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Musculoskeletal I > General Exam Scheme > Flashcards

General Exam Scheme Flashcards

1
Q

List the traditional 4 step exam flow.

A
  • Listen
  • Look
  • Feel
  • Move
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2
Q

What 5 categories should be considered before determining how aggressive a PT can be in their exam?

A

SINSS

  • Severity: Mild/ Moderate/ Severe effect on function
  • Irritability: Stimulus required to irritate/ time to baseline (Mild/ Moderate/ Severe)
  • Nature of the problem: What’s wrong?
  • Stability: Getting worse? Better? Unchanging?
  • Stage: Acute? Subacute? Chronic?
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3
Q

What does the therapist do during the listen stage?

A
  • Allows the patient to speak
  • Summarizes and repeats complaints/ history
  • Asks open ended questions
  • Delves deeper into specific areas of interest
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4
Q

How can musculoskeletal pain be differentiated from visceral pain? What some sources of visceral pain?

A
  • Pain does not change with muscle/ joint positioning
  • Pain is not related to activity (except for heart/ lung pain)
    Sources:
  • Heart
  • Lungs
  • Vasculature
  • Kidneys
  • etc.
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5
Q

What does the therapist assess during the look portion of the exam?

A
  • Posture/ alignment
  • Swelling/ edema
  • Muscle hyper/atrophy
  • Skin/ nail color/texture changes
  • Splinting/ guarding, spasms
  • Facial expressions
  • Adaptive devices
  • Willingness to move
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6
Q

What determines the aggressiveness of the therapist during the Feel stage of the exam?

A

SINSS

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7
Q

What can the therapist asses in the feel portion of the exam?

A
  • Dermal/ subdermal flexibility
  • Density/ edema
  • Tenderness
  • Temperature
  • Muscle spasm
  • Trigger points
  • Tender points
  • Fascial tightness or tenderness
  • Joint lines and bony prominences
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8
Q

In what manner should the therapist work through the feel portion of the exam?

A

From superficial to deep.

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9
Q

What types of tests are performed during the movement portion of the exam?

A
  • Clearing tests
  • Movement tests
  • Muscle strength tests
  • Neurological tests
  • Special tests
  • Functional tests
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10
Q

What joints should be cleared in an exam?

A

The joint above and below the area of complaint, and also either the cervical or lumbar spine.

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11
Q

If pain is felt from AROM and PROM in the same direction, what type of lesion is indicated?

A

Inert (joint, ligament, capsule)

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12
Q

If pain is found in AROM and PROM in opposite directions, what type of lesion is indicated?

A

Contractile (muscle)

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13
Q

How much great is PROM than AROM in a healthy joint?

A

5 degrees.

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14
Q

Where is pain felt in relation to the movement barrier of ROM for the acute inflammatory stage, the subacute stage, and the chronic stage of irritability.

A

Acute inflammatory: Before barrier
Subacute: At barrier
Chronic: After barrier

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15
Q

What scale is used to assess arthrokinematic motion?

A

0 (anklyosed) - 6 (hypermobile)

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16
Q

What are some methods of neurological examination tools/ tests?

A
  • Light touch
  • Temperature
  • Vibration
  • DTR
  • Proprioception
  • Balance
  • Tinel
  • etc…
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17
Q

What are steps are left after the examination is complete?

A
  • Evaluation
  • Diagnosis
  • Prognosis
  • Interventions
  • Outcomes/ re-evaluations
18
Q

What are the 3 philosophical approaches to Musculoskeletal therapy assessment?

A
  • Biomechanical - Pathological model
  • Patient response model
  • Mixed
19
Q

What is the common systematic approach to all MS therapy assessment models?

A
  • Clinical exam
  • Treatment
  • Re-exam

Generates diagnostic label.

20
Q

What are pathology-based diagnostic labels?

A
  • Medical diagnoses

- Linked to pathology

21
Q

Why are pathology-based diagnostic labels rarely used to guide PT treatment?

A
  • No information on severity, nature, stage of MS problem.
22
Q

What are impairment-based diagnostic labels?

A
  • Clinical subjective, objective, and patient response combine to form label.
  • Treatment guided by what relieves symtpoms
23
Q

What type of diagnostic label is used by the PT guide?

A

Impairment-based.

24
Q

What is the systematic process used to generate an impairment-based diagnostic label?

A 
- Generate hypothesis
    History/intake
    Systems review
    Lab tests and imaging studies
- Eliminate and refine hypotheses
    Physical exam/ special tests
25
Q

What 5 questions should begin a follow-up visit?

A
  • How did you feel when you left last time?
  • How did you feel the next day?
  • How are you progressing with (subjective asterisks)?
  • Are you doing your HEP? - Show me.
  • How are the objective asterisks progressing? (Not asked to patient directly. Measured. Tested)
26
Q

What is performed during a formal re-evaluation?

