Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ortho 1-first half > UE differential diagnosis > Flashcards

UE differential diagnosis Flashcards

1
Q

shoulder/UE screening clues

A
  • simultaneous/alternating pain in other joints, esp easy fatigue, malaise, fever
  • urologic S/S
  • presence of hepatic S/S, esp when accompanied by risk factors for jaundice
  • lack of improvement after tx, including trigger point therapy
  • shoulder pain in a woman of childbearing age of unknown cause associated with missed menses (rupture of ectopic pregnancy)
  • left shoulder pain w/in 24 hours of abdominal surgery, injury, trauma (Kehr’s sign, ruptured spleen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

general systemic questions- cancer

A

Does your pain wake you at night? -cancer
Can you find any way to relieve the pain and get back to sleep? -cancer
If yes, how? (cancer: pain is usually intense and constant; nothing relieves it or if relief is obtained in any way, over time pain gets progressively worse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

general systemic questions- +Kehr sign

A

Have you sustained any injuries in the last week during a sports activity, car accident, etc? -ruptured spleen associated with pain in the L shoulder, +Kehr’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

general systemic questions: rheumatic disease

A

Since the beginning of your shoulder problem, have you had any unusual perspiration for no apparent reason, sweats or fever?
Have you had any unusual fatigue (more than usual with no change in lifestyle), joint pain in other joints, or general malaise?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

general exam questions: for the PT

A

has the client had a laparoscopy in the last 24-48 hours?

-L shoulder pain: + Kehr’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

systemic causes of shoulder pain

A 
cancer
cardiovascular/vascular
pulmonary
renal/urologic
gastrointestinal/hepatic
gynecologic/other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

cancer & shoulder pain

A

NECK: metastases (leukemia, Hodgkin’s disease); cervical cord tumors; bone tumors

CHEST: metastases to nodes, lungs; bone metastasis to Tspine; breast cancer

ABDOMEN: pancreatic cancer; spinal metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

cardiovascular/vascular & shoulder pain

A

NECK: TOS

CHEST: angina/MI; pacemaker; pericarditis; aortic aneurysm

ABDOMEN: abdominal aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pulmonary & shoulder pain

A

NECK: pulmonary tuberculsis

CHEST: pulmonary embolism; pulmonary TB; pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

renal/urologic & shoulder pain

A

ABDOMEN: kidney stones; obstruction, inflammation or infection of upper urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GI/hepatic & shoulder pain

A

CHEST: hiatal hernia

ABDOMEN: peptic/duodenal ulcer; ruptured spleen; liver disease; gallbladder disease; pancreatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

gynecologic/other & shoulder pain

A

CHEST: mastodynia; infection; diabetes; sickle cell anemia; hemophilia

ABDOMEN: ectopic pregnancy (rupture); subphrenic abscess; diaphragmatic hernia; anterior spinal surgery (post op hemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PMH screening clues

A
  • hx of rheumatic disease
  • hx of DM (adhesive capsulitis)
  • “frozen” shoulder of unknown cause in anyone with coronary artery disease, recent hx of hospitalization in coronary care or intensive care unit, status post CABG
  • recent hx (1-3 months) of MI
  • hx of cancer, esp breast or lung (metastasis)
  • recent hx of pneumonia, recurrent upper respiratory infection, influenza
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

subjective exam: pulmonary questions

A

-Have you been treated recently for a lung problem (or think that you have any lung or resp problems)?

Do you currently have a cough?

  • smoker’s cough?
  • how long?
  • productive cough (can you bring up sputum) and is the sputum yellow, green black or tinged with blood?

Do you ever have SOB, trouble catching your breath or feel breathless?

Does your shoulder pain increase when you cough, laugh or take a deep breath?

Do you have chest pain?

What effect does lying down or resting have on your shoulder pain?

