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*CLINICAL EXERCISE PHYSIOLOGY > CH4- General Interview + Examination Skills > Flashcards

CH4- General Interview + Examination Skills Flashcards

1
Q

what is important during the general interview

A

to be as detailed as possible throughout
-everything the patient mentions is important, don’t assume ANYTHING

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2
Q

what does the general interview do

A

establish baseline

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3
Q

is the general interview confidential

A

yes

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4
Q

should you assume the patient is referred based on the reason for referral listed

A

NO
-don’t always assume the patient knows why they were referred

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5
Q

general interview topics (7)

A

-reason for referral
-demographic information
-history of present illness (HPI)
-current medications/allergies
-past medical history
-family history
-social history

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6
Q

interview demographics

A

-age
-sex + ethnicity
-also includes medical history

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7
Q

in the interview, what is age a predictor of

A

independent predictor of survival in almost every cardiopulmonary condition

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8
Q

in the interview, why is sex + ethnicity important

A

there are certain diseases that are more prevalent in males vs females, same with sex, ethnicity, etc.
-this is called the “scope of the disease”

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9
Q

scope of the disease

A

areas where the disease is more prevalent- like gender, ethnicity, etc.

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10
Q

HPI

A

history of present illness

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11
Q

history of present illness (HPI)

A

-record + convey information that led to the referral
-chief complaint + manifestations
-symptoms (OPQRSTA)
-objective (medical record) vs. subjective (patient)

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12
Q

HPI- differentiate signs vs. symptoms

A

signs: things you can see (ex: patient is pale)

symptoms: NOT things you can see, things the patient is reporting to you (ex: pain)

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13
Q

in HPI, do objective (medical record) + subjective (patient) always match

A

no

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14
Q

what is objective of the HPI

A

medical record

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15
Q

what is subjective of the HPI

A

patient

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16
Q

HPI- how do we characterize symptoms

A

OPQRSTA

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17
Q

OPQRSTA

A

onset
provocation + palliation
quality
region + radiation
severity
timing
associated signs + symptoms

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18
Q

when characterizing symptoms (OPQRSTA) on the HPI, what is the first thing you must do

A

identify the chief complaint
-we complete OPQRSTA based on the chief complaint

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19
Q

OPQRSTA- onset

A

the very first occurrence of the chief complaint

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20
Q

OPQRSTA- provocation

A

things that make the symptom worse

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21
Q

OPQRSTA- palliation

A

things that make the symptom better/go away

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22
Q

OPQRSTA- quality

A

ADJECTIVES, look for adjectives/words that describe the chief complaint
(ex: severe, dull, aching, tingling, burning, stinging, intense)

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23
Q

OPQRSTA- region

A

anatomical region of the body where symptom occurs

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24
Q

OPQRSTA- radiation

A

does it occur anywhere else?

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25
Q

OPQRSTA- severity

A

be careful with how we define severity because it can be subjective

-try to quantify the severity using scale 1-10
-“given your symptom on the scale 1-10 how bad is it right now”
-this isn’t perfect because symptoms fluctuate, so also ask how bad it is when 1-10 when it is at its BEST + WORST

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26
Q

for severity on OPQRSTA, how many values should we get

A

3
-1-10 how bad is it right now
-1-10 how bad is it at its worst
-1-10 how bad is it at its best

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27
Q

if you don’t get 3 values for severity on OPQRSTA, what do you do

A

it is okay to use other information to estimate or substitute for severity if we don’t have all 3 values
-in the real world you won’t always have access to the patient

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28
Q

OPQRSTA- timing

A

what is the most recent event related to the chief complain
-we want to know WHEN it occurred + WHAT occurred

-don’t confuse this with onset

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29
Q

OPQRSTA- associated signs + symptoms

A

include ANY other information here
-ex: patient says pain is so bad it causes them to vomit

