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Flashcard 1402802933004

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Question

What are the 2 important things to check on general inspection for abdo pain?

Answer

Change in mental status (infection - UTI)
Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis)

Original toplevel document

Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm 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

Flashcard 1402805292300

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Question

What should you look for on an abdo exam for a patient coming in with abdo pain? (7 pts)

Answer

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)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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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)

Original toplevel document

Flashcard 1402809224460

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Question

Rectal & pelvic exams if [...] pain

Answer

lower abdo & pelvic

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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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

Original toplevel document

Flashcard 1402811583756

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Question

What are you checking for on a DRE for abdo pain?

Answer

fecal impaction, palpable mass, occult blood in stool

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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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 (

Original toplevel document

Flashcard 1402813943052

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Question

DRE - Tenderness & fullness on R of rectum suggests [...]

Answer

retrocecal appendix

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Parent (intermediate) annotation

Original toplevel document

Flashcard 1402816302348

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Question

What are you looking for on a pelvic exam for pt with abdo pain?

Answer

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

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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ms 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) <body><html>

Original toplevel document

Flashcard 1402822855948

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#has-images

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402827574540

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#has-images

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402830458124

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status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402835963148

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status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402838846732

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#has-images

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402844351756

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Question

CONSIDER IN ALL OLDER PTS w/ abdo pain (3 pts)

Answer

occult UTI

perforated viscus

ischemic bowel dz

*often missed or dx late in elderly pt - potentially fatal*

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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*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

Original toplevel document

Abdo Pain
#13; 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) 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)

Flashcard 1402847759628

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Question

In pt with HA on on >/= 15d/mo for >3mo & normal neuro exam, dx ... (2 pts)

Answer

- chr migraine if HA meets migraine dx criteria or are quickly aborted by migraine meds (triptans/ergots) on >/= 8d/mo
- chr TT HA if meets episodic TT HA criteria, except mild nausea may be present

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402849594636

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Question

chr migraine w/ med overuse if:

Answer

uses ergots/triptans/opioids/combo analgesics on >/= 10d/mo or plain acetaminophen/NSAIDs on >/= 15d/mo

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402852478220

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Question

When med-overuse h/a suspected, evaluate pt for presence of: (3 pts)

Answer

-psych comorbidities (anxiety/depression) - might need to be considered in planning overall rx strategy
-psychological/physical drug dependence
-use of inappropriate coping strategies - might benefit from training & development of more adaptive self-management strategies (manage controllable triggers, activity pacing, etc)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402854313228

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Question

headache diaries that record [...] are important in the prevention & tx of med-overuse h/a

Answer

acute medication intake

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402856148236

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Question

adult Migraine management (4pts)

Answer

- acute meds
- monitor for med overuse
-prophy meds (when to use on other flash card)
-behav management (specifics on other card)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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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 ---disabil

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402858507532

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Question

Migraine management

-acute meds
-monitor for med overuse
-prophy meds if:
---[...]
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

Answer

HA >3d/mo and acute meds not effective

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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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 -lifesty

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402860080396

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Question

Migraine management

-acute meds
-monitor for med overuse
-prophy meds if:
---HA >3d/mo and acute meds not effective
OR
---[...]
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

Answer

HA >8d/mo b/c risk of overuse

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Parent (intermediate) annotation

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402861653260

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Question

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
---
[...]
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

Answer

disability despite acute meds

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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l>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

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402863226124

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Question

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 - [...]
-lifestyle factors - reduce caffeine, regular exercise, regular/adequate sleep/meals
-stress management strategies - relaxation training, CBT, pacing activity, biofeedback

Answer

freq, intensity, triggers, meds

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

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-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</s

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402864798988

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Question

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 - [...]
-stress management strategies - relaxation training, CBT, pacing activity, biofeedback

Answer

reduce caffeine, regular exercise, regular/adequate sleep/meals

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Parent (intermediate) annotation

Open it
>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<body><html>

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402866371852

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Question

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 - [...]

Answer

relaxation training, CBT, pacing activity, biofeedback

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Parent (intermediate) annotation

Open it
---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<body><html>

Original toplevel document

Headache
Headache Adult Headache Algorithm Subjective Objective Plan

Flashcard 1402880789772

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Question

What is pattern 1 back pain?

Answer

disc pain

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402882624780

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Question

Meds for pattern 1 (disc pain) back pain (2pts)

Answer

acetaminophen, NSAID

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402884459788

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Question

Pattern 1 back pain recovery position + starter exercises

Answer

repeated prone lying passive extensions (hips on ground, arms straight)
-10 reps, 3x day

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402886294796

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Question

Pattern 1 back pain exercises resources (3pts)

Answer

ISAEC, health link BC, sask pattern 1

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402888129804

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Question

Pattern 1 backpain functional activities (3)

Answer

-encourage short freq walking
-reduce sitting activities
-use extension roll for short duration sitting

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402889964812

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Question

pattern 1 back pain follow up (2)

Answer

- 2-4 wks if referred to therapy or prescribed med
- PRN if given home program & relief noted in office visit

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402891799820

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Question

in pattern 1 back pain, engage pt for self management goals [when?]

Answer

once pain is reduced

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402893634828

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Question

what is pattern 2 back pain?

Answer

facet joint pain

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402895469836

Tags

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Question

What meds can you give for pattern 2 backpain? (2)

Answer

acetaminophen
NSAID

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402897304844

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Question

What are the recovery position & starter exercises for pattern 2 backpain?

Answer

-sitting in a chair, bend forward & stretch in flexion
-use hands on knees to push trunk upright
-small freq repetitions through the day

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402899139852

Tags

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Question

what are exercise resources for pattern 2 backpain?

Answer

isaec
health link bc
sask pattern 2

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402900974860

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Question

what functional activities are recommended for pattern 2 backpain? (2)

Answer

-encourage sitting or standing with foot stool
-reduce back extension and overhead reach

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402902809868

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Question

follow up for pattern 2 back pain

Answer

- 2-4 wk if referred to therapy or prescribed meds
-prn if given home program & relief noted in office visit

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402904644876

Tags

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Question

self management can be initiated for pattern 2 back pain [when?] with most patients

Answer

in 1st or 2nd session

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402906479884

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Question

What is pattern 3 back pain?

Answer

compressed nerve pain (sciatica)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402908314892

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Question

meds for pattern 3 back pain

Answer

may require opioids if 1st line pain meds not sufficient
(not sure what 1st line meds are yet)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402910149900

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#fm

Question

what are the recovery positions & starter exercises for pattern 3 backpain?

Answer

"Z" lie
*caution: exercise will aggravate the pain so start w/ pain reducing positions

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402911984908

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Question

what is the functional activity for pattern 3 back pain?

Answer

change positions freq from sit to stand to lie to walk

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402913819916

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Question

follow up plan for pattern 3 back pain

Answer

2 wks for pain management & neuro review

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402915654924

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Question

self management plan for pattern 3 back pain

Answer

pt not usually suitable for self management d/t high pain lvls & possible surgical intervention

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402917489932

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Question

what is pattern 4 back pain?

Answer

symptomatic spinal stenosis (neurogenic claudication)

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402919324940

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#fm

Question

what are meds for pattern 4 back pain?

Answer

acetaminophen
NSAID

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402921159948

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#fm

Question

what are the recovery position & starter exercises for pattern 4 back pain?

Answer

rest in a seated position or other flexed position to relieve the leg pain

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402923519244

Tags

#fm

Question

what is the functional activity recommended for pattern 4 back pain?

Answer

use support w/ walking or standing. use freq sitting breaks

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402925354252

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#fm

Question

what is the follow up plan for pattern 4 back pain?

Answer

6-12 wks for sx management & determination of functional impact

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402927189260

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#fm

Question

self management can be intiated for pattern 4 back pain [when] w/ most patients

Answer

in 1st or 2nd session

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402929024268

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#fm

Question

how can you divide up non-mechanical back pain? (2)

Answer

-non-spine related pain
-spine pain does not fit mechanical pattern

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402930859276

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#fm

Question

non-spine related pain (non-mechanical back pain):
what are other etiologies to consider prior to pain meds? (4)

Answer

internal organ pain referral
-kidney
-uterus
-bowel
-ovaries

status	not learned	measured difficulty	37% [default]	last interval [days]
repetition number in this series	0	memorised on		scheduled repetition
scheduled repetition interval		last repetition or drill

Flashcard 1402932694284

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what should you consider when a spine pain does not fit any of the mechanical patterns?

Answer

consider centralized pain meds (anti-depressants, anti-seizure, opioids)
-consider pain disorder

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Question

back pain

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back pain

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back pain

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back pain

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back pain

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back pain

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back pain

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back pain

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back pain

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back pain

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Question

what are specialist referrals for back pain? (5)

Answer

-physiatry
-cbt
-pain specialist
-multidisciplinary pain clinic
-rheumatologist
-other

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Question

what are the red flags (NIFTI) in back pain?

Answer

-neuro (diffuse motor/sensory loss, progressive neuro deficits, cauda equina syndrome)
-infection (fever, IV drug use, immune suppressed)
-fracture (trauma, osteoporosis risk/fragility fracture)
-tumour (hx of cancer, unexplained wt loss, sig unexpected night pain, severe fatigue)
-inflammation (chr low back pain >3mo, age of onset <45, morning stiffness >30min, improves w/ exercise, disproportionate night pain)

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Question

neuro back pain red flag - investigation = [...]

Answer

urgent MRI

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Question

back pain red flag: infection investigation = [...]

Answer

xray & MRI

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back pain red flag - fracture investigation = [...]

Answer

xray, may require ct

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Question

back pain red flag: tumour investigation = [...]

Answer

xray & MRI

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Question

back pain red flag: inflammation investigation = [...]

Answer

rheum consult & guidelines

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Question

what are sx's of acute cauda equina syndrome? (3)

Answer

-urinary retention followed by insensible urinary overflow
-unrecognized fecal incontinence
-distinct loss of saddle/perineal sensation

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Question

yellow flags in back pain are [...] for developing chronicity

Answer

psychosocial risk factors

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Question

back pain yellow flags

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back pain yellow flags

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back pain yellow flags

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back pain yellow flags

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back pain yellow flags

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Question

What qn's can you ask to determine presence of vertigo? (2)

Answer

“Does it feel like either the room is spinning or that you are spinning?” and/or “Is it triggered or worsened by turning your head or rolling over in bed?”

