1C Flashcards

1
Q

components of PT exam (7)

A
  1. review ALL MED HX
  2. Pt interview/history
  3. chief complaints
  4. functional limits
  5. review relevant med hx
  6. review systems
  7. physical exam (vitals, anthropometric measures, UQ/LQ/thoracic scanning, systems review)
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2
Q

what does a physical exam compose of?

A

vitals
anthropometric measures
Scanning exams (UQ/LQ/thoracic)
systems review!

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3
Q

During patient history, what are you listening for in regards to patient’s symptoms?

A

SINSS

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4
Q

Severity is….

A

intensity of symptoms related to functional activity
(high symptoms=low function)

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5
Q

What is irritability?

A

(how easy/hard to tick off=what activity and time?)

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6
Q

What is Nature of Complaint?

A

what could it be? Anything that you need to be cautious of during exam…and how does it present based on psych/personality/ethnicity/SES)

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7
Q

Describes acute, subacute, or chronic stages

A

stage of pathology

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8
Q

time frame for acute, subacute, chronic

A

acute: 3-7 days
subacute: over 7
chronic: over 3 months

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9
Q

progression of patient’s symptoms over time…is it getting better, worse, or same?

A

stability

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10
Q

What are RED FLAGS to be cautious of?

A
  1. Trauma
  2. Age over 50
  3. Cancer
  4. fever, chills, sweats
  5. unexplained weight change
  6. recent infection
  7. immunosuppression
  8. rest/night pain
  9. saddle anesthesia
  10. bowel/bladder dysfunction
  11. LE neuro deficits
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11
Q

Why are you worried about unexplained weight loss or fever/chills?

A

infection or cancer

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12
Q

Why are you worried about night pain?

A

cancer
infection
AAA

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13
Q

three red flags associated with cauda equina

A

saddle anesthesia
B&B dysfunction
LE neuro deficits

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14
Q

What is a patient centered interview model?

A

Exploring pt’s disease/diagnosis & its effect on their life
Understanding the whole person
Finding common ground regarding intervention &/or management
Advocating prevention & health promotion
Enhancing pt-provider relationship
Providing realistic expectations

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15
Q

If someone comes in with cervical and shoulder (shoulder girdle, L/R) pain….what 3 systems should I check first?

A
  1. CV
  2. Pulm
  3. GI
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16
Q

If someone comes in with thoracic spine/back pain…what 4 systems should i check?

A

1.CV
2.Pulm
3. GI
4. Genitourinary (T-L junction)

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17
Q

If someone has lumbar-pelvic pain…what 3 systems should I check first?

A
  1. GI
  2. Urogenital
  3. peripheral vascular
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18
Q

If someone has mid-humerus to hand or femur to foot pain, what system should I check first?

A

peripheral vascular

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19
Q

What systems have inconsistent symptom patterns?

A

Psychologic
Endrocrine
Neurologic
Rheumatic disorders
Adverse drug reactions

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19
Q

Referred pain can be mechanical or nonmechanical (T/F)

A

TRUE
(dermatomal symptoms due to back)

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20
Q

Most common MSK pain that PTs treat

A
  1. LBP
  2. shoulder
  3. knee
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21
Q

What does MSK pain sound like?

A

pain fluctuates in 24 hour time period (time frame increases in patients with neuro stuff like CVA, MS, TBI)

AND
motion makes pain change, varies consistently!

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22
Q

NON MSK pain sounds like

A

inconsistent locations of pain
no obvious MOI
vague, dull ache not located near normal MSK structures
does not fluctuate/change with positions or movement
pain during/after eating or urinating

