Pantar fasciitis

Pain of bottom foot on walking few first steps in the morning

Tender anteromedial calcaneus
Pain on dorsiflexion of big toe
Plantar Fascitis
Pain of bottom foot on walking first few step in the morning
Tender anteromedial calcaneus
Pain on dorsiflexion of left big toe.
Fracture of Ankle
Twisted ankle
Felt pop
Tender at lateral malleolus
Decreased ROM
Sprain of Ankle
Twisted ankle
Felt Pop
Tender lateral ligament of ankle
Decreased ROM
Cellulitis of Ankle
Fever, Redness, swelling
Abraison 1 week Ago
Tender to touch
PE:
Inspect, palpate the foot( anteromedial calcaneus, medial and lateral
malleolus, medial and lateral ankle ligament). Patient dorsiflexion and
plantar flexion( ROM: fracture and sprain). Palpate the foot during
dorsiflexion (tendinitis)
KNEE PAIN
Without Trauma : unable to bear weight
Acute
Septic A
Gout A
Pseudogo Osteoarthri
ut A.
tis flare
Acute,
Acute,
Acute,
Acute, ROM
ROM
ROM
ROM
Fever,
Fever
Fever
Hx chrq
discharge
pain
Rash
Stiffness
with mvmt

Acute Question: Fever, Penile/vaginal discharge,

Chronique
Lime
RA
Chq
pain,
stiffne
ss d
mvnt

Chq pain
Stiffness d
mvt
oligoarthit
is

Psoriatric
a
Chp pain,
stiffness d
mvt
Polyarthris

Rhumatoid
A
Chq pain,
Stiffness d
mvt
Polyarthritis

SLE

Osteoarthritis

Chq pain,
Stiffness d
mvt
Polyarthritis

Chr pain,
improve with
rest
Stiffness in
mvt
Clicking
sensation

Eye
Discharge Sclaly
Facial rash
bull
Cunjuctivi rash over
Rash
tis
flexor
Travel,
Tick
bite
Other Joint, rash, conjunctivitis, penile, vaginal discharge, camping hx
Trauma /unable to bear weight
OPQST
ACL/PCL
CL
Meniscal Tear
Acute pain after
Acute pain
Intermitent Pain and
foce applied
Pain with Walking( OA
Lock up knee while walking
anteriorly.
like)
Popping sound(ACL)
Force applied
Force applied laterally
Repetitive use
Anteriorly,
posteriorly
swelling
TRAUMA QUESTION: What where you doing before the pain start. Did you
hear any popping sound, Does the knee lock when you walk swelling?
CALF PAIN
DVT

Backer cyst
rupture

Cellulitis

Pain, redness,
sweeling, SOB
chest pain

Pain and
swelling,
redness

Pain,
swelling,
redness
Fever

Peripheral
vascular
disease
Intermittent
pain on walikg,
relieved when
stop

Lumbar
Spinal
Stenosis
Intermittent
leg pain and
low back
pain on
walking,
relieve by
sitting

Hx of recent
immobilization,
travel, OCP

Hx rheumatoid
Arthritis

History of
trauma of
fungal
infection of
skin

Fever, SOB recent immobolization, hx skin infection, `

HIP PAIN
ABCDE
Avascular Necrosis, Trochanteric Bursitis, slipped Capital Femoral,
Dislocation and Fracture of Head of Femur, (Entorse)Muscle Sprain.
BACK PAIN.
Rule out FIRST before to consider muscle strain( no Rx wanted):
Fracture, Infection, Radiculopathy and Cauda equine Sd, Spinal cord
Stenosis, Tumor
Urinary accident, stool accident, change in appetite and weight loss,
urinary symptom
LIMCOTS
Lumbar spine stenosis
Intervetebral disk herniation, Infections
Myeloma, Metastasis prostatic cancer
Cauda equina syndrome, Conus medullary syndrome
Osteoarthritis
Trauma, TB
Strain( spinal muscle strain)
Metastatic prostatic cancer: progressive lower back pain worse at night,
not relieve by rest with urinary retention.
MM
Disk herniation: lower back pain that irradiate to the buttock, knee, L4, L5,
S1 , positive straight leg raising.
Lumbar spinal stenosis: Lower back pain increasing with standing and
walking, decreasing with sitting and leaning forward.
Lumbar muscle strain: Lower back pain after activity with paraspinal
muscle tenderness
Lumbar vertebra fracture: Lower back pain with vertebral tenderness.
Degenerative arthritis. Lower back pain relieved by rest exacerbated by
activity

