Imperial Job Interview Flashcards
Explain what you would ask in a Subjective Assessment?
Check Details of name, GP, etc
Get Consent
HPC
What their pain is, how they did it, when they did it, better/worsening/ static, if had pain previously – any investigations or treatments? Did they work? Did GP xray? Or take bloods?
Body Chart
Aggravating factors, easing factors, 24hr pattern, exactly where pain is, any other pain? Type of pain? VAS? Any Pins and Needles or Numbess? Any night pain?
PMH
T H R E A D, History of Ca, Unexplained weight loss, General health?
Neck: Diplopia, dysarthria, dysphagia, dizziness, drop attacks, Nausea, Numbness, Nystagmus.
Back: Saddle anaesthesia, bladder and bowel, gait disturbance, pain on coughing or sneezing.
Knee: Crepatis, giving way, locking, swelling.
DH
Steroids? Anticoagulants?
SH
Occupation
Hobbies
Family situation
Ask them what they feel their main problem is
ENSURE YOU ADAPT YOUR WORDS TO THE PATIENT.
ASK OPEN QUESTIONS
What are red flags?
Red flags help to identify potentially serious conditions. The questions include:
Over 55, under 20 History of Cancer, History of HIV/ TB Unexplained weight loss General Health Saddle Anaesthesia Bladder, Bowel Gait disturbances Pain on cough or Sneeze Dizziness Drop Attacks Diplopia Dysarthria Dysphagia Nausea Nystagmus Numbess Pins and Needles Night Sweats
What are yellow flags?
Yellow Flags help to identify Psychosocial Issues. It’s the patient’s belief towards their pain:
Often done by Questionnaires such as the Roland Morris Questionnaire, HAD, patient self-efficacy questionnaire.
Services such as cope are available for patients that are positive for Yellow flags.
What is Tendinitis and Tendonosis and how do they differ?
Tendinitis is an acute inflammatory condition that with correct treatment will heal between 2 and 4 weeks.
Treatment for Tendinitis includes rest, ice, compression, elevation and they gentle stretching and strengthening.
Tendonosis is a more degenerative condition that occurs because of cell death due to a lack of blood supply and therefore nutrients to the tendon. When this occurs,
The collagen fibres within the tendon start to degenerate and become entertwined.
Treatment includes ice therapy and friction massage. Combined with Eccentric loading exercise programme as some evidence to suggest that eccentric loading with encourage the fibres to reform parallel and decrease the likelihood of injury reoccurring
What is ACBT?
ACBT is Active Cycle of Breathing Technique. It is used within respiratory physiotherapy as a method of encouraging deep breathing and can be used in conjunction with sputum clearance.
There are three parts to ACBT.
First part: BREATHING CONTROL: Relaxed abdominal breathing in through the nose and out through the mouth. Breathing from the bases of the lungs. Often getting a patient to place their hand on their stomach and say ‘breathe so that you push your hand out’ works.
Second part: THORACIC EXPANSION: Deep Breaths. Often you can place your hands on the patient’s ribs and get them to push your hands out without elevating their shoulders. Can use inspiratory holds for collateral ventilation.
Third part: Huffing. Explain this to the patient as imagining you are trying to steam up a mirror with your breath. There are two types of huff a long huff and short, sharp huff. Long huff (low lung volume) : Clearance for distal secretions Short Huff (high lung volume) : Clearance for more proximal secretions.
What are the differences between acute back pain and chronic back pain and how would you manage them?
Acute back pain
Back pain that has started in the last 12 weeks with no previous injury of the same kind.
More hands on compared to chronic pain.
Advise on medication and to keep active.
Manual therapy
Exercise program
Aim to get back to work within 6 weeks and evidence suggests after 6 weeks there are worse outcomes.
Chronic Back Pain
Back pain that lasts more than 3 months as that is the time it takes for the longest bone in the body to heal.
More hands off and patient education, some hospitals run pain education sessions. Teach them about the pain cycle.
Encourage them to keep active and to stay at work if possible.
A patient centred rehabilitation programme including exercise, relaxation and pacing.
Can attend back rehabilitation group or structured exercise programme. Unless patient is not keen then one to one.
