Term
| What is the most challenging decision for the PCP regarding chest pain? |
|
Definition
| determining if the cause is life threatening or not |
|
|
Term
| list a few common causes of non-cardiac chest pain |
|
Definition
Peptic ulcer disease (PUD)
Gastroesophageal reflux disease (GERD
Costochondritis
Acute anxiety |
|
|
Term
| when ruling out life-threatening conditions related to chest pain, things to consider are |
|
Definition
| MI, PE, and Aortic dissection |
|
|
Term
| Sudden onset of symptoms not relieved by rest or nitroglycerine |
|
Definition
|
|
Term
sudden tearing pain located in the anterior or posterior chest
May radiate to arms, legs abdomen or back |
|
Definition
|
|
Term
| what are s/s of pulmonary PE? |
|
Definition
Dyspnea
Apprehension
hemoptysis |
|
|
Term
| what are a few risk factors for PE? |
|
Definition
| bedrest or recent orthopedic surgery |
|
|
Term
| PE cause gripping/stabbing pain that increases with |
|
Definition
|
|
Term
| pain from PE may radiate to |
|
Definition
| back of neck and shoulders |
|
|
Term
| Pt with PE, can _____ to the exact location of the pain |
|
Definition
|
|
Term
| list some risk factors for CAD |
|
Definition
Male >45, female >55
Family history of premature coronary heart disease
Cigarette smoking
Hypertension
Low HDL <40
High LDL >130 |
|
|
Term
| review the following reasons to make an ED referral |
|
Definition
Non localized pain
Lasting > 20 minutes
Associated with
Diaphoresis
Dyspnea
N & V
Dizziness
Radiation
Neck
Jaw
Shoulder
arm |
|
|
Term
| it is important to remember that most life threatening conditions present as |
|
Definition
| acute conditions rather than chronic |
|
|
Term
| what population of people with caridiac disease may present with atypical symptoms? |
|
Definition
| Women, older adults and diabetic patients |
|
|
Term
| during the physical exam, a person with cardiac symptoms may appear |
|
Definition
Grimacing
Diaphoresis
Cyanosis
Pallor
Tachypnea |
|
|
Term
| a person with an MI may present with elevated |
|
Definition
|
|
Term
| A person with aoritic dissection may have a decrease in |
|
Definition
|
|
Term
| what breathing pattern is associated with chest pain< |
|
Definition
|
|
Term
| pain with palpation over the cartilage between the sternum and ribs |
|
Definition
|
|
Term
| when auscultating breath sounds, what is most commonly heard in a pt with PE? |
|
Definition
|
|
Term
| A new, transient, paradoxical S2 during pain can indicate |
|
Definition
|
|
Term
| S4 indicates stressed heart which can result from____,_____,or_____. |
|
Definition
| from MI hypertension or CAD |
|
|
Term
| Aortic diastolic murmur can occur with a |
|
Definition
|
|
Term
| when are irregular rhythms most often heard? |
|
Definition
|
|
Term
| PUD, cholecystitis, pancreatitis may cause |
|
Definition
|
|
Term
| peripheral cyanosis can indicate |
|
Definition
|
|
Term
| Lower extremity edema can indicate |
|
Definition
|
|
Term
| Absent peripheral pulses can occur with |
|
Definition
|
|
Term
| tx of costochondritis involves |
|
Definition
application of heat
NSAIDs
Condition is self limiting
avoid overuse and trauma |
|
|
Term
| if an acute MI has occurred, what is typically seen with cardiac troponins? |
|
Definition
| will rise 2-4hrs afterwards and remain elevated for 7-10days |
|
|
Term
| Rise 4-8 hours after MI and return to normal 48-72 hours |
|
Definition
|
|
Term
| ____rank as one of the ten most common problems seen in primary care |
|
Definition
|
|
Term
| what type of HAs are the most common in the general population? |
|
Definition
|
|
Term
| how long do tension HAs last |
|
Definition
| 30mins to a few hours; not seen in primary care typically |
|
|
Term
| review common descriptions of tension HA pain |
|
Definition
Bilaterality
Steady and nonpulsatile
Mild to moderate intensity (may prohibit but not inhibit activity)
