Pt 2 Medical Screening and Differential Diagnosis for Physical Therapists

Vocabulary practice flashcards covering medical screening terminology, referred pain signs, and systemic pathology indicators for physical therapy students.

describe the different sources of pain

can have cutaneous sources of pain, somatic sources, visceral, neuropathic pain, and referred pain

describe nociceptive pain

due to activation of nociceptors (inflammatory, mechanical irritant, injury)

describe nociplastic pain

pain due to disturbance of central pain processing (increased excitability or decrease inhibition), examples are fibromyalgia, temporomandibular disorder, nonspecific low back pain

describe neuropathic pain

due to lesion or disease of the somatosensory system, examples include diabetic neuropathy, carpal tunnel syndrome, complex regional pain syndrome

typically, how is pain presentation with MSK pain vs systemic pain?

in MSK, pain is above and below the joints, in systemic the clinical presentation may not fit the expected pain pattern

describe the signs and symptoms of MSK pain

• decreases with rest, lessens at night

• sharp or superficial pain

• usually decreases with stopping of activity

• aggravated by mechanical stress

• trigger points may be accompanied by nausea, sweating depending on location

describe the symptoms associated with systemic pain

• disturbs sleep/awakens at night

• deep aching or throbbing

• reduced by pressure

• not aggravated by mechanical stress

• constant or waves of pain

• associated with jaundice, arthralgia, skin rash, enlarged lymph nodes, fatigue, weight loss, fever (low grade), generalized weakness, cyclic and progressive symptoms

what are the characteristics of viscerogenic pain?

gradual, progressive and cyclical pain patterns, constant pain, PT interventions “fail”, pain does not fit the expected pattern

describe the referral patter of different visceral organs

see image

what are the guidelines for immediate medical attention?

sudden worsening of intermittent claudication, symptoms of TIAs in any individual, esp with hx of HTN, heart disease, or tobacco use. onset of anginal pain requires immediate cessation of exercise, anyone with coronary artery stent experiencing chest pain, difference of more than 40 mmHg in pulse pressure, women with chest/breast pain who have family hx of breast cancer or heart disease, palpitation in person with hx of unexplained sudden death in family, fainting w/o warning, report any new arrythmias, extreme dyspnea

what are the signs and symptoms of pulmonary system dysfunction

cough, dyspnea, cyanosis, clubbing, altered breathing patterns

describe the referred pain patters of the pulmonary system

usually localized in the substernal or chest region over the involved lung fields, can radiate to the neck, UT, costal margins, thoracic region, scapulae, or shoulder. tracheobronchial pain, pleural pain, and diaphragmatic pleural pain

describe the screening for gastrointestinal disease

• age over 45

• previous hx of NSAID induces GI bleeding

• symptoms increase within 2 hours after taking NSAIDs or other meds

• symptoms affected by food

• back, shoulder pelvic, or sacral pain

• iliopsoas/obturator sign, McBurney’s sign, heel tap

• joint pain with arthralgias with skin rash

how is abdominal pain normally described?

deep aching, penetrating, gnawing, vague burning, or deep grinding (can be caused by inflammation, organ distension, necrosis)

Kehr's Sign

Pain in the left shoulder when pressure is placed on the upper abdomen, often caused by retroperitoneal bleeding, free air or blood in the abdomen, or a damaged/ruptured spleen.

Danforth Sign

Shoulder pain occurring with inspiration, which may indicate retroperitoneal bleeding or air/blood within the abdominal cavity.

where might perforated duodenal or gastric ulcer refer pain?

due to leakage that irritates the diaphragm may refer pain to the R shoulder or the R armpit/axilla region

where might pancreatic cancer or pancreatitis refer pain to?

the left shoulder

where might spleen, liver, or stomach bleeding refer pain to?

bilateral shoulders (due to irritation of the diaphragm)

Palmar Erythema

Also known as liver palms, this condition causes reddening of the skin over the palms and occurs in the presence of liver impairment.

Leukonychia

The appearance of white bands across the nail plate, which can be an integumentary sign of liver impairment.

Epigastric Pain

Visceral pain located from the mid-sternum to the xiphoid process originating from organs with a $T3-T5$ sympathetic nerve distribution, such as the heart, esophagus, stomach, duodenum, gallbladder, and liver.

Periumbilical Pain

Visceral pain corresponding to a $T9-T11$ nerve distribution, originating from the small intestine, pancreas, or appendix.

Hypogastric Pain

Visceral pain in the lower abdomen originating from the large intestine or colon, which may easily be mistaken for bladder or uterine pain.

Rhabdomyolysis

A condition characterized by muscle aches, cramps, soreness, and weakness, which can be seen with acute trauma or COVID-19 and may involve respiratory muscle myopathy, liver, or renal impairment.

VINDICATE Mnemonic

A framework for identifying causes of low back pain based on underlying system mechanisms: Vascular, Inflammatory, Neoplastic, Drugs, Infectious, Congenital, Autoimmune, Traumatic, and Endocrine/Psychosocial.

what are some sigs of hepatic or biliary dysfunction ?

• hepatic or biliary referred pain patterns

• enlarged and palpable liver

• skin and nail bed changes

  • jaundice, pallor, orange or green skin

  • spider angiomas and palmar erythema

  • white bands across the nail plate, clubbed nails, koionychia

Upper Urinary Tract Pain

Pain from the kidneys or ureters typically located in the posterior subcostal and costovertebral regions, which remains constant and unchanged by altering body position.