Upgrade to remove ads
Only $35.99/year

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
Sets with similar terms