Not aggravated by routine activity |
|
|
Term
|
Definition
|
|
Term
| Photophobia and phonophobia can be present in tension headaches except, they |
|
Definition
| do not occur simultaneously |
|
|
Term
| tension HAs do not have evidence of |
|
Definition
| underlying associated disease |
|
|
Term
| how long do migraines, without aura last? |
|
Definition
|
|
Term
| at least two of the following features must be present for dx of migraines |
|
Definition
Unilateral head pain
Throbbing
Moderate to severe intensity
Pain aggravated by routine activity |
|
|
Term
| another term for migraine with aura is |
|
Definition
|
|
Term
| in common migraines, one of the two additional symptoms should be presnt |
|
Definition
Nausea and/or vomiting
Photophobia and phonophobia |
|
|
Term
| ____occur in approximately 15% of migraine attakcs |
|
Definition
|
|
Term
| what time frame do auras occur? |
|
Definition
| preceed the headache by one hr |
|
|
Term
| most auras are visual and include symptoms like |
|
Definition
| flashes of light, alternating geometric patterns, alterations in perception – the “ Alice in Wonderland” syndrome |
|
|
Term
| _________consist primarily of numbness and tingling in the lips and fingers although they can occur anywhere. |
|
Definition
|
|
Term
| what are the three phases of migraine headaches? |
|
Definition
| prodrome, headache phase, postdrome |
|
|
Term
| prodrome involves changes in |
|
Definition
| mood or energy level (depression, euphoria, fatigue), alteration in sensory processing, changes in muscle tone, food cravings, fluid retention, yawning and a variety of other nondescript symptoms |
|
|
Term
| historically, chocolate was thought to be a trigger of migraines but recent studies have proven that it is a |
|
Definition
|
|
Term
| _____are important markers for the tx of migraines |
|
Definition
|
|
Term
|
Definition
|
|
Term
| headache phase can start off as mild in progress to severe in |
|
Definition
|
|
Term
| migraines are usually _____ but can be______. |
|
Definition
|
|
Term
| ______migraines last longer than 4-72hrs. |
|
Definition
|
|
Term
| migraines in children and adolescents last less than |
|
Definition
|
|
Term
| after a migraine headaches has resolved, post headaches symptoms may |
|
Definition
|
|
Term
| Fatigue, irritability, inability to concentrate, muscle pain, and/or food intolerance are common symptoms in the |
|
Definition
|
|
Term
| what are the 4 most important migraine dx questions? |
|
Definition
How do your headaches interfere with your life?
Has there been any change in your headache pattern
How do you experience headaches of any type?
How often do you use medication to treat headaches? |
|
|
Term
| pt with migraines should be encouraged to keep a ____ and document _____ |
|
Definition
|
|
Term
| dx should not be done in pt with migraines unless it will |
|
Definition
|
|
Term
| if dx of migraines HA is uncertain based on H and P, then test may need to be completed to differentiate______ or______ |
|
Definition
|
|
Term
| cluster HAs are seen most often in ____ and are _______. |
|
Definition
| men and extremely painful |
|
|
Term
| people who suffer from cluster HAs are a |
|
Definition
|
|
Term
| other vascular causes of HAs include_____,____, and _____. |
|
Definition
cerebral aneurysm
Subarachnoid hemorrhage
Increased intercranial pressure |
|
|
Term
|
Definition
| occurs with analgesic daily use; suspect when c/o daily HA |
|
|
Term
| what are some non-pharmacological ways to tx migraines? |
|
Definition
AVOID triggers
Relaxation techniques
Accupressure
Regular exercise, adequate sleep and good nutrition |
|
|
Term
| when should migraine abortive therapy be implemented? |
|
Definition
| at first indication of headache |
|
|
Term
| Triptans are used as abortive tx for migraines. What precuations should be taken with this medication? |