  • in the supine or recumbent position, a pulmonary problem may be made worse, whereas a MS problem may be relieved
  • pulmonary pain may be relieved when the client lies on the affected side, which diminishes the movement of that side of the chest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pulmonary causes

A

pleural irritation results in sharp, localized pain aggravated by resp movement

“autosplinting”-lying on the affected side to decrease movement: also decreases pain
-if pain is MS, it would increase in this position

Yellow flag- shoulder pain worsening with recumbence bc of increased venous return

pneumonia: shoulder pain when affected lung presses on diaphragm-usually accompanied by confusion

should look for:

  • persistent/productive cough
  • chest pain
  • tachypnea
  • dyspnea
  • wheezing
  • hyperventilation

should do chest auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

subjective exam: cardiac questions

A

Have you recently (ever) had a heart attack?- referred pain via viscerosomatic zones

Do you ever notice sweating, nausea, or chest pain when the pain in your shoulder occurs?

Have you noticed your shoulder pain increasing w/ exertion that does not necessarily cause you to use your shoulder (climbing stairs, bicycle)?

does your mouth, jaw or teeth ever hurt when your shoulder is bothering you? -angina

for the client with known angina: does your shoulder pain go away when you take nitroglycerin? ask about effect of taking antacids/acid-relieving drugs for women

17
Q

cardiac causes

A

felt in shoulder bc heart and diaphragm supplied by C5 and C6

pain with increased activity not directly involving arm/shoulder

ask about:

  • nausea
  • unexplained sweating
  • jaw pain/toothache
  • back pain
  • chest discomfort/pressure

if known to have heart disease ask about:

  • effect of nitroglycerin (men) on shoulder symptoms
  • antacids/ acid-relieved drugs (women) on shoulder symptoms

take vital signs
do chest auscultations

angina/MI
complex regional pain syndrome
TOS
bacterial endocarditis
pericarditis
aortic aneurysm
18
Q

angina/MI

A

can appear as arm and shoulder pain
-misdiagnosed as arthritis or MS pathology

shoulder pain starts 3-5 minutes after starting activity even with isolated LE activity

pain is unaffected by position, breathing, movement

19
Q

stage 1 complex regional pain syndrome (type 1)

A

stage 1: acute lasting several weeks

  • burning, aching, throbbing pain
  • sensitivity to touch
  • swelling
  • muscle spasm
  • stiffness, loss of motion, and function
  • skin changes (warm, red, dry)
  • accelerated hair growth (dark hair in patches)
20
Q

stage 2 complex regional pain syndrome (type 1)

A

subacute, lasting 3-6 months

  • severity of pain increases
  • swelling may spread; tissue goes from soft to boggy to firm
  • muscle atrophy
  • skin becomes cool, pale, bluish, sweaty
  • nail bed changes (cracked, grooved, ridges)
  • bone demineralization (early onset of osteoporosis)
21
Q

stage 3 complex regional pain syndrome (type 1)

A

chronic, lasting >6 months

  • pain may stay the same, improve or get worse
  • irreversible tissue damage
  • muscle atrophy and contractures
  • skin becomes thin and shiny
  • nails are brittle
  • osteoporosis
22
Q

TOS

A

compression of neurovascular bundle

-variety of symptoms affecting arm, hand, shoulder girdle, neck, chest

23
Q

bacterial endocarditis

A

most common symptom is arthralgia (usually in proximal joints)

usually only 1 or 2 painful joints in the following order:

  • shoulder
  • knee
  • hip
  • wrist
  • ankle
  • MTP
  • MCP
  • AC

onset of pain is sudden with warmth, tenderness and redness

24
Q

pericarditis

A

accompanied by inflammatory process

accumulation of fluid in pericardial sac
-causes chest pain mimicking MI

pain may be relieved by kneeling with hands on floor, leaning forward, sitting upright

pain may be worsened by deep breathing, swallowing, belching

MI pain is unaffected by position, breathing, or movement

Ortho 1-first half (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions