Differential Diagnosis Practical

Terms in this set (96)

General Health Checklist
Fatigue / Malaise
- outside of patient's normal or worsening
- feeling of something being wrong

Fever / Chills / Sweats
- fever >102 or 99.5 (low grade) for 2 weeks
- for elderly, body temperature is naturally lower, so a lower temp than 102 or 99.5 may be a fever
cold for weeks on end, can't get warm
excessive sweating

Nausea / Vomiting
- more than 2 weeks

Unexplained weight change
-gain or loss of >10 lbs in 1 month, unless done healthfully or there is a reason (emotional distress gain)
- 3-5 lbs/day with cardiac impairment (CHF)

Paresthesia / Numbness / Weakness
- bilateral is not normal
- not following a myotomal/dermatomal pattern

Dizziness / Lightheadedness
- 2 weeks or more - refer to MD if been going on for a few days though

Mentation / Cognitive deficits
- confusion is NEVER normal, no matter what the age; it is not a normal part of aging
- may have to ask family members
- a o x __
Acute Coronary Syndromes
MI S/S
- pain in chest, arm, shoulder, back
- indigestion, n/v, belching, dyspnea, diaphoresis, dizziness
- precipitated by activities that involve reaching overhead

Demographics
- older age, menopausal women, African American > Caucasian
Pericarditis
Associated factors
- infectious process (flu, HIV, TB); can take 2-3 weeks to develop after infection
- cancer, kidney failure, autoimmune
- injury to heart (MI, radiation, surgery)

S/S
- chest pain
- radiation to neck, upper back, upper trap, left supraclavicular area, left arm, costal margins
- malaise
- fatigue
-dyspnea
- myalgia
- increased temp
- increased HR

Relieving factors
- anything/position that reduces stress on heart
- sitting upright
- leaning forward
- holding breath

Aggravating factors
- anything/position that puts stress on heart
- trunk movement
- laying down
- deep breathing
Endocarditis
Risk factors
- previous valve damage
- congenital heart defects
- invasive diagnostic procedures

Symptom differentiation compared to pericarditis
- arthralgia most common (shoulder, knee, hip, wrist, ankle - usually 1-2 joints)
- myalgia
- muscle fatigue
Mitral Valve Prolapse
Often no S/S unless patient is taxed

Can be caused by autoimmune or infectious disease
Congestive Heart Failure - Left Sided
Respiratory S/S
- SOB
- cough
- dyspnea
Congestive Heart Failure - Right Sided
Systemic S/S
- edema
- JVD
- weight gain (3-5 lbs/day = bad)
- cyanosis
Conduction Problems - Fibrillation
Risk factors
- previous MI
- CAD
- HTN
- digitalis toxicity
- pericarditis
- alcohol
- caffeine
- high fevers
- neurological impairment

S/S
- generalized weakness
- postural instability
- increased falls
- balance impairment

Rehab concerns
- monitor vitals, especially with activity
Peripheral Vascular Disorder - Arterial
Pathogenesis
- blood flow doesn't meet muscle demand with exercise

Acute arterial risk factors
- vascular surgery
- arterial invasive procedures
- AAA
- trauma
- chronic atrial A fib

Acute arterial S/S
- 6 Ps
- pain
- pallor
- pulselessness
- paresthesias
- poikliothermia (feeling cold)
- paralysis


Chronic arterial risk factors
- older age
- m > f
- genetics
- DM
- smoking
- HTN
- high cholesterol
- obesity
Arterial Peripheral Vascular Disorder - Claudication
Vascular claudication
- severe pain after legs are elevated
- pain relieved with sitting

Neurogenic claudication
- tingling
- burning
- numbness
- ischemic pain

Vascular vs. Neurogenic Claudication
- reproducible
- pain decreased within 5-10 minutes at rest
- VanGeldren's test (bicycle test)
Well's Clinical Decision Rule
Active cancer (treatment within 6 months) +1

Paralysis, paresis, immobilization of LE +1

Bedridden >3 days due to surgery within 4 weeks +1

Localized tenderness along deep veins +1

Entire leg swollen +1

Unilateral calf swelling >3 cm (below tibial tuberosity) +1

Unilateral pitting edema +1

Collateral superficial veins +1

Alternative diagnosis as likely or more likely than DVT -2
Well's Clinical Decision Rule - Scoring
Well's score >3
- high risk of DVT
- consider imaging legs

Well's score 1-2
- moderate risk of DVT
- consider blood test (d-dimer)

Well's score 0
- low risk of DVT
COPD - Associated Signs
Bronchitis
- mild fever
- malaise
- cough
- dyspnea
- wheezing


Emphysema
- dyspnea
- orthopnea
- weight loss
- malaise
- wheezing
- increased RR
- peripheral cyanosis


Asthma
- wheezing
- dyspnea episodes
- cough
- unusual pallor
- unexplained sweating!
- fatigue
Asthma - S/S
Exercise Induced
- coughing, wheezing
- tightening of chest
- unusual fatigue
- SOB when exercising


Status asthmaticus
- BP drop >10 mmHg during inspiration
- SOB
- unable to speak in full sentences
- bluish tinge on lips
- agitation, confusion, inability to concentrate
- accessory respiratory muscle use
- medical emergency!
- can cause lack of oxygen to brain
Pneumonia - Causes and Unusual S/S
Causes
- aspiration (common in SCI, CVA, PD, myasthenia gravis)
- inhalation of caustic chemicals, dust, gasses, smoke
- infectious agents


Unusual S/S
- confusion in older adults
- painful/swollen knees
- shoulder pain
Tuberculosis - General Info and S/S
Passed in the air (airborne droplets)


S/S
- weight loss
- decreased appetite
- night sweats
- fever
- fatigue
- cough


TB can affect pulmonary and MS system
- Pott's disease (spine)
- Osteoarticular TB (hips)
Spinal TB aka Pott's Disease
TB comes out of pulmonary system and starts to affect bone


S/S
- back pain
- constitutional symptoms
- fatigue/malaise
Neoplastic Disease - Metastases
Metastases to
- long bones
- vertebral column
- liver
- adrenal glands
- brain
- places near the lungs


Metastasis from
- colon
- kidney
- breast
- pancreas
- uterus
Lung Cancer S/S
- change in respiratory patterns
- recurrent pneumonia
- hemoptysis
- persistent cough
- change in cough
- hoarseness/dysphagia
- sputum streaked with blood
- wheezing
- sharp/pleuritic pain
- sudden, unexplained weight loss
- chest, shoulder, or arm pain
- atrophy and weakness of the arm and hand muscles
Lung Cancer - Tumor Location
Centrally located
- arrhythmias possible due to tumor pressing on heart


Peripheral tumors
- often asymptomatic


Apical (Pancoast) tumors
- C8-T2
- main S/S in C8-T2:
- weak intrinsics
- weak forearm muscles
- upper trap inflammation/swelling
- shoulder blade pain
Pneumothorax
Free air in the pleural cavity; air between lung and chest wall


Caused by
- spontaneous
- injury (MVA, fight)
- scuba diving!


Risk factors
- history of pulmonary disease (especially COPD)
- 20-40 years old


Treatment
- chest tube
- must make sure patient can be taken off suction for PT


S/S
- dyspnea
- change in respiratory movements
- sudden, sharp chest pain
- increased neck vein distention
- fall in BP
- weak and rapid pulse
- dry, hacking cough
- shoulder pain
- relieved by sitting upright
Pulmonary Embolism
Blood clot breaks off and goes to the lungs


Risk factors
- age
- recent surgery (especially THA - 1 in 20)
- recent trauma
- F > M

S/S
- non-specific, can vary
- dyspnea
- pleuritic pain
- cough
- increased anxiety
- skin color changes
- diaphoresis
Anemia - S/S
- fatigue
- bruising
- pallor
- SOB
- dyspnea with exertion
- weakness
- nail bed changes
- headaches
- dizziness
- syncope
- higher HR
- lower BP
- sensitive to changes in BP and HR


Patients with long-term anemia may not be as symptomatic as someone with acute anemia because the body adapts


Need to know
- hemoglobin M: 13-18, F: 12-16
- hematocrit M: 42-53%, F: 37-48%
- H & H = hemoglobin & hematocrit
Sickle Cell Anemia - Crisis
Crises Causes
- infection
- hypoxia
- extreme temperatures
- dehydration
- fever
- strenuous physical exertion
- fatigue
- stress


Crisis S/S
- determined by clot location
- pain
- bone/joint crisis
- paresthesias
- CVA
- chronic ulcers


Some patients will have symptoms all the time and some won't have any until a crisis
Polycythemia - S/S
Clinical
- insidious onset
- vague complaints
- related to increased blood viscosity (too many RBCs --> thicker blood)


S/S noticed by PT
- SOB
- fatigue
- dizziness
- thrombus formation
- cyanosis
- clubbing
- peripheral vascular neuropathy
Leukocyte Disorders - Types
Body's reaction to disease process and noxious agents

Leukocytosis
- high leucocyte count (>10,000 mm3)
- high WBCs = infection brewing!
- be able to recognize S/S of infection
- sweats/chills, confusion, fever, redness/discharge in wounds