WEAKNESS NUMBNESS
Weakness/Numbness(DDPP)
Distribution (Unilateral, bilateral proximal or distal)
Duration (transient, permanent)
Progression: ascending, descending
Pain (headache, neck pain, back pain)
1. If DDPP lead to Paraplegia( V,N,NM,M): urine stool accident,
numbness muscle pain, rash, stiffness, cold intolerance double
vision, difficulty swallowing, recent infection, recent camping
history, fever, weight change
Vertebral (Tumor of Vertebral canal, with CES or CMS, acute transverse
myelitis,)
Neural: GBS, Polyneuropathy
NM: Myasthenia Gravis, Tick bone Paralysis
Myopathy: CDE
Tumor of Vertebral Canal:
CES: Back pain, paraplegia, urinary retention, fecal incontinence saddle
anesthesia, and loss of sensation below the lesion, hyporeflexia
CMS: Back pain, bilateral spastic paralysis, perianal anesthesia, urinary
retention, fecal incontinence, no sensory loss, hyperreflexia
Acute Transient Myelitis: Back pain, paraplegia, urinary retention, fecal
incontinence, loss of sensation below the lesion.
Acute polymyelitis: Paraplegia, loss of sensation below the lesion, no
vaccination.
Guillain Barr Syndrom: ascending Paraplegia, loss of distal sensation, hx
of recent infection
Peripheral neuropathy( polyneurpaty): ascending paralysis, loss of distal
sensation( gloves and stocking distribution), diabetes, B12, Alcoholic

Myasthenia Gravis: Weakness after use of affected muscle, diploplia,

dysphagia, ptosis, no sensory loss
Tick bone paralyisis: ascending paralysis without sensory loss, recent
camping.
Inflammatoty myopathies: Proximal muscle weakness( Shoulder, hip),
arthralgia, Fever, weight loss, periorbital purpirish erythema: heliotrope
rash
Drug induced Myopathy: Proximal muscle weakness, statin use (Heart
disease)
Endocrine Myopathies: Steroid myopathy (MCC), proximal muscle
weakness, weight gain, treatment with steroid
Addison disease: Proximal muscle weakness, dizziness, rash:
hyperpigmentation of sun exposed area
Hypothyroidism: Proximal muscle weakness, cold intolerance, weight gain.
2. If DDPP lead to hemiplegia (Unilateral paralysis, headache):
Ask CNS Questions: Numbness, difficulty speaking, vision, hearing,
understanding, swallowing, balance, seizure, headache. Nausea, LOC,
Dizziness. Palpitation, chest pain, trauma.
The duration:
Persistent symptom: PERSIST( PERidural , Subdural, Subarachnoid
hemorrages, Ischemic stroke, Intracerebral hemorrhage,
Intracranial neoplasm, Seizure, Tia)
Intracerebral hemorrage: headache, nausea, LOC, then Focal sign, High
blood pressure
Subarchnoid Hemorrage: Headache, LOC then FOC, nuchal rigidity, No hx
of HT
Ischemic stroke: Focal neurological deficit, Cardiovascular risk.
Intracranial tumor: Progressive headache or morning headache, nausea,
focal neurological sign.
Extra cerebral hemorrhage:
Peridural Hemorrage: Trauma, LOC, progressive neurological deficit
Subdural Hemorrage: Trauma, LOC, progressive neurological deficit,
cognitive impairement
HEADACHE:
VINT HEENT
Vascular: Hypertension, Migraine, Cluster
Increased ICP: Pseudotumor cerebri, Neoplasm
Infection: Meningitis, Meningoencephalitis(acute), brain Abcess
T: Tension Headache, Trauma, Temporal arteritis, Trigeminal neuralgia
Hemorrage: Epidural, subdural, subarchnoid hemorrhage, intracebral
hemorrhage
Eye: Acute closed angle glaucoma
Ear: OTM, mastoiditis(acute)
Nose: acute sinusitis

T: Viral sd, toothache

Hypertensive emergency: occipital headache, blurred vision and vomiting.
Chest pain, extremities swelling and oliguria.
Migraine: Heache, photophobia, vomiting, nausea, no fever
Cluster: Retroorbital headache, water eye, runny nose, same time of day
ICP: Headache, morning vomiting, blurred vision, OCP( pseudo tumor
cerebri)
Meningitis: Fever, Headache, vomiting, photophobia, nuchal rigidity,
kerning sign
Meningoencephalitis: fever, headache, confusion, seizure,
Abcess: Fever, headache, vomiting, focal sign
Tension headache: Squezing pain, relieved by massage, stress.
Tempora arteritis: Fever, Temporal headache, decreased vision, scalp
tenderness.
Trigeminal neuralgia: Stabbing pain of the face, lasting 4 min
Glaucoma: Pain around the eye, decreased vision, red eye, dilated pupil
Sinusitis:Facial headache, nasal discharge, facial tenderness

