PC: Lecture 3 Flashcards
(96 cards)
1
Q
How much BW loss is significant?
A
5-10% loss unexplained
could be cancer, GI, inflammatory disorders
2
Q
If a pt answers YES, the following questions should cause concern:
A
- does complaint represent something NEW, DIFFERENT OR UNUSUAL for the pt?
- is there an explanation that would minimize concern?
- has the pt mentioned this to a physician?
- if the physician is aware, has it become worse?
3
Q
referred pain can be
A
mechanical - dermatomes
non mechanical - visceral referral
4
Q
anything that touches the diaphragm can refer pain where?
A
right shoulder
5
Q
know the referral patterns
A
picture
6
Q
What screening do all pts receive?
A
General health checklist
7
Q
Your pt comes in with shoulder or neck/cervical region issues. What screenings do you give?
A
general health
Cardiovascular
pulmonary
GI
8
Q
your pt comes in with thoracic spine pain (rare) what screenings do you give?
A
general health
CV
pulm
GI
GU
think just adding one below from cervical
9
Q
your pt comes in with lumbar-pelvic pain, what screens do you give them?
A
general health
GI
GU
peripheral vascular
10
Q
Your pt comes in with mid-humerus, femur to toes pain. what screenings do you give them?
A
general health
peripheral vascular
11
Q
the likelihood of non-msk origin of pain/dysfxn the more ____ you go, decreases
A
distal
aka probably msk if you go more distal
12
Q
inconsistent symptom pattern - symptoms check multiple boxes. what screens do you give them?
A
general health
psychologic
endocrine
neurologic
rheumatic disorders
adverse reactions
13
Q
what is on the general health screen?
A
fatigue - interfering with daily activities?
malaise - don’t feel good
fever, chills, sweats
weight loss, gain
nausea, vomiting
dizziness, lightheadedness
paresthesia, numbness, weakness
change in mental or cognitive abilities
14
Q
What are other causes of nausea and vomiting besides GI? question!
A
metabolic, CV, liver dysfxn
pregnancy
meds
ICP, HA, hemorrhage
15
Q
with hematologic: remember you are looking for…
A
erythrocyte, leukocyte, platelet conditions
bleeding disorders
16
Q
heart burn vs angina
A
did it happen with eating?
17
Q
When is a fever significant?
A
99.5 for over 2 weeks
18
Q
Dyspnea, Cough, Palpitations, Syncope, Sweats
What system is this?
A
Cardiovascular or pulmonary
19
Q
Edema, Cold Extremities, Skin Discoloration, Open Wounds, Clubbing of nails, Wheezing
What systems is this?
A
Cardiovascular or pulmonary
20
Q
Dyspnea, cough, clubbing of nails, wheezing
what system is this?
A
Pulmonary
21
Q
Exertional Dyspnea, Palpitations, Anginal Pain, Fatigue, Palor, Digital Clubbing, Light Headedness
What system is this?
A
Hematologic system
22
Q
Syncope, Drowsiness, Confusion, Easy bruising/bleeding, Fever/chill, Malaise
What system is this?
A
Hematologic
23
Q
Difficulty swallowing
indigestion
heartburn,
Bowel Dysfunction
What system is this?
A
GI system
24
Q
What does black tarry shiney sticky stool mean?
A
upper GI bleed
25
What does black but not sticky stool mean?
Ingestion of iron/bismuth salts (example: Pepto-bismol)
26
What does light gray/pale stool mean
obstructive jaundice
27
What does bright blood red stool mean
Lower GI bleeding
28
What are different indicators of a urinary problem?
Color
Frequency/urgency/retention
Decreased stream
difficulty initiating stream
incontinence
29
What does dark urine mean?
Red urine?
Reddish urine?
**Dark urine**- hepatic or billary obstructive/ rhabdomyolosis
**Red (blood)** - many GI disorders
**Reddish** - blood or ingestion of vegetable dyes or use of some meds, dysuria, period
30
Reproductive system symptoms
Urethral/vaginal discomfort
sexual dysfunction
pain during intercourse
mensuration - frequency, length of cycle, dysmenorrhea, blood flow
Number of pregnancies
menopause - vaginal bleeding or spotting (note this would be reproductive not GU!)
31
Numbness/tingling, weakness, tremors, seizures, vision changes, sexual difficulties, hearing problems
What system is this?
Nervous system
32
Difficulty swallowing (CN), Urinary incontinence, vomiting w/o nausea, dizziness, recent falls, balance problems
what system is this?
Nervous system
33
What other systems does endocrine affect? (where else could you see symptoms)
general health
physiologic
GI
Uro-genital
MSK
sensory
dermatologic
miscellaneous
more than one system? endocrine screening!!
34
Fatigue, unexplained weight loss, personality changes, weakness, memory loss, confusion, irritability, anorexia, dysphagia, diarrhea, constipation
what system is this?
