Intro to Medical Screening Flashcards
1
Q
What is medical screening
A
- medical tests that health care providers use to check for diseases and health conditions before there are any major signs or symptoms
2
Q
Why do we need to know and perform medical screening
A
- to be able to identify signs and symptoms of systemic disease that can mimic neuromuscular or musculoskeletal dysfunction
3
Q
Key factors that create need for medical screening
A
- Side effects of medications
- Comorbidities: depression, chemical dependency, HTN
- Visceral pain mechanisms
- PT role in disease prevention
- Direct access
- signed prescription
- medical specialization
- disease progression
4
Q
Describe primary prevention
A
- stopping the process that lead to the development of disease, illness, & other pathologic health conditions through education, risk factor reduction, & general health promotion
5
Q
Describe secondary prevention
A
- early detection of disease, illness, & other pathologic health conditions through regular screening
6
Q
Describe tertiary prevention
A
- providing ways to limit the degree of disability while improving function in patient/clients with chronic and/or irreversible diseases
7
Q
Describe health promotion and wellness
A
- providing education & support to help patients/clients make choices that will promote health or improve health
8
Q
Examples of contextual barriers when performing a patient interview
A
- illiteracy
- language deficits
- hearing deficits
- anger
- depression
- physical layout (environmental barriers)
9
Q
Examples of effective communication when performing a patient interview
A
- listening
- nonverbal cues
- patience
- repeated hard work
- humility
- clarity
- self criticism
10
Q
Describe a yellow flag versus a red flag
A
- Yellow: a cautionary or warning symptom that signals “slow down” and think about the need for screening
- Red: a warning symptom thought to be associated with a high risk of serious disorders such as infection, inflammation, cancer, or fracture
11
Q
Examples of AHCPR red flags in low back pain
A
- age
- trauma
- immunosuppression
- rest/night pain
- lower extremity neurological deficit
- Hx of cancer
- saddle anesthesia
- bladder dysfunction
- weight loss
- fever, chills, night sweats
- recent infection
12
Q
Pittsburgh knee clinical prediction rules for if a radiograph is required
A
- MOI = fall, blunt trauma AND (one of the following)
- age <12 or >50 y/o OR inability to walk 4 weight bearing steps
- only applies <6 days after injury
13
Q
What are the components of a comprehensive screening model
A
- past medical history
- risk factor assessment
- clinical presentation
- associated signs & symptoms
- review of systems
14
Q
Different colored flags to note during screening
A
- Red: medical
- Orange: psychiatric
- Yellow: psychosocial
- Blue: work perceptions
- Black: work context/policy
15
Q
Red flags clinical presentation
A
- no known cause
- no improvement in PT/worsening
- improvement during PT but then gets worse
- weight loss/gain w/o effort (>10% in 10-21 days)
- cyclical presentation (better/worse/better)
- unrelieved by rest
- Sx out of proportion
- Sx persist
- unable to alter Sx during examination
- no mechanical or neuromuscular pattern
- growing mass
- postmenopausal vaginal bleeding
- bilateral Sx
- change in muscle tone/ROM in pt’s with neurological conditions
16
Q
Rad flags pain pattern
A
- back or shoulder pain (common referral area)
- pain that is not consistent with emotional or psychologic overlay (Waddell’s testing)
- night pain/wakes them up (consistent & intense)
- Sx that are constant & intense
- pain made worse with activity & relieved by rest
- pain described as throbbing (vascular) knife-like, boring, or deep aching
- pain that is poorly localized
- pattern of coming & going like spasms
- pain accompanied by signs & Sx associated with a specific viscera or system
- change in Sx with food intake or medication use
17
Q
Pain patterns
A
- Vascular: throbbing, pounding, pulsing, beating
- Neurogenic: sharp, crushing, pinching, burning/hot/searing, itchy, stinging, pulling, jumping, shooting/electrical, gnawing, pricking
- Musculoskeletal: aching, sore, heavy, hurting, deep, cramping, dull
- Emotional: tiring, miserable, vicious, agonizing, nauseating, frightful, piercing, dreadful, punishing, exhausting, killing, unbearable, annoying, cruel, sickening, torturing
18
Q
Red flags associated signs and symptoms
A
- report of confusion
- constitutional symptoms or unusual vital signs
- proximal muscle weakness with change in DTRs (deep tendon reflexes)
- joint pain with skin rashes or nodules
- clustered signs/Sx of a particular organ system
- unusual menstrual cycle/symptoms
19
Q
What does the ABCDEFW mnemonic stand for (used for yellow flags)
A
- Attitudes & beliefs
- Behaviors
- Compensation issues
- Diagnosis & treatment
- Emotions
- Family
- Work
20
Q
When yellow flags present what follow up questions do you ask using the ABCDEFW mnemonic
A
- A: what do you think is the cause of your pain
- B: what are you doing to relieve your pain
- C: is your pain placing you in financial difficulties
- D: have you been seen & examined for your pain or are you worried that anything may have been missed
- E: is there anything that is upsetting or worrying you about the pain at this moment
- F: how does your family react to your pain
- W: how is your ability to work affected by your pain
21
Q
Risk factors for substance abuse and domestic violence (CAGE & SAFE)
A
- CAGE: have you felt the need to CUT DOWN; have people ANNOYED you by criticizing your drinking; have you felt GUILTY about drinking; have you had a drink first thing in the AM (EYE OPENER)
- SAFE: Stress/safety; Afraid/abused; Friends/family; Emergency plan
22
Q
For any “yes” response to the initial review of systems (ROS) follow up with what questions
A
- Does the complaint represent something new, different, or unusual for the patient?