A
  • Assess progress of existing condition
    Maybe revise goals
  • Are new problems surfacing?
27
Q

What does a category 1 red flag require?

A
  • Immediate medical attention
28
Q

What are 8 examples of category 1 red flags?

A
  • Pathological changes in bowel/ bladder function
  • Symptoms not musculoskeletal in origin
  • Blood in sputum (mucus)
  • Numbness or parathesias in perianal (saddle) region
  • Progressive neurological deficits
  • Pulsatile abdominal masses (aneurism)
  • Neurological deficits not explained by monoradiculopathy (not radiating pain)
  • Elevated sedimentation rate
29
Q

What implications do category 2 reg flags have?

A
  • Require subjective questioning

- Contraindications to certain manual therapy techniques

30
Q

What are 8 examples of category 2 red flags? (16 total possible responses) (Don’t forget 3 legal red flags)

A
  • Impairment caused by recent trauma (fall –> find crack in arm)
  • Writhing pain
  • Nonhealing sores/ wounds
  • Fever
  • Clonus
  • Gait defects
  • Cancer history
  • Long-term steroid use
  • History of disorder that leads to infections or hemmorhage
  • History of a metabolic bone disorder
  • Recent unexplained weight loss
  • Age greater than 50
  • Litigation for current complaint
  • Long-term worker’s comp
  • Poor relationship with employment supervisor.
31
Q

What are the implications of a category 3 red flag?

A
  • Require further physical testing and differentiation analysis
32
Q

What are 3 examples of category 3 red flags?

A
  • Bilateral or unilateral radiculopathy/ parathesia
  • Unexplained limb weakness
  • Abnormal reflexes
33
Q

If there is a new visceral pain found during a therapy session, what is protocol?

A
  • REFER OUT
34
Q

What is perceived risk?

A

Risk perceived by the therapist AND the patient.

35
Q

What are 6 absolute contraindications for active movement?

A
  • Cancer of targeted region
  • Cauda equina lesions (saddle parathesia)
  • Rheumatoid collagen necrosis
  • Red flags indicating cancer, fracture, or systemic disease
  • Signs of VBI
  • Unstable upper C-spine (except specific movements for stabilizing)
36
Q

What are the one A, 5 D’s, 2 H’s, 3N’s for vertebral basilar insufficiency?

A
  • Ataxic gait disturbances
  • Drop attacks/ sudden weakness/ loss of conciousness
  • Dysphagia: trouble swallowing
  • Dysarthria: trouble with speech
  • Dizziness
  • Diplopia or other visual disturbances
  • Headaches (context dependent)
  • Hearing disturbances (not hearing loss)
  • Numbness on one side of face or body
  • Nystagmus (beating of eyes)
  • Nausea (unexplained)
37
Q

What are 8 relative contraindications for active movement?

A
  • Active, acute inflammatory conditions
  • Significant segmental stiffness
  • Systemic disease
  • Neurological deterioration
  • Irritable patient
  • Osteoporosis
  • Rapidly worsening condition
  • Hamstring or UE active stretching on acute nerve root irritations
38
Q

What are 6 absolute contraindications for passive movement?

A
  • Cancer of targeted region
  • Cauda equina lesions (saddle anethesia)
  • Rheumatioid collagen necrosis
  • Red flags indicating cancer, fracture, or systemic disease
  • VBI signs
  • Unstable upper C-spine (except specific movements for stabilizing procedures)
39
Q

The relative contraindications for passive movement are the same as those for active movement, but have 3 additional contraindications. What are they?

A
  • Acute nerve root irritation
  • Immediately post-partum
  • Blood clotting disorder
40
Q

What are 4 indications of a potential acute nerve root irritation?

A
  • Subjective and objective don’t add up
  • Any patient condition that is worsening with appropriate treatment
  • Oral contraceptives (c-spine)
  • Long term oral corticosteroid use (c-spine)
41
Q

What are the absolute contraindications for manipulation in addition to those for passive movement?

A
  • Practitioner lack of ability
  • Spondylolithesis
  • Gross foraminal enroachment
  • Children/ teenagers
  • Pregnancy
  • Fusions
  • Psychogenic disorders
  • Immediately post-partum
42
Q

What are the 11 relative contraindications for manipulation? (same as those for passive movement)

A
  • Active, acute inflammatory conditions
  • Significant segmental stiffness
  • Systemic disease
  • Neurological deterioration
  • Irritable patient
  • Osteoporosis
  • Rapidly worsening condition
  • Hamstring or UE active stretching on acute nerve root irritations
  • Acute nerve root irritation
  • Immediately post-partum
  • Blood clotting disorder

Musculoskeletal I (8 decks)

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