|
Definition
Separate all doses by at least 2 hours
May augment with Reglan if N & V severe
Preg Cat C - contraindicated |
|
|
Term
| preventative therapy for migraine tx should be initiated in those who |
|
Definition
have more than 4 per month
Very severe
Do not respond well to medication |
|
|
Term
| list the classes of preventative medications for migraines |
|
Definition
Beta blockers
Ca channel blockers
Anticonvulsants
Tricyclic antidepressants
SSRI’s |
|
|
Term
| what comorbid conditions should be considered in migraines? |
|
Definition
|
|
Term
| when should the pt with migraines f/u? |
|
Definition
| every 2-4 weeks X 3 months until responding well to medication |
|
|
Term
| differentiate b/t dizziness and vertigo |
|
Definition
| dizziness is a symptom and vertigo causes dizziness |
|
|
Term
the sensation of the person spinning or the environment spinning around the person
is called |
|
Definition
|
|
Term
Loss of balance and lack of coordination
is called |
|
Definition
|
|
Term
| Feeling that one is about to faint |
|
Definition
|
|
Term
| less than half of people presenting with dizziness actually have |
|
Definition
|
|
Term
| vestibular vertigo is caused by a |
|
Definition
| imbalance in the vestibular system |
|
|
Term
| peripheral vestibular vertigo is the |
|
Definition
| most common cause of vertigo |
|
|
Term
| vestibular vertigo is caused by |
|
Definition
| the inner ear and cranial nerve 8 |
|
|
Term
| central vestibular vertigo, though uncommon, is caused by |
|
Definition
| brainstem ischemia and infarction and demylenating disease such as MS |
|
|
Term
| Typically present with vertigo in association with other brainstem deficits |
|
Definition
| central vestibular vertigo |
|
|
Term
| Systemic viral or bacterial infection causing postural hypotension is a sign of |
|
Definition
|
|
Term
| metabolic problems such as ____,_____,and____ are cause of nonvestibular vertigo |
|
Definition
Hypo or hyperglycemia
Electrolyte disturbances
Anemia |
|
|
Term
| drugs such as ____,____,___, and ____ are causes of nonvestibular vertigo |
|
Definition
| antihypertensives, alcohol, analgesics, tranquilizers |
|
|
Term
| most common type of vertigo – caused by free floating particular matter which moves within the semicircular canal with certain head movements |
|
Definition
| Benign positional paroxysmal vertigo (BPPV) |
|
|
Term
| BPPV is a common problem seen in the |
|
Definition
|
|
Term
| what are some things that may set off vertigo in pt with BPPV? |
|
Definition
|
|
Term
| BPPV is not associated with ringing or hearing loss but is accomapanied by |
|
Definition
|
|
Term
| when diagnosing Meniere’s disease; the following are criteria for proper dx: |
|
Definition
2 episodes
Last at least 20 minutes each
Accompanied by hearing loss, tinnitus or aural fullness |
|
|
Term
| Vertigo is unrelated to position changes in this condition |
|
Definition
|
|
Term
Meniere’s disease is characterized
by______ hearing loss that may become _____ in 75% of pts. |
|
Definition
|
|
Term
| Meniere’s disease symptoms are usually |
|
Definition
|
|
Term
| Vestibular neuronitis, also known as labyrhitis is caused by |
|
Definition
| caused by viral infection of the labyrinth |
|
|
Term
| vestibular neuronitis involves the ____ and may cause____ |
|
Definition
|
|
Term
| how long does it take for vestibular neuronitis symptoms to resolve? |
|
Definition
|
|
Term
| vestibular neuronitis most often occurs after___ followed by____ |
|
Definition
|
|
Term
| review the questions that should be asked when obtaining the history of vestibular neuronitis |
|
Definition
Describe dizziness
Medical problems?
Do episodes occur with any specific activity or movement?
Associated symptoms?
Describe episodes especially onset, duration and any hearing involvement
Medications?
Recent infections?
