Systems Review - LQ Flashcards
(100 cards)
1
Q
What is the purpose of a systems review?
A
Identify suspicious non-MSK or RED FLAG S&S that require referral to another healthcare profession
2
Q
What is a systems review NOT?
A
a dx of a non-MSK condition but recognition of suspicious non-MSK S&S
3
Q
Are red flag S&S informative in isolation?
A
not usually - few red flag S&S in isolation are informative, look for combinations
4
Q
Is there a consensus on which red flag S&S are most useful?
A
NO
5
Q
What are the best tools to raise suspicion of pathology?
A
RED FLAGS
6
Q
What are systems determined by?
A
HX and observation
7
Q
What is the onset like for non-MSK and red flag S&S?
A
Gradual and unknown onset for many non-MSK conditions and red flag S&S with minimal to no mechanical provocation
8
Q
What are some constitutional S&S or general health components requiring review when present?
A
- Fever, chills, sweats- MOST often associated with systemic illness
- Prolonged (≥2 wks.)
> 102° may require hospitalization - Weight changes, particularly loss of ≥ 5% and if unexplained
- Nausea and Vomiting (N&V)
- Dizziness and lt. headedness
- Fatigue- prolonged (≥ 2 wks.) and limiting
- Weakness- limiting
- Paresthesia’s/Numbness
- Malaise or ill feeling- “I feel like I’m coming down with something”
- Mentation or cognitive changes
9
Q
What are the structures involved with the urinary system?
A
Kidneys, ureters, bladder, and urethra
10
Q
What are the functions of the urinary system?
A
- Filter fluid from renal blood flow
- Remove waste
- Retain essential substances for fluid and contents balance i.e., electrolytes, acid base balance, etc.
- Stimulates RBC production
- Blood pressure regulation
- Converts Vitamin D to its active form
11
Q
What are urinary S&S?
A
- P! in trunk, flank, and/or pelvic regions
- Discoloration
- Urinary changes
> Frequency
> Urgency
> Bleeding
> Pus - Dysfunction
> Flow
> Initiation
> Control - Nocturia- awake to urinate
12
Q
What is a part of the urinary review?
A
- most from hx
- observation of urine unlikely
- pain with kidney percussion
- pain with palpation/percussion of system organs during abdominal assessment
13
Q
What is the function of the reproductive system?
A
- producing sex cells such as eggs/sperm and creating sex hormones with endocrine system
- maintaining fertilized eggs for development
14
Q
What are the S&S of the reproductive system?
A
- pain in pelvis, LB, abdominal regions and/or sexual organs
- dysfunction: sexual or bowel and bladder due to proximity
- abnormal: discharge from sex organs or menstration
15
Q
What are early and possibly unknown pregnancy indications?
A
- polyuria (excessive urination)
- breast tenderness
- fatigue
- N&V with possible weight loss
- heartburn
- constipation
- abnormal vaginal discharge
16
Q
What will we use for our reproductive review?
A
- most from hx
- observation unlikely
- no other specific assessment
17
Q
What makes up the metabolic system?
A
gut, liver, adipose tissue, pancreas, kidney, and muscle
18
Q
What are the functions of the metabolic system?
A
- conversion of foods and liquids into: energy for all cellular processes / building blocks for proteins, fats, and carbohydrates
- elimination of waste
19
Q
What is key for cellular metabolism?
A
Fluid and electrolyte balance
20
Q
What does sodium do as an electrolyte?
A
- maintains fluid volume and cell function for messages to and from CNS
21
Q
What is the most frequent electrolyte disorder and contributor to neurological S&S?
A
Hyponatremia - low sodium
22
Q
What does potassium do as an electrolyte?
A
Maintains fluid volume
23
Q
What is the skeleton a storehouse for?
A
- calcium
-phosphorus
24
Q
What does calcium do?
A
involved with bone health, muscle actions, nerve impulses, circulation, and hormone balance
25
What does phosphorus do?
- majority located in our bones and teeth
- plays a crucial role with the metabolism for the growth, maintenance and repair of all tissues
26
What does bicarbonate do as an electrolyte?
- works as an acid buffer
27
What is the main reason for loss of bicarbonate?
Diarrhea
28
What does magnesium do as an electrolyte?
