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Primary Care PT > Exam 1-- week 1-2 > Flashcards

Exam 1-- week 1-2 Flashcards

1
Q

Characteristics of Primary Care

A 
Comprehensive
Coordination
Continuity
-safe
-effective
-timely
-efficient
-equitable
-patient-centered
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2
Q

Characteristics of Secondary Care

A 
Consultative
Short term
disease oriented
assisting PCP
historically what PT was considered
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3
Q

List of Primary Care providers

A 
Family physicians/general practitioners
osteopathic physicians
general internists
nurse practitioners
physician assistants
physical therapists
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4
Q

Family/Osteopathic Physicians/GPs

A

Graduation from med school
minimum of 3 years post-grad training
at least 1 month learning MSK conditions
Shadowing orthopedist/sports medicine

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5
Q

General Internist

A

Graduate of med school
complete minimum of 3 years post-grad training
Focus of expertise in internal medicine (viscera)
Focus on chronic conditions–Cardiac disease, hypertension, diabetes, chronic pulmonary disease, etc.
(Treat mostly older population)
No requirement for training with orthopedist or SM to treat MSK conditions
knowledge of MSK conditions and treatment is limited

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6
Q

Physician assistants

A

Two years of training
- 1 yr classroom
-1 yr rotations in various IP and OP clinical settings
BS and MS degrees
PAs never practice completely independently
clinical focus depends on supervising physician’s expertise

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7
Q

Nurse Practitioners

A

Graduates of RN training program
length and focus of training is variable
Not typically a general practitioner–more focused on a specification
Generally VERY good primary care practitioners because of their background of patient-centered care and patient interaction

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8
Q

Physical Therapists

A

Postgraduate degrees–BS > MS > DPT (as of 2016)
CAPTE accreditation
content required in basic science
general practitioners upon graduation
eligible to apply for post-grad residency programs and specialty certifications

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9
Q

Physical therapy specialties

A 
Cardiovascular and Pulmonary (CCS)
Clinical Electrophysiology (ECS)
Neurology (NCS)
Orthopedics (OCS)
Pediatrics (PCS)
Sports (PCS)
Women's Health (WCS)
Geriatrics
Oncology
Wound management
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10
Q

T/F All 50 states have achieved some sort of form of direct access

A

True

Varying from Eval Only to unrestricted care

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11
Q

Potential benefits of Primary Care PT

A

more efficient use of health care resources
care being delivered in a more timely manner
interdisciplinary collaboration

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12
Q

US Army Model

A

Preparation for primary care practice
neuromusculoskeletal evaluation (triage model)
privileges
outcomes

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13
Q

US Army prerequisites and competencies

A

National selection through military review board
strong academic background
adapt to variable clinic environments
commitment to serve
Advanced training in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and acute MSK injuries
Completion of ongoing CE

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14
Q

Kaiser Permanente Model

A

Largest not-for-profit HMO in US
PT services are primary care in most regions
PTs work with medical providers
Outcomes

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15
Q

Kaiser PT prerequisites and competencies

A

Strong foundation in orthopedic PT
4-6 years of OP PT
Required CE
competency in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and acute MSK injuries

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16
Q

VA PT services and access

A

MSK, neuromuscular, integumentary, cardiovascular/pulmonary systems
PTs screen patients in the ED
primary care clinic– triage by a nurse
Direct: overweight patients or those who wish to improve their general health

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17
Q

Mercy Model prereqs and competencies

A

strong foundation in orthopedic PT
demonstrated competency in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and chronic MSK injuries
Ability to work in collaboration with medical residents

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18
Q

Mercy Model educational program for medical residents

A 
PT instructs medical residents in low back, neck, shoulder, and knee
Rotations
MSK examination performed by medical residents 
Case presentations--clinical reasoning
residents observe a PT
Benefits: 
enhanced use of resources
multidisciplinary approach
better utilization of resources
more efficient access
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19
Q

Elements of the patient-centered interview

A
  • exploring pt’s disease/diagnosis and its effect on his or her life
  • understanding the whole person
  • finding common ground regarding intervention or management
  • advocating prevention and health promotion
  • enhancing the patient-provider relationship
  • providing realistic expectations
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20
Q