Any recent head trauma? Ear surgeries? |
|
|
Term
| describe the weber test. Significance |
|
Definition
|
|
Term
| describe the rhinne test. significance |
|
Definition
|
|
Term
| the hallpike manuveur is a dx test for vertigo and causes |
|
Definition
intense vertigo in pt with vestibular problems
causes mild vertigo in those with central problems |
|
|
Term
Hallpike:
When performed on those with peripheral causes, what details are seen with nystagmus? |
|
Definition
| causes a 3-10sec delay in nystagmus that fatigues over time and is in a fixed position |
|
|
Term
Hallpike:
When performed on those with central causes, what details are seen with nystagmus? |
|
Definition
| it is immediate and does not fatigue and can predominate in any position |
|
|
Term
| ______can be useful in diagnosing chronic pheripheral disorders such as Meniere’s and persistant BPPV |
|
Definition
| Electronystagmography (ENG) |
|
|
Term
| An MRI should be completed in those who present with |
|
Definition
| if vertigo is of suddent onset and accompanied by severe HA, direction changing nystagmus or if risk factors for stroke |
|
|
Term
|
Definition
| in a few weeks without medical tx |
|
|
Term
| What affect does PT have on vestibular BPPV? |
|
Definition
|
|
Term
| what is the medicinal tx of choice for vertigo? |
|
Definition
|
|
Term
| ________________be used but is not as effective as exercises and do not suppress acute attacks |
|
Definition
|
|
Term
| review the management for menierie's disease |
|
Definition
Refer to otolaryngologist for testing and management
Bed rest during an attack
May recommend decreasing NA, caffeine, alcohol and tobacco but benefit unclear
Antivert and antiemetics with severe symptoms may help
Diuretics may reduce severity of attacks |
|
|
Term
| review the management for vestibular neuronitis |
|
Definition
Lie down in darkened room
Antibiotics if associated bacterial infection
Methylprednisone |
|
|
Term
| Antivert and antiemetics can be helpful during a vertigo attack but should be |
|
Definition
| stopped after 3 days since continuing may slow recovery |
|
|
Term
| vestibular neuronitis symptoms resolves spontaneously in |
|
Definition
|
|
Term
| ______Presents with unilateral paralysis of face |
|
Definition
|
|
Term
| Bell's palsy is proceeded by ______ and involves _____. |
|
Definition
| viral infection and cranial nerve 7 |
|
|
Term
| bell's palsy is acute in onset and maximum paralysis occurs within |
|
Definition
|
|
Term
| bell's palsy may cause altered _____ and increased sensitivity to ____ |
|
Definition
|
|
Term
| review pertinent hx questions for those with suspected bell's palsy |
|
Definition
Onset and progression
History of recent infections, especially viral
Any chronic diseases
Insect bites – Bell’s palsy is a common neuropathy with Lyme’s disease
Facial trauma?