Mainly involved in neuromuscular functions
29
What does chloride do?
Regulates fluid in and out of cells
30
Are metabolic S&S varied?
YES
31
What can it mean if the S&S dont match a specific system and seem widespread?
Possibly a metabolic condition because altered metabolism can affect multiple systems
32
What are the overall S&S of the metabolic system due to?
Fluid and electrolyte imbalances, altered pH
33
What is fluid and electrolyte imbalance most commonly due to?
Conditions involving fluid loss and dehydration
34
What are some conditions involving fluid loss and dehydration?
* Diabetes
* Kidney dysfunction- regulates MOST electrolytes followed by intestines, bone, and parathyroid gland
* Malignancy
* Alcoholism/liver disease
* Medication side affects e.g., diuretic
* HTN
* Burns
* Surgery
* Diarrhea
* N&V
35
What can fluid and electrolyte imbalance do to skin?
- loss of skin elasticity
- altered temperature
36
What can fluid and electrolyte imbalance do to the neuromuscular system?
- weakness
- fatigue
- twitching
- cramping
- tetany
37
What can fluid and electrolyte imbalance do regarding CNS involvement?
- memory impairment
- depression
- delusions/hallucinations
- seizures
38
What can fluid and electrolyte imbalance do regarding cardiovascular changes?
- tachycardia
- postural hypotension
- altered respirations
39
What is the ideal pH?
Between 7.35 - 7.45
"narrow window"
40
What do the lungs do for pH regulation?
- balance the acidic CO2 with the neutral O2
- work with the circulatory system to provide O2 and remove waste products of metabolism
41
What do the kidneys do for pH regulation?
- remove acids and keep bases
42
What can aging result in regarding pH regulation?
- decreased respiration so less gas exchange
- oxidation where oxygen molecules lose electrons and steal them from other electrolytes and cells
43
What are the 4 acid-base classes?
1. respiratory acidosis
2. respiratory alkalosis
3. metabolic acidosis
4. metabolic alkalosis
44
What type of altered pH can cause confusion and fatigue S&S?
ALL classes
45
What is respiratory acidosis?
Lowered ph
46
What can respiratory acidosis cause?
Hypoventilaiton and an accumulation of acidic CO2 may occur along with:
- aging
- pulmonary conditions
- drugs that suppress respiration like opioids/muscle relaxers
- sleep apnea
47
WHAT IS RESPIRATORY ALKALOSIS?
higher pH - hyperventilation leading to a loss of acidic CO2
48
What can respiratory alkalosis occur with?
- pulmonary conditions
- anxiety
- hypoxemia disorders such as anaemia / anxiety (hyperventilate trying to get more O2 in)
49
What are S&S of respiratory alkalosis?
- shortness of breath is the ONLY sign
- otherwise highly variable
50
What is metabolic acidosis? (KNOW THIS)
MOST common acid base abnormality
- accumulation of acidic H+ ions
51
What is metabolic acidosis most commonly due to?
- build up of ketone bodies or acids : diabetes
* also can be due to diarrhea/ dehydration leading to greater acid concentration
* kidney conditions that hold onto too many acids
52
What are S&S of metabolic acidosis?
- rapid deep breaths with a fruity smell, from ketone bodies, trying to get rid of CO2 acids
> diabetes cardinal S&S
- dry mouth
- extreme thirst (polydipsia)
- decreased skin turgor
- blurry vision
- weakness / fatigue
53
What is metabolic alkalosis?
* higher pH
Accumulation of bicarbonate base
54
What can metabolic alkalosis & accumulation of bicarbonate be caused by?
- vomiting by loss of stomach acids
- kidney disorders or medications that keep too many bases
- excessive antacid, laxative, or diuretic medications
- diarrhea
55
What are S&S of metabolic alkalosis?
- headache
- neuromuscular excitability ( paresthesias/numbness, twitching and cramping, particularly in feet and hands, seizures)
- muscle alterations due to associated lowering of CA2+ (skeletal weakness, cardiac arrhythmias)
56
What is a part of our metabolic review?