Leukopenia
- low leukocyte count (<5000 mm3)
- decrease in WBCs = may be autoimmune
- very susceptible to pathogens
- must keep everything very clean around them and keep away from sick people
Thrombocyte (Platelet) Disorders
Function
- stop active bleeding
- maintain capillary integrity


Count
- normal = 150K-450K
- decreased: radiation, chemo --> increased bleeding risk
- increased: smoking, sickle cell, polycythemia, smoking, diet, obesity --> put on blood thinners
Thrombocytosis
Increased blood viscosity caused by increased platelet count
- different from polycythemia
- polycythemia is increased viscosity due to increased RBC count


Causes
- compensatory post-op
- hemorrhage
- iron deficiency
- active cancer
Thrombocytopenia
Decreased platelets

Look at INR to determine thrombocytosis /vs. thrombocytopenia
- normal INR = 2-3

S/S
- bleeding after minor trauma
- spontaneous bleeding
- hemorrhage
- bleeding of gums
- blood in stools


Treatment
- Must be SO careful with patient falling!
- Give assistive devices, home safety/fall education
Coagulation Disorders
Hemophilia
- patients will bleed longer, but not faster
- a lot of patients will bleed into the joint space

Cause
- may be identifiable or spontaneous

S/S
- recurrent hemarthrosis
- muscle hemorrhage
- GI bleeds
Hepatic and Biliary Systems
Refer to
- right shoulder
- right scapular area
- mid-thoracic
- low back
- abdominal region
MS Pain Patterns
Liver
- location: mid-epigastric and RUQ
- referral: inter scapular region (T7-10), sub scapular region, right shoulder, upper trap
- pain description: diffuse, constant, dull ache
- pain intensity: mild-moderate
- aggravating factors: exercise, alcohol/drug use


Gallbladder
- location: mid-epigastric (heartburn), RUQ
- referral: right shoulder, interscapular region, sub scapular area, tip of 10th rib
- pain description: dull, achy, stabbing
- aggravating factors: fatty/greasy foods (2-3 hours after meal)
- usually female, >40, overweight
- check Murphy's sigh
Hepatic Osteodystrophy
Abnormal development of bone due to bile suppression and hepatic disease

Higher risk
- older age
- high alcohol/drug use


S/S
- bone pain, skeletal deformity, muscle weakness and wasting
- wasted muscles, small extremities, distended stomach


Osteomalacia: Softening of bone due to vitamin D deficiency
- caused by liver not metabolizing everything properly
- seen a lot on x-ray in high weight bearing bones


Osteoporosis: porous bone
- most prevalent bone disease in the world
Skin Changes
Skin color: greyish skin, jaundice seen in very severe, late stage disease

Pruritus: itchiness, especially in hand/thenar eminence

Spider angiomas: seen a lot on nose and cheeks (picture of skin redness)

Liver palms: palms of hands get very red and itchy
Neurological Symptoms
Confusion
- primary symptom

Sleep disturbances

Muscle tremors

Hyperactive reflexes

Asterixis sign
- inability to maintain wrist extension with arm extension
- flap forward into wrist flexion with arm extension

Bilateral carpal tunnel
- build up of ammonia affects tendon sheaths
Hepatic Encephalopathy
Ammonia builds up into system and starts affecting brain

Patients very confused, cannot do what they want (delayed initiation of movement similar to PD)

How to distinguish between hepatic encephalopathy and dementia or infection: lab values! - BUN, ammonia, urea


Four stages
Prodromal (mild)
- slight personality changes

Impending (moderate)
- temors, asterixis, increased muscle tone, ataxia
- usually when patient starts seeking help

Stuperous (severe)
- marked confusion, hyperventilation

Comatose
- unarousable
- +Babinski
Hepatitis - Types
Hepatitis A and E
- fecal/oral route of transmission
- exposure to contaminated food/water


Hepatitis B, C, D, G
- blood born pathogens
- IV drug use, health care workers, sexually transmitted


Hepatitis C additional
- blood transfusions
- organ transplants
- allografts from cadavers
Hepatitis - Symtoms
S/S related to PT
- myalgias
- arthralgias
- peripheral neuropathies

Rheumatic disease can occur concurrently
- pain disproportionate to physical findings
- palmar tendonitis
- risk factors for hepatitis
Chronic Hepatitis - Metabolic Diseases
Wilson's Disease
- impaired biliary excretion of copper
- S/S: copper ring around iris of eye, tremor, shuffled gait, stooped posture
- genetic; very rare
- treatment: gait training, low copper diet


Hematochormatosis
- storage of excessive iron
- S/S: joint pain, fatigue, menstrual changes
- demographics: women >50, men 30-50; Northern European descent
Hepatitis Associated S/S
- fatigue
- anorexia
- fever
- arthralgia
- myalgia
- clay colored stools
- dark, orange urine
- headache
- jaundice
- indigestion
Cirrhosis - Progression
Portal hypertension
- blood stays in portal vein due to not being able to flow through liver which causes blood to back up into esophagus (esophageal varices) and abdomen (ascites)
- blood will eventually bypass the liver


Esophageal varices
- when blood from portal vein backs up into esophagus, causes blood vessels to enlarge and rupture
- often fatal unless patient gets transplant

S/S
- vomiting blood
- black, tarry stool
- decreased urine output due to liver not working enough to convert ammonia to urea in order to be excreted
- light headedness


Ascites
- bloated abdomen due to fluid in abdominal cavity
- can lead to abdominal hernias and increased lordosis
Cancer Metastases
Primary metastatic site from
- stomach
- esophagus
- colorectum
- pancreas
- lung
- breast


Associated S/S
- jaundice
- failure of health
- anorexia/weight loss
- muscle weakness
- constant ache mid-back
Gallbladder and Duct Diseases - Cholecystitis
Cholecystitis
- inflammation of the gallbladder
- can be caused by sludge of bile, infection, inflamed liver
- if patient goes through a rapid, large weight loss and not as much bile is needed, bile may remain in gallbladder and get sticky and eventually lead to stones (cholelithiasis) or infection inflammation (cholecystitis)
Gallbladder and Duct Diseases - Cholelithiasis
Cholelithiasis
- presence and formation of gallstones either blocking bile duct or blocking flow of bile
- accounts for 90% of gall bladder disease



Risk Factors
- age
- W>F if <60 years
- elevated estrogen (BC, pregnancy)
- obesity
- poor diet
- DM
- liver disease
- rapid weight loss
- genetics
- ethnicity (Native Americans, Mexican Americans)
Gallbladder and Duct Diseases - Primary Biliary Cirrhosis
Chronic Progressive inflammatory disease

- bone disease (anything that affects the liver and bile duct can affect the bones --> osteopenia/osteoporosis)

S/S
- chills
- low grade fever
- jaundice
- GI symptoms
- tenderness
Referral - Hepatic and Biliary
- new onset of myopathy
- obvious signs of hepatic disease
- development of arthralgias
- bilateral carpal or tarsal tunnel (buildup of ammonia can affect tendon sheaths)
- sensory neuropathy of unknown origin (caused by backup of ammonia)
GI Pain Patterns - Primary
Epigastric
From: gall bladder, stomach, pancreas, spleen, liver; must rule in/out cardiac
Refers to
- midsterum to xiphoid
- structures from T3-5
- around ribs/through chest

Periumbilical
From: small intestine, small amount of pancreas, appendix
Refers to
- structures from T9-11


Hypogastrium
From: bladder, kidneys, colon, large intestine
Refers to
- structures from T10-12


Reasons for abdominal pain
- organ distension (burning/tension)
- inflammation
- necrosis

Pain description
- gnawing, deep aching, boring, vague burning

Bi-directional referral (L or R)
GI Pain Patterns - Referred
Sympathetic reflexes

Sensory
Hyperesthesia
- increased sensitivity of skin
- afferent impulses S/S: itchy, skin temperature changes, dry skin

Hyperalgesia


Motor changes
- muscle spasm/guarding
- loss of segmental motion
Epigastric Pain
Ulcers
- intense, sharp pain behind breastbone
- radiates to back

Gastric ulcers = proximal GI tract
- pain related to food and usually begins 30-90 minutes after eating

Red flag
- PMD of peptic ulcers with new onset of back or shoulder pain --> bleeding ulcer

Pyloric/duodenal ulcers = distal GI tract
- pain begins 2-4 hours after eating



Heartburn (GERD)
- burning sensation that radiates towards neck
- bitter/sour tast in back of throat
- abdominal bleeding


MS Symptoms
- visceral problems may cause biomechanics changes
- muscle contractures
- spinal/rib movements


Early satiety could be due to: cancer/mass in/around stomach, obstruction, some ulcers


Gastroparesis
- slowing down of GI tract
- caused by: Crohn's, UC, end-stage diabetes, PD
Arthralgia
Relationship between gut inflammation and joint inflammation
- antigens cross from gut and cause inflammation elsewhere
- joint pain can occur 3-4 weeks after GI impairment

Usually asymmetric, migratory, and oligoarticular (1-2 joints)

Accompanying S/S
- fever
- skin rash
- malaise
- eye inflammation
- symptoms may not occur with GI symptoms


Enthesitis = inflammation of tendons, bony insertions (patellar tendon and costovertebral joints common)
Reactive Arthritis
Inflammatory spinal pain or synovitis
- can be caused by C-diff, flu, acute illness
- can turn into chronic arthritis due to disuse --> bony growths, contractures, etc.