Pregnancy? Occurs more frequently |
|
|
Term
| bell's palsy physical exam may reveal the following: |
|
Definition
Head and neck
Cranial nerve assessment
Corneal light reflex may be decreased
Eyeball may roll upward when close eyelid |
|
|
Term
| Bell's palsy is often seen in those with |
|
Definition
|
|
Term
| review management of bell's palsy |
|
Definition
Prevention of eye injury is the most important goal
Prevent exposure keratitis by protecting cornea with eye drops (methylcellulose bid_ and lubricant at HS)
Protective eyewear
Patching at bedtime
Massage of facial muscles |
|
|
Term
| how soon should pharmacological management of bell's palsy begin? |
|
Definition
| within the first couple of weeks |
|
|
Term
| what medications are recommend for the tx of bell's palsy? |
|
Definition
predisone in all patients
and antivirals in pts with severe symptoms
valacycolvir in preg Cat B |
|
|
Term
| how long is recovery time for bell's palsy? |
|
Definition
| 4-6months, 12months for full recovery |
|
|
Term
| this condition affects the 5th cranial nerve |
|
Definition
|
|
Term
| trigeminal neuralgia presents with recurrent episodes of |
|
Definition
| intense sharp, penetrating electric like pain on one side of the face |
|
|
Term
| frequency and duration of trigeminal neuralgia symptoms |
|
Definition
| varies; the cause is idiopathic in most cases |
|
|
Term
| name triggers associated with trigeminal neurolgia pain |
|
Definition
| cold, chewing, touch, talking or facial movements within trigger zone |
|
|
Term
| Physical exam of pt with trigeminal neurolgia should include examination of all |
|
Definition
|
|
Term
| the ____exam should be normal in pt with trigeminal neurolgia |
|
Definition
|
|
Term
| what medication is used to tx trigeminal neurolgia? |
|
Definition
| anticonvulsants; tegretol |
|
|
Term
|
Definition
| 100mg, BID with a max of 1200mg daily |
|
|
Term
| What lab test should be done while on tegretol? |
|
Definition
Need serial blood counts and liver function tests
Abrupt withdrawal should be avoided |
|
|
Term
| who should initiate tx for trigeminal neuralgia? |
|
Definition
| neurologist; PCP can manage condition after initial tx |
|
|
Term
| SSRI's are used for____ in pts with trigeminal nuerolgia. |
|
Definition
|
|
Term
| if symptoms do not respond to tx, those with trigeminal neurolgia require consultation with a |
|
Definition
|
|
Term
| _____presents with high fever, headache, photophobia and neck pain and stiffness (nuchal rigidty |
|
Definition
|
|
Term
| Meningitis is most often caused by |
|
Definition
|
|
Term
| Hx of meningitis should include |
|
Definition
Travel
Food consumption
Sexual practices
Systemic disorders
Drug use
History of infectious disease
immunocompromise |
|
|
Term
| signs of meningeal irritation can be assessed by testing for ____ and ______ |
|
Definition
| Brudinski’s sign and kernig's sign |
|
|
Term
| Brudinski’s sign is demonstrated when |
|
Definition
| hip and knee flexion with the neck flexed |
|
|
Term
| kernig's sign can be elicited when |
|
Definition
| inability to fully extend the legs |
|
|
Term
| when assessing for altered level of consciousness in meningitis, what are common signs encountered? |
|
Definition
Confusion
Lethargy
Stupor
Coma |
|
|
Term
| Assessment of cranial nerves in meningitis may reveal |
|
Definition
Diplopia
Deafness
Facial weakness
Pupillary abnormaliti |
|
|
Term
| review the labs indicated for suspect meningitis |
|
Definition
CBC – marked elevation of WBC’s
Blood cultures
Serum glucose
LP is indicated but will be done after referral |
|
|
Term
| what are ways meningitis can be prevented in unexposed persons? |
|
Definition
| pneumococcal vaccine, h influenza vaccine, and meningitis vaccine |
|
|
Term
| what are ways meningitis can be prevented in exposed persons? |
|
Definition
| Rifampin or cipro in those exposed to h influenza and meningiccocal; none recommended in pneumoccocal |
|
|
Term
| Radiculopathy is a pathologic process affecting the |
|
Definition
|
|
Term
| what vertebrae are most often affected by radiculopathy? |
|
Definition
|
|
Term
| the etiology or radiculopathy can be ____ or _____ |
|
Definition
| compressive or non-compressinve |
|
|
Term
| examples of compressive radiculopathy are____ and _____ |
|
Definition
Cervical Spoldylosis and
Disc Herniation |
|
|
Term
| examples of non-compressive radiculopathy are |
|
Definition
infectious processes (especially herpes zoster and Lyme disease
Nerve root infarction
Root avulsion
Infiltration by tumor
Infiltration by granulomatous tissue
Demyelination |
|
|
Term
| reflexes are reduced in radiculopathy of which cervical vertebrae? |
|
Definition
|
|
Term
| radiculopathy of C8 and T1 do not have any associated ______ to demonstrate affected nerve roots |
