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Diff Dx > General Approach > Flashcards

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
Q

if someone is less than 18, what are the ddx of low back pain?

A

congenital defect, tumor, infection, spondylolysis, spondylolisthesis

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26
Q

if someone is above 50, what are the ddx of LBP?

A

tumor, intra abdominal process, infection

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27
Q

if there is major trauma, or minor trauma in elderly, what is usually the cause?

A

fracture

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28
Q

recent genitourinary or gastrointestingal procedure usually indicates?

A

infection

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29
Q

night pain usually indicates what DDX?

A

tumor, infection

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30
Q

unremitting pain, even when supine indicates what ddx?

A

tumor, infection, AAA, nephrolithiasis

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31
Q

pain worsened by coughing, sitting or valsalva maneuver indicades what ddx?

A

herniated disc

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32
Q

pain related below knee indicates what?

A

herniated disc, NR compression below L3

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33
Q

incontinence, saddle anesthesia, severe or rapidly progressive neurologic deficit indicates what ddx?

A

cauda equina syndrome, spineal cord compression

34
Q

red flags

A 
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
Q

when should you generally refer/refer or comanage?

A

refer- fractures/dislocations, infections, tumors (orthopedic management)
refer/comanage- RA, CT disorders

36
Q

if problem is instability w/o ligament rupture?

A

stabilize the joint through appropriate exercise program using brace if necessary

37
Q

if problem is weakness?

A

strengthen associated muscles

38
Q

those who want to return to ADLs, dowhat?

A

functionally retrain

39
Q

what do you do for articular dysfucntion?

A

manipulation/mobilization

40
Q

WIRS pain

A 
weakness
instability
restricted movement
surface complaints
pain
41
Q

weakness

A

may be due to pain inhibition, muscle strain or neurologic interruption

42
Q

instability

A

maybe due to damaged ligaments, muscles or inherent looseness

43
Q

restricted motion

A

due to pain, muscle spasm, soft tissue contracture, joint mice, fracture or soft tissue swelling/effusion

44
Q

surface complaints

A

skin lesions, cuts/abrasions, swelling, patient subjective sense of numbness of paresthesia

45
Q

pain is..

A

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
Q

nociceptive pain

A

caused by stimulation of peripheral nerve fibers

47
Q

neuropathic pain

A

damage or disease affecting nervous system

48
Q

psychogenic pain

A

mental, emotional, behavioral factors

49
Q

phantom pain

A

type of neuropathic pain

50
Q

scleratogenous sources

A

nondermatomal pattern, with no hard neurological findings, refers primarily to facet and disc generated pain

51
Q

referred pain

A

historical screening is helpful in revealing a visceral complain, referral zones

52
Q

bone pain

A

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
Q

nociceptive pain represents the normal response to..?

A

noxious insult or injury of tissues such as skin, muscles, visceral organs, joints, tendons or bones

54
Q

examples of nociceptive pain

A

somatic

visceral

55
Q

somatic nociceptive pain

A

musculoskeletal (joint of myofascial), cutaneous, well localized

56
Q

visceral nociceptive pain

A

hollow organs and smooth muscle, usually referred

57
Q

neuropathic pain is initiated by?

A

primary lesion or disease in the somatosensory nervous system

58
Q

sensory abnormalities for neuropathic pain

A

deficits perceived as numbness to hypersensitivity and to paresthesias

59
Q

examples of neuropathic pain

A 
diabetic neuropathy
postherpetic neuralgia
spinal cord injury pain
phantom limp
pain
post stroke central pain
60
Q

what should you consider if the msuculoskeletal pain doesn’t have an obvious mechanical or taumatic cause?

A

search for myofascial disorders, arthridites, phychological factors, CT disorders, cancer, infection

61
Q

sharp pain on motion

A

joint

62
Q

contant pain

A

joint or nerve

63
Q

burning/hot pain

A

nerve

64
Q

sharp no motion

A

nerve

65
Q

stabing

A

nerve

66
Q

tingling/numbness

A

nerve

67
Q

cramping/knot/spasm

A

muscle

68
Q

dull ache

A

muscle

69
Q

deep burning, dull pain

A

bone/ligament

70
Q

pinpoint pain over paraspinal tissue

A

MTRP

71
Q

crawling sensation

A

myofascial pain

72
Q

throbbing

A

vascular

73
Q

well localized

A

peripheral

74
Q

diffuse

A

central

75
Q

what structures can you directly palpate to test?

A

ligaments (stress), tendons (stretch), muscles (contraction)

76
Q

how do you test nerves?

A

tapping, compression, muscle testing, deep tendon reflexes, sensory testing

77
Q

decreased ROM can be caused by?

A 
subluxation
muscle spasm/strain
ligament sprain
arthritic conditions
obesity
78
Q

how can you tell between contracile and non-contractile tissue?

A

PROM

AROM

79
Q

contractile tissue

A

painful with stretch or mid range contraction

AROM not painful, painful PROM non contractile tissue involved

80
Q

pain on AROM

A

muscle or ligament

81
Q

pain on PROM

A

ligament, bursa, capsule

82
Q

bone pain

A

deep and worse at niht

Diff Dx (17 decks)

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