Asymmetrical presentation in the LE
- migratory
- 1-2 joints

Can be triggered by infection in distal site (hand/foot)

Usually resolves in 3-12 months, but if untreated and favored --> chronic arthritis


Risk factors
- 20-40 years; M>F
- +family history
- IBD
- urethritis, cervicitis, diarrhea within 1 month of onset of S/S
- alternating buttock pain
- enthesopathy
- sacrolilitis


Sponydyloarthropathy family
- ankylosing spondylitis
- psoriatic arthritis
- enteropathic arthritis
- juvenile ankylosing spondylitis
- genetic component!
Psoas/Obturator Abscess
S/S
- fever
- night sweats
- lower abdominal, pelvic, back pain
- referred pain to hip, medial thigh, groin, knee


Screening tests
- heel tap
tapping on heel very hard --> +ipsilateral R/L lower quadrant pain
- hop test
hopping on one leg --> +ipsilateral R/L lower quadrant pain
- muscle test
psoas test
- palpation
Gastroesophageal Reflux Disorder
Pain patterns
- apnea and dysphagia
- clearing throat
- sensation of being unable to swallow or lump in throat
- pain in upper/mid back, peri-scapular area
- highly acidic foods usually problematic
- may sleep in recliner due to not being able to lay flat


Demographics
- >40
- M>F


Infants
- frequent, forceful spiting up and irritability
- respiratory distress
- apnea
- dysphagia
- failure to thrive


Must watch out for patient self medicating --> masking of severe symptoms
Peptic Ulcer
Loss of tissue lining of the lower esophagus, stomach, and duodenum

Can erode the stomach arteries

Can perforate the stomach --> leaking out of contents

Red flag
- PMD of peptic ulcers with new onset of back or shoulder pain --> bleeding ulcer


Pain patterns
- gastric: worse with certain foods, better with buffering foods
- duodenal: worse on empty stomach


Associated S/S
- unexplained weight loss
- feeling of being full
- bleeding in stools or emesis
- S/S of anemia (fatigue, dizziness, SOB, etc.)


Complications
- hemorrhage
- perforation
- obstruction
Diverticulitis and Appendicitis
Diverticulosis = benign condition where lining of colon (mucosa) balloons out through weakened are of wall
- LLQ/pelvic pain

Diverticulitis = infection and inflammation accompanying micro-perforations of the diverticula (folds)
- Inflammatory response of diverticulosis
- Only 10-20% will develop diverticulitis from diverticulosis, but can happen if untreated or if patient eats foods they should not (nuts, seeds, etc)
- LLQ/pelvic pain

Appendicitis
- pain in waves
- aggravated by movement
- relieved by hook lying position
- +Hop test
- +McBurney's sign
Pancreatic Disorders
Digestion of pancreas by its own enzyme

Causes
- chronic alcoholism (main cause - 92% of cases)
- use of steroids
- autoimmune disease
- mass in pancreas


Pain pattern
- body of pancreas: epigastric radiating to back T5-9
- tail of pancreas: flank and left shoulder
- both have abrupt onset, penetrating pain
- aggravating factors: walking, supine
- relieving factors: sitting, leaning forward
Pancreatic Cancer
Frequently asymptomatic


Hard to pick up on and therefore is caught late and is most deadly
- Mass/tumor in the body or tail = poorer prognosis compared to mass in the head


S/S
- jaundice (due to obstruction of bile duct)
- LBP
- gray stools
- diffuse pain in area of pancreas


Pain quality
- vague and diffuse
- relieved by leaning forward and sitting upright
- aggravated by laying down and eating
Inflammatory Bowel Disease
Ulcerative Colitis
- usually only in one location of the digestive tract

Crohn's Disease
- can occur anywhere in digestive tract, can cause obstruction --> intestine removal

Risk factors: Caucasian, smoking, northern climates, diet, genetics

Risk of having: reactive/infectious arthritis (due to chronic gut inflammation), anemia, other autoimmune diseases

Pain patterns
- shoulder
- groin
- back
- mid-lower abdomen cramping
- dull, steady pain

Associated S/S
- bloody diarrhea
- urgency
- rectal pain
- weight loss (especially Crohn's)
Colorectal Cancer
3rd leading cause of cancer death in US
- Leading cause of cancer death among non-smokers (pretty much all other cancers are due to smoking)

Diet can be a cause: burnt food on grill, processed meats, red meats, fried foods