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30
Q

OPQRSTA example- LBP

A

ONSET- 60 days ago

PROVOCATION/PALLIATION-
Increased pain when bending/lifting
Decreased pain when sitting or using hot/cold pack

QUALITY-
Sharp with movement
Dull ache while sitting

REGION/RADIATION-
Middle region of lumbar spine radiating up into thoracic spine

SEVERITY- Highest = 9/10 Lowest = 4/10

TIMING- worsened while lifting 50 lb bag of bird seed 3 days ago

ASSOCIATED S&S: hunched over due to stiffness and pain

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31
Q

interview medications + allergies- what to include for cucrent medications

A

-medication name (generic vs brand)
-dosage (be sure to indicate correct units)
-administration route (enteral vs parenteral)
-time (when to take medicine, morning/evening/etc.)

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32
Q

enteral vs parenteral

A

enteral- orally, through digestive system (pill, feeding tube, etc.)

parenteral- through bloodstream (IV)

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33
Q

interview medications + allergies- what to include for allergies

A

-allergy name (could be food, medication, environment, etc.)
-reaction (hives, closed airway, rash, etc.)

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34
Q

interview medications + allergies- drug purpose

A

DO NOT confer new functions but rather attentuate, accentuate, or replace a response

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35
Q

interview medications + allergies- desired effect vs. side effect

A

-all medications have 2 effects: desired effect + side effect
-desired effect: medication is doing what it is supposed to
-side effect: any other causes the drug has, not all side effects are bad

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36
Q

interview medications + allergies- medical reconciliation

A

-compare the medications that patients state they are taking against their medical records

-THIS SHOULD HAPPEN EVERY TIME YOU SEE THE PATIENT, ALWAYS DO THIS
-“have you had any changes in your medical history?”

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37
Q

how frequently should medical reconciliation be done

A

EVERY TIME you see the patient

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38
Q

exercise + drug absorption

A

-medications can affect the heart rate response at rest or during exercise
-blood redistribution during exercise is significant
-can result in shunting of blood away from important drug absorption + metabolism sites
-blood flow during exercise, is also redistributed to the skin; important for patients with transdermal medications

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39
Q

3 important drug absorption + metabolism sites

A

-liver
-kidneys
-GI tract

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40
Q

how is liver important in drug absorption/metabolism

A

main organ responsible for drug metabolism

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41
Q

how are kidneys important in drug absorption/metabolism

A

main organ for drug elimination

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42
Q

how is GI tract important for drug absorption/metabolism

A

drug absorption
(this is all the slide said)

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43
Q

when someone is exercising, what happens with blood/drug absorption

A

when someone exercises, blood is redistributed to the periphery, so if a medication affects internal organs, it might not absorb well
-therefore we must plan our exercise testing or PT exercise around the times they take this medication

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44
Q

important question to ask patient about medication

A

DID YOU TAKE YOUR MEDICATION TODAY?

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45
Q

interview- medical history

A

this is everything OUTSIDE OF THE CHIEF COMPLAINT

-past medical problems
-focus on problems that may have potential to influence ability to exercise test or train

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46
Q

medical history- musculoskeletal probelms that may influence ability to exercise test/train

A

-LBP
-gout
-joint issues

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47
Q

medical history- neurologic probelms that may influence ability to exercise test/train

A

-cerebrovascular disease
-stroke
-dementia

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48
Q

medical history- respiratory probelms that may influence ability to exercise test/train

A

-asthma
-obstructive lung disease

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49
Q

interview- family history

A

-restrict to FIRST-DEGREE relatives (parents, siblings, + offspring)
-identify relevant heritable disorders (certain cancers, adult diabetes, familial hypercholesterolemia, coronary heart disease after age 55 in men + 65 in women)

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50
Q

interview family history- what are some heritable disorders we should look out for

A

-certain cancers
-adult diabetes
-familial hypercholesterolemia
-coronary heart disease after age 55 in men + 65 in women

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51
Q

interview- social history

A

-social
-inquire about tobacco, alcohol, illicit drugs
-nutrition patterns + habits
-sleep habits + snoring
-leisure activities
-prior + current exercise habits

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52
Q

interview- other ideas

A

-marital status
-transportation
-occupation

this is the END of the interview portion

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53
Q

examination- general state

A

-abnormal findings?
-patient complains?
-general observation (does patient appear comfortable/distressed? anxious? healthy or frail? well nourished or undernourished?)