- hx
- observation of:
* muscle twitching / tetany
* altered respiration
* memory loss
* incoordination
* dry mouth
* fruity breath
- resisted and/or manual muscle testing: wide spread weakness
- neuro tests: possibly wide spread altered sensations
- abdominal assessment
- standard vital signs (HR, hypotension, RR)
- palpation of skin for mobility and temperatures
57
What are we looking at with our abdominal assessment as a part of our metabolic review?
pain with palpation and percussion of:
- liver
- pancreas
- kidney
58
What are the standard vital signs we should look at with metabolic review?
- irregular heart rate
- postural hypotension
- altered respiratory reate
59
What are we palpating for with our metabolic review?
- loss of skin mobility
- extreme skin temperature
60
What are the PT implications of the metabolic system?
- adequate hydration: (likely more than just water, such as electrolyte drinks)(
- ensure efficient respiration
- increase antioxidant foods (veggies and fruits)
61
What type of referral is metabolic system?
URGENT
62
What are infection S&S?
may be local and less asymptomatic but more concerned about systemic and greater S&S affecting multiple systems
- malaise
- fever, chills, sweats
- N&V
- enlarged and likely tender lymph nodes
- redness ( maybe lymphangitis or streaks towards lymph nodes), access, head, and/or swelling
- specific infected system S&S as well
63
What is a part of our infection review?
- hx
- observation: redness / swelling
- palpation: abnormal lymph nodes (> 2 cm diameter, firm, tender due to rapid onset of inflammation with infection), heat, swelling, possible pain with abdominal quadrant assessment of involved structure
- standard vital signs: high temp
64
What are some systemic S&S in the older adult that can be subtle and atypical with infection?
- mentation changes
- subnormal body temp
- bradycardia or tachycardia
- tachypnea
- fatigue
- lethargy (lack of energy)
- decreased appetite
65
What are some S&S of an autoimmune condition?
Gradual onset
- GI S&S due to majority of immune cells in gut
- constitutional S&S
- inflammation (persistent with possible acute bouts, local or systemic)
- myalgia/arthralgia
- swollen lymph nodes (tender if acute, non-tender with chronicity), may be immobile if fibrotic)
- typically affect > 1 part of the body
- skin and weight changes
- emotional changes
66
What is the function of the immune system?
Defends the body against harmful substances, pathogens, and cells or non-selfs from internal and external threats
67
What is a part of the immune review?
- hx
- observation of: persistent swelling and possibly pitting edema, skin changes
- vital signs: high temp
- palpation: swollen and tender lymph nodes, muscle and joint TTP
68
What are S&S of cancer?
Gradual onset
- asymptomatic in early stages and may affect multiple systems
- pain: local and referred (progressive, esp at nigh and likely at a similar time after falling asleep due to metabolic activity, often invariable with position of movement, may become constant)
- N&V
- loss of appetite
- unexpained weight loss of ≥ 5-10% over a 3-6 month period
- fever, chills, sweats (night) - even in absence of infection due to increased circulating white blood cells or production pyrogen agent)
- swollen and NON tender lymph nodes, possibly hard and immobile due to fibrosis
- unusual malaise and fatigue
- secondary infections due to lowered immunity
69
What is a part of our cancer review?
- hx (hx of cancer?)
- palpation of lymph nodes (> 2 cm , firm, immobile and NON-tender due to limited inflammation with typical slow growth of most cancers)
- vital signs: high temp?
70
What are S&S of the cardiovascular system?
Gradual or sudden onset
- family hx of heart attack prior to age 60
- pain in chest (angina), with/without upper thorax, neck, UE, and/or face due to shared innervation from C4-T4; L UE more common, UE pain is in ulnar nerve distribution medially into little finger, esp upon exertion
- heart palpitations
- nausea
- sweating
- SOB/wheezing
- dizziness/light headedness, fainting (syncope)
- fatigue, particularly with minimal exertion
71
What makes up the cardiovascular system?
Heart and blood vessels
72
What are the functions of the cardiovascular system?
- in coordination with respiratory and nervous system
- circulate oxygenated blood through the arterial system to cells throughout the body
- deoxygenated blood carried by venous system to lungs for reoxygenation
73
What are S&S of the cardiovascular system due to?
- insufficiency of heart and vessels
74
What other systems can the cardiovascular system influence?
Respiratory and lymphatic systems
75
What is a part of the cardiovascular review?