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23
Q

If its throbbing, pounding, pulsating….could be

A

vascular disorder

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24
If its sharp, shocking, burning, lancinating....could be
neurologic disorder
25
If it is aching, squeezing, burning, cramping, gnawing...could be
visceral disorder
26
If they have LBP, what else could it be?
1. tumor 2. infection 3. cauda equina 4. spinal fx 5. abdominal aneurysm
27
LBP that is constant, not changing with position/mvmt worse at night...DIFF DX is (age over 50, also weight loss)
TUMOR
28
LBP, deep constant that is worse with WB -fever, swelling -spine rigidity (pt is IV drug user or immunosuppressed) DIFF DX is
osteomyelitis (or infection)
29
Pt has hx of spinal stenosis or DDD. LBP with weak LEs...what are you worried about
cauda equina other symptoms: -urinary retention/B&B -saddle anesthesia -LE weakness -sensory deficits -ankle DF, toe ex, ankle PF weakness (L4, L5, S1)
30
What are risk factors for spinal fx?
1. over 70 2. history of trauma/overuse for osteoporotic pts 3. steroid use long term
31
Patient comes in with LBP, very tender to palpation. Hurts to stand/WB. There is edema. HX OF TRAUMA. What is diff dx?
spinal fx Exquisitely tender w/ palpation over fx site ↑’d pain w/ WB Edema in local area
32
Someone comes in with back pain (or ab/groin). They have PVD/CAD and risk factors like over 50, smoker, HTN, DM pain does not change with movement. What should you be worried about/check?
AAA ascultate for bruit
33
Patient is over 50, has pain in pelvis that is tender to touch in abdomen. may have ascites. unexplained weight loss, bowel issues.... diff dx is
COLON CANCER
34
Patient is woman over 70 with hip/thigh pain. In constant pain, hurts more when moving it. Walking with leg in ER. MOI: fall... Diff dx is
pathologic fx in femoral NECK
35
AVN patient looks like...
osteonecrosis of femoral head -long term steroid use (has SLE, asthma, RA) -has had osteonecrosis in opp hip before -trauma hx
36
Patient has gradual onset of pain in hip and medial knee, worse with WB. Hip is stiff and restricted in IR and flexion. DIFF DX is
AVN -gradual -groin, thigh, medial knee referred pain -stiff hip restrict: IR, flex
37
Patient is 5-8 yr old boy LIMPING with groin pain. Pain hurts more with hip abduction/IR. Diff Dx is...
Legg-Calve-Perthes (head of femur loses blood supply) -young boy -antalgic gait -hurts with hip abd, IR
38
Patient is overweight adolescent that fell on bike...pain in groin, hurts to put weight on it. Leg is held in ER, can't IR. Diff dx is...
SCFE (epiphysis/head slips off femoral neck) -groin ache, worse with WB -leg in ER -ROM limits in IR
39
What are knee/leg/ankle/ft red flags conditions to be aware of?
1. peripheral arterial occlusive disease 2. DVT 3. compartment syndrome 4. septic arthritis 5. cellulitis
40
Risk factors for peripheral arterial occlusive disease
1. over 60 2. Hx of DM, heart disease 3. smoking 4. sedentary 5. intermitt. claudication
41
Pt is 60 year old, diabetic smoker: comes in with pain in leg. Leg is cool to touch with decreased pulses. Prolonged vascular filling time. What are you worried about
peripheral arterial occlusive disease -unilat cool extremity or bilateral if its aorta -capillary refil time over 2 seconds -decreased arterial pulses -long vascular filling time -Ankle brachial index below 0.9
42
Patient has calf pain, edema, tenderness. Warm to touch. Hurts more to stand/WB, better with rest/elevation Leg is pale, no pulse. DIFF DX
DVT -edema, tender, warm -worse with WB, better w rest -pale, loss of dorsalis pedis pulse recent sx, cancer, immob, trauma, pregnancy
43
Leg pain that is severe, worse with stretching. Edema, tender, tension/hardness Leg is also weak, numb, and pale. No pulse. DIFF DX
compartment syndrome! Severe, persistent leg pain that is intensified w/ stretch applied to involved muscles Swelling, exquisite tenderness & palpable tension/hardness of involved compartment Paresthesia, paresis, pallor, pulselessness Hx: trauma, crush injury, new exercise
44
Patient has constant throbbing pain, joint swelling, warmth in knee/ankle. They have had a recent infection/Sx/injection. Diff dx is...
septic arthritis! *joint pain/swelling *fever *immunosuppressed or recent infection
45
patient has pain in leg swelling, warmth, reddish streaks. They also have fever, malaise, weakness. What could it be?
cellulitis! Hx of recent skin ulceration or abrasion, venous insufficiency, CHF or cirrhosis Pain, skin swelling, warmth, advancing irregular margin of erythema/reddish streaks Fever, chills, malaise & weakness
