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Abdo Pain
#fm
Objective
  • General inspection

    • Change in mental status (infection - UTI)

    • Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis)

  • Vitals

  • Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams

    • Tachypneic (pneumonia)

  • Abdo

    • peritoneal signs

    • Carnett’s sign (high ppv for abdo wall pain)

      • ↑ pain when supine pt raises head & shoulder, tensing abdo wall

    • Murphy’s sign (high ppv for choleycystitis)

    • Psoas sign (high ppv for appendicitis)

    • Sever pain out of proportion (ischemic bowel, pancreatitis)

    • restless/writhing (biliary/renal colic, testicular torsion)

    • LLQ tenderness (diverticulitis)

  • Rectal & pelvic exams if lower abdo & pelvic pain

    • DRE - fecal impaction, palpable mass, occult blood in stool

      • Tenderness & fullness on R of rectum suggests retrocecal appendix

    • Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess)

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Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm <span>Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss




Abdo Pain
#fm
Assessment
  • Common causes

    • IBS (discomfort/pain assc w/ altered bowel habits >3d/mo in prev 3 mo)

  • Less common but important causes

    • Appendicitis

    • Acute cholecystitis

    • Diverticulitis

    • Acute pancreatitis

    • Perforated ulcer

    • Bowel infarction

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Abdo Pain
Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss Psychosocial factors assc w/ chr & recurrent abdo pain <span>Assessment Common causes IBS (discomfort/pain assc w/ altered bowel habits >3d/mo in prev 3 mo) Less common but important causes Appendicitis Acute cholecystitis Diverticulitis Acute pancreatitis Perforated ulcer Bowel infarction Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx Labs CBC (infection/blood loss)




Headache
#fm #has-images

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan Non-pharm for migraine: &#




Abdo Pain (objective)
#fm

General inspection

  • Change in mental status (infection - UTI)

  • Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis)

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Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) &#13

Original toplevel document

Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm <span>Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss




Abdo Pain (objective)
#fm

Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams

  • Tachypneic (pneumonia)

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ive General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals <span>Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, ten

Original toplevel document

Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm <span>Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss




Abdo Pain (objective)
#fm

Abdo

  • peritoneal signs

  • Carnett’s sign (high ppv for abdo wall pain)

    • ↑ pain when supine pt raises head & shoulder, tensing abdo wall

  • Murphy’s sign (high ppv for choleycystitis)

  • Psoas sign (high ppv for appendicitis)

  • Sever pain out of proportion (ischemic bowel, pancreatitis)

  • restless/writhing (biliary/renal colic, testicular torsion)

  • LLQ tenderness (diverticulitis)

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e pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) <span>Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & ful

Original toplevel document

Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm <span>Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss




Abdo Pain (objective)
#fm

Rectal & pelvic exams if lower abdo & pelvic pain

  • DRE - fecal impaction, palpable mass, occult blood in stool

    • Tenderness & fullness on R of rectum suggests retrocecal appendix

  • Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess)

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pendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) <span>Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) <span><body><html>

Original toplevel document

Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm <span>Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss




Acute Abdo Pain
#fm

Labs

  • CBC (infection/blood loss)

  • Amylase + lipase (pancreatitis)

  • LFT (RUQ pain)

  • Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone)

  • Beta hcg (women in childbearing age)

  • Chlamydia + gonorrhea (women @ risk of STIs)

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Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx Labs CBC (infection/blood loss) Amylase + lipase (pancreatitis) LFT (RUQ pain) Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone) Beta hcg (women in childbearing age) Chlamydia + gonorrhea (women @ risk of STIs) Imaging (based on location) U/S (RUQ pain) abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain Transvag u/s for ectop

Original toplevel document

Abdo Pain
#13; Appendicitis Acute cholecystitis Diverticulitis Acute pancreatitis Perforated ulcer Bowel infarction <span>Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx Labs CBC (infection/blood loss) Amylase + lipase (pancreatitis) LFT (RUQ pain) Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone) Beta hcg (women in childbearing age) Chlamydia + gonorrhea (women @ risk of STIs) Imaging (based on location) U/S (RUQ pain) abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain Transvag u/s for ectopic pregnancy CT w/ IV contrast media (adults w/ acute RLQ pain) CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis LUQ pain (many causes so depends) Suggested esophageal/gastric patho = endoscopy or upper GI series Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature) Xray Free air under diaphragm (=perforation of GI tract) Abn calcifications (10% gallstones, 90% kidney stones) Mult dilated loops of bowel & air-fluid lvls (bowel obstruction) May see with paralytic ileus *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain Initial investigations & basic management for chr/recurrent abdo pain IBS Exercise: vigorous 3-5/week (all types of IBS)