Endocrine
more than one system? endocrine screening!!
35
Impotence, intermimittent urine stream, muscle weakness, cramps, stiffness, numbness, foot ulceration, edema, impaired wound healing, temperature intolerance, visual changes, orthostatic hypertension, increased thirst
What system is this?
Endocrine
more than one system? endocrine screening!!
36
What are symptoms of a integumentary system problem?
Changes in skin, nails, hair
Change in sweating or dryness of skin
Pruritus (itching)
37
What is the starting point of checking the psychological system of a patient
General health checklist:
Fatigue, sleep, confusion, concentration, weightloss
38
What are the other things to check for the psychological system
Major clinical depression - 2 question screen
chemical dependence
abuse
39
What kind of pain is this:
Pain fluctuates over 24 hours
Specific motions or activities make it worse
MSK pain
40
how to decide what checklists to issue?
system location or pattern
PMHx - hx of a condition warrants cheklists for the associated system
follow up visits - new symptoms, or changes?
adverse drug reactions?
41
How would you describe 80% of all adverse drug reactions?
A magnification of what the drug was meant to do therapeutically
42
non-symptoms specific symptoms
joint pain
limb pain
dizziness
headache
43
What is the most common cause of joint pain, for which PTs should be primary care providers for?
OA
44
T/F: PTs should be primary care providers for all types of arthritis
FALSE - other types of arthritis that may require physician oversight ad medical management
45
What kind of problem is this?
30+ mins morning stiffness
improvement w/ exercise
no improvement with rest
pain at night
insidious onset
40+ years or older
Inflammatory backpain
46
what is the scoring you need for inflammatory back pain
4+ to be confident
3+
2+
47
ankylosing spondylitis vs NSLBP?
AS is rare, NSLBP common
AS -< 40, NSLBP 33-55
More males with AS
AS will have autoimmune arthritis in spine, NSLBP has degenerative arthritis
AS has symptoms in hip OR/AND NECK, NSLBP just hip
AS pain will inc with rest, NSLBP will dec with rest
AS will have NIGHT PAIN and the TRIAD
48
what non joint conditions will you see with AS and not NSLBP?
uveitis, IBS!
49
Classification for RA: 4 or more of these in 1 year:
CRITERA MUST BE PRESENT FOR > OR EQUAL TO 6 WEEKS
Morning stiffness 1+ hours
Arthritis of 3+ joints + soft tissue swelling?
Arthritis of hands - one area swollen in the wrist, MCP or PIP
Symmetric arthritis
Rheumatic Nodules
Serum Rheumatoid factor
Radiographic changes - erosion, bony decalcification
50
SLE vs RA
RA: 20-50, autoimmune thyroids disorders
SLE: 15-40, infection, sunlight or UV light exposure, meds, african american
51
What condition is this:
Peak onset 20-50
Females more likely
Family history
Auto immune disorders
Symptoms increase w/ rest and intense activity
symptoms decrease w/ short rest and mild activity
Rheumatoid arthritis
52
what condition is this?
Tenderness at affected joints
severe post-rest stiffness
night pain less evident
symptoms vary from mild to severe
Also Rheumatoid Arthritis
53
What condition is this:
Onset 15-40
Females more likely, african americans more likely
+ Family History
Caused by infection, UV exposure, or medications
Symptoms increase w/ rest and intense activity
symptoms decrease w/ short rest and mild activity
Tenderness at affected joints
moderate post-rest stiffness
night pain less evident
symptoms vary from mild to severe
SLE
54
What condition is this?
Peak onset men in 50s, women in 60s, more common in males
+ family history
more likely w/ renal disorders w inc uric acid or leukemia, chemotherapy, hypothyroidism, heavy drinking, diuretic use
Increased symptoms w/ weight bearing
decreased pain at night, but pain still there at night
Symptoms are severe
rapid progression
gout
feels like standing on glass
55
What condition has peak onset in the 2nd and 3rd decade of life w/ arthritis followiing up to 20 years later
it has no gender predilection
causes tenderness at affected joints
psoriatic arthritis
56
What condition causes Psoriasis, tenderness at joints, moderate post rest stiffness
and symptoms increase w/ rest or intense activity
and decrease with short rest or mild activity
psoriatic arthritis
57
What condiiton is more common in men, with an acute peak onset in the 3rd decade of life
(young men)
veneral or dysenteric disease
moderate to severe post-rest stiffness
not a lot of night pain, symptoms can range from mild to severe
Reactive arthritis (reiter's syndrome)
58
What condition has an abrupt onset with no gender predilection
causes excruciating pain and severe symptoms with rapid progression
septic arthritis
Gout would be males!