46
If patient has chest pain, pale, sweating, can't breathe well, nauseous, palpitations -not relieved by nitroglycerin, longer than 30 min symptoms DIFF DX IS
MI
47
Risk factors for MI
-Presence of risk factors: previous hx of CAD, HTN, smoking, DM, elevated blood serum cholesterol (>240 mg/dL) Men >40 yr women >50 yr
48
unstable angina pectoris looks like
Chest pain that occurs outside of predictable pattern Not responsive to nitroglycerin (Hx of CAD)
49
stable angina pectoris looks like
Chest pain/pressure that occurs w/ predictable levels of exertion responds w/ rest or sublingual nitroglycerin (common in 65+, esp men. Hx of CAD)
50
If someone has hx of MI, renal failure, open heart surgery, radiation autoimmune disease like RA/SLE.... what could their chest pain be caused by?
pericarditis Often associated w/ autoimmune disease (SLE, RA) Hx of myocardial infarction Hx of renal failure, open heart surgery or radiation therapy
51
Patient has sharp/stabbing pain in shoulder and/or neck sidelying on left side increases pain sitting and leaning forward decreases pain DIFF DX
pericarditis Sharp/stabbing chest pain that may be referred to lateral neck or either shoulder ↑’d pain w/ L sidelying Relieved w/ forward leaning while sitting (supporting arms on knees or a table)
52
Patient has chest/shoulder/upper ab pain. 1. abnormal, fast breathing 2. heart rate over 100 bpm DIFF DX
PE risk factors: DVT, immob, cancer, trauma
53
Patient has severe, knife pain with inhaling. Abnormal breathing, decreased chest wall excursion. Hx of infection/respiratory disorder (pneumonia, TB, tumor) DIFF DX
Pleurisy/pleuritis
54
Patient has chest pain, worse with inhaling. difficulty expanding ribs decreased breath sounds hyperresonance percussion DIFF DX
pneumothorax hx: coughing, strenous exercise/trauma
55
Patient has chest and shoulder pain fever, chills, headache, malaise, nausea. What could it be....
pneumonia (hx of bacterial, viral, fungal, infection) -pleuritic pain referring to shoulder too
56
Patient is middle age woman. Pain in R upper ab with R scapula pain Worse with eating fatty foods. Pain is not worse/better with activity/rest. DIFF DX
cholecystitis (gall bladder!) *WBC count elevated *common in middle age women colicky pain R upper ab quad with R scap pain!
57
Dull or gnawing pain or burning sensation in epigastrium, mid-back or above clavicle Symptoms relieved w/ food****** Hx of infection (H. pylori) Hx of multiple stressors, poor coping skills, persistent anxiety & depression
peptic ulcer
58
Patient is tender to touch in Right abdomen, and they are having poop problems (bleeding, vomiting, tarry colored stool, coffee ground emesis)
peptic ulcer!
59
Patient has positive murphy's sign (tender over costovertebral angle) fever, chills, headache, flank pain DIFF DX
pyelonephritis! UTI/KIDNEY INFECTION
60
Patient has UTI symptoms with SUDDEN, SEVERE BACK PAIN chills, fever, nausea, vomiting renal colic DIFF DX
nephrolithiasis (kidney stones!) *hot climates, past episode of stones
61
Patient presents with tenderness in mid back, bruising, LE neuro deficits like sensory and weakness. increased thoracic kyphosis DIFF DX
spinal fx! esp if Hx of fall of MVA Hx of osteoporosis Long-term steroid use Age >70 yrs Loss of function or mobility
62
most common thoracic fx levels
T11-L1
63
What are red flag conditions to look out for with head/face/TMJ pain?
1. meningitis 2. tumor 3. subarachnoid hemorrhage
64
Patient presents with flu like symptoms. Then, head/face pain. + slump test headache, fever, nausea/vomiting photophobia, confusion, sleepy, seizures DIFF DX
meningitis! *STIFF NECK, FEVER, confusion, vomiting, seizures, light sensitivity, headache
65
Patient presents with: headache altered mental status speech deficits ataxia visual changes, seizures, GI issues, sensory issues
BRAIN TUMOR (age 20-64 yrs old)
66
Patient suddenly has severe headache. Then, brief LOC. fever, photophobia, nausea, vomiting, stiff neck (like meningitis) brain tumor signs like nausea, vomit, neuro dysfunction DIFF DX
subarachnoid hemorrhage!
67
If someone has pain in neck and shoulder, what are red flag conditions?
MI cervical ligament instability cervical/shoulder peripheral nerve entrapment pancoast's tumor
68
Patient hx: -trauma (major) -RA or AS -uses birth control presents with: dizziness, nystagmus, vertigo with neck movement +clonus +babinksi
Cervical liagamentous instabilities w/ possible cord compromise
69
