Case history, etc. Flashcards
list the components for a case history
details of chief complaint
comprehensive health history
review of systems
components of examination process
general inspection vitals CN exam visceral exam cerebellar and proprioception exam multimodal exam sensory exam muscle strength exam DTR exam superficial, pathological, visceral reflexes ROM orthopedic test (standardized) orthopedic test (specific)
chiropractic examination
instrumentation static palpation motion palpation leg lengths x rays
synthesis/assessment
group together clues from history, exam, special studies and procedures performed
create a problem list in order of priority
therapeutic program
chiropractic management plan adjustments support procedure physical therapy work instruments sleep and activity instructions exercise instructions diet instructions
concurrent care
recommending consulting with another healthcare provider while under care
referral
referring patient to another healthcare provider before any other chiropractic care
recommendations
review findings with patient and explain your findings
recommend therapeutic program
when are re-evaluations done?
at predetermined intervals or as the case demands
patient status/current plan
continue with therapeutic program
modify therapeutic program
recommend consultation or referral OR
dismiss patient if they have reached maximum medical improvement
as a chiropractic physician one of our duties to the patient is to…
formulate a diagnosis
history process and gathering of information by the interview process, what types of questions are preferred? what are the other types of questions you could ask?
open ended questions
direct questions
leading question
Questions to ask about the onset.
can you point to where it is?
when did you first notice it? Gradual or sudden?
what was the exact day you noticed it?
do you know what caused your symptoms?
have the symptoms changed over time?
are there any new symptoms associated with it?
has it gotten worse or better?
how long has it been since you have felt well?
provoke examples
lifting, bending, reaching, sitting
palliative examples
anti-inflammatory drugs, ice, rest, adjustments
joint quality of pain
sharp pain on motion, constant pain
nerve quality of pain
constant pain, burning, hot, tingle
peripheral nerve quality of pain
numbness, tingling, burning (multidermatomal)
muscle quality of pain
dull ache, cramping, knot, spasm
sceratogenous quality of pain
radiating dull or deep ache
ligament quality of pain
deep burning or dull pain
vascular quality of pain
throbbing
unilateral radiating pain that follows a dermatome indicates?
NR irritation/compression
unilateral radiating pain that follows a multi-dermatomal pattern indicates?
peripheral N irritation/compression, vascular, brachial plexus injury
bilateral radiating pain that involves the upper extremities only indicates?
cervical myelopathy C6-T2
bilateral radiating pain that involves the upper and lower extremities indicates?
spinal cord lesion C5 and above
bilateral radiating pain that involves the lower extremities indicates?
lumbar spinal cord lesion, spinal cord stenosis
visual analog scale
patient marks on a 10 cm line how much pain they are in
borg scale
ask patient on a scale of 1-10 how bad their pain is
minimal pain
pain is annoying, no impairment with activity
slight pain
pain is tolerable, impairment with activity
moderate pain
pain causes marked impairment with activity
marked pain
pain keeps patient from doing any acitivities
increased pain that occurs at night and the patient reports having unexplained weight loss suggests?
cancer
intermittent pain
less than 25% of the time
occasional pain
25-50% of the time
frequent pain
50-75% of the time
constant pain
75-100% of the time
benefits of a good examination
determine that a musculoskeletal lesion is present
location of the problem
pathological conditions that could cause these problems
analyze the history, examination and testing
dermatome pain pattern
radiating, sharp, stabbing, well demarcated
myotogenous pain pattern
pain referral within muscular or fascial tissue
scerotogenous pain pattern
dull, achy, diffuse, difficult to pinpoint
vascular pain pattern
throbbing
visceral pain pattern
referred pain, deep
components of vital signs
respiration blood pressure temperature height and weight mental status
active ROM importance
helps determine if there is subluxation, muscle spasm, muscle strain, ligament sprain, general arthritic condition, post surgical condition, obesity
passive ROM importance
tests end of ROM for any pathologies or subluxationsf
bone to bone passive ROM
abrupt stop when two hard surfaces meet
capsular end feel
“leathery” slight give at end of ROM
springy block
usually pathological, generally represents interarticular displacement
empty feel
usually pathological
your static and motion palpation examination findings reveal that the patient experiences pain before end range can be reached you with your passive ROM. what does this suggest?
