Internal Medicine: Integrative Medicine, Abdominal Pain, Weight Loss, Headache, and Chest Pain

Flashcards covering core terminology, diagnostic criteria, and clinical features across Integrative Medicine, Abdominal Pain, Weight Loss, Headache, and Chest Pain.

Integrated Care (Integrated Medicine)

A practice team of primary care and behavioral health clinicians working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.

Ideal Candidates for Integrated Medicine

Patients presenting with at least 2 out of 3 problems: complex medical, psychological, or addiction issues.

Level 6 Integration

Full collaboration in a transformed/merged practice where clinicians work completely merged as a team and as a single healthcare unit that treats the whole person of the patient.

Visceral Pain

Diffuse, non-specific abdominal pain arising from internal viscera that are insensitive to cutting or burning, but sensitive to distension, contraction, twisting, and stretching.

Parietal Pain

Sharp, well-localized, and lateralized abdominal pain arising from the parietal peritoneum, which is innervated by somatic nerves.

Referred Pain

Pain perceived at a site distant from the affected organ, resulting from adjacent structures that shared embryological origin and subsequently migrated away from each other.

Visceral Pain Localization by Embryological Origin

Foregut pain localizes to the epigastric area, midgut pain localizes to the periumbilical area, and hindgut pain localizes to the suprapubic area.

Upper GIT Alarm Features

Red flag symptoms including weight loss, dysphagia, persistent vomiting or early satiety, abdominal distension, hematemesis or iron deficiency anemia, and new-onset persistent symptoms at age $> 55$ years.

Mesenteric Ischemia

Condition characterized by dull epigastric or paraumbilical pain that increases with eating (abdominal angina), typically seen in patients with atherosclerosis.

Clinically Significant Involuntary Weight Loss

Weight loss that exceeds $5\%$ or more of usual body weight over a period of $6\text{--}12$ months.

Addison's Disease (Weight Loss Presentation)

An endocrine cause of weight loss presenting with lethargy, weakness, dizziness, hypotension, and buccal or scar hyperpigmentation, confirmed by a $9\text{ A.M.}$ plasma cortisol and impaired response to a short ACTH stimulation test.

Pain-Insensitive Intracranial Structure

The brain substance itself, which cannot sense pain directly despite irritation, compression, or traction.

Migraine

A chronic episodic headache lasting $4\text{--}72$ hours, typically unilateral ($60\%$ of cases), throbbing, moderate-to-severe, worsened by movement, and accompanied by nausea, vomiting, photophobia, or phonophobia.

Cluster Headache

A rare, severe form of chronic headache characterized by exclusively unilateral orbital or supraorbital attacks lasting $15\text{--}180$ minutes, recurring $1\text{--}3$ times daily for $1\text{--}2$ months, with ipsilateral autonomic symptoms.

Partial Horner Syndrome (in Cluster Headache)

An ipsilateral autonomic manifestation during cluster headache attacks consisting of ptosis and miosis without anhidrosis.

Tension-Type Headache (TTH)

The most common primary headache disorder, characterized by bilateral pressing or tightening pain of mild-to-moderate intensity lasting $30$ minutes to $7$ days, not aggravated by routine physical activity.

Chronic Tension-Type Headache

Tension-type headache occurring at a frequency of $> 15$ attacks per month for at least $3$ successive months.

Anginal Equivalents

Symptoms of myocardial ischemia other than classic chest pain, including pressure, tightness, or discomfort in the shoulders, arms, neck, back, upper abdomen, or jaw, as well as shortness of breath and fatigue.

Chest Pain Categorization (AHA/ACC Guideline)

The recommended approach classifying chest pain as cardiac, possibly cardiac, or noncardiac, specifically discarding the term 'atypical.'

Acute Aortic Dissection Signs

Severe abrupt ripping chest pain radiating to the back, accompanied by an extremity pulse differential ($30\%$ of patients), an aortic regurgitation murmur, and a widened mediastinum on chest X-ray.

10-Minute ECG Rule

The clinical standard requiring an electrocardiogram to be acquired and reviewed for STEMI within $10$ minutes of arrival in all patients presenting with acute chest pain.

Supplemental ECG Leads $V_7\text{--}V_9$

Posterior chest leads indicated to rule out posterior myocardial infarction in patients with intermediate-to-high clinical suspicion for ACS whose initial standard 12-lead ECG is non-diagnostic.

Boerhaave's Syndrome (Esophageal Rupture)

A life-threatening thoracic emergency characterized by emesis, unilateral decreased or absent breath sounds, subcutaneous emphysema, and pneumothorax (present in $20\%$ of patients).