S/S
- abdominal, pelvic, back, sacral pain
- pain may radiate down legs (due to tumor compressing nerves)
- changes in weight
- changes in stool

Demographics
- >40
- M>F
- African American > Caucasian women
- PMH IBD, polyps
- family history of colorectal cancer
- obesity
- alcohol use
Referral - GI System
Medical Attention
Suspicion of appendicitis, abdominal inflammation, infection or access
- +McBurney's
- +Psoas test
- rebound tenderness

Suspicion of retroperitoneal bleed
- +Kehr's sign
- history of pregnancy, trauma, missed menses


Referral
- Back pain or shoulder pain with NSAID use = Ulcer, GI bleed
- Brought on by food: ulcers, GERD, mass in stomach
- Relieved by bowel movement: mass, constipation, obstruction
- Back and abdominal pain at the same level
- Back pain of unknown etiology that doesn't fit MS pattern
Kidneys
Kidney location: roughly T11-L3


Upper portion of kidney usually in contact with the diaphragm
- Respiration can irritate kidneys


MS S/S of kidney dysfunction:
- unilateral costovertebral tenderness
- low back, flank, inner thigh/leg pain
- ipsilateral shoulder pain (due to touching diaphragm)
Upper Urinary Tract Pain Patterns
Innervation: T10-L1

Can have hypersensitivity of skin (hyperesthesia)


Distention
- constant, achy, dull pain
- from stone, urine back up

Ischemia
- constant, achy or sharp
- from tumor, stone

Obstruction
- intermittent, sharp
- from stone blocking ureter


Associated S/S
- pain with urination
- difficulty initiating urination
- stream changes (flowing or stop/go)
- color of urine (should be pale yellow; orange color = spleen impairment)
- blood in urine
- nausea
Pseudorenal Pain
Usually caused by mechanical derangement of costovertebral joints associated with a trauma that mimics renal pain

Pain pattern
- irritation of costal nerves (radiculitis)
- localized over costovertberal joints; common T10-12
- acute onset
- affected by position changes
- pain referring to lower abdomen

Differentiate between renal pain and pseudorenal pain = ask about associated S/S
Lower Urinary Tract
Pain
- achy
- above pubis
- lower abdomen

Sensation
- urgency, but nothing coming out
- dysuria
- burning sensation (caused by irritation of thermosensory receptors)
Upper and Lower UTIs
Upper UTI
- unilateral costovertebral tenderness
- flank pain
- ipsilateral shoulder pain
- fever
- confusion
- SERIOUS (chronic stones/infection can damage kidney tissue)

Lower UTI
- LBP
- abdominal pain
- burning pain
- urgency
- pain is more pressure like
- less serious

Blood in urine = cancer or severe infection
Polycystic Kidney Disease
Cluster of cysts within the kidney
- genetic
- normally need dialysis
- still get PT while on dialysis

S/S
- HTN
- increased size of abdomen
- HA
- blood in urine
- frequent urination
- kidney stones
- back/flank pain
Renal Failure
Chronic kidney disease causes
- HTN
- DM
- lupus
- polycystic kidney disease


Hemodialysis
- Dialysis center: 3 days a week, 3-5 hours at a time
- Constant dialysis (retroperitoneal dialysis) at home: 6-7 days a week for about 2 hours
- Usually on dialysis for life or until get a transplant

Acute injury/kidney pathology only need short-term dialysis until kidney can do the work on its own
- Usually just use a temporary catheter --> limb alert!
- No weight bearing/heavy resistive activity on extremity with catheter
Bladder Cancer
Risk factors
- >40 yrs
- smoking
- M 3x > W
- occupation
- infections, including parasitic
- treatment for other cancers
- white > asian
- personal or family history


S/S
- blood in urine
- pain during urination
- urgency
Renal Cancer
Risk factors
- >40 yrs
- smoking
- obesity
- HTN
- long term dialysis (typically on dialysis and awaiting transplant)
- occupation
- M 2x > F

S/S
- blood in urine
- pain with urination
- urgency
- flank pain
- lump or mass
- weight loss
- fever
- fatigue
Prostatitis
Acute inflammation/infection

Differentiated from BPH by the discomfort associated with voiding

MS S/S
- low back, inner thigh, perineal pain
- arthralgia
- myalgia
- intermittent pain
- exercises increases S/S

Associated S/S
- fever/chills
- nocturne, dysuria
- frequency/urgency
- weak/interrupted urine flow
- sexual dysfunction
- malaise

Risk factors
- 40-70 yrs
- STD
- bladder outlet obstruction
- DM
- immunosuppression
- urethral catheterization --> prostate inflammation
Benign Prostatic Hyperplasia (BPH)
Age related (>50 yrs)
- a lot of cell turnover with age --> new cells and older cells backing up --> enlargement