Acute Abdo Pain
#fm

Imaging (based on location)

  • U/S (RUQ pain)

    • abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain

    • Transvag u/s for ectopic pregnancy

  • CT w/ IV contrast media (adults w/ acute RLQ pain)

  • CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis

  • LUQ pain (many causes so depends)

    • Suggested esophageal/gastric patho = endoscopy or upper GI series

    • Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature)

  • Xray

    • Free air under diaphragm (=perforation of GI tract)

    • Abn calcifications (10% gallstones, 90% kidney stones)

    • Mult dilated loops of bowel & air-fluid lvls (bowel obstruction)

      • May see with paralytic ileus

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itis) LFT (RUQ pain) Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone) Beta hcg (women in childbearing age) Chlamydia + gonorrhea (women @ risk of STIs) <span>Imaging (based on location) U/S (RUQ pain) abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain Transvag u/s for ectopic pregnancy CT w/ IV contrast media (adults w/ acute RLQ pain) CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis LUQ pain (many causes so depends) Suggested esophageal/gastric patho = endoscopy or upper GI series Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature) Xray Free air under diaphragm (=perforation of GI tract) Abn calcifications (10% gallstones, 90% kidney stones) Mult dilated loops of bowel & air-fluid lvls (bowel obstruction) May see with paralytic ileus *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain<span></bo

Original toplevel document

Abdo Pain
#13; Appendicitis Acute cholecystitis Diverticulitis Acute pancreatitis Perforated ulcer Bowel infarction <span>Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx Labs CBC (infection/blood loss) Amylase + lipase (pancreatitis) LFT (RUQ pain) Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone) Beta hcg (women in childbearing age) Chlamydia + gonorrhea (women @ risk of STIs) Imaging (based on location) U/S (RUQ pain) abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain Transvag u/s for ectopic pregnancy CT w/ IV contrast media (adults w/ acute RLQ pain) CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis LUQ pain (many causes so depends) Suggested esophageal/gastric patho = endoscopy or upper GI series Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature) Xray Free air under diaphragm (=perforation of GI tract) Abn calcifications (10% gallstones, 90% kidney stones) Mult dilated loops of bowel & air-fluid lvls (bowel obstruction) May see with paralytic ileus *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain Initial investigations & basic management for chr/recurrent abdo pain IBS Exercise: vigorous 3-5/week (all types of IBS)




Acute Abdo Pain
#fm #has-images

  • *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt

    • CONSIDER IN ALL OLDER PTS w/ abdo pain

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Abn calcifications (10% gallstones, 90% kidney stones) Mult dilated loops of bowel & air-fluid lvls (bowel obstruction) May see with paralytic ileus <span>*occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain<span><body><html>

Original toplevel document

Abdo Pain
#13; Appendicitis Acute cholecystitis Diverticulitis Acute pancreatitis Perforated ulcer Bowel infarction <span>Plan (for acute abdo pain) - acute abdo = sudden, non-traumatic disorder needing urgent dx & tx Labs CBC (infection/blood loss) Amylase + lipase (pancreatitis) LFT (RUQ pain) Urinalysis (hematuria, dysuria, flank pain - UTI/kidney stone) Beta hcg (women in childbearing age) Chlamydia + gonorrhea (women @ risk of STIs) Imaging (based on location) U/S (RUQ pain) abdo/transvag ultrasound for pregnant women, even for LLQ/RLQ pain Transvag u/s for ectopic pregnancy CT w/ IV contrast media (adults w/ acute RLQ pain) CT w/ oral + IV contrast media (LLQ pain) - for sigmoid diverticulitis LUQ pain (many causes so depends) Suggested esophageal/gastric patho = endoscopy or upper GI series Others = CT (can image pancreas, spleen, kidneys, intestines, vasculature) Xray Free air under diaphragm (=perforation of GI tract) Abn calcifications (10% gallstones, 90% kidney stones) Mult dilated loops of bowel & air-fluid lvls (bowel obstruction) May see with paralytic ileus *occult UTI, perforated viscus, ischemic bowel ds* - potentially fatal, often missed or dx late in elderly pt CONSIDER IN ALL OLDER PTS w/ abdo pain Initial investigations & basic management for chr/recurrent abdo pain IBS Exercise: vigorous 3-5/week (all types of IBS)




