Overview of Pathology and The Changing Roles of PTs- Lecture 1

Question 1

Pathology

Answer 1

Branch of medicine that investigates the nature of disease

Changes in tissues and organs

Question 2

Clinical Pathology

Answer 2

Pathology applied to the solution of clinical problems

Question 3

Pathogenesis

Answer 3

Development of unhealthy conditions

Question 4

Pathophysiology

Answer 4

Study of altered body function due to disease

Question 5

Morphology

Answer 5

Fundamental structure or form of cells or tissue

Question 6

Histology

Answer 6

Study of cells and extracellular matrix of body tissues

Question 7

Health

Answer 7

No universally accepted definition
Ability to function normally in society
A disease-free state
WHO: a state of complete physical, mental, and social well-being

Question 8

Disease

Answer 8

A dynamic process disrupting physiologic function that manifests itself with a set of signs and symptoms
Has an etiology, pathogenesis, morphologic changes (cellular changes), clinical manifestations, diagnosis, and clinical course

Question 9

Illness

Answer 9

Sickness or deviation from a healthy state
Perception and response of the person
-Can have a disease and not be ill and vice versa.

Question 10

Acute

Answer 10

Rapid onset & short duration

Often resolve fully, following an expected pattern of recovery

Question 11

Subacute

Answer 11

Disc herniation, mono, stroke (often ends up being chronic).
Between acute & chronic
Days to months

Question 12

Chronic

Answer 12

MS, cancer, diabetes
Long-standing illness or disability
May involve exacerbations- something may get worse.
6 months-1 year

Question 13

Etiology

Answer 13

Cause of the disease

Question 14

Risk Factors

Answer 14

Conditions, events or substances suspected of contributing to the development of the disease

Question 15

Epidemiology

Answer 15

The study of the cause and distribution of disease in a population

Question 16

Incidence

Answer 16

Number of new cases during a specified time

Question 17

Prevalence

Answer 17

Number of existing cases in a population at a given point in time

Question 18

Morbidity

Answer 18

Effect an illness has on a person’s life. Health conditions that interact to affect health.

Question 19

Mortality

Answer 19

Rate of death.

Question 20

Signs

Answer 20

Observable phenomena.

Question 21

Symptoms

Answer 21

Subjective characteristics of the disease/condition

Question 22

Medical Diagnosis

Answer 22

Identification of pathology
Performed by the physician
 Based on:
Interview with patient and family
Medical history of patient and family
Physical examination
Medical diagnostic test results

Question 23

PT Diagnosis

Answer 23

The label encompassing a cluster of signs and symptoms, syndromes, or categories; also, the process of arriving at that label

• Various diagnostic schemas are used by PTs
• Differential Diagnoses: Process of arriving at the label.

Question 24

Examples of PT Diagnoses

Answer 24

• Force production deficit
  a. k.a. impaired strength
• Biomechanical deficit
  a. k.a impaired ROM
• Movement coordination deficit
• Signs and symptoms of lumbar flexion movement impairment syndrome consistent with L4-5 disk protrusion
• Impaired airway clearance associated with cystic fibrosis

Question 25

PT Role