Interferes with passage of urine
- stream is very stop and go
- not painful, but patient will know they have to go but cannot (pressure)

Other problems
- UTIs
- constipation
- loss of bladder muscle tone (due to constant stretch)

Prostatitis vs. BPH
- prostatitis = pain
- BPH = pressure; unable to void
Prostate Cancer
Measured by prostate specific antigen (PSA)

Diagnosed
- obstructive symptoms: problem initiating urination, problem with urine stream
- low back, hip, or leg pain

Unless getting PSA checked and getting regular physicals, the only S/S would be LBP and it can be easily missed until it has metastasized!

Metastases
- spine, pelvis, femur

Metastases can result in
- paralysis
- sciatica
- bone pain
- neurological changes


Risk factors
- age ~50 yrs
- family history
- multiple sex partners
- diet (not enough fruits/veggies)
- chemical exposure
- African American > Hispanic = Caucasian > Asian = American Indian
Uterine Fibroids
Fibroids
- usually due to increase in estrogen
(estrogen replacement therapy, estrogen with menstruation cycle, BC pills)

Pain can be coordinated with menstruation

Fibroid flare up typically during menstruation

S/S
- hip, low back, sacral/pelvic pain
- abnormal bleeding
Endometriosis
Misplaced tissues adhere outside the uterus
- can go anywhere (rectum, colon, bladder)
- keeps everything tight and stuck together --> pain

Pain is there all the time, not associated with menstrual cycle


Risk factors
- age 30-50
- have kids later in life
- do not have kids
- periods >7 days
- cycle <28 days
- first menses <12 years
- family history
- low BMI
- chronic disease


S/S
- hip, low back, sacral/pelvic pain
- abnormal bleeding
- trouble getting pregnant
Fibromyalgia
S/S
- tender points

Diagnosis
- widespread pain >3 months
- bilateral pain above and below waist in at least 11 out of 18 tender points

Risk Factors
- W>M
- pre-adolescent
- post-menopause
Polymalgia Rheumatica
S/S
- low grade fever
- weight loss
- malaise/fatigue
- depression
- temporal arteritis = inflammation of temporal arteritis HA, fatigue, fever, loss of vision


Diagnosis
- age
- bilateral aching in 2 of 3 areas (UE, LE, torso)
- 1 month duration
- prompt response to corticosteroids

Risk Factors
- W>M
- age >55
- caucasian
Scleroderma
Inflammation and fibrosis of many parts of the body
- skin
- blood vessels
- synovium
- skeletal muscles
- organs

S/S
- joint pain
- Raynaud's
Ankylosing Spondylitis
Risk Factors
- SI, spine, larger joints affected
- stiffness >3 months in male <40 years

S/S
- stiffness
- pain worse in morning
- pain improves with activity
Psoratic Arthritis
Variant of RA

S/S
- brittle nail beds
- sausage fingers
- joint pain, swelling, redness
Myasthenia Gravis
S/S
- eye muscle weakness and fatigue
- difficulty swallowing and chewing
- neck, respiratory, proximal postural muscles most involved
- drooping eyelids
- double vision
- slurred speech


Risk Factors
- age 20-30; >50
Systemic Lupus Erythematosus
S/S
- classic butterfly rash on cheeks
- discoid rash = looks like ringworm, can be on scalp
- symmetrical arthralgia/arthritis in small joints (wrist, hands, knees)
- peripheral neuropathy

Risk Factors
- W>M
- age 15-40
- African, Hispanic, Asian descent
Rheumatoid Arthritis
S/S
- Remember SERIOUS
¬ S = swelling in 1 or more joints
¬ E = early morning stiffness
¬ R = recurring pain and tenderness in any joint
¬ I = inability to move a joint normally
¬ O = obvious redness and warmth in a joint
¬ U = unexplained weight loss or fever
¬ S = symptoms >2 weeks

Risk Factors
- 20-40 years
- W>M
Lymes Disease
Early Infection S/S
- red rash
- flu-like symptoms
- migratory musculoskeletal pain
- neurologic symptoms (severe HA, numbness, pain, weakness of extremities, impaired coordination, cognitive dysfunction/memory loss/mood changes/sleep disturbances)

Less Common S/S
- eye problem (conjunctivitis)
- heart abnormalities and myocarditis