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54
Q

**see slide 15

A
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55
Q

examination- BP, HR, + respiratory rate

A

-collect vitals during EVERY appointment with the patient, even if you are doing just the interview
-vitals tell us a lot about the current state of the person, are relatively noninvasive, + easy to get so no reason not to

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56
Q

how frequently should you collect vitals (BP, HR, respiratory rate)

A

every appointment

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57
Q

examination- BP

A

know how to classify BP (found on following cards)
-pay attention to and/or

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58
Q

normal BP

A

systolic less than 120
AND
diastoic less than 80

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59
Q

prehypertension BP

A

systolic 120-139
OR
diastolic 80-89

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60
Q

what is 120/80 classified as

A

prehypertensive

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61
Q

stage 1 hypertension BP

A

systolic 140-159
OR
diastolic 90-99

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62
Q

stage 2 hypertension BP

A

systolic greater than or = 160
OR
diastolic greater than or = 100

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63
Q

HR- unexplained tachycardia

A

greater than 100 bpm

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64
Q

HR- unexplained bradycardia

A

less than 40 bpm

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65
Q

examination- HR

A

MUST write down UNEXPLAINED tachycardia/bradycardia not just tachy/bradia

66
Q

examination- respiratory rate

A

unexplained SOB (shortness of breath) or labored breathing

67
Q

the more you see a patient, what will happen during vitals of examination

A

you will get a better idea of what is normal for them

68
Q

beta blockers

A

reduce resting heart rate by 10-15 bpm

69
Q

tachypnea

A

respiratory rate greater than 20 breaths per minute

70
Q

bradypnea

A

respiratory rate less than 8 breaths per minute

71
Q

hypoxia

A

blood oxygen saturation below 95%

72
Q

examination- body fatness

A

-height, weight, BMI
-circumferences (WHR)
-skinfolds
-BIA
-underwater weighing
-bod pod
-DEXA

73
Q

what is important when taking height + weight

A

everything must be calibrated

74
Q

what is used to take height + weight

A

-stadiometer
-scale

75
Q

stadiometer

A

-stand up TALL

-shoes off
-stand nice + tall up against the wall

76
Q

scale

A

-take shoes off
-EMPTY POCKETS
-take coat off
-set purse down

77
Q

body mass index (BMI)

A

-estimate of body fatness
-assumes one’s weight should be proportional to height

78
Q

units for BMI

A

kg/ (m^2)

79
Q

downfall of BMI

A

doesn’t differentiate fat vs lean mass
-solely based on HEIGHT + WEIGHT

80
Q

should BMI be used as a measure of body composition

A

NO
-most clinical settings use this but choose something more accurate if there are signs like the person is a bodybuilder

81
Q

BMI classifications

A

-underweight
-normal
-overweight
-obese class 1
-obese class 2
-obese class 3

82
Q

BMI- underweight

A

less than 18.5

83
Q

BMI- normal

A

18.5-24.9

84
Q

BMI- overweight

A

25-29.9

85
Q

BMI- obese class 1

A

30-34.9

86
Q

BMI- obese class 2

A

35-39.9

87
Q

BMI- obese class 3

A

greater than 40

88
Q

WHR

A

waist to hip ratio

89
Q

waist to hip ratio (WHR)

A

-based on fat distribution using circumference measurements
-looks at where you carry excess fat
-android (apple) vs gynoid (pear)

90
Q

is WHR similar to BMI

A

yes, but not a measure of body fatness
-rather, WHR indicates likelihood of developing chronic diseases