|
Definition
|
|
Term
Cervical radiculopathy Clinical symptoms:
____ and ______ associated with numbness and paresthesias in the upper extremity in the distribution of involved root |
|
Definition
|
|
Term
Cervical radiculopathy Clinical symptoms:
___ or _____ in the involved myotomes may occur |
|
Definition
| Muscle spasms, or fasciculations |
|
|
Term
Cervical radiculopathy Clinical symptoms:
The following symptoms are seen in those with root pressure above C5 |
|
Definition
| weakness, lack of coordination, changes in handwriting, grip strength, dropping objects from the hand, pain radiating into the paraspinal and scapular regions |
|
|
Term
Cervical radiculopathy Clinical symptoms:
Pts may report they can relieve the pain by |
|
Definition
| placing the hands on top of their head, as this decreases tension on the involved nerve root. |
|
|
Term
| The major aim of the neurologic examination in patients with suspected cervical radiculopathy is to look for evidence of weakness and sensory disturbance in _____ and _____. |
|
Definition
| myotomal and dermatomal patterns. |
|
|
Term
| when should the sperlings test be discontinued? |
|
Definition
| if limb pain or paresthesias present |
|
|
Term
| ______is helpful for supporting the diagnosis of cervical radiculopathy |
|
Definition
| a positive spherlings test; but a negative test does not rule it out |
|
|
Term
the spherlings test demonstrates a
High specificity for the presence of_________ , but low to moderate _____. |
|
Definition
| cervical radiculopathy and sensitivity |
|
|
Term
| sphurlings test should never be performed in those who |
|
Definition
| have instability of the cervical spine |
|
|
Term
| performing the sphurlings test in those with instability of the cervical spine may cause |
|
Definition
| it may cause further injury to the spine |
|
|
Term
| Cervical meyolopathy is another occasion when _____ in contraindicated. |
|
Definition
|
|
Term
| ____________ is positive when the pt has a decrease or elimination of radicular symptoms with this manuveur. |
|
Definition
|
|
Term
| in this test,the patient is asked to lift the symptomatic arm above the head, resting the hand on the top of the head |
|
Definition
| the patient is asked to lift the symptomatic arm above the head, resting the hand on the top of the head |
|
|
Term
| Neuroimaging and electrodiagnostic testing is indicated with |
|
Definition
| persistent symptoms that do not resolve with four to six weeks of conservative therapy |
|
|
Term
| Neuroimaging and electrodiagnostic testing is indicated with |
|
Definition
| significant neurologic findings or localizing symptoms are present, including myotomal weakness or myelopathy |
|
|
Term
| ___________is currently the study of choice in most patients for the initial neuroimaging evaluation of the cervical spine |
|
Definition
|
|
Term
| Performing electrodiagnostic testing when symptoms have been present for less than three weeks reduces the |
|
Definition
|
|
Term
| what test confirms the dx of radiculopathy? |
|
Definition
| needle electromyography (EMG), |
|
|
Term
| review differentials for radiculopathy. |
|
Definition
Adhesive capsulitis
Demylenating conditions
Myocardial ischemia
Peripheral nerve entrapment
Rotator cuff disease
Thoracic outlet syndrome |
|
|
Term
| Conservative Treatment is recommended for patients with cervical radiculopathy who have clear radicular pain and symptoms of |
|
Definition
| paresthesia, numbness, or nonprogressive neurologic deficits |
|
|
Term
| once physical pain is under control, pt with radiculopathy may |
|
Definition
| initiate physical therapy with exercise and gradual mobilization |
|
|
Term
| ________Injections for patients with refractory symptoms despite a course of conservative therapy, and who do not have a progressively worsening neurologic deficit |
|
Definition
|
|
Term
| pain management for radiculopathy can include____,_______, or _____ in severe/hard to tx cases. |
|
Definition
| oral analgesics (e.g., NSAIDs), avoidance of provocative activities and steroids |
|
|
Term
| the following individuals would be candidates for surgical intervention if dx with radiculopathy |
|
Definition
Symptoms and signs of cervical radiculopathy
Cervical nerve root compression by MRI or CT myelography at the appropriate side and level(s)
Persistence of radicular pain despite nonsurgical therapy for at least 6 to 12 weeks, or progressive motor weakness that impairs function |
|
|
Term
| ____ is a common condition and is self limiting |
|
Definition
|
|
Term
| muscle injury to the neck |
|
Definition
|
|
Term
| ligamentous stretching-type injury |
|
Definition
|
|
Term
| ” when ligament is torn, usually C7 |
|
Definition
|
|
Term
| Cervical pain may occur after |
|