If patient has neck/shoulder pain and muscles are tender to touch, muscles/sensory distribution follows specific nerve pattern -patient reports paresthesias (numb/ting) and PAIN AT REST with possible retrograde distribution
Cervical & shoulder girdle peripheral entrapment neuropathies
70
what are ways to injury spinal accessory nerve?
Hx of penetrating injury, such as stab or gunshot Direct blow or stretching of nerve during a fall or MVA Surgical hx of radical neck dissection for tumor or cervical lymph node biopsy Hx of blow from a hockey stick or lacrosse stick
71
what are ways to injure axillary nerve?
Pts >40 yrs w/ shoulder dislocation Hx of traction force or blunt trauma to shoulder Hx of brachial neuritis or quadrilateral space syndrome
72
What are ways to injure long thoracic nerve?
Identified in players of many sports, including tennis, volleyball, archery, golf, gymnastics, bowling, weight lifting, soccer, hockey & rifle shooting
73
Patient has suprascapular nerve injury. What could it be due to?
-Hx of fx of scapula w/ involvement of the notch & blade of scapula -Traction injury mechanism -Direct compression of suprascapular nerve at level of scapular notch or at spinoglenoid notch bc of a ganglion cyst or hypertrophied transverse scapular or spinoglenoid ligament
74
Patient is male, over 50, smoker. Pain in shoulder and vertebral scapular border. Nagging, burning pain down arm into 4th/5th digits DIFF DX
Pancoast’s tumor (superior sulcus lung tumor)
75
Patient has weakness in abduction and ER -atrophy of supra and infra, just like a rotator cuff tear. -pain is deep, vague what is the issue?
suprascapular nerve
76
Patient has scapular winging weakness in 45 degree scaption/flexion, protraction -loss of scap/hum rhythm
SALT! long thoracic
77
Patient has drooping shoulder, can't shrug. Lack of scap stabilization weak abduction...
spinal accessory nerve
78
patient has: weakness of shoulder abduction & flexion Lack of sensation of lateral aspect of upper arm
axillary nerve
79
Patient has pain, tenderness, swelling, bruising on arm. What are you suspecting
FX data: Recent fall or trauma Hx of osteoporosis Extended use of steroids (i.e. respiratory problem) Pathologies w/ improper bone remodeling
80
Patient is holding elbow at 70 degree flexion, slightly supinated. antero-lat pain and tender at elbow. unable to supinate or pronate. WHAT DO THEY HAVE
radial head fx
81
MOI: FOOSH with supinated forearm. DIFF DX
radial head fx
82
MOI: FOOSH with forceful wrist extension woman over 40 hx of osteoporosis
colles fx (distal radius fx)
83
Patient is holding wrist in neutral, swellling in wrist, and extending wrist is painful
Distal radius (Colles’) fx
84
MOI: FOOSH Wrist swelling Wrist held in neutral position Pain in ‘anatomic snuff box’
scaphoid fx
85
MOI: FOOSH or diffuse synovitis Generalized wrist swelling & pain ↓’d motion ↓’d grip strength (r/o capitate fx)
Lunate fx or dislocation
86
MOI: fall! FOOSH, forearm pronated. Ulnar-sided wrist pain Tenderness & clicking w/ wrist movement (passive ulnar deviation) Weakness w/ grip strength Dorsal ulnar head subluxation
TFCC tear Traumatic fall after slipping or tripping on outstretched hand w/ forearm pronated *Commonly associated w/ Colles’ fx
87
Recent puncture of skin Recent insect bite Presence of an abscess Purulent tenosynovitis of tendons that go through a space what are you worried about
Space infection of the hand
88
Patient comes in with hand pain. inflammation: swelling in palm, dorsum of hand or fingertips Pain, tenderness, warmth, erythema Signs of long-standing infection: high fever, chills, weakness, malaise What are you worried about?
Space infection of the hand
89
PAIN IN HAND> local tenderness, swelling, muscle spasms, hematoma, pain w/ motion & w/ passive stretch of hand. Patient has history of RA, steroids, respiratory issues, or trauma
grade 1 or 2 muscle tear of long flexor tendons
90
HAND PAIN: total loss of motion & palpable defect in muscle, swelling, tenderness, ecchymosis of overlying skin
Long flexor tendon rupture grade III
91
Hands or feet that blanch, go cyanotic & then turn red when exposed to cold or emotional stress Pain & tingling in hands & feet when they turn red PMH significant for RA, occlusive vascular disease, smoking or use of beta blockers
Raynaud’s phenomenon or Raynaud’s disease
92
Trauma including fx, dislocation or surgery Pain does not respond to typical analgesics Severe aching, stinging, cutting or boring pain that is not typical of injury Hypersensitivity Area swollen (pitting edema), warm & erythematous
Complex regional pain syndrome (formerly reflex sympathetic dystrophy)