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Differential Diagnosis Practical
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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
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