Lecture 2 & 3 - Differential Diagnosis

Front 1

5 things to look for when assessing nail beds?

Back 1

1) Color
2) Shape
3) Texture
4) Thickness
5) Presence of a lesion

Front 2

Onycholysis?

Back 2

Painless loosening of the nail bed(s)

Front 3

Associated with Onycholysis?

Back 3

Myeloma, neoplasm, graves disease, anemia and active arthritis

Front 4

Koilonchia?

Back 4

Spoon nails - thin depressed nail and the edges tip upwards

Front 5

Associated with Koilonchia?

Back 5

Hypochromic anemia, iron deficiency, long term poorly controlled diabetes, thyroid problems, syphilis, rheumatic fever

Front 6

Beau lines?

Back 6

Groves in the nail plate

Front 7

Associated with Beau lines?

Back 7

Acute illness, chemotherapy, poor peripheral circulation, eating d/o, cirrhosis, Hx of MI

Front 8

Leukonychia?

Back 8

Dots of white

Front 9

Associated with Leukonychia?

Back 9

Hypocalcemia, hypochromic anemia, hodgkin's renal failure, malnutrition, MI, lepracy, hepatic cirrhosis, Arsenic poisoning

Front 10

Splinter Hemorrhage?

Back 10

Thin lines of blood running vertical along the nail bed

Front 11

Associated with Splinter Hemorrhage?

Back 11

Silent MI, bacterial endocarditis, vasculitis, renal failure

Front 12

Clubbing?

Back 12

Exagerated convexity of the nail.

Front 13

Associated with Clubbing?

Back 13

Advanced COPD and pulmonary abscess

Front 14

Test for assessing clubbing?

Back 14

Shamroth test

Front 15

Nail Patella Syndrome?

Back 15

Genetic under development of nail bed

Front 16

Associated with Nail Patella Syndrome?

Back 16

Joint problems

Front 17

3 things to do when assessing lymph nodes?

Back 17

1) Swelling
2) Redness
3) Change in pigmentation

Front 18

As a PT, where would you palpate one's lymph nodes?

Back 18

1) Head/neck
2) Axilla
3) Inguinal
4) Trochlea

Front 19

Variety of things that can cause swollen lymph nodes?

Back 19

Infection, virus, bacteria, allergies, thyroid issues

Front 20

A few examples of follow up questions for a swollen lymph node?

Back 20

1) Recent illness?
2) Allergic Rhinitis?
3) Food intolerances?

Front 21

3 major red flags when palpating a mass?

Back 21

Firm, Immovable and non-tender

Front 22

Briefly describe an musculoskeletal screen?

Back 22

1) Examine above and below joint
2) A/PROM, accessory motions, strength
3) Special tests

Front 23

Briefly describe a neurologic screen?

Back 23

1) A/O; emotional state
2) Cranial nerves
3) Sensory -> Motor -> Reflexes
4) Neural tension tests

Front 24

Severity of PVD based on ABI values?

Back 24

Norm: 1.0-1.3
Mild: .8-1.0
Mod: .5-.8
Severe: <.5

Front 25

Two things to be aware of during palpation of the chest and back?

Back 25

1) Crepitus
2) Tactile fremitus

Front 26

Possible implications of tactile fremitus?

Back 26

Inflammation, interstital congestion, consolidation of a lung

Front 27

4 components of a chest and back screen?

Back 27

1) Palpation
2) Percussion
3) Auscultation
4) Heart Auscultation

Front 28

Crackles?

Back 28

Air moving through fluid-filled airways

Front 29

Wheezing?

Back 29

Air moving through narrow cavity.

Front 30

Gurgles?

Back 30

Air moving through thick secretions

Front 31

Pleural friction rub?

Back 31

A high pitched/scratchy sound d/t inflamed pleural surfaces rubbing against each other.

Front 32

Guidelines of immediate referal to MD?

Back 32

1) DM or immunocompromised with: red/swollen nail beds or skin lesions involving feet
2) Detect fluid, irregular, immobile mass
3) Suspicion of inflammed lymph nodes
4) Unusual/suspicious findings of the 4 components of the exam
5) Skin lesions w/Hx of CA
6) New onset of SOB
7) Tachycardia
8) Diaphoretic or Cyanotic
9) Abrupt change in mental status

Front 33

4 cells/components responsible for hematologic diseases?