For patients who need a more multi disciplinary approach there are services such as COPE (Centre of pain education) who help with psychological issues.
Advise on pain medication, regular paracetamol or NSAIDS
Chronic Behavioural Therapy – evidence shows more benefit from group setting and MDT approach.
Roland Morris Questionnaire
Hospital Anxiety and Depression (HAD) – An Increase HAD = COPE and more MDT approach, otherwise back rehab programme.
Patient Self-efficacy questionnaire to find out who it affects their life.
Cost of treating back pain is 1% of UK NHS budget.
The British pain society
Physiotherapy Pain Association
What would be your different management strategies for a patient with Parkinson’s Disease patient?
Patient’s who have Parkinson’s Disease often present with rigidity, a tremor, difficulty initiating movements, festinating gait pattern and stiffness.
For a patient with Parkinson’s Disease, according to the NICE guidelines I would work on:
Improving and maintaining Flexibility to help reduce stiffness
Improving and maintaining Balance
Gait Re-education as often festinating gait pattern.
Aerobic Exercise
Initiating movement – visual and auditory cueing
Functional movements and activities of daily living to promote functional independence.
Advice and education about home adaptations
Advice about other professions that could help: speech and language therapy, occupational therapy.
MEDICATION – ensure PD patients take their medication at regular intervals so that it does not affect their symptoms
Nice guidelines for Parkinson’s Disease
What would be your different management strategies for a patient with Stoke patient?
Stroke patient’s often present with unilateral weakness, sensory loss, lack of balance and dexterity
For a patient who had had a stroke: Gait re education. Standing balance, Seated balance Orthotics may be considered. Constraint induced therapy. Practise of ADL’s Aerobic exercise. Ensure adequate pain control. Proprioception training,
National stroke strategy
Physiotherapy concise guide for stroke; National clinical stroke guidelines. – royal college of physicians
What are normal ABGS?
PH: 7.35 – 7.45 Pco2: 4.6 – 6 kPa P02: 10.7 – 13.3 kPa Hco3: 22 – 26 mm mol BXS: -2 – 2
Name some outcome measures used in Elderly care?
180 degree turn TUS TUAG Berg Balance EMS Tinetti Functional reach Falls risk assessment tool.
How would you answer an On – call Question?
What you would ask before you came in: To speak to doctor Name of patient Location of patient What they are in for? Type and date of surgery? How long they’ve been in for? If they’ve had any physiotherapy today and if so then what? And was it productive? What their Sats were, and the rest of their OBS. If they are on any Oxygen, or nebulisers. (British Thoracic Society Guidelines say that Dr has to prescribe amount or o2 and initial device and target o2 sat, but I would check policy, flowchart can refer to) What position they are in? Is pain controlled?
Then you would ask them to administer nebuliser if applicable and position them, control pain until you came in.
When you got in:
Get handover from Nurse in charge. Any changes?
Check patients notes
Check their observations
Look at X-ray if applicable
Ask for consent.
Observe them: position, colour, fast respiration rate, chest expansion, difficulty of breathing.
Check RR, Auscultation and chest expansion.
Treatments: ACBT Positioning to increase lung volumes and improve ventilation/ perfusion match Teach supported cough IPPB (can you prescribe?) Sit out of bed, Mobilise depending on time of day.
Then Re- check obs / auscultation to see if improvement.
Patient with a history of low BP presents with neck pain and pain radiating down his left arm, what do you do subjectively and objectively?
Ask how long he has had his arm pain, if he has any chest pain or tightness or is feeling nauseas, light headed, sick or is having trouble breathing. If he answers yes to any of these questions or his arm pain has come on very recently then you would suspect a heart attack. Speak to your senior and then send him straight to A&E.
What would you do if you saw an assistant doing something unsafe?
- Get patient to a place of safety.
- Take RA aside in private.
- Ask them non-confrontationally if they thought they had done something wrong?
- Ask questions to determine if it was due to a lack of knowledge or awareness.
- Educate, suggest reflection or self directed study.
- Make action plan with short term goals and get them to be signed by both of you.
- Document what you saw and what plan you made. Mention it to your senior.
How would you prioritise patients on a ward?
- Chest patients
- Discharges / First day post op
- People unable to mobilise without a therapist.
- General mobility.
