Clinical Reasoning I Final

What is unrelenting nocturnal pain a sign of?

65, male, African American, deep bone pain, prone to fracture/bleeding/bruising, fatigue

What % of body weight is on the facet?

8-10 y/o girls, 10-12 y/o boys, heel pain, inflamed growth plate

Males>females, 20-30 y/o, athletes, medial knee pain, unable to extend knee, joint may lock

40+, >females, achy neck pain, + or - valsalva, - distraction, + bakody

What is considered normal blood pressure?

4-10 y/o, male, painless limp progresses to hip/knee pain, unilateral, avascular necrosis of hip

What does the D in VINDICATE stand for?

What type of history is a longer visit, the initial visit, for a new patient, and gathers baseline information?

What is Stage 1 Hypertension?

Which is NOT a component of the HPI?

whiplash, repetitive overuse, achy neck pain, +PROM, -RROM, - valsalva, + compression tests

> females, middle age, runners/cyclists, deep buttock pain down to knee or calf, walking alleviates, wakes up at night

What does the T in VINDICATE stand for?

What is the least common region to experience a disc lesion?

Which of the following is NOT an inflammatory arthritide?

30-50 y/o, male, feels like joints in hand/foot on fire, diet high in meat and seafood, alcohol, uric acid formations

What type of history is with an established patient and focused on a specific body system?

How much spine pain is mechanical?

What does the E in VINDICATE stand for?

What type of cartilage is in the facet?

a signal that’s felt it noticed by the person who has it

What is swelling caused by excess fluid trapped in the body’s tissues?

50-59, females, athletes, anterior knee pain, over-pronation, increased pain with running, stairs, kneeling

15-30 y/o, athletes, misstep or collision, trauma from outside to inside, feeling of instability, swelling

>50, males>females, ossification of ALL, pain/stiffness in thoracic spine, NOT an inflammatory arthritide

>50 y/o, males, palmar fascia thickening, 4th and 5th fingers, slow progression

women, reproductive years, lumbar pain, pelvic/hip/groin pain, headaches, hereditary

40-60 y/o, 2 million/year, partial or full tears, supraspinatus tendon common, achy, weak, FOOSH

Pain improves or worsens with position, unilateral, sharp, dull, achy, burning

What is Stage 2 Hypertension?

<20, male, spinal stiffness, pain for longer than 5 months, hyperkyphosis, genetic, inflammatory arthritide

What does the N in VINDICATE represent?

13-17 y/o, male, endplate trauma, hyperkyphosis, thoracic pain and stiffness

male=female, athletes, can’t lay on involved side, pain with stairs, lateral thigh/knee pain, + Obers

30-50 y/o, females, repetitive overuse, walking/running, pain following activity, heel/foot pain

Proportion of people without the disease that do not have a clinical finding or they have a negative test

What does HEENT stand for?

What type of pain is caused by trigger points, muscles, tendons, ligaments, and organs?

What does the second I in VINDICATE stand for?

Clinical finding is present but the patient does not have the disease

What is elevated blood pressure?

What kind of data is what you observe, palpate, and test for?

What does “ecchymosis” mean?

> female, pain with prolonged seated, stairs, walking, fall on buttocks, pain at PSIS, - valsava, + nachlas, +ely

30-50 y/o, bend twist lift, LBP and LP, sitting increases pain, + valsava, + or - SLR, + bechterews

What does the V in vindicate stand for?

10-30, male=female, inversion most common, poor landing, high arches, partial or full ligament tear

40-60 y/o, females, non dominant side more common, sedentary, immobilized shoulder joint

Musculoskeletal diseases have the 2nd greatest impact on overall health.

mid 40s, male, runners, repeated overuse, posterior foot/ankle pain, swelling

Clinical finding is absent and the patient has the disease

What does the A in VINDICATE stand for?

50-60 y/o, women, feels a catch or click, finger gets stuck, farmers/musicians/smokers

doctor squires specific information, provides information about other possible diseases, used to achieve a diagnosis

30-50 y/o, male, bend lift twist, LP, standing increases pain, + SLR, - valsalva

4-6 million/yr, middle back pain, burning, stomach pain, bacterial, overuse or aspirin or alcohol or smoking

younger, female, large curves, right side more common, un-level hips/shoulders

Patient expresses what’s most important to them, doctor facilitates narration; rarely complete

50+, cartilage and capsule injured in hyperextension, no pain seated/supine, + standing kemps, - valsalva

baseball, swimmers, associated with SLAP injuries, tendon impingement, anterior shoulder pain, full ROM

What does the first I in VINDICATE stand for?

Which of the following is NOT an inflammatory arthritide?

>50, pinching, comes from breast, prostate, or lung, history of cancer, unexplained weight loss

No position of relief, bilateral, pain doesn’t change with position, rest doesn’t help, deep boring pain

Proportion of people with the disease that have a clinical finding/positive test

women, pain between 3rd and 4th digit, feels like standing on a pebble, numbness/tingling/shooting pain

What type of pain is from a nerve root? (pins and needles, burning)

What kind of data is what the patient tells you?

30-50 y/o, LBP, forced over-rotation, sitting increases pain, + or - valsalva, - SLR, + seated kemps

plumbers, air technicians, develops over several months, pain, redness, swelling

45-60 y/o, female, tingling/numbness/weakness/pain in anterior thumb and index fingers

a signal that can be seen by someone else

<40 y/o acute, >40 y/o chronic, popping/grinding/catching in shoulder joint, MVA, FOOSH,

What is the normal pulse for infants?

>50, bacterial infection, lumbar, IV drug use, unrelenting pain worse with activity

Clinical finding is absent and the patient does not have the disease

Musculoskeletal diseases are the #2 cause of disability

older, viral infection, pain, burning, itching, sensitive to touch, sometimes fluid filled blisters

40-60 y/o, throwing sports, weak rotator cuff muscles, poor posture, pain in abduction, achy, pain @ night

>60 y/o, women, inflammatory, causes muscle pain and stiffness, worse in morning, bilateral, bad sleep

What does the C in VINDICATE stand for?

>65, male, smoking, hypertension, tearing/ripping pain, back pain, low BP, increased pulse, SOB

>40, female, dominant arm, pain/burning/weakness, can be medial or lateral

Clinical finding is present and the patient has the disease

What is the normal pulse for toddlers?

40-50 y/o, male=female, affects spine and extremities, joint sx. appear 10 yrs after skin sx, inflammatory arthritide

30-50 y/o, women, hard to grasp, holding a baby, overuse, injury

What is the normal pulse for adults?

leaning on forearm, keeping elbow bent for long time, pain, weakness, numbness, tingling

male, inflammation of SI joint, caused by injury or bacterial infection, buttock and LBP

>70, women, increased kyphosis, prednisone use, sudden onset, post menopausal, pain with movement