Examination and the diagnostic threshold Flashcards
where does the exam fit into the flow of reasoning?
after developing sinns and before the intervention
what is the purpose of the exam ?
- determine if patient appropriate-complete tests needed to rule out red flags
- ID nature and extent of the movement dysfunction /injury
- reproduce and determine comparable signs
- system screen; mindful
- Rule in a working hypothesis and Rule out competing hypotheses
- ID contributing factors; movements or bahviors that may have predisposed the patient to the current problem
what should you do 1st in physical exam?
Rule out contraindications to exam first!
progression though exam depends on?
pt SINNS
how should navigate your way through an exam?
General>Specific
- Stepwise
- Observe>neuro exam>functional screen>AROM>PROM>neural dynamics>palpation>muscle exam (activation, motor control, strength, endurance, speed)>special tests
- Positional
- Standing>Sitting>Supine>Sidelying>Prone
when it comes to measurement sin the exam, what should you keep in mind?
Standardize the measurement
•L cervical rotation…do it the same every time
•Sitting with calf touching edge of table, erect posture, feet on floor
•Don’t measure everything you examine
•Establish objective asterisks
•Measure those things that will be retested to recognize progress
•Should be linked to subjective asterisks
how can you differentiate structures in a exam?
Multiple structures involved in most tests
•Need to attempt to isolate structures
•Often a combo of tests needed
- Examples
- Lumbar AROM reproduces hip pain (is it hip or lumbar referral?)
- Unweight affected hip and repeat lumbar flexion
- During neural dynamics-move proximal or distal segment
what is a comparable or concordat sign ?
- Reproduction of symptoms that are familiar to the patient in the specific area, with the same sensory responses
- Combination of responses to tests and measures (stiff, sharp pain, etc) the patient considers comparable to their symptoms
- May change over time as condition changes
what is the Diagnostic or Treatment Threshold?
Point at which testing has afforded a reasonably accurate diagnosis
- will affect the accuracy of the following exam components
- when the exam begins, various hypo are made, its narrows after questioning, narrowing after exam
- when testing yields this threshold , narrowed hypos, a decision to begin txing is made
how can you know yourself and your biases ?
- How do you process info?
- How does your thinking bias your interpretation of facts?
- What are your tendencies when solving problems?
what are types of unhelpful thoughts?
- All/nothing or black/white thought
- Overgeneralization
- Confirmation bias
- Disqualifying the positive
- Jumping to conclusions
- Catastrophization
- Emotional reasoning
- Labelling
- Personalization
what is availability bias ?
judgment affected by ease of recall easy to remember gets more weight
what is similarity bias ?
approval of things similar to us
what is conservatism ?
failing to change dx probability based of data
what is anchoring bias ?
putting less weight on the facts/info that do not support hypothesis
what is hickmans dictum?
pt can have as many dx as they need
Occams razor/
dont need to multiply dx for no reason, simplest solution is the best