Patient had a total knee replacement two weeks ago, she is now complaining of pain at the back of her knee radiating down her calf, what would you do?
Assess for DVT, Deep Vein Thrombosis is a blood clot that can occur in the deep veins of your leg, most commonly it occurs in your femoral or popliteal vein. Symptoms include:
Swelling
Redness
Increase pain
Increased temperature
Pain on dorsi flexion of foot. (Homans sign) and pain to touch posterior calf.
Send patient to A&E as chance of a PE, treatment may include anti coagulants and wear ted stockings.
What would you do in an Objective Assessment in outpatient department?
Depends on the joint as to what order but the general order would be:
Observe: o Muscle imbalance o Skin creases o Redness o Swelling o Discolouration o Posture o Gait, different phases, any compensation? Palpate: o Feel for increased temperature o Increased sensitivity. o Swelling o Muscle spasming or thickening. AROM PROM Resisted ROM If indicated: o Dermatomes o Myotomes o Reflexes o ULTT o SLR o Slump test o Clonus o Babinski Functional tests: o Single leg squat o One footed heel raise Accessory movements: o PPIVMS o PAIVMS o NAGS o SNAGS o Special Tests
You are asked to see a patient who has a recent falls history. What assessment would you do and why?
Read Medical notes
Get handover from Nurse
Check obs
Ask for consent
Start Subjective assessment:
o Why they have been admitted?
o Any injuries, when? Any treatment?
o Previous history of falls? When? How many? Admitted to hospital?
o Do they know why they fell?
o Any PMH?
o Eyesight?
o Go to any classes?
o Hobbies
o Are they able to get up from the floor?
o What type of accommodation do they live in?
o If they live alone?
o If they have stairs?
o Steps going into house?
o Any equipment fitted? Bed lever, toilet frames, trolley, caddy?
o Do they make their own meals? Meals on wheels?
o Do they’re own cleaning? Shopping? Washing? Dressing?
o Any carers?
o Do they have safecall? Or telecare?
o How do they usually mobilise? With an aid? Outside? Bus? Car?
o Do they usually go out of the house?
o Do they administer their own medication? Sometimes risk of fall!?
o Any pets?
o Any Rugs?
o Ask them what they would like to get back to, their goals?
o Falls efficacy scale
Objective assessment:
o Try to make it functional as patients are more likely to become tired and their goals are going to be more functional.
o AROM
o Muscle strength in lower limbs
o For upper limbs – hand behind back, hand behind head. Functional.
o If on the bed then sitting balance.
o If strong enough, would assess transfers with assistance of another person.
o Mobility.
o Gait assessment
o Outcome measure: EMS, Tinetti, Berg balance, 180 degree turn, TUAG, TUS, FRAT
What is clinical governance?
Clincal governance is a system put in place to ensure that we are providing the best possible quality of care. It is traditionally explained using 7 pillars:
Clinical Effectiveness Audit Risk management Education and development People and public involvement Using information and IT Staffing
What would happen if you came in and all your fellow physiotherapists were off sick?
Would prioritise patients, delay supervision/ IST if appropriate.
Inform Manager
Write list
Delegate to RA, OT if available
Ring round to see if anyone has capacity who can help.
Document in notes that patients were unable to be seen due to staffing levels.
Run through the dermatomes, myotomes and the reflexes of the body?
Myotomes
C1 – Neck Extension C2 – Neck Flexion C3 – Neck Lateral flexion C4 – Shoulder Elevation C5 – Shoulder abduction C6 – Elbow Flexion C7 – Elbow Extension C8 – Thumb Extension T1 – Finger Ab/Adduction L1 – Hip flexion L2 – Knee Extension L3 – Dorsi flexion L4 – Big Toe Extension L5 – Hip Extension S1 – Knee Flexion
How would you test the Neurological system?
Dermatomes Myotomes Reflexes ULTT SLR Slump
You go to see a patient first day post hip hemi arthroplasty, what do you do? how do you assess?
- Check their medical notes, look for post op instructions, check PMH, any contraincications to treatment.
- Get a handover from nursing or ward staff.
- Check obs – look for HB level, if it is < 8 then do not get them up –WILL NEED TRANSFUSION. Check sats, blood pressure.