acute condition
your static and motion palpation exam findings reveal that the patient experiences pain as the end range can be reached you with your passive ROM. what does this suggest?
subacute condition
your static and motion palpation exam findings reveal that the patient experiences pain after the end ROM reached you with your passive ROM. what does this suggest?
chronic condition
resisted muscle testing that is painless and strong
normal
resisted muscle testing that is painful and strong
grade I strain
resisted muscle testing that is painful and weak
grade II strain
resisted muscle testing that is painless and weak
grade III strain
decreased RBCs mean..?
anemia, neoplasm of bone, lupus
increased RBCs mean..?
polycythemia, severe diarrhea, dehydration, poisoning
total WBC count
shifts in differential may be present in infections
increased ESR
infection, neoplasm and other necrotic processes
alkaline phosphatase
increase in primary and secondary osseous neoplams
acid phosphatase
increased in prostatic tumors
decreased serum proteins
edema, liver disease, malabsorption, diarrhea, starvation
increased serum proteins
lupus, RA, chronic infection, multiple myeloma
what are the indications for Xray?
soft tissue injury bony misalignment loss of integrity/osseous structures and joint space dislocation fracture certain tyes pf stress injuries metastatic disease degenerative disease abnormalities in growth plate some primary tuors metabolic disease
red flags for xray and other lab studies
prior cancer or recent infection, fever over 100, IV drug abusee, prolonged steroid use, low back pain worse with rest, unexpected weight loss
indications for CT
fracture, IVD protrusions or herniations
facet disease
central canal and lateral recess stenosis
metabolic bone disease
indications for MRI
IVD protrusion, herniation early stages of DDD spinal cord tumors intracranial disease CNS disease metastatic bone disease spinal stenosis cerebral edema meniscal tear soft tissue tumor
when do you order MRI with contrast?
patietn with acutre low back apin and have had recent surgery
indications for bone scan
spinal tumor
infection
occult fracture
indications for electromyography
muscle issues
indications for nerve conduction velocity exam
sciatica
indications for angiography
intercranial aneurysms, vascular disorders, hematomas, tumors
indications for thermography
NR compression
instrumentation beak to the right along with radiating pain to the right suggests?
nerve compression
instrumentation break to the left along with radiating pain to the right suggests
nerve irritation
what patient would benefit from a cranial nerve exam?
trauma, stroke, etc
control all motor and sensory functions of the head, face and neck as well as..?
special senses
___pain may be the greatest cause of headaches
cervicogenic
___vertigo may be the greatest cause of dizziness
cervicogenic
CN abnormalities may arise from…
specific lesions to the nerve
lesion in nucleus
communicating pathways to and from cortex, diencephalon, cerebellar or other parts of brainstem
generalized problems with nerves or muscles
more than one CN may be affected by a generalized disorder like…?
myasthenia gravis
multiple lesions may be noted with…?
MS, cerebral vascular disease
unilateral cranial nerve syndrome affection V, VII, VIII…
cerebellopontine angle lesion
unilateral cranial nerve syndrome affecting III, IV, V and VI…
cavernous sinus lesion
combined unilateral cranial nerve syndrome affection IX, X and XI…
jugular foramen lesion
the most common cause of instrinsic brainstem lesion in younger patient is..? older patient?
young: MS
old: vascular disease
hypoalgesia
area of greatest sensory loss
hyperalgesia
area where sensory increases
alganesthesia/analgesia
insensitive to pain
hypalgesia
decreased sensitivity
hyperalgesia
increased sensitivity