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Dizziness/Vertigo
Dizziness/Vertigo Approach to patient with Dizziness Subjective “Does it feel like either the room is spinning or that you are spinning?” and/or “Is it triggered or worsened by turning your head or rolling over in bed?” Yes = vertigo BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common) brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting Vestibular Neuritis rapid onset, severe, persistent (days), N/V, imbalance Ménière’s Disease recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo) Disequilibrium Dizziness – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc Nonspecific Dizziness – “woozy”, “giddy”, “light-headed” DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications Objective Assessment viral labyrinthitis benign positional vertigo Eustachian tube dysfunction (often with s

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Question

What are the 4 types of vertigo?

Answer

BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common)

[brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting]

Vestibular Neuritis

[rapid onset, severe, persistent (days), N/V, imbalance]

Ménière’s Disease

[recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness]

Vestibular Toxicity

[aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin]

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Subjective “Does it feel like either the room is spinning or that you are spinning?” and/or “Is it triggered or worsened by turning your head or rolling over in bed?” Yes = vertigo BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common) brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting Vestibular Neuritis rapid onset, severe, persistent (days), N/V, imbalance Ménière’s Disease recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered

Original toplevel document

Flashcard 1403063766284

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Question

BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common type of vertigo) consists of [what sx's?]

Answer

brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting

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Flashcard 1403066125580

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Question

Vestibular Neuritis (form of vertigo) is [like what?]

Answer

rapid onset, severe, persistent (days), N/V, imbalance

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Yes = vertigo BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common) brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting Vestibular Neuritis rapid onset, severe, persistent (days), N/V, imbalance Ménière’s Disease recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness Ves

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Question

Ménière’s Disease (form of vertigo) consists of [...]

Answer

recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness

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; brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting Vestibular Neuritis rapid onset, severe, persistent (days), N/V, imbalance Ménière’s Disease recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = o

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Question

Vestibular Toxicity (cause of vertigo) is caused by [...]

Answer

aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin

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scheduled repetition interval		last repetition or drill

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Open it
stent (days), N/V, imbalance Ménière’s Disease recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered

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Question

Other than vertigo, what are other forms of dizziness? (3)

Answer

Presyncopal Dizziness – “feels like nearly fainting or blacking out”

Disequilibrium Dizziness – “unsteadiness while walking”

Nonspecific Dizziness – “woozy”, “giddy”, “light-headed

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Open it
13; Vestibular Toxicity aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo) Disequilibrium Dizziness – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc Nonspecific Dizziness – “woozy”, “giddy”, “light-headed” DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications &

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Flashcard 1403075562764

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Question

What investigation should you do for presyncopal dizziness?

Answer

ECG

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uretics, ASA, NSAIDs, amiodarone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If y

Original toplevel document

Flashcard 1403077922060

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Question

What qn's should you ask a pt with presyncopal dizziness? (5)

Answer

Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice)

status	not learned	measured difficulty	37% [default]	last interval [days]
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Open it
darone, quinine, cisplatin No = other forms of dizziness Presyncopal Dizziness – “feels like nearly fainting or blacking out” ECG Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. med

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Flashcard 1403080281356

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Question

presyncopal dizziness:
Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice)

If yes to any, [suspect what, and do what?]

Answer

suspect cardiac etiology. Refer to Emergency

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Flashcard 1403082640652

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Question

Presyncopal dizziness:
Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice)

If no, [what should you check for?]

Answer

orthostatic hypotension

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Flashcard 1403084999948

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Question

If a pt with presyncopal dizziness has orthostatic hypotension, what should you do?

Answer

investigate underlying cause. meds/alcohol? Consider CBC/ lytes

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den death? Abnormal ECG? (if pt stable, fax ECG for urgent advice) If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo)

Original toplevel document

Flashcard 1403087359244

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Question

What is the likely etiology in a pt with presyncopal dizzness and no orthostatic hypotension?

Answer

likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo)

status	not learned	measured difficulty	37% [default]	last interval [days]
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Open it
If yes to any, suspect cardiac etiology. Refer to Emergency If no, orthostatic hypotension? Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo) Disequilibrium Dizziness – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out periph

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Flashcard 1403089718540

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Question

Disequilibrium Dizziness is often multifactorial, [common in who? a risk for ...? what exams should you do to rule out what?]

Answer

common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, et

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No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo) Disequilibrium Dizziness – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc Nonspecific Dizziness – “woozy”, “giddy”, “light-headed” DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, al

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Flashcard 1403092077836

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Question

What is the ddx for nonspecific dizziness? (8)

Answer

DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma

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s – “unsteadiness while walking” Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc Nonspecific Dizziness – “woozy”, “giddy”, “light-headed” DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications &

Edited, memorised or added to reading queue

on 02-Oct-2016 (Sun)

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