator)
Lumbar plexopathy
Shingles
Charcot arthropathy
Transient bone marrow edema syndrome
Osgood-Schlatter disease

35
Q

What are common causes of posterior knee pain?

A

Osteoarthritis
Ligament sprain (anterior/posterior cruciate ligaments)
Bakers’ cyst
Fracture (tibial plateau, femur [distal or proximal], patella)
Hamstring tendinopathy/tear
GS, plantaris, popliteus tendinopathies
Vascular

36
Q

What are less common causes of posterior knee pain?

A

Patellar dislocation/subluxation
Avascular necrosis
Referred pain from hip joint (osteoarthritis, fracture)
Radiculopathy (L2 through L4)
Osteochondral defect
Metastatic disease, multiple myeloma, primary osseous tumor (eg, chondrosarcoma)
Iliotibial band syndrome
Popliteal cyst (Baker’s cyst)
Tendinitis (distal hamstring, popliteus, patellar)
Prepatellar bursitis
Myofascial pain (eg, quadriceps strain, myalgia)
Contusion (muscle or bone)
Instability (eg, genu recurvatum, Ehlers-Danlos syndrome)
Proximal tibiofibular joint pathology (osteoarthritis, ganglion cyst)
Pigmented villonodular synovitis (PVNS)
Synovial plica syndrome
Septic arthritis (Gonorrhea, Staphylococcus, Streptococcus)
Rheumatoid arthritis
Crystalline arthritis (gout, CPPD)
Hemarthrosis
Hyperparathyroidism
Neuropathy (femoral, obturator)
Lumbar plexopathy
Shingles
Charcot arthropathy
Transient bone marrow edema syndrome
Osgood-Schlatter disease

37
Q

What are some specific questions to ask with ankle/foot pain?

A

Finger test, Pain location
Trauma, falls, injury
MOI
Weight bearing
History
Chronicity
24 hr behavior
Quality – sharp, achy, throbbing
Edema, ecchymosis
PMH – DM?

38
Q

What are some MSK causes of anterior ankle/foot pain?

A

Fracture (Talus)
Tendon injury or tendinopathy (Tibialis anterior)
Syndesmotic injury (“high ankle sprain”)
Cartilage injury (especially to the talar dome)
Oosteochondritis dissecans (OCD)
Contusion
Growth plate injury (pediatric)

39
Q

What are some MSK causes of lateral ankle/foot pain?

A

Fracture (lateral malleolus, anterior process of calcaneus)
Tendon injury or tendinopathy (Fibularis longus & brevis)
Ankle sprain
Syndesmotic injury (“high ankle sprain”)
Cartilage injury (especially to the talar dome)
Osteochondritis dissecans (OCD)
Contusion
Os peroneum (ossicle in lateral foot)
Jones fracture

40
Q

What are some MSK causes of medial ankle/foot pain?

A

Fracture (medial malleolus, navicular, calcaneal)
Tendon injury or tendinopathy (Tibialis posterior, Flexor hallucis longus)
Medial ankle sprain (deltoid ligament)
Tarsal tunnel syndrome
Osteochondritis dissecans (OCD)
Contusion
Baxter nerve entrapment
Os tibiale externum (accessory navicular bone)

41
Q

What are the diagnoses associated with the point of pain?

A

(1) heel pad atrophy
(2) plantar fasciitis
(3) Baxter nerve entrapment
(4) calcaneal stress fracture
(5) tarsal tunnel syndrome

42
Q

What are possible causes of posterior ankle/foot pain?

A

Fracture (Talar stress fracture, calcaneal insufficiency)
Achilles tendon rupture
Tendinopathy (Achilles tendinitis)
Inflammatory enthesitis (psoriatic arthritis, ankylosing spondylitis, reactive arthritis)
Severs disease (calcaneal apophysitis)
Retrocalcaneal bursitis
Haglund deformity
Ruptured popliteal cyst
Posteromedial tarsal coalition

43
Q

What are possible MSK causes of plantar foot pain?

A

Plantar fasciopathy
Heel pad atrophy
Fracture (Lisfranc, metatarsals, calcaneal, Jones)
Metatarsalgia
Morton’s neuroma
Tendinopathy (Fibularis, Achilles tendinitis)
Inflammatory enthesitis (psoriatic arthritis, ankylosing spondylitis, reactive arthritis)
Severs disease (calcaneal apophysitis)
Retrocalcaneal bursitis

Differential Diagnosis (7 decks)

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