91
Q

what does WHR indicate

A

likelihood of developing chronic diseases
-this is why we use it in the clinical setting

92
Q

in WHR, where is excess fat bad

A

around midsection

93
Q

WHR- android

A

apple
-person carries excess weight in thier midsection
-NOT IDEAL

94
Q

WHR- gynoid

A

pear
-person is narrow at the top + wider at the bottom
-less indicative of disease risk

95
Q

WHR- android or gynoid is worse

A

android is worse

96
Q

units for WHR

A

cm
-inches can be used too, as long as units for waist + hip are same

97
Q

WHR equation

A

WHR = waist (cm) / hip (cm)

98
Q

for WHR, define where waist is measured

A

smallest circumference of midsection

99
Q

for WHR, define how hip is measured

A

largest circumference around hips

100
Q

WHR value meanings

A

-lesser than 1 = waist is smaller from hip measurement, LOWER RISK
-closer to 1 = GREATER RISK

101
Q

WHR- women vs men

A

values are different for women + men because women tend to have higher body fat + tend to carry in hips/thighs due to childbearing reasons

102
Q

skinfold assessment

A

-premise that subcutaneous fat levels correlate highly with total body fat
-based on thickness of several skinfolds across the body

103
Q

for skinfold, all measurements are taken on what side of the body

A

ALL measurements done on right side of body

104
Q

subcutaneous fat

A

fat just beneath the skin
-highly correlated to total body fat levels

105
Q

why are several skinfolds taken

A

because everyone holds fat in different areas

106
Q

how many sites are used for skinfold

A

7

107
Q

skinfold can be used to get what

A

body density
-which leads us to % fat

108
Q

biggest downfall of skinfold assessment

A

takes a lot of practice to be good at
-even the best administrators still have about 3% degree of error

109
Q

BIA

A

bioelectrical impedance analysis

110
Q

bioelectrical impedance analysis (BIA)

A

-uses physics
-fat is highly impedant to electricity
-muscle + water are not impedant to electricity

111
Q

BIA- muscle + body water

A

-electricity flows easily
-low resistance
-low impedance

112
Q

BIA- fat

A

electricity does not flow
-high resistance
-high impedance

113
Q

what values does BIA give us

A

% body fat + BMI

114
Q

pros of BIA

A

-quick
-straightforward
-cheap

115
Q

what do you have to account for with BIA

A

our body has a lot of water which can fluctuate a LOT on a daily basis
-depending on hydration status, body fat % will change
-if you use this machine, you must give the patient pre-appointment instructions to drink lots of water for A FEW DAYS BEFORE

116
Q

what must patient do before BIA

A

drink lots of water for a FEW DAYS beforehand

117
Q

2 types of BIA

A

-handheld
-laying down

118
Q

laying down BIA

A

-used in the clinical setting, more in hospitals
-gives a much more breakdown of fat, lean, mass, AND hydration status

119
Q

when comparing BIA over the course of months for a patient, what is the first thing you should look at

A

hydration status

120
Q

what would dehydration do to BIA

A

overestimate body fat
-therefore more impedance

121
Q

what is the gold standard

A

bod pod

122
Q

why is bod pod the gold standard

A

super simple + quick

123
Q

cons of bod pod

A

patient could be claustrophic, would not want to use for this instance

124
Q

how does bod pod work

A

works through air displacement
-seal the door + the machine will standardize the amount of air inside + measure that
-looks at when the person is in it, how much air they displace; hence why they must wear tight clothes + head cap so air doesn’t get trapped in between

125
Q

what must you know about DEXA

A

x-ray/radiation is used

126
Q

can anyone administer a DEXA

A

no, must be a tech

127
Q

can a pregnant woman do DEXA

A

no- becasue radiation

128
Q

is DEXA or bod pod more accurate

A

equally accurate
-we use bod pod over DEXA because DEXA is expensive
-bod pod doesn’t have radiation