Dimensions of the illness experience

A
  • patient profile
  • patient goals
  • functional limitations
  • patient’s perception about the disorder
  • patient’s feelings about the disorder
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21
Q

Goals of patient history

A
  • establishing rapport
  • identifying any barriers to communication
  • identifying the patient’s preferred learning style
  • establishing the patient’s goals for physical therapy in addition to our functional based goals
  • SINSS
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22
Q

Communication strategies

A
  • ask one question at a time
  • periodic restatement or summarization
  • avoid medical jargon
  • use patient’s line of thought
  • avoid assumptions
  • self-assessment
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23
Q

Keys for patients with hearing deficits

A
  • utilize a quiet area for the interview
  • patient should use hearing and visual aids when available
  • clinician should position themselves to facilitate lip reading
  • use of interpreter (ASL) may be needed
24
Q

Manifestations and cautions for angry patients

A 
Manifestations:
-obvious
-use of sarcasm or cynicism
-negativity
-lack of compliance
-non-verbal forms of communication
-escalation
Be cautious:
-patient tensely moving toward edge of chair
-patient tensely gripping arm rests
-loud, forceful speech
-restless agitation, pacing, and inability to be still
25
Q

Signs of depressed patients

A
  • impaired concentration
  • poor compliance with home instructions
  • clinician should acknowledge the situation
  • explore potential reasons
  • recognize potential for suicide
26
Q

Important keys to a thorough exam

A
  1. differential diagnosis
  2. safe delivery of physical exam
  3. review patient’s list of medications
  4. assess potential impact of co-morbidities
27
Q

Patient health history data

A
  1. patient demographics
    - age, sex, race, marital status, level of education
    - Body chart
  2. social history
    - cultural customs, religion, occupation, living environment, family/social support
  3. current medical situation
  4. past medical history–illness, allergies, surgeries, injuries, medications
  5. social habits
    - exercise frequency/intensity, use of tobacco, alcohol, caffeine
  6. family medical history
28
Q

CAGE (questions for alcoholism)

A

have you ever felt you should Cut down on your drinking?
have people Annoyed you by criticizing your drinking?
have you ever felt bad or Guilty about your drinking?
have you ever had a drink first thing in the morning to steady your nerved or get rid of a hangover? (Eye-opener)

29
Q

presentation of caffeine withdrawal

A 
headache
lethargy
fatigue
dysphoric mood
muscle pain/stiffness
30
Q

Pertinent documents for health history information

A

medical records
patient self-reports
screening questionnaires

31
Q

Do not want to miss list

A 
major depression
suicide risk
femoral head/neck fracture
cauda equina syndrome
cervical myelopathy 
AAA
DVT
PE
atypical myocardial infarction
32
Q

Clinical manifestations of major depression

A

Yes to one/both of the following: 1) felt down, depressed or hopeless and/or 2) little interest or pleasure in doing things
Noting 3-4 of the following:
1) significant weight change, 2) insomnia or hypersomnia, 3) psychomotor agitation, retardation, 4) fatigue, 5) feelings of worthlessness and/or guilt, 6) difficulty concentrating, thinking ot 7) recurrent thoughts of suicide

33
Q

risk factors associated with major depressive disorder

A
  • current or previous history of major depressive episodes
  • women, especially during pregnancy or postpartum
  • significant medical history such as DM, MI, cancer, CVA, chemical dependency
  • suffering from significant loss
  • positive family history from immediate relative
34
Q

common risk factors associated with suicide

A
  • gender (males higher completion rate, females higher attempt rate)
  • widowed, divorced, living alone
  • history of psychiatric illness
  • previous suicide attempts
  • history of chronic progressive illness
  • recent significant loss
  • unemployment
  • sense of hopelessness
  • family history of suicide completion or attempt
35
Q

risk factors for femoral fractures

A
  • female
  • hormonal menstruation irregularities
  • involvement in running, jumping, marching activities
  • change in training program or routine
  • nutritional deficiencies
  • leg length discrepancy
  • diminished muscle strength
  • loss of general function and mobility
36
Q

clinical manifestations of femoral neck/head fractures

A
  • pain and local tenderness
  • deformity
  • edema
  • ecchymosis
  • loss of general function and mobility
37
Q

what % of those suffering a hip fx die within a year?

