Lecture 02-Review Of Systems Flashcards
What are the steps of the diagnostic process?
- Identify the pt’s chief concern
- Identify barriers to communication
- Identify special concerns
- Create symptom timeline
- Create a diagnostic hypothesis list (remote + local pathology)
- Sort the list by epidemiology and specific case characteristics
- Ask specific Q’s to rule out specific conditions or pathological categories less likely
- Re-sort the list based on pt’s response to Q’s from step 7
- Perform tests to differentiate among the remaining diagnostic hypotheses
- Re-sort the diagnostic hypothesis list based on the pt’s response to specific tests
- Decide on a diagnostic impression
- Determine the appropriate pt disposition
The following describes which part of the subjective examination/diagnostic process?
- series of checklists or questions of common symptoms relevant to major body symptoms
- not intended to identify or rule out specific diseases
- part of the subjective screening process (medical model for pre-examination screening)
The Review of Systems
What is the purpose fo the review of systems?
- identify symptoms that may have been overlooked
- identify symptoms related to a principle complaint
- identify existing co-morbid conditions
- identify occult disease
- identify adverse drug reactions (ADR)
When should a PT complete a review of systems?
- Pt’s medical history or health risk reveals several red flags
- unable to determine that the source of the symptoms is mechanical
- pt doesn’t respond appropriately to the developed POC
- something changes during the course of the treatment making it appropriate
What is screened during a review of systems?
- general health
- cardiovascular system
- pulmonary system
- gastrointestinal system
- genitourinary system
- nervous system
- integumentary
- endocrine system
- MSK
True or False: the general health screen should be completed the screen that is most often completed in clinical practice.
TRUE
When does fatigue become a red flag?
When
- it interferes with the pt’s ability to carry out typical daily activities at home, work, social settings, school, or rehabilitation
- it lasts for 2-4 wks or more
What is malaise and when does it become concerning?
Malaise = sense of uneasiness or general discomfort or an “out of sorts” feeling
- you should ask the pt if the feeling of malaise occurred at/around the same time that the pain began OR does the pt feel it after aggravating movement/factors
- malaise becomes concerning when there is no clear connection between it no the presenting problem
When does a fever become a red flag?
- 99.5 F (37.5 C) > 2 wks without seeing MD
- 102 F (39 C)
When is weight loss/gain concerning?
- if the pt has experienced unexplained weight loss/gain (5-10% of body weight) over the last 6 months
- note; weight gain is associated with fluid retention (seen with CHF)
When does nausea and vomiting become a red flag?
- if the physician is not aware
- if symptoms have worsened since the pt’s last visit
- if there is an unexplained cause
- note; consider going back 6 months in the pt’s history to discuss incidences of nausea and/or vomiting
- also note; headaches originating from the neurovascular system often involve nausea and vomiting while those originating from the MSK system typically do not
What can you ask a pt about concerning medications and experiencing dizziness/lightheadedness?
If the symptoms began within 4-6 wks of taking the medication(s).
Is a pt more likely to experience tunnel vision with lightheadedness or fatigue?
Fatigue
When does paresthesia and/or numbness become a red flag?
If the pt is experiencing
- “Stocking-and-Glove” distribution
- “Saddle” distribution
- progressive deficits such as urinary problems (retention, incontinence) and bilateral extremity deficits or UE/LE combination
If a pt presents with changes in mentation, their examination should include assessment of:
- level of consciousness (alertness)
- attention (ability to focus)
- memory (short-term vs long-term)
- orientation (person, place, time)
- thought process (logical and coherent)
- judgement (evaluate alternatives and follow appropriate values while choosing a course)
What are the definitions of the following terms?
- orthopnea
- Trepopnea
- platypnea
- orthopnea = difficulty breathing when lying supine
- Trepopnea = difficulty breathing when in side-lying on one side, but then relieved when lying on the other side
- platypnea = difficulty when breathing upright
-note; platypnea is very rare and associated with some neurological diseases, S/P pneumonectomy
What is syncope?
