MSK Clinical Reasoning & Systems Review

Question 1

[Hypothetic-Deductive/Narrative-Inductive] Reasoning is when a clinician generates a hypothesis based on data from the patient, which is then tested, and further hypotheses are generated until a management pathway is defined clearly.

Answer 1

Hypothetic-Deductive Reasoning

Question 2

[Hypothetic-Deductive/Narrative-Inductive] Reasoning is a ‘process of inquiry, examination and reflective management’ by which the clinician understands the patient’s problem, the patient’s perspective, and the context of that problem. Context dependent, socially constructed, allows for multiple versions of reality.

Answer 2

Narrative-Inductive Reasoning

Question 3

Deductive or Diagnostic Reasoning utilized P1, H1, H2, H3 to deduce which hypothesis is most relevant for the patient’s problem. What do P1, H1, H2, H3 stand for?

Answer 3

P1 = problem

H1 = most likely hypothesis

H2 = 2^nd most likely hypothesis

H3 = 3^rd most likely hypothesis

Question 4

[Forward Reasoning or Pattern Recognition/Narrative-Inductive Reasoning] is when a clinician associates problems of the current patient with previously seen clinical problems and adopts a previously-successful management strategy.

Answer 4

Forward Reasoning or Pattern Recognition

Question 5

[Extensive History & Physical Exam/Conditional Reasoning] is when the clinician reviews in detail every part of the history and testing everything possible, in an attempt not to miss anything.

Answer 5

Extensive History & Physical Exam

Question 6

[Extensive History & Physical Exam/Conditional Reasoning] is when the clinical performs reasoning on their own thinking processes, on the clinical encounter with the patient, and critiques their reasoning process.

Answer 6

Conditional Reasoning

Question 7

[Representativeness/Availability] heuristic is when we place particular weight on examples of things that come to mind easily, perhaps because they are easily remembered or recently encountered.

Answer 7

Availability heuristic

Question 8

[Representativeness/Availability] heuristic is when we are led astray by the likelihood of a particular event based on situational information, without considering how likely the event is in the absence of that information.

Answer 8

Representativeness heuristic

Question 9

[Illusory Correlation/Outcome bias] is when we have the tendency to overreliance on outcome information of an event to drive out thought processes around clinical reasoning.

Answer 9

Outcome bias

Question 10

[Illusory Correlation/Outcome bias] is when we have the tendency to perceive two events as causally related, even when the connection between them is coincidental or even non-existent.

Answer 10

Illusory Correlation

Question 11

[Overconfidence/Confirmation bias] is when we have the tendency to look for, notice, and remember information that fits our pre-existing expectations.

Answer 11

Confirmation bias

Question 12

[Overconfidence/Confirmation bias] is we tend to overestimate both how much we know and how reliably we know information.

Answer 12

Overconfidence

Question 13

[MSK/Visceral] pain is dull, aching, diffuse, and deep.

Answer 13

visceral pain

Question 14

[MSK/Visceral] pain is local, sharp, aching, intermittent, changes with movement (etc.) and has an asterisk sign or something that reproduces their pain (i.e. time of day, movement, exam/test)

Answer 14

MSK pain

Question 15

1st question to ask for each patient is what?

Answer 15

Should this patient be in physical therapy? Are they appropriate for physical therapy?

Question 16

Non-MSK pain has an atypical location and many other factors. What are these factors/characteristics?

Answer 16

increasing severity, constant, systemic qualities, no relief with movement, prolonged AM stiffness, unexplained weight loss, changes in cough, bowel and bladder, gait, numbness and tingling, saddle paresthesias, dizziness, fever/chills

Question 17

What are the most common areas/sites that pain gets referred to? (6)

Answer 17

back, shoulder, chest/thorax, hip, groin, and SI/pelvis

Question 18

Referred pain is due to the convergence of ______ afferent neurons to the same _____ order neuron in the _____ _____.

Answer 18

primary afferent neurons

second order neuron

spinal cord

Question 19

[Review of Systems/Systems Review] is when you look at the patient’s past medical history.

Answer 19

Review of Systems

Question 20

[Review of Systems/Systems Review] is when you conduct an exam for each of the systems.

Answer 20

Systems Review

Question 21

What are the 10 questions to include on a patient screening tool according to OSPRO to identify any patient red flags?

Answer 21

1. Have you recently experienced abnormal sensations (eg, numbness, pins and needles)?
2. Have you recently experienced headaches?
3. Have you recently experienced night pain?
4. Have you recently experienced sustained morning stiffness?
5. Have you recently experienced light-headedness?
6. Have you recently experienced trauma (eg, a motor vehicle accident, a fall)?
7. Have you recently experienced night sweats?
8. Have you recently experienced constipation?
9. Have you recently experienced easy bruising?
10. Have you recently experienced changes in vision?

Question 22

List the 12 constitutional symptoms.

Answer 22

Unexplained weight loss
Night sweats
Fatigue
Malaise
Lethargy
Sleeping pattern
Appetite
Fevers
Chills
Itching/Rashes
Lumps/Bumps/Masses
Unexplained falls

Question 23

In the diagnosis process when you choose to pursue the most likely disorder 1st, you are being ______.

Answer 23

probabilistic

Question 24

In the diagnosis process when you choose to pursue the most serious disorder 1st, you are being ________.

Answer 24

prognostic

Question 25

In the diagnosis process when you choose to pursue the disorder most responsive to RX, you are being _______.

Answer 25

pragmatic

Question 26

What does SINSS Reasoning stand for?

Answer 26

S-severity

I-irritability

N-nature

S-stage

S-stability

Question 27

In the SINSS Reasoning, [severity/irritability] is the degree of pain or impact on function.

Answer 27

severity

Question 28

In the SINSS Reasoning, [severity/irritability] is the amount of activity to exacerbate the symptoms, degree of exacerbation, and time to subside.

Answer 28

irritability

Question 29

In the SINSS Reasoning, [severity/nature] is the pain generator or specific tissue dysfunction (could be nociceptive, neuropathic, or nociplastic).

Answer 29

nature

Question 30

In the SINSS Reasoning, [stage/stability] is the chronicity (acute, subacute, chronic), recurrent, and episodic nature of the symptoms.

Answer 30

stage

Question 31

In the SINSS Reasoning, [stage/stability] is the rate of progression of change in the condition over time.

Answer 31

stability

Question 32

A ___ _____ is something that is misleading or distracting in a patient’s signs or symptoms.

Answer 32

red herring

Question 33

When clinical reasoning through a patient’s signs/symptoms, what should you consider as a source of their signs/symptoms? (4)

Answer 33

JOINTS under area of symptoms

Structures which may REFER to area

CONTRACTILE structures in the area

OTHER structures