- Is there an explanation for it that would minimize concern?
- Has the patient mentioned this to a physician?
- If a physician is aware of it, has it become worse?
23
Q
What is included in a general health screen component of the. ROS
A
- fatigue (interferes with ADLs, work, school, social settings for >2-4 wks)
- malaise (generalized discomfort associated with systemic conditions with fever)
- fever, chills, sweats (99.5-101 deg. of unknown origin for 3 wks = consult)
- weight loss/gain (10% unexplained)
- nausea/vomiting
- dizziness/lightheadedness
- paresthesia/numbness
- weakness
- change in mentation/cognitive abilities
24
Q
Things to look out for with unexplained weight changes
A
- Weight gain = fluid retention due to heart failure, liver/renal disease
- Unintentional loss/gain. of 5-10% bodyweight in 6-12 months
- Loss of 5% bodyweight in 1st trimester
- Gain ≥5 lbs in 1 wk period during pregnancy (preeclampsia)
25
What can cause unexplained weight changes
- Decreased caloric intake: depression, dementia, anxiety, poor dentition, upper GI disease, malignancy, infection, alcoholism, CHF
- Maldigestion/malabsorption: gallbladder/pancreatic disorders, infection, small bowel disease, Crohns disease
- Excessive demand: infection, hyperthyroidism, malignancy, manic disorder
- Excretion: burns, GI bleeding, uncontrolled diabetes
26
Causes of nausea/vomiting if acute or initial symptom
- ketoacidosis
- inferior myocardial infarction
- hepatitis
- drug withdrawal
- early pregnancy
- medication use: opiates, digitalis, cancer chemotherapeutic agents
27
Causes of nausea/vomiting if recurrent or chronic symptom
- psychogenic disorders (bulimia)
- metabolic disorders (adrenal insufficiency/uremia)
- bile reflux after gastric surgery
- pregnancy
28
Causes of nausea/vomiting when in association with neurologic symptoms
- increased intracranial pressure
- vestibular disturbances
- migraine headaches
- midline cerebellar hemorrhage
29
Red lags for paresthesia, numbness, or weakness
- glove and stocking distribution
- bilateral extremity deficits
- combination of UE & LE deficit patterns
- LBP: strength/sensory loss, saddle anesthesia, urinary retention, increased urinary frequency, overflow incontinence
30
What to observe for changes in mentation/cognitive ability
- Level of consciousness
- Attention
- Memory
- Orientation
- Thought processes
- Judgement
31
Red flags for integumentary system
- recent rash, nodules, or other changes
- unusual hair loss or breakage
- increased hair growth
- change in nail beds
- itching
32
Red flags for musculoskeletal/neurologic systems
- joint pain, redness, warmth, swelling, stiffness, deformity
- frequent or severe headache
- change in vision/hearing
- vertigo
- paresthesias
- change in muscle tone
- weakness/atrophy
- abnormal DTRs
- problems with coordination/balance/falling
- tremors
- radicular pain
- seizure or loss of consciousness
- memory loss
- paralysis
- mood swings/hallucinations
33
Red flags for rheumatologic system
- presence/location of joint swelling
- muscle pain, weakness
- skin rashes
- reaction to sunlight
- Raynaud's phenomenon
- change in nail beds
34
Red flags for cardiovascular system
- chest pain/heaviness/discomfort
- palpitations
- limb pain during activity
- discolored or painful feet, swelling of hands/feet
- pulsating/throbbing pain (anywhere but especially the back/abdomen)
- peripheral edema
- sudden weight gain
- persistent cough
- fatigue, dyspnea, orthopnea, syncope
- high or low BP
- differences in BP from side to side with position change (≥10 mm Hg decrease or increase/diastolic or systolic)
- positive findings during auscultation
35
Red flags for pulmonary system
- cough/hoarseness
- sputum (mucus), hemoptysis (coughed up blood)
- shortness of breath (SOB)
- night sweats/anytime
- pleural pain
- cyanosis/clubbing
- positive. findings. during auscultation
36
Red flags for psychologic system
- sleep disturbance
- stress levels
- fatigue, psychomotor. agitation
- change in personal habits/appetite
- depression, confusion, anxiety
- irritability/mood changes
37
