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
Q
What can cause unexplained weight changes
A
- 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
Q
Causes of nausea/vomiting if acute or initial symptom
A
- ketoacidosis
- inferior myocardial infarction
- hepatitis
- drug withdrawal
- early pregnancy
- medication use: opiates, digitalis, cancer chemotherapeutic agents
27
Q
Causes of nausea/vomiting if recurrent or chronic symptom
A
- psychogenic disorders (bulimia)
- metabolic disorders (adrenal insufficiency/uremia)
- bile reflux after gastric surgery
- pregnancy
28
Q
Causes of nausea/vomiting when in association with neurologic symptoms
A
- increased intracranial pressure
- vestibular disturbances
- migraine headaches
- midline cerebellar hemorrhage
29
Q
Red lags for paresthesia, numbness, or weakness
A
- 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
Q
What to observe for changes in mentation/cognitive ability
A
- Level of consciousness
- Attention
- Memory
- Orientation
- Thought processes
- Judgement
31
Q
Red flags for integumentary system
A
- recent rash, nodules, or other changes
- unusual hair loss or breakage
- increased hair growth
- change in nail beds
- itching
32
Q
Red flags for musculoskeletal/neurologic systems
A
- 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
Q
Red flags for rheumatologic system
A
- presence/location of joint swelling
- muscle pain, weakness
- skin rashes
- reaction to sunlight
- Raynaud’s phenomenon
- change in nail beds
34
Q
Red flags for cardiovascular system
A
- 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
Q
Red flags for pulmonary system
A
- cough/hoarseness
- sputum (mucus), hemoptysis (coughed up blood)
- shortness of breath (SOB)
- night sweats/anytime
- pleural pain
- cyanosis/clubbing
- positive. findings. during auscultation
36
Q
Red flags for psychologic system
A
- sleep disturbance
- stress levels
- fatigue, psychomotor. agitation
- change in personal habits/appetite
- depression, confusion, anxiety
- irritability/mood changes
37
Q
Red flags for gastrointestinal system
A
- 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
Q
Red flags for hepatic/biliary system
A
- 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
Q
Red flags for hematologic system
A
- 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
Q
Red flags for genitourinary system
A
- 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
Q
Red flags for gynecologic system
A
- 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
Q
Red flags for endocrine system
A
- 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
Q
Symptoms consistent with cancer
A
- 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
Q
Red flags for immunologic system
A
- 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
Q
When is medical evaluation warranted
A
- 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
Q
What is the general rule for the referral process
A
- 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
Q
When referring a patient with suspected system involvement other than musculoskeletal what do you need to communicate to them (SBAR)
A
- 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