- hx
- observation of: SOB, wheezing, sweating
- abnormal vital signs: HR, RR, BP
- abnormal heart or vessel sounds with stethoscope aka auscultations
76
What are the S&S of the respiratory system?
- pain in neck and/or upper shoulder regions
- thorax pain due to shared T2-4 innovation: possibly exacerbated by
> deep inspiration
> coughing
> motion in UE and/or trunk
- cyanosis
- digital clubbing
- SOB, wheezing, and/or altered breathing patterns
- cough
- decreased breath sounds and possible pleural rub of lungs together with respiration
- hyper resonance with percussion
77
What makes up the respiratory system?
nose, mouth, pharynx, airways, lungs, and diaphragm
78
What are the functions of the respiratory system?
In coordination with cardiovascular, nervous, and immune systems to facilitate gas exchange:
- nutrients and oxygen to tissues
- removed carbon dioxide and waste from tissues
79
What is a part of our respiratory review?
- hx
- observation: cyanosis, digital clubbing, SOB, cough
- vital signs: altered respiration rate
- decreased breath sounds and pleural rub with stethoscope aka auscultations
- hyperresonance with percussions
80
What are some S&S of the GI system?
- pain in neck, trunk (thoracic, lumbar, and abdominal), pelvic, and / or shoulder regions due to multiple levels of shared innervations
- dysphagia (swallowing difficulties)
- N&V
- food aversion / intolerances
- indigestion and/or heartburn
- full feeling
- bowel dysfunction ( color, shape, constipation, incontinence or lack of control)
81
What makes up the GI system?
Mouth, esophagus, stomach, intestines, to colon and rectum
82
What are the functions of the GI system?
* digestion - stomach and small intestines
* absorption - stomach and small intestines
* excretion - large intestines, colon, and rectum
* protection: all major categories of immune cells in the gut, 70-80% of bodies immune cells in gut
* assisted by hepatic system
* also an emotional physiological connection for gut health
83
What is a part of the gastrointestinal review?
- primarily hx
- observation of difficulty swallowing, swelling/bloating in abdominal quadrants
- abdominal quadrant: auscultation (altered sounds), palpation for tenderness, percussion for abdominal sounds
84
What makes up the nervous system?
- central (brain/spinal cord) and peripheral (somatic/autonomic) nervous systems
85
What are the functions of the nervous system?
- sensory processing
- involuntary and voluntary responses and actions
- maintaining system homeostasis, particularly with endocrine system
- MAJOR controlling, regulatory, and communicating bodily systems
86
Where does the endocrine system meet the nervous system?
At the hypothalamus - pituitary interface
87
What is the hypothalamus?
The MAIN integrative center of endocrine and autonomic nervous system functions by hormonal and neural pathways
88
What are some LMN structures?
- cranial nerves
- anterior grey column of spinal cord
- cauda equina
- spinal nerves to terminal nerve branches
89
What are some UMN structures?
- above anterior horn of spinal cord
- brain and MOST of spinal cord
90
What are some LMN S&S?
- decreased or flaccid muscle tone
- incontinence or leakage of bowel and bladder
- single segment dermatome/paresthesias
- single segment of hypoactive for DTRs
- single segment of fatiguing weakness for myotomes
- possible sexual dysfunction
91
What are some UMN S&S?
- increased or spastic muscle tone
- spastic/retentive bowel and bladder
- multi-segmental diminished dermatomes/paresthesias
- multiple segmental hyperactivity for DTRs
- multi-segmental weakness for myotomes
92
Which motor neuron will have mentation changes?
UMN
93
Which motor neuron will have superficial reflexes be altered?
UMN - hypoactive
94
Which motor neuron will have speech, swallowing, and vision changes
UMN
95
Which motor neuron will have positive dural mobility?
LMN, UMN if acute, not if gradual
96
What does it mean if the umbilicus moves in the direction of the stroke in the abdominal quadrant?
WNL
97
What does it mean if the umbilicus does not move with light strokes applied in each of the abdominal quadrants around the umbilicus?
hypoactive
98
What are some other S&S that may occur with either LMN or UMN conditions?
- N&V
- dizziness
- visual or auditory dysfunction
99
What can the WORST HA ever be?
impending stroke
100
What is a part of the neurological review?
hx and observation plus assessments