Definition
| trauma or may be spontaneous onset |
|
|
Term
| cervical pain is often worse with _____ and accompanied by ______. |
|
Definition
| motion and paraspinal spasm |
|
|
Term
| _________ may occur in the early phase and may persist longer than pain following strains and sprains of spontaneous onset. |
|
Definition
|
|
Term
| The straight leg raise test may be useful to help confirm |
|
Definition
|
|
Term
| With lumbar radiculopathy there may be____ and _____ |
|
Definition
| decreased DTRs and early neurological changes |
|
|
Term
| Subacromial bursitis-most common in _____ and young______ |
|
Definition
| older adults and athletes who throw |
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Term
| _______is the most likely diagnosis when pain is accompanied by stiffness and a significant loss of movement (debilitation) in both active and passive motion of the shoulder. |
|
Definition
| adhesive capsulitis/frozen shoulder |
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Term
| Cervical nerve root impingement can produce sharp pain radiating from the |
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Definition
| neck into the posterior shoulder area and arm |
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Term
| Patients who complain of elbow swelling most often have |
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Definition
|
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Term
| arises either from the medial epicondyle or the ulnar nerve as it travels through the cubital tunnel. |
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Definition
| Medial epicondylitis – “golfer’s elbow” (pain) |
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Term
| is well localized and is aggravated by actions that contract the wrist flexors, such as lifting or repetitious use of the forearm and wrist. |
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Definition
|
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Term
| is aggravated by activity involving resistive wrist extension, including repetitious use of the forearm and wrist and shaking hands |
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Definition
|
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Term
| review the symptoms of lateral epicondylitis |
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Definition
tenderness of the lateraly epicondylitis
pain produced by resisting wrist extension
pain reproduced by resisting radial deviation of the wrist
dimished grip strength |
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Term
| review symptoms of medical epicondylitis |
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Definition
tenderness of the medial epicondyle
pain reproduced by resisted wrist flexion
pain reproduced by resisted ulnar deviation of the wrist
diminished grip strength |
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Term
| review symptoms of olecranon bursitis |
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Definition
| cystis swelling or thickening over the olecranon process |
|
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Term
| review symptoms of radiohumeral bursitis |
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Definition
loss of full elbow extension
lateal bulge sign
loss of full elbow extension
loss of full flexion
loss of supination and pronation |
|
|
Term
| review symptoms of referred shoulder and neck pain |
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Definition
pain through the elbow
normal elbow range of motion
no local epicondylitis tenderness
no olecneon swelling |
|
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Term
| this condition is caused by Entrapment of the median nerve at the wrist. |
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Definition
|
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Term
| what population is most affected by carpal tunnel syndrome |
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Definition
|
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Term
| In pregnancy, when do symptoms occur? Resolve? |
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Definition
| 2nd/3rd trimester and 3months pp when swelling goes away |
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Term
| Review s/s of carpal tunnel syndrome |
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Definition
Reports vague aching that radiates into the thenar area.
Aching may be perceived in the proximal forearm, an pain can extend into the shoulder.
Pain is typically accompanied by paresthesias or numbness in the median distribution (thumb index finger, long finger, and radial half of the ring finger, or some combination of those).
Often symptoms are worse at night.
