MSK Clinical Reasoning & Systems Review Flashcards
[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.
Hypothetic-Deductive Reasoning
[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.
Narrative-Inductive Reasoning
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?
P1 = problem
H1 = most likely hypothesis
H2 = 2nd most likely hypothesis
H3 = 3rd most likely hypothesis
[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.
Forward Reasoning or Pattern Recognition
[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.
Extensive History & Physical Exam
[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.
Conditional Reasoning
[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.
Availability heuristic
[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.
Representativeness heuristic
[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.
Outcome bias
[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.
Illusory Correlation
[Overconfidence/Confirmation bias] is when we have the tendency to look for, notice, and remember information that fits our pre-existing expectations.
Confirmation bias
[Overconfidence/Confirmation bias] is we tend to overestimate both how much we know and how reliably we know information.
Overconfidence
[MSK/Visceral] pain is dull, aching, diffuse, and deep.
visceral pain
[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)
MSK pain
1st question to ask for each patient is what?
Should this patient be in physical therapy? Are they appropriate for physical therapy?
Non-MSK pain has an atypical location and many other factors. What are these factors/characteristics?
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
What are the most common areas/sites that pain gets referred to? (6)
back, shoulder, chest/thorax, hip, groin, and SI/pelvis
Referred pain is due to the convergence of ______ afferent neurons to the same _____ order neuron in the _____ _____.
primary afferent neurons
second order neuron
spinal cord
[Review of Systems/Systems Review] is when you look at the patient’s past medical history.
Review of Systems
[Review of Systems/Systems Review] is when you conduct an exam for each of the systems.
Systems Review
What are the 10 questions to include on a patient screening tool according to OSPRO to identify any patient red flags?
- Have you recently experienced abnormal sensations (eg, numbness, pins and needles)?
- Have you recently experienced headaches?
- Have you recently experienced night pain?
- Have you recently experienced sustained morning stiffness?
- Have you recently experienced light-headedness?
- Have you recently experienced trauma (eg, a motor vehicle accident, a fall)?
- Have you recently experienced night sweats?
- Have you recently experienced constipation?
- Have you recently experienced easy bruising?
- Have you recently experienced changes in vision?
List the 12 constitutional symptoms.
Unexplained weight loss
Night sweats
Fatigue
Malaise
Lethargy
Sleeping pattern
Appetite
Fevers
Chills
Itching/Rashes
Lumps/Bumps/Masses
Unexplained falls
In the diagnosis process when you choose to pursue the most likely disorder 1st, you are being ______.
probabilistic
In the diagnosis process when you choose to pursue the most serious disorder 1st, you are being ________.
prognostic
In the diagnosis process when you choose to pursue the disorder most responsive to RX, you are being _______.
pragmatic
What does SINSS Reasoning stand for?
S-severity
I-irritability
N-nature
S-stage
S-stability
In the SINSS Reasoning, [severity/irritability] is the degree of pain or impact on function.
severity
In the SINSS Reasoning, [severity/irritability] is the amount of activity to exacerbate the symptoms, degree of exacerbation, and time to subside.
irritability
In the SINSS Reasoning, [severity/nature] is the pain generator or specific tissue dysfunction (could be nociceptive, neuropathic, or nociplastic).
nature
In the SINSS Reasoning, [stage/stability] is the chronicity (acute, subacute, chronic), recurrent, and episodic nature of the symptoms.
stage
In the SINSS Reasoning, [stage/stability] is the rate of progression of change in the condition over time.
stability
A ___ _____ is something that is misleading or distracting in a patient’s signs or symptoms.
red herring
When clinical reasoning through a patient’s signs/symptoms, what should you consider as a source of their signs/symptoms? (4)
JOINTS under area of symptoms
Structures which may REFER to area
CONTRACTILE structures in the area
OTHER structures