- Introduce yourself, ask how they would like to be addressed. Ensure they have understood what operation they have had. Explain that although no precautions, be very careful, do not do big movements.
- Ensure their pain is under control.
- Complete subjective assessment:
a. HPC
b. PMH
c. DH
d. SH - Ensure that there are two professionals on first contact.
- Complete Objective assessment.
a. Observation including DVT, will have bandage and clips in so unable to see incision site.
b. Active range of movement lower limbs right and left, and upper limbs
c. Measure leg length –
i. Apparent – from xiphisternum to medial maleolus
ii. True – can then compare from side to side. - from asis to medial maleolus
- from greater trochanter to lateral knee joint line
- from medial joint line to medial maleolus
- Sensation – light touch/ pin prick, be aware that they have had a femoral block and so sensation may be affected because of that.
- Teach bed exercises.
- Transfer onto side of bed with assistance of two.
- Suitable footwear, Get a wheeled zimmer frame.
- Try marching and quads through range including ankle rolls on edge of bed.
- If pain ok and patient able to complete those activities then Stand with assistance of two.
- Transfer into chair. Walk further as patient’s pain and muscle strength allows.
- Ensure patient is within easy reach of buzzer, raise feet to decrease swelling.
- Document and provide exercise programme.
Initial Assessment of an acute stroke patient.
Check patient notes.
Get Handover
Check Obs
Subjective Assessment
HPC: - Nature, severity, frequency and pattern of the problem - What makes it worse/ better - What diagnosis? What tests have been done? - Impact on daily living PMH: SH: DH: Patient’s goals from physiotherapy.
Objective Assessment
- Observation – decreased muscle size/ muscle imbalance, posture
- AROM – to test muscle strength and RROM for muscle strength
- PROM - to test joint function and muscle shortening along with tone.
a. Spasticity – Measure using modified Ashworth scale 0-4. (p34)
b. Rigidity – Can be measured using the unified Parkinson’s Disease Rating System Scale, 0-4 - Reflexes
- Co- ordination
- Testing for tremor and Ataxia – Finger to nose test
- Test Core stability for ataxia at the hips
- Proprioception – Moving big toe into a position whilst patients eyes are shut. Asking patient to respond as to what movement you are doing.
ROMBERG’s test – patient standing, closes eyes, if falls then suggests lack of proprioception. - Pin prick and light touch.
- Hot or cold to test temperature reaction.
- Transfer onto edge of bed. Test sitting balance.
- Standing Balance
- Gait Assessment
- Rivermead Motor Assessment outcome measure
- Berg Balance / elderly mobility scale
- 9 Hole peg test
Explain what Respiratory Failure is!?
There are two types of respiratory failure.
- type 1 – Low oxygen, normal carbon dioxide.
- Type 2 – Low oxygen, high carbon dioxide.
Treatment:
- Type 1 – Oxygen
- Type 2 – Non invasive ventilation e.g CPAP
Patient with left sided hemiparesis, how do they present? And how do you treat them?
- Decreased AROM but full PROM
- Decreased muscle strength left side.
- Decreased sensation left side
- Decreased Proprioception left side
- Pusher Syndrome – pushing away from non hemiparetic side
- Decreased standing balance
- Decreased sitting balance
- Decreased mobility
- Neglect on left side
- Aphasia
- Facial weakness
- Difficulty swallowing
- Cognition deficits
- Subluxed shoulder due to muscle weakness or spasticity
- Spasticity
Treatments – According to the national stroke strategy and the concise physiotherapy guidelines
- Sitting balance exercises
- Standing balance exercises
- Muscle strengthening
- ADL practise
- Constraint induced therapy
- Aerobic exercises
- Proprioception exercises
- Gait re education
- Working in front of a mirror
You arrive to see the patient. They are slumped in bed, sats 94% on 2L of oxygen via a facemask, crackles throughout on auscultation and reduced air entry bibasally. What would you do?
- Ascultate so you have an outcome measure
- Position them in high sitting, increasing FRC, check SaO2
- ACBT, check SaO2,
- If they were able to get up then get them in chair and possibly walking.
- find out why on a facemask, when not on nasal cannulae (up to about 4 L) – if they were a mouth breather then they would be on facemask.