Late Infection S/S
- chronic or intermittent arthritis
- encephalopathy (sleep and mood disturbances)
- neurocognitive dysfunction
- peripheral neuropathy
Multiple Sclerosis
S/S
- unilateral vision impairment
- paresthesias
- ataxia/unsteadiness
- vertigo
- fatigue
- muscle weakness
- bowel/bladder dysfunctions
- speech impairment
- optic neuritis
- nystagmus
- spasticity/hyperreflexia
- Babinski's sign
- absent abdominal reflexes
- dysmetria/intention tremotr
- labile/changed mood
- Lhermitte's sign

Risk Factors
- W>M
- family history of MS
- age 20-40 (peak onset age is 30)
Sjogren's Disease
Systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine organs

S/S
- dry mouth
- dry eyes
- parotid gland enlargement
- arthralgia
- arthritis
- Raynaud phenomenon
- myalgia
- pulmonary disease
- GI disease
- leukopenia
- anemia
- xeroderma
- urticaria

Risk Factors
- W>M
- age >50
Ankylosing Spondylitis
Early Stage S/S
- intermittent LBP (non-traumatic, insidious onset, relieved by activity, >3 months)
- scaroilitis (inflammation, pain, tenderness of SI)
- spasm of paravertebral muscles
- loss of normal lumbar lordosis
- intermittent, low grade fever
- fatigue
- anorexia/weight loss
- anemia
- painful, limited cervical ROM

Advanced Stage S/S
- constant LBP
- loss of normal lumbar lordosis
- ankylosis of SI and spine
- muscle wasting in shoulder and pelvic girdles
- dorsocervical kyphosis
- decreased chest expansion
- arthritis involving peripheral joints (hips and knees)
- hip flexion in standing

Extraskeletal S/S
- cauda equina
- iritis/iridocyclitis (inflammation or iris)
- conjunctivitis
- enthesitis
- carditis
- pericarditis/pulmonary fibrosis
- prostatitis
Degenerative Disc Disease (DDD)
Intervertebral discs lose height and hydration --> unable to cushion and provide mobility between vertebrae

Aggravating factors:
- sitting for extended periods of time
- rotating, bending, or lifting

Relieving Factors:
- frequent position changes
- lying down
- staying active
Thoracic Spine Compression Fracture
S/S
- pain in back, arms, or legs
- numbness and/or weakness in UE/LE (if SC is involved)
- loss of height
Patellar Tendonitis
S/S
- anterior knee pain over the patella tendon
- pain made worse with jumping, landing or running activity and sometimes with prolonged sitting
- gradual onset of pain; usually related to an increase in sport activity
- localized tenderness over the patella tendon
- morning stiffness in tendon
- thickened tendon
Sacral Stress Fracture
Stress Fracture S/S
- aching/deep pain
- pain increases with activity and improves with rest
- muscle weakness
- compensatory gait
- localized pain
- pain with WB
- pain reproduced with heel strike or hop test
- possible localized swelling
Carpel Tunnel
S/S
- paresthesia/tingling/numbness in median nerve distribution (thumb, middle, index, radial half of ring finger)

Bilateral = hepatic disease!
- build up of ammonia affects tendon sheaths
Endometriosis
S/S
- intermittent, cyclical, or constant pelvic/LBP (unilateral or bilateral)
- pain during or after sexual intercourse
- painful bowel movements/urination during menstruation
- spotting between periods
- heavy/irregular menstrual cycle
- bleeding anywhere else (nose bleeds, coughing up blood, in urine/stools)
- fatigue
- history of ectopic pregnancy/miscarriage/infertility
- GI problems
Prostate Cancer
Early S/S
- none!
- must get PSA checked on the reg

Later S/S
- bladder palpable above pubic symphysis
- lower abdominal discomfort
- feeling the need to void
- low back, hip, upper thigh pain/stiffness
- suprapubic/pelvic pain
- difficulty having an erection
- blood in urine or semen
- urinary problems (hesitancy, weak stream, dribbling, nocturne, increased frequency)
Cervical Radiculopathy
S/S
- pain in the neck, shoulder blade, shoulder, upper chest, or arm
- pain possibly radiating into the fingers following the path of the involved nerve root
- sharp/tingling pain in cervical region
- general dull ache or numbness anywhere along the pathway of the nerve
- weakness in the shoulder, arm, or hand.
- pain worsens with certain neck movements
- pain improves when the arm is lifted over and behind the head
BPPV
S/S
- vertigo
- light headedness
- loss of balance
- nausea
- vomiting
- nystagmus with positional change of the head
Duodenal Ulcer
S/S
- pain 2-4 hours after eating
- pain worse on empty stomach
- pain relieved by food, milk, antacids, vomiting
- can refer to back, stomach, right shoulder
- nausea/vomiting
- anorexia/weight loss
- bloody stools
- lightheadedness/fainting
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