Red flags for gastrointestinal system
- abdominal pain
- indigestion/heartburn
- difficulty swallowing
- nausea/vomiting or loss of appetite
- diarrhea or constipation
- change in stool or bowel habits
- fecal incontinence
- rectal bleeding/blood in stool/blood in vomit
- skin rash followed by joint pain (Crohns disease)
38
Red flags for hepatic/biliary system
- Change in taste/smell
- Anorexia
- Feeling of abdominal fullness
- Change in urine color (dark, cola-colored)
- Light-colored stools
- Change in skin color (yellow, green)
- Skin changes
39
Red flags for hematologic system
- Change in skin color or nail beds
- Bleeding: nose, gums, easy bruising, melena
- Hemarthrosis, muscle hemorrhage, hematoma
- Fatigue, dyspnea, weakness
- Rapid pulse, palpitations
- Confusion, irritability
- Headache
40
Red flags for genitourinary system
- Reduced stream, decreased output
- Burning or bleeding during urination; change in urine color
- Urinary incontinence, dribbling
- Impotence, pain with intercourse
- Hesitation, urgency
- Nocturia, frequency
- Dysuria (painful or difficult urination)
- Testicular pain or swelling
- Genital lesions
- Penile or vaginal discharge
- Impotence (males) or other sexual difficulty (males or females)
- Infertility (males or females)
- Flank pain
41
Red flags for gynecologic system
- Irregular menses, amenorrhea, menopause
- Pain with menses or intercourse
- Vaginal discharge, vaginal itching
- Surgical procedures
- Pregnancy, birth, miscarriage, and abortion histories
- Spotting, bleeding, especially for the postmenopausal woman 12 months after last period (without hormone replacement therapy)
42
Red flags for endocrine system
- Change in hair and nails
- Change in appetite, unexplained weight change
- Fruity breath odor (diabetes)
- Temperature intolerance, hot flashes, diaphoresis (unexplained perspiration)
- Heart palpitations, tachycardia
- Headaches
- Low urine output, absence of perspiration
- Cramps
- Edema, polyuria, polydipsia, polyphagia
- Unexplained weakness, fatigue, paresthesia
- Carpal/tarsal tunnel syndrome
- Periarthritis, adhesive capsulitis
- Joint or muscle pain (arthralgia, myalgia), trigger points
- Prolonged deep tendon reflexes
- Sleep disturbance
43
Symptoms consistent with cancer
- Constant, intense pain, especially bone pain at night
- Unexplained weight loss (10% of body weight in 10–14 days); most patients in pain are inactive and gain weight
- Loss of appetite
- Excessive fatigue
- Unusual lump(s), thickening, change in a lump or mole, sore that does not heal; other unusual skin lesion or rash
- Unusual or prolonged bleeding or discharge anywhere
- Change in bowel or bladder habits
- Chronic cough or hoarseness, change in voice
- Rapid onset of digital clubbing (10–14 days)
- Proximal muscle weakness, especially when accompanied by change in one or more deep tendon reflexes
44
Red flags for immunologic system
- Change in skin or nail beds
- Fever or other constitutional symptoms (especially recurrent or cyclical symptoms)
- Lymph node changes (tenderness, enlargement)
- Anaphylactic reaction
- Symptoms of muscle or joint involvement (pain, swelling, stiffness, weakness)
- Sleep disturbance
45
When is medical evaluation warranted
- when medical screening & the systems review process at any time during examination. or treatment indicate body system involvement or conditions beyond the scope of physical therapist practice
46
What is the general rule for the referral process
- try to send the client back to the referring physician or other appropriate health care provider if there is one
- if this is not the best plan of action, call & ask the physician how they want to handle the situation
47
When referring a patient with suspected system involvement other than musculoskeletal what do you need to communicate to them (SBAR)
- Situation: a concise statement of the problem
- Background: pertinent & brief information related to the situation
- Assessment: analysis and considerations of options, what you found/think
- Recommendation: action requested/recommended, what you want