- Re ascultate, check SaO2
- Check British thoracic society guidelines for oxygen levels.
What are the different types of methods of oxygen delivery and at what level are the suitable?
Oxygen therapy:
Venturi – suitable for COPD, can humidify
Non rebreathe – used to be 10-15L O2 but now only 15L, can humidify
Normal facemask, cannot humidify
What Neuro outcome measures are available?
Standing Balance Tests
- Timed Static Standing Tests - Clinical Test of Sensory Interaction of Balance - Functional Reach - Lateral Reach - Step Test - Pastor, Day and Marsden Test
Functional Performance Tests
- Timed Up and Go - !80 degree turn - Timed 10 metre walk – calculation of gait parameters (velocity, stride length and cadence
Functional Performance Scales
- The Modified Elderly Mobility Scale - Motor Assessment Scale - The Clinical Outcome Variables scale (COVS) - Berg Balance scale - Tinetti
Explain what you would look for in a chest x ray?
Name, date and time, AP/PA, Right and Left
Under/ over exposure
Clavicle alignment equidistant from vertebral body
Ribs, 6/7th rib should intersect the hemi diaphragm
Small intercostals spaces = low lung volum
Large Intercoastal spaces = Hyperinflation e.g. COPD patients.
Look for any fractures
Trachea should be straight, trachea falls towards collapse and away from pneumothorax, pleural effusion and tumours
Any equipment / drains/tubes
Heart should be one third on right two thirds on left.
Should have clear cardio and cost phrenic angles
Right diaphragm 2cm higher than left due to liver, dome shaped.
Look at lungs – surgical emphysema, pneumothorax, can often see breast shadows
Hila should have sharp edges, roughly equal in size right = left.
Describe the ULTTs
2a – Medial Nerve bias
2b – Radial Nerve bias
3 – Ulnar Nerve bias
What is COPD an umbrella term for?
COPD consists of chronic emphysema and bronchitis
Emphysema:
- Disease which decreases the elasticity of the alveoli, therefore decreases the surface area for ventilation perfusion.
- Patients have an increase in carbon dioxide as they are unable to excrete the carbon dioxide as the small airways collapse.
Bronchitis:
- Chronic inflammation of the bronchioles
- Increases mucus secretions
- Coughing, wheezing and shortness of breath.
- Treated with steroids and bronchodilators
What is MS, what would your treatment involve and what other MDT members might be involved?
MS is an autoimmune inflammatory condition where demyelination of the axons in your nerves occur. There are 3 types:
- Relapsing/ remitting.
- Secondary Progressive
- Primary Progressive
Therapy is to maintain what function patients have. Symptoms: Tremor Ataxia Cognitive impairment Muscle spasm Decreased sensation Pins and needles Numbness Bladder and bowel dysfunction Diplopia Dysarthria Dysphagia Pain
Other MDT members may include: SLT OT GP Orthotist DN Dietician Psychologist Tissue viability nurse – for pressure ulcers
LBP differential diagnosis?
- Muscular strain
- Ligamentous Strain
- Facet joint dysfunction
- Disc Lesion
- Nerve root aggravation
- Inflammatory conditions (eg OA or RA)
- Pain referred from viscera eg. bowel and pelvic organs can refer to lumbar spine
- Hip lesions may also refer hip to lumber spine
Why have you applied?
Clinical:
- I have been working for the Trust since October, enjoyed it, would like to continue, Trust values?
Academic:
- Studied at Oxford Brookes with 1st class honours, lots of diverse placement experience, rfu pitchside, assistant experience.
Management:
- Trust values?, CPD?
Personal:
- I enjoy the team, research focus, evidence based practice culture
Difficult colleagues or ethical issues (e.g see college acting incorrectly/disagreement)
Seek info: Patient Safety: Initiative: Escalate: Support:
Tellme about a time when…(clinical mistake you made, led a team/project, enhanced the efficiency of your department)
Background: Action Taken: Reasoning: End Result: Reflection:
Examples of Volume loss and treatment options
- Volume loss
Reduced air entry
Reduced lung expansion
Atelectasis
TREATMENT OPTIONS Mobilise Position ACBT Manual Hyperventilation(bagging) Manual insufflation