Back 33

1) Plasma
2) Erythrocytes
3) Leukocytes
4) Platelets

Front 34

Anemia?

Back 34

Deficiency of erythrocytes

Front 35

Possible causes of iron deficiency?

Back 35

1) NSAIDS
2) Chronic RA; Lupus
3) Infectious disease
4) Neurologic conditions

Front 36

Polycythemia

Back 36

Increase in RBCs and hemoglobin concentration

Front 37

Secondary causes of Polycythemia?

Back 37

1) Living at high altitude
2) d/t smoking or exposure to radiation
3) heart and lung conditions

Front 38

S&Sx of Polycythemia?

Back 38

SOB
Fatigue
Gout (usually at the great toe)

Front 39

Sickle Cell Anemia?

Back 39

Autosomal recessive d/o. Essentialy an abnormal form of HgB.

Front 40

2 major features of Sickle Cell Anemia?

Back 40

1) Chronic hemolytic anemia
2) Vasoclusions

Front 41

Characteristics of an acute sickle cell crisis?

Back 41

Severe pain in bone or joint

Front 42

3 major Erythrocyte disorders?

Back 42

1) Anemia
2) Polycythemia
3) Sickle Cell Anemia

Front 43

Leukocytosis?

Back 43

Greater than 10k leukocytes per mm cubed.

Front 44

Associated with Leukocytosis?

Back 44

Inflammation/trauma, necrosis, localized or systemic infection, neoplasms, fever

Front 45

Leukopenia?

Back 45

Less than 5k leukocytes per mm cubed.

Front 46

Associated with Leukopenia?

Back 46

Persistent infections, distorted growth, high fever, chills, ulceration of mucous membrane, frequent or painful urination

Front 47

2 major Leukocyte disorders?

Back 47

1) Leukocytosis
2) Leukopenia

Front 48

Thrombocytosis?

Back 48

Increased platelet count

Front 49

S & Sx of Thrombocytosis?

Back 49

Increased thrombosis
Splenomegaly
Easy bruising

Front 50

Thrombocytopenia?

Back 50

Decreased platelet count

Front 51

Thrombocytopenia is most often seen in what kind of patients?

Back 51

1) Cancer patients (bone marrow failure d/t radiation Tx, leukemia, metastatic CA, cytotoxic agents)
2) Drug induced platelet reduction

Front 52

S & Sx of Thrombocytopenia?

Back 52

Severe bruising
Superficial hematomas
Jt swelling d/t jt bleeds
Multiple petychia

Front 53

Vitilgo

Back 53

Lack of pigmentation of skin d/t melanocyte destruction

Front 54

Associated with vitilgo?

Back 54

Hyperthyroidism, pernicious anemia, DM, autoimmune d/o, stomach CA

Front 55

4 primary causes of skin rash?

Back 55

1) Virus
2) Lupus
3) Parasites
4) Reaction to metals or various chemicals

Front 56

Associate with hemorrhagic rash?

Back 56

Petechia

Front 57

Causes of dermatitis?

Back 57

Stress, allergies, infection environmental infiltrates

Front 58

Rosacia maybe linked to...?

Back 58

GI disorders specifically H-pylori

Front 59

Xanthomas

Back 59

Benign fatty fibrous yellow plaque nodules

Front 60

Xanthomas are typically associated with...?

Back 60

Disorders of lipid metabolism
1) primary biliary cirrhosis
2) uncontrolled DM

Front 61

1st signs of rheumatologic disease?

Back 61

1) Rheumatic fever
2) Discoid lupus
3) Psoriatic arthritis
4) Rubella

Front 62

Erythema Chronica Migrams?

Back 62

Bull eye rash

Front 63

Herpatic Witlow

Back 63

Intermittent painful infection of the terminal phalanx of fingers

Front 64

Cause of herpatic witlow?

Back 64

HSV 1 & 2

Front 65

Herpes Zoster?

Back 65

Shingles - lies dormant in thoracic DRG

Front 66

Cancer related skin lesions (4)?

Back 66

1) Skin rash
2) Pinch purpura
3) Kaposi's sarcoma
4) Lymphomas