Headache (subjective)
#fm #has-images

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Subjective

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan Non-pharm for migraine: &#




Headache (subjective)
#fm #has-images

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Subjective

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan Non-pharm for migraine: &#




Headache (subjective)
#fm #has-images

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan Non-pharm for migraine: &#




Adult Headache Algorithm
#fm
Red flags
  • emergent - thunderclap onset, fever & meningismus, papilledema w/ focal signs or reduced LOC, acute glaucoma
  • ​​urgent - temporal arteritis, papilledema, relevant systemic illness, elderly patient (new headache w/ cognitive change)

    If yes, refer & investigate

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Adult Headache Algorithm

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
Possible indicators of 2ndary headache
-unexplained focal signs
-atypical headaches
-unusual h/a precipitants
-unusual aura sx's
-onset >50 y/o
-aggravation by neck movmement - abn neck exam findings (consider cervicogenic h/a)
-jaw sx's - abn jaw exam findings (consider tmj disorder)

if yes to above, refer & investigate

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
If no red flags or 2ndary h/a, check for migraine:

h/a w/ 2 or more of:
-nausea
-light sensitivity
-interference w/ activities

*consider migraine dx for recurring 'sinus' h/a

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
If no red flags/2ndary HA/migraine, check for tension-type

HA w/ no nausea but 2 or more of:
-bilat HA
-nonpulsating pain
-mild to mod pain
-not worsened by activity

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
If migraine/TT headache, consider medication overuse:

Assess
-ergots/triptans/combo analgesics/codeine/other opioids for 10 or more d/mo
OR
-acetaminophen/NSAIDs 15 or more d/mo

Manage
-educate
-consider prophy med
-provide effective acute med for severe attacks but limit freq of use
-gradual withdrawal if opioids/combo analgesics w/ opioid or barbiturate
-abrupt/gradual withdrawal if acetaminophen/NSAID/triptan

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
Migraine management

-acute meds
-monitor for med overuse
-prophy meds if:
---HA >3d/mo and acute meds not effective
OR
---HA >8d/mo b/c risk of overuse
OR
---disability despite acute meds

behavioural management
-HA diary - freq, intensity, triggers, meds
-lifestyle factors - reduce caffeine, regular exercise, regular/adequate sleep/meals
-stress management strategies - relaxation training, CBT, pacing activity, biofeedback

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
If T-T HA:

-acute meds
-monitor for med overuse
-prophy meds if disability despite acute med

behavioural management
-HA diary - freq, intensity, triggers, meds
-lifestyle factors - reduce caffeine, regular exercise, regular/adequate sleep/meals
-stress management strategies - relaxation training, CBT, pacing activity, biofeedback

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Adult headache algorithm
#fm
If not migraine/TT HA, check for uncommon HA syndromes.

If all of:
-freq HA
-severe
-brief (<3h)
-unilat, always same side
-ipsilat eye redness/tearing/restlessness during attacks

Then cluster HA or another trigeminal autonomic cephalagia:
-acute med
-prophy med
-early specialist referral


If all of
-unilat, same side
-continuous
-dramatically responsive to indomethacin

Then hemicrania continua: specialist referral


if HA continuous since onset: new daily persistent HA - specialist referral

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Adult Headache Algorithm

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Headache
Headache Adult Headache Algorithm Subjective Objective Plan




Flashcard 1401981373708

Tags
#fm
Question
Manning criteria (3 or more of) for IBS
Answer
-pain relief w/ bowel mvnt
-more freq stools w/ onset of pain
-loose stools w/ onset of pain
-passage of mucus
-sensation of incomplete evacuation
-abdo distention