129
Q

does hydration status affect DEXA

A

no
-however, it does PROVIDE hydration status

130
Q

what do colors of DEXA mean

A

-yellow/orange colors represent fat
-light blue/dark blue represents bone/lean tissue

131
Q

what does DEXA do

A

tells us where we have most of our fat mass

132
Q

auscultation

A

the action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope, as a part of medical diagnosis

133
Q

examination- pulmonary system

A

auscultation of the anterior + posterior chest surfaces for breath sounds, characterized as:
-normal
-decreased or absent
-coarse
-wheezing
-crackling

(all are present in COPD)

134
Q

regardless of why you are seeing a patient, what should be included in every exam

A

auscultation of pulmonary system

135
Q

auscultation of pulmonary system- decreased/absent sounds

A

likely means this person has airway issues, hard time getting air in/out

136
Q

auscultation of pulmonary system- coarse

A

rough sounds

137
Q

auscultation of pulmonary system- wheezing

A

high pitched whistling noise

138
Q

auscultation of pulmonary system- crackling

A

best described as a wood burning fire

139
Q

examination- cardiovascular system

A

-cardiac pulse can be palpated in wrist + feet
-skin temperature/moisture should be warm/dry
-look for peripheral edema

140
Q

what is pulsed used for in cardiovascular part of examination

A

used to get an idea of circulatory issues

141
Q

which pulses should you palpate

A

radial pulse + ankle pulse
-because might not have same circulation in both places

142
Q

cold/clammy skin temperature/moisture means what

A

poor perfusion

143
Q

peripheral edema aka swelling of extremities is a sign of what

A

congestive heart failure (CHF)

144
Q

signs of someone with poor circulation

A

-white hands/fingers/feet
-cold + clammy
-might feel sweaty

(all these are signs of poor circulation)

145
Q

peripheral edema

A

swelling on the outskirts of the body

146
Q

pitting

A

when you push on skin + there is a dimple that doesn’t rebound right away

147
Q

what is pitting a sign of

A

peripheral edema

148
Q

examination of musculoskeletal system looks at what 3 things

A

-gait
-joints
-LBP, red flags

149
Q

examination of musculoskeletal system- what do we look at for gait

A

-normal
-antalgic
-hemiplegic
-shuffling
-wide
-etc.

150
Q

antalgic gait

A

limping

151
Q

hemiplegic gait

A

leg abducts in semicircle

152
Q

examination of musculoskeletal system- what do we look at for with joints

A

-redness
-warmth
-swelling
-tenderness

153
Q

examination of musculoskeletal system- what do we look at for LBP

A

-radiating pain or numbness present? (indicate nerve involvement which is much more serious than muscle tissue)
-new onset?

154
Q

if LBP is new onset, what must we do

A

send them back to PCP to get checked for clearance

155
Q

functional fitness tests

A

dry run of the patient’s physical performance before the real exercise testing
-gives us a baseline measure of the patient’s functional status

156
Q

3 types of functional fitness test

A

-6 min walk test
-time up + go (TUG)
-short physical performance battery (SPPB)

157
Q

functional fitness test- time up + go

A

patient sits in chair, administrator has stop watch, patient walks down + turns around, comes back + stops watch once they sit down
-uses weight shifting, lateral, etc.

158
Q

functional fitness test- short physical performance battery

A

gives better representation than just a walking test because there are 4 things involved
-balance, chair stands, short walk
-KNOW it has more functional components than just a walk

159
Q

chair stand

A

patient sits in chair, crosses arms, + measures how many times they can stand + sit for 30 seconds to 1 minute

160
Q

balance test

A

Berg balance scale

161
Q

what is Berg balance scale used for

A

basline balance testing

162
Q

what else important to do for a patient in an exercise program

A

educate + motivate the patient

*CLINICAL EXERCISE PHYSIOLOGY (5 decks)

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