59
What condition can be caused by systemic corticosteroid use, DM, infection elsewhere, has night pain, causes severe pain, and presents like gout
increased pain with WB activity
less pain with rest, but pain never goes away
Septic arthritis
60
post rest stiffness for RA, SLE, GOUT, Psoriatic Arthritis, Reactive Arthritis and Septic Arthritis
RA: severe, >60
SLE: moderate, >60
Gout: less evident
Psoriatic Arthritis: Moderate >60
Reactive Arthritis: Moderate to severe >60
Septic Arthritis: less evident
Post Rest stiffness- the R’s
61
which of the arthritis conditions increase s/s with WB, and reduce them rest?
Gout
Septic arthritis
the others have s/s increase with rest - RA, SLE, Psoriatic, Reactive
62
Which conditions have a rapid progression?
GOUT and septic
63
What condition is commonly associated with uveitis (inflammation of the eye)
fatigue, weight loss,, maliase
cardiac/pulmonary complications?
anklosing spondylitis
64
What condition is associated with skin rash (malar rash most common
SLE
65
what condition is associated with:
Fever, fatigue, malaise, photosensitivity, dyspnea, cough, peripheral neuropathies
SLE
66
What disease is associated with severe joint pain, fever, malaise, tachycardia?
Gout
67
What condition is associated with feeling itchy, having joint pain, fever, malaise, fatigue
Psoriatic arthritis
68
What condition is associated w/ infection-like symptoms w/ joint pain, chills, malaise
septic arthritis
69
A patient presents with calf/thigh pain, antalgic gait, difficulty walking
Name 4 conditions that cause limb pain that are not typically managed by PTs
Hypothyroidism
Lyme Disease
Polymyalgia Rheumatica
Statin-Induced Myopathy
70
What could cause dizziness or vertigo in children?
brain tumor
71
Dizziness vs Vertigo
**Vertigo** - sensation of **spinning**
**Dizziness** - impaired **spatial perception** and **stability**
72
At what rate does dizziness become more common as you get older
10% increase w/ every 5 years in age
(rare in children)
73
What should you be most worried about if a patient presents w/ dizziness?
serious pathological neck conditions must be ruled out
ex: Verterbral Artery Insufficiency, cervical ligament instability
74
What are the 5 Ds and 3 Ns of Vertebral Artery Insufficency
Drop Attack
Dizziness
Dysphagia
Dysarthria
Diplopia
Nausea
Numbness
Nystagmus
+ Cranial Nerve signs
75
Vertebral artery insuffiency is an impending marker for what?
an impending CVA
76
What condition could this be:
Occipital Headache and numbness
severe limitation in neck AROM in all directions
signs of cervical myelopathy
Upper cervical ligamentous instability
77
What are 5 serious pathological neck conditions?
Vertebral Artery Insufficency
Upper Cervical Ligamentous Instability
Cervical Myelopathy
Neoplasm
Inflammatory or systemic disease
78
Vertigo definition
Sensation of spinning, caused by asymmetric involvement of vestibular system
79
what's more common, peripheral vertigo or central vertigo
Peripheral vertigo
80
Dysequilibrium definition
Dizziness, unsteadiness and imbalance w/o vertigo
can be caused by degenerative changes
81
What is presyncope?
Vascular compromise to cerebellum
82
What are non-specific causes of dizziness
panic/anxiety
Cervicogenic
83
Who is more affected by headache, men or women?
Women
84
What is the most common kind of headache
tension headache
85
What kind of headache can stress/anxiety cause?
tension
note: feels like a band tightening
86
What are the symptoms of a migraine?
Pounding/Pulsating
Nausea, vomiting, photophobia or phonophobia
severe
87
what kind of headache has mild to moderate symptoms
occurs due to upper c-spine dysfunction
provoked by neck movements or sustained postures
cervicogenic
note: non-throbbing and non-pulsating
88
What kind of headache happens atleast every other day for 8 days,
can be due to nasal congestion, rhinorrhea, eyelid edema, sweating, restlessness, ptosis
cluster
89
What is the most severe kind of headache?
Cluster- Severe or very severe
migrane - severe
90
Physical symptoms of concussion
Headache
nausea
balance,
dizziness
fatigue
sensitivity to light
numbness
dazed/stunned
91
emotional symptoms of concussion
irritable
sadness
emotional
nervous
92
cognitive concussion symptoms
feeling foggy,slow
difficulty remembering and concentrating
forgetful of recent info, conversations
confused about recent events
answers questions slowily
repeats questions
93
concussion symptoms about sleep
drowsiness
more sleepy than usual
less sleepy than usual
difficult falling asleep
94
What are the red flags of a head injury
DSSVAC
"this vaccums up red flags)
double vision
severe/worsening HA
Seizure/convulsion
(changes in counsciousness) deteriorating consciousness
vomiting/agitation/combativeness
95
How is a concussion diagnosed?
No validated test, the diagnosis is made clinically
96
Repetitive over use injury sites:
Femoral Neck
Anterior Cortex of tibia
medial malleolus
tarsal navicular
base of 2nd and 5th metatarsal
talus
patella