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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Pain relief w/ bowel mvnt, More freq stools w/ onset of pain, Loose stools w/ onset of pain, Passage of mucus, Sensation of incomplete evacuation, abdo distention Manning criteria (3 or more of) for IBS

Original toplevel document

Abdo Pain
; Not just hx of fever/ds, physical findings too (e.g. distention, tenderness, rectal blood, etc) Onset, duration, severity, quality, exacerbating/remitting factors <span>Pain relief w/ bowel mvnt, More freq stools w/ onset of pain, Loose stools w/ onset of pain, Passage of mucus, Sensation of incomplete evacuation, abdo distention Manning criteria (3 or more of) for IBS Red flags New onset of pain, Change in pain, Altered bowel habits in elderly Check if all 3 are particular to elderly, or just the altered







Flashcard 1401983733004

Tags
#fm
Question
S&S of surgical abdo
Answer
-fever
-protracted vomiting
-syncope/pre-syncope
-evidence of GI blood loss


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss

Original toplevel document

Abdo Pain
retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) <span>S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss Psychosocial factors assc w/ chr & recurrent abdo pain Assessment Common causes IBS (discomfort/pain assc w/ a







Back Pain
#fm #has-images
Subjective

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Back Pain
Back Pain (acute and chronic) *Just use the core back tool, it’s so good* Subjective Objective Plan Opioid Risk Tool </bod




Back Pain
#fm #has-images

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Back Pain
Back Pain (acute and chronic) *Just use the core back tool, it’s so good* Subjective Objective Plan Opioid Risk Tool




Back Pain
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#13; Back Pain (acute and chronic) *Just use the core back tool, it’s so good* Subjective Objective <span>Plan Opioid Risk Tool <span><body><html>




Back Pain
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Flashcard 1402094882060

Question
Do zagadnień wchodzących w zakres elektrotechniki należą: wytwarzanie, przesyłanie, rozdzielanie, przetwarzanie energii elektrycznej.
Answer
Do zagadnień wchodzących w zakres elektrotechniki należą: wy twarzanie, przesyłanie, rozdzielanie, przet warzanie energii elekt rycznej.


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Prąd stały Prądem elektrycznym nazywamy stosunek ilości ładunku przepływającego przez przekrój przewodnika w małym przedziale czasu lub jest to zjawisko uporządkowanego ruchu ładunków elektrycznych przez badany przekrój poprzeczny środowiska pod działaniem pola elektrycznego. Wyrażany jest za pomocą zależności: I =d q /d

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Article 1402100387084


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D et Coaching Adjustments Manual Everything you need to succesflly cut to shreds R B JP Purchased by Richie Han, richiehanschool@gmail.com #6478326 1 Table of content Part 1 Why Successful People Don’t Just Make Random Cuts To Their Calorie Intake 4 Part 2 Forget Your Calculations - Why We Need To Track & Make Adjustments As We Diet 7 Part 3 Expect Fluctuations, Identify Stalls, And Anticipate Whooshes 10 Part 4 How I Recommend You Track Your Progress 14 Part 5 How Quickly Should I Cut? 19 Part 6 The Role Of The Diet Break 24 Part 7 When & How To Make Adjustments To Your Calorie Intake 27 Part 8 Full Examples Of How I Coached The Clients You Voted On 38 Part 9 Coming Back Up To Maintenance To Maximally Maintain Your Shreds 48 R BODY JP Purchased by Richie Han, richiehanschool@gmail.com #6478326 2 This book is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of



Flashcard 1402200788236

Question
• If we slash calorie intake too much we risk losing muscle mass. - There are limits to how
much fat we can lose each day, and the leaner we get, the less we can lose. More on this in
part 5.
Answer
[default - edit me]


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d. This can actually work fairly well if you’re pumped full of drugs that help to maintain your muscle mass, and keep your hormones in check, but for the rest of us it’s really not a good idea. Why is this not a good idea? <span>• If we slash calorie intake too much we risk losing muscle mass. - There are limits to how much fat we can lose each day, and the leaner we get, the less we can lose. More on this in part 5. • You’ll have less energy for your workouts, and without sufficient training intensity your ability to maintain your muscle mass will be hampered. • You’ll run out of places to