By Guilherme H. M. Oliveira, Gillian C. Nesbitt, Joseph G. Murphy
In case you are a doctor on name, you wish a prognosis and remedy advisor that can assist you make quickly and exact decisions-one that is finished concise. Now, for the 1st time, the recent Mayo health center clinical guide offers simply the ideal details to accomplish nearly any differential prognosis you stumble upon. Conceived at Mayo hospital, this new guide comprises every thing you want to instantly investigate and overview symptoms and laboratory abnormalities in a condensed but concise easy-to-access instruction manual.
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It is more specific if symptoms occur at <60° of straight leg raise. , lumbar disk) causing radiculopathy. ▲ Cauda equina syndrome is a surgical emergency and manifests as asymmetric leg weakness or sensory loss (including perianal area), variable areflexia, and bowel/bladder dysfunction; X-rays usually show osteoarthritis, MRI is test of choice when necessary. Osteoarthritis ▲ Pain worsens with activity, resolves with rest ▲ Brief morning stiffness, gelling, local tenderness, crepitus ▲ X-rays exclude other important osseous problems, but radiographic osteoarthritis is not always symptomatic.
Look for Bence Jones proteins in urine, check serum protein electrophoresis. ▲ Other primary bone tumors, both benign and malignant, are rare and primarily observed in younger patients (10-30 years). ▲ Most metastatic tumors are in older patients. ■ If cauda equina or conus medullaris, treat urgently. ■ Cancer risk factors include age ≥50 years, history of cancer, unexplained weight loss, or failure to improve after 4-6 weeks of conservative therapy. ▲ If none of these four risk factors is present, cancer can be ruled out with virtually 100% sensitivity.
26 Table 1. Addressing the Risk Condition Abdominal aortic aneurysm rupture Aortic dissection Vital signs Hypotension, unequal pulse/blood pressure upper vs. lower limbs Hypertension or hypotension, loss of pulses TEE, transesophageal echocardiography. Exam findings Treatment Severe pain in abdomen, back, flank(s), shock Acute tearing pain in chest and/or interscapular area Pulsatile abdominal mass Two large-bore IVs of normal saline, blood, emergency surgery consult Don’t waste time on tests! If hypertensive, give IV β-blocker (pulse 60), sodium nitroprusside If hypotensive, IV fluid & blood, TEE, CT Emergency surgical consult Back pain, usually aggravated by coughing or straining Weakness/numbness of legs, bladder or bowel disturbances Loss of or unequal pulses/blood pressure Aortic regurgitation, pulmonary edema, neurologic findings Localized spinal tenderness, lower motor neuron & dermatomal deficits Emergency spine surgery consult and analgesics CT, MRI, possibly lumbar puncture Surgery if trauma, dexamethasone and surgery if tumor, IV antibiotics & surgery if infection 27 I SIGNS & SYMPTOMS Cord compresFever (if infection or sion (trauma, tumor), otherwise may tumor, epidural be normal abscess) Symptoms Table 2.