ANKLE PAIN
Septic arthritis: Sudden Onset of Ankle pain, swelling redness, Inability to
walk, Fever, hx trauma and surgery or discharge
Gouty arthiritis: SO ankle pain, swelling, redness, worsened by walk, Fever,
Big toe pain, Hx of heavy alchohol cunsumption
Pseudogouty arthritis: Sundden Osnet of Ankle pain, Swelling, redness,
worsen by walk, Fever, precipitated by trauma, surgery,
Ligament strain: SO ankle pain, swelling and redness, worsen by walk, Felt
Pop sensation after Hx of trauma (twisted ankle)
Ankle fracture: As Ligament sprain
ACL tear: SO keen pain, swelling, redness, worsened by walking, Knee
instability, and Felt Pop sensation after trauma
Meniscal Tear: Intermittent pain, swelling and lock up when walking( wear
and tear old age, trauma for young)
OA: Progressive ankle pain, worsen by walk, relieve by rest, stiffness,
Morton neuroma
Plantar fasciitis: icing, Taping decrease the stress of the facia acutely to
improve pain.heel lift( decrease the travel of plantar facia), stretching**
multiple time a day and night splint( help flacia to heel in stretch
position),Orthodic control foot position,
Carpal tunnel sd: Progressive foot surface burning pain with walking or
standing, numbness, positive tinel or phalen sign. : hx of foot fracture:
Calcaneal malleolus, talus fracture,(Foot inversion with brace, CTC
injection, surgical decompression)

Motor neuroma: Pain and numbness when walking at the base between
the 2/3rd toes relieved by rest and removing shoes.( Rest and massage,
Ice, Arche support with special shoes metatarsal pad,
RICE decrease swelling of sprain because it delays recovery.
Splint(short period of time) vs brace
JOINT PAIN.
SIQORA,
Joint characteristic
Stiffness( ortho inflama) of any part, where, how long it takes,
Ortho : is related to an invent, knee lock, do you walk alot( ankle)
Infl : Fever, out of energy, weight loss, appetite, sore in mouth that doesnt,
skin rash, phosensivty, discharge,
ORTHOPEDIC CAUSES to consider in ALL JOINTS.
CF :Pain with mvmt, relieved by rest.
Tenderness and swelling for every of them, more localized in tendintis,
bursitis
Fracut
Always ask for XR to rule out, even no hx of trauma.
Fracture of dislocation(Shoulder hip), Tenditis, Bursitis, Ligament strain,
Muscle sprain or spasm.

URINARY SYMPTOMS
Fullness : SIQORA
1. Difficulty starting or decreased force ( weak stream).
2. dribbling sensation
3. Nocturia( when it is worse, how many time wake up)
4. Pelvic injury
5. Facial weakness, limb weakness, bowel accident
Incontinence :
Urge incontinence : occurs immediatly after the desire(children young
adult*)
Stress incontence : situation of abnormal increased abdominal pressure
that cause urination with coughting, sneezing mvt urethral,
insufficiency( Pelvic surgery, PP women*, , cystocelle, fecal impact)
Overflow : smal leakage constantly, dribbling BPH* in male
Functional : Inhability to recognize the need(dementia, stroke) or physical
inhability to reach the bathroom : MCC in elderly
HPI. 1 amount , time, cicumstance, precipitating factor( cough, sneezing)
2. Sens the need to void ? if yes, is it Normal ? urgency

ROS. 3.Dysuria, weak stream-incomplete emptying-, Constipation

PMH : Stroke, dementia, stone, Pelvic, abdominal surgery
Meds : Most of them cause overflow or urgency, Alchohol and psychoactive
cause functional due to impaired moblity, Misoprostol cause stress
incontinence by relaxing urethra
SH : Ability to reach toilet, availability of bathroom, avaibility of care give
FH : OBGYN complications,
TRANSIENT URINARY INCONTINENCE.( treatable)
DIAPPERS.
Delirium, Infections, Atrophic vaginitis and urethritis, Pharmaceutical,
Psychological(depression), Excessive output(Polyuria), Restricted mobility,
Stool(Fecalocel)
1. Do you not realize when your bladder is full and you need to go ?
1. Problem with walking to the toilet
2. problem reaching
3 intial test : UA, UC, BMP, post coit residual blader volume(US) : estimate
bladder capacity and proprioception
If No etiology : Urodynamic test : cystometry(study bladder function when
filled : urge incontinence. Then peak urinary flow to confirm or exclude
outlet obstruction in male, then cystograpy to study sphincter function.
Treatment : general measure : decrease fluid intake, bladder training( void
every 3 hours) and pelvic muscle training( keygel exercise)
PE : Neuro : gait, sensory, pelvic, rectal exam( fecalocelle, bph)
Urinary frequency
1. rule out polyuria(3L /d) due to increased intake( amount o fluid
consumed and voided)caffeine,
4 majors causes : UTI(fever, flank goin pain, hematuria) , BPH( decrease
tream and , Stone( flank and goin pain), incontinence( bending, sneezing),
recent sexual contact discharge, cunjunctivitis, arthritis.
Gross hematuria( calculi in young, malignancy in older
Red flag : spinal cord injury( strength of lower limb, infection
PMH : Pelvic Sgx( Stress incontinence)
SH : sexual contact, alchohol
PE : ABd, pelvic(BPH), cyctocele(female), Lower limb weakness
Test : UA and UC
Cystitis( cystoscopy, cystogram, urethrogram) and outlet obstruction
In elderly man : Post void residual urinary volume
In older : PSA, US and prostate biopsy to differenciate BPH from prosate
cancer
Infection : women children
Alcohol caffeine : in normal