A

30%

38
Q

disorders that may compromise bone density

A 
chronic renal failure
GI malabsorption
rheumatoid arthritis 
ankylosing spondylitis 
hyperparathyroidism
hypogonadism
T2 DM
MS
chronic alcohol dependency
Cushing's syndrome
39
Q

medication/substance use or abuse that may compromise bone density

A 
aluminum 
anticonvulsants
corticosteroids
cytotoxic drugs
excessive thyroxine
heparin, warfarin (coumadin)
methotrexate
caffeine (> 3 cups daily)
tobacco
soft drinks
40
Q

risk factors for cauda equina syndrome

A 
low back injury, central disk herniation
congenital or acquired spinal stenosis
spinal fx
ankylosing spondylitis
tuberculosis, Pott's disease
41
Q

clinical manifestations of cauda equina syndrome

A 
urinary dysfunction
bowel dysfunction
sexual dysfunction
sensory deficits (perineum, "saddle" region, LE paresthesia)
motor deficits (LE--multiple spinal levels)
42
Q

risk factors for cervical myelopathy

A

spondylotic changes in cervical spine
Age mid 50-60s and older
previous neck trauma (MVA, sports injury)
rheumatoid arthritis

43
Q

clinical manifestations of cervical myelopathy

A 
History:
-impaired hand dexterity
-gait, balance difficulties
-numbness/paresthesia in UE/LE
-neck stiffness
-urinary dysfunction 
physical exam:
-hand--intrinsic atrophy
-muscle weakness, often triceps; hand intrinsic
-muscle weakness of LE
-UMN signs (hyperreflexia, clonus,, Babinski's, Hoffman's)
44
Q

Risk factors of Abdominal Aortic Aneurysm (AAA)

A 
Age
male
hx of smoking
hypercholesterol
hx of coronary heart disease
family hx of AAA
45
Q

clinical manifestations of AAA

A

usually asymptomatic, but may produce pain in lumbar region, back, hip and buttock, groin, abdominal region
satiety, weight loss, and nausea
palpable abdominal mass

46
Q

Signs of AAA vessel dissection

A 
LBP described as:
sudden, severe
intense, persistent
hot, searing
ripping or tearing sensation
*medical emergency*
47
Q

risk factors for DVT

A 
previous hx of DVT
hx of cancer or chemotherapy
hx of CHF
hx of SLE
major surgery or other trauma 
immobility
hormone changes in women
age > 60 yrs
48
Q

clinical manifestations of DVT

A

ache, tightness, tenderness
general pitting edema
prominent superficial venous plexus
increased local skin temperature

49
Q

Modified Wells criteria for detecting probability of DVT

A

active cancer
paralysis, paresis, recent immobilization of LE
recently bedridden for 3 days or major surgery in last 12 weeks
localized tenderness along deep venous system
entire leg swollen
calf swelling > or = 3 cm larger than asymptomatic side
pitting edema confined to symptomatic leg
collateral superficial veins
previously documented DVT
alternative diagnosis at least as likely as DVT

50
Q

Risk factors of Pulmonary Embolism

A 
previous hx of PE or DVT
immobility
hx of abdominal, pelvic surgery
total hip or knee replacement
late-stage pregnancy
LE fx
malignancy in pelvis or abdomen
51
Q

clinical manifestations of PE

A 
dyspnea
tachypnea
pleuritic chest pain
pain with respiration, cough
persistent cough
apprehension, anxiety
tachycardia
palpitations
52
Q

risk factors for atypical myocardial infarction

A 
Modifiable:
-smoking
-high cholesterol
-HTN
-DM
-obesity
-sedentary
-excessive alcohol 
non-modifiable:
-age: >55 yr for women, >45 yr for men
-family hx
-ethnicity: highest in African Americans
53
Q

clinical manifestations of atypical MI

A 
50% experience chest pain with out without left UE pain
shortness of breath
fatigue
sleep disturbance
nausea with or without vomiting
palpitations
dizziness 
diaphoresis
anxiety
54
Q

Descriptive words for vascular disorders

A

throbbing
pounding
pulsating

55
Q

descriptive words for neurologic disorders

A

sharp
lancinating
shocking
burning

56
Q

descriptive words for visceral disorders

A 
aching
squeezing
gnawing
burning
cramping

Primary Care PT (1 decks)

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