Differential Diagnosis Final Actual Exam
Questions and CORRECT Answers
What is the acronym SAD PUCKER? - CORRECT ANSWER✔✔- Retroperitoneal structures
S: suprarenal (adrenal glad)
A: Aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: esophagus
R: rectum
What are the risk factors for kidney and urinary tract system? - CORRECT ANSWER✔✔- -
age over 60
- personal or family hx of diabetes or hypertension, kidney disease, heart attack, or stroke.
- African, Hispanic, pacific island, or native American descent
-exposure to chemicals (ex paint, glue, degreasing solvents, cleaning solvents), drugs, or
environmental conditions
Cardiac Signs for Angina - CORRECT ANSWER✔✔-
What to look for in the medical history when screening the UE? - CORRECT ANSWER✔✔-
1) HTN, DM II, hyperlipidemia. Stress to vasculature, especially small vessels -> occlusive
disease = atherosclerosis. Other risk factors for heart disease -> smoking, overweight/obese,
poor diet, physical inactivity, excessive alcohol use.
2) Angina, MI refer to: jaw, L/R arm, retrosternal, midback, L neck.
What are modifiable risk factors for heart disease? - CORRECT ANSWER✔✔- Exercise,
weight management, alcohol consumption, smoking.
,What are non-modifiable risk factors for heart disease? - CORRECT ANSWER✔✔- Age,
family hx, gender (men up to age 40 and women because of estrogen).
21 yo female, R UE pain after weight lifting. After workouts, RUE appeared slightly larger
vs. left. Last week the size difference between had become much more obvious, felt like there
was a "bump" in her arm pit that was constantly present during past 3 days. What systems to
review? - CORRECT ANSWER✔✔- Review: Cardiovascular, musculoskeletal,
neuromuscular
21 yo female, R UE pain after weight lifting. More details: distended varicose-type veins
subclavian/axillary regions, entire RUE swelling, syanotic discoloration of the hand, decrease
in brachial & radial pulses RUE vs. LUE, RUE paresthesia & decreased sensation in a non-
dermatomal pattern, C-spine/shoulder ROM WNL, did not reproduce sx, palpation: bump in
axilla was well defined, tender, reproduced paresthesia.
1) What system do these cluster around?
2) Do you agree with the Dx of tendonitis?
3) What do the findings possibly indicate?
4) What is your next step?
5) What level of urgency is the referral? - CORRECT ANSWER✔✔- 1) Neuromuscular
2) No: tendons can be swollen, but more localized
3) Thoracic Outlet Syndrome, UE DVT
4) DVT? CALL ER!
5) Urgent.
She actually had PSS (Paget-Schroetter Syndrome), a rare classification of UE DVT
sometimes associated with TOS and caused by effort-related DVTs of the subclavian and
axillary regions. Birth control can cause blood clots, and if she is a smoker that causes MORE
probs.
What are varicose veins across the chest and into the arm an indicator of? - CORRECT
ANSWER✔✔- UE DVT
What could cyanosis, swelling, and redness in unilateral UE mean? - CORRECT
ANSWER✔✔- UE DVT
,DVT of UE signs and symptoms? - CORRECT ANSWER✔✔- numbness or heaviness of
UE; itching, burning, coldness; swelling, discoloration, warmth or redness; pitting edema;
limited ROM of c-spine, shoulder; low-grade fever, chills, malaise; for individuals with a
PICC line (in addition with any of the sx above): pain or tenderness at or above the insertion
site - BIG DEAL.
What are the risk factors for developing pulmonary TB? - CORRECT ANSWER✔✔- Health
care workers; homeless population; prison inmates; immunocompromised individuals; older
adult > 65; immigrants from areas where TB is endemic; injection drug users; malnourished
What is the referral pattern for diaphragmatic irritation? - CORRECT ANSWER✔✔-
Shoulder has common innervation with diaphragm (C3-C5) so any messages to the spinal
cord from the diaphragm can result in referred shoulder pain!
Irritation of the peritoneal or pleural surface of the central diaphragm refers sharp pain to the
ipsilateral upper trap, neck and/or supraclavicular fossa.
Referred shoulder pain patterns - CORRECT ANSWER✔✔-
Associated signs and symptoms with shoulder pain patterns? - CORRECT ANSWER✔✔-
Pleuritic component; exacerbation by recumbency; recent hx of laparoscopic procedure;
diaphoresis (cardiac); assiciated GI sxs; exacerbation by exertion unrelated to shoulder mvmt
(cardiac)
If somebody fell mountain biking, and c/o L shoulder pain, which systems would you screen?
- CORRECT ANSWER✔✔- Neuromuscular; musculoskeletal; joints/GHJ/RC/dislocatino;
fractures (palpation/osteophony/observation/mvmt)
Which bacterial infection causes enlargement of the spleen? - CORRECT ANSWER✔✔-
Mononucleosis (pt canNOT play contact sports, it could rupture their spleen!)
Mononucleosis is a risk factor for what disease? - CORRECT ANSWER✔✔- Hodgkin
Lymphoma
Shoulder pain relieved by learning forward, kneeling with hands on the floor, and sitting
upright (versus lying down)? - CORRECT ANSWER✔✔- Pericarditis
, Presence of localized warmth felt over the scapular area? - CORRECT ANSWER✔✔-
Neoplasm
Shoulder pain increased by exertion not related to shoulder movement? - CORRECT
ANSWER✔✔- Cardiac
Shoulder pain in a woman of childbearing age of unknown cause associated with abdominal
pain and missed menses? - CORRECT ANSWER✔✔- Rupture of ectopic pregnancy
Guidelines for immediate medical attention in an Upper Quadrant screen? - CORRECT
ANSWER✔✔- 1) Presence of suspicious lymph nodes, especially hard, fixed nodes in a
client with a previous hx of cancer.
2) Clinical presenation and hx suggestive of an ectopic pregnancy.
3) Trauma followed by failure of symptoms to resolve with tx; pain out of proportion to the
injury.
How might a pt present in clinic with pleuropulmonary or rib pain? - CORRECT
ANSWER✔✔- 1) Sharply localized pain.
2) Worsens with coughing, deep breathing, other respiratory movements.
3) Motion of the chest wall increases pain.
4) Pain decreased by maneuvers that limit chest expansion.
5) Symptoms that are relieved by sitting up.
6) Symptoms that increase with deep breathing and activity.
7) Red flags: presence of a productive cough with bloody or rust-colored sputum.
8) SOB, potentially.
What would you look for in the medical chart for someone you suspect of pleuropulmonary
causes of chest, breast, or rib pain? - CORRECT ANSWER✔✔- PMH: cancer of any kind
(mets to lungs); recent hx of pulmonary infection; recent accident or hospitalization.
Risk Factors: age; smoking; prolonged immobility; immune system suppression.