Dropping objects, can’t open jars or twist lids. |
|
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Term
| what age group is most often affected by osteoarthritis? |
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Definition
|
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Term
| osteoarthritis pain is caused and relived by_____ |
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Definition
|
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Term
| what symptom is present upon awakening in the morning in those with osteoarthritis? |
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Definition
| stiffness; resolves within 30mins after awakening |
|
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Term
| what is gelling, when relating to osteoarthritis? |
|
Definition
| stiffness that occurs from inactivity |
|
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Term
| though osteoarthritis may stabilize in some pt, it is typically a disease of |
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Definition
|
|
Term
| Herbden’s nodes and Bouchard’s nodes are found in where, in those with osteoarthritis? |
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Definition
| (distal joints)and (proximal joints |
|
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Term
| OA does not affect all joints equally; it has a predilection for the_____,_____,_____ ,and _______ and rarely affects the elbows, wrists, and ankles |
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Definition
| fingers, knees, hips, and spine |
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Term
| _____________is a chronic, systemic, inflammatory disorder of unknown etiology that primarily involves joints. |
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Definition
|
|
Term
| RA affects the joints_____. |
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Definition
|
|
Term
| subcutaneous nodules and ulnar drift are present in what condition? |
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Definition
|
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Term
| RA progress from proximal to distal joints and those who do not respond to initial therapy can expect |
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Definition
| significant locomoter disability in 10-20yrs |
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|
Term
| in RA, morning stiffness can last from ____to_____. |
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Definition
|
|
Term
| hand xrays in those with RA reveal |
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Definition
| bone erosions or bony decalcifications |
|
|
Term
| what are the most common knee injuries? |
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Definition
|
|
Term
| with most knee injuries pt are able to |
|
Definition
| continue doing normal activity right after the event |
|
|
Term
| with knee injury, pt will typically report why type of injury? |
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Definition
|
|
Term
| review symptoms of a 1st degree ankle injury |
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Definition
Results from mild stretching of a ligament with microscopic tears.
Mild swelling and tenderness.
No joint instability on examination, and the patient is able to bear weight and ambulate with minimal pain. |
|
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Term
| review symptoms of a 2nd degree ankle injury |
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Definition
More severe injury involving an incomplete tear of a ligament.
Moderate pain, swelling, tenderness, and ecchymosis.
Mild to moderate joint instability on exam with some restriction of the range of motion and loss of function.
Weight bearing and ambulation are painful |
|
|
Term
| review the symptoms of a 3rd degree ankle injury |
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Definition
Involves a complete tear of a ligament.
Severe pain, swelling, tenderness, and ecchymosis.
Significant mechanical instability on exam and significant loss of function and motion.
Patients are unable to bear weight or ambulate |
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Term
| this condition is thought to be as a result of altered central pain processing |
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Definition
|
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Term
| elevated CSF substance P; altered pain inhibitory mediators serotonin, norepinephrine; dysregulated response to HPA axis describes the pathophysiology of what condition? |
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Definition
|
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Term
| to be dx with fibromyalgia, the pt must exihibit pain in ____of____ pressure points |
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Definition
|
|
Term
| pain must be present for ____ or more months in fibromyalgia |
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Definition
|
|
Term
| depression, anxiety, chronic fatigue syndrome, migraine, IBS, restless legs, TMJ dysfunction, female urethral syndrome are often present in those with |
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Definition
|
|
Term
| review the tx for women dx with fibromyalgia |
|
Definition
Non-pharmacologic treatment
Exercise – supervised aerobic exercise
Cognitive behavioral therapy
Strength training, acupuncture, hypnotherapy, biofeedback, medicinal baths
Pharmacologic treatment
NSAIDs are not effective
Tricyclic antidepressant - initiating therapy with a low dose of a tricyclic medication (amitriptyline 10 mg at night time) to improve sleep
In patients with mild to moderate symptoms, cyclobenzaprine is an alternative to amitriptyline |
|
|
Term
| what affect does opiod use cause in those with fibromyalgia |
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Definition
| neuroadaptive changes that maintain or enhance central sensitivity to pain |
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