A sudden loss of consciousness (fainting)
When is diaphoresis (excessive and unexplained seating) considered serious?
When accompanied by pain at the
- chest
- UE’s
- Neck, jaw, and teeth
- left shoulder
- epigastium or mid-thoracic
When is a cough considered to be “chronic”?
- lf it’s duration is > 3 wks
- can be associated with asthma, pneumonia, heart failure, lung cancer
What are some integumentary signs that can be assessed for as part of a screen of the cardiovascular system?
- cold hands/feet (poor circulation)
- open wounds (venous insufficiency, diabetes)
- ski discoloration (venous insufficiency, diabetes, poor circulation)
- hair loss
-note; having cold hands/feet + hair loss around the area + skin that is blue in color = concern, not just having cold hands/feet alone
Who is most at risk of developing a thrombosis?
The most significant clinical risk factors for development of a thrombosis are age over 70 and previous thromboembolism.
Where do DVTs most commonly occur in the body?
In the LEs
- popliteal and thigh veins = proximal
- tibial and calf veins = distal
-note; DVTs have the greatest occurrence in pt’s who have been recently immobilized, undergone surgery, and/or have had an MI
What does TIM VaDeTuCoNE stand for?
- Trauma
- Inflammation
- Metabolic
- Vascular
- Degenerative
- Tumor
- Congenital
- Neurogenic/Psychogenic
What are some things to assess for as part of a screen of the pulmonary system?
- Dyspnea
- Chronic cough
- Wheezing/stridor
- clubbing of the nails (often accompanies cyanosis)
- edema (i.e., pulmonary hypertension)
___ is the loss of coordinated local muscle control that affects swallowing.
___ is also know as indigestion (the body may be unable to digest fatty foods, etc.)
- dysphasia: can be caused by MS, PD, stroke, etc.
- Dyspepsia: often associated with food intolerance and can cause heartburn symptoms (fatty foods => Gall Bladder disease)
With concern to the GI system, when is constipation considered a red flag?
When it occurs with a change in mental status or confusion.
__ is urination at night at least 2-3 times, which is a common complaint in diabetes mellitus.
__ = can a a sign of infection/irritation.
___ can be caused by blockage (prostate) or can be a central cord sign (spastic bladder).
- Frequency
- Urgency
- Retention
The following problems concerning urination can be signs of what condition(s):
- dysuria (painful urination)
- reduced caliber or force of urination or difficulty initiating urine stream
- incontinence
- color (reddish or dark brown)
- Inflammation, infection, and/or distension
- Associated with obstructive disorders (enlarged prostate)
- Central cord sign, pelvic floor dysfunction
- Acute rhabdomyolysis, hydration
The following are clinical signs that the ___ system is pathological:
- muscle weakness and atrophy
- fatigue
- progressive joint degeneration
- altered cardio respiratory function
- changes in skin pigmentation
- changes in body temperature
- changes in reproductive function
- mental changes
The endocrine system
-note; if the endocrine system is involved, if effects everything => changes in hormone levels will have a negative impact on homeostasis
The following are signs of which thyroid condition:
- multi-region joint or muscle pain
- dry, scaly skin
- brittle hair and nails
- cold intolerance
- paresthesia
- hoarseness of voice
- weight gain
- fatigue
- muscle weakness
Hypothyroidism
The following are signs of which thyroid condition:
- thin hair
- exophtalamos (bulging eyes)
- enlarged thyroid
- tachycardia
- weight loss
- warm skin (sweaty palms)
- hyperreflexia
Hyperthyroidism
Generally, what is the difference between diabetes inspidus and diabetes mellitus?
- Diabetes insipidus = irregular control of body fluids while diabetes mellitus = irregular control of blood sugars
- recall; type 1 diabetes = pancreases produces little to no insulin while type 2 = pancreases provides little insulin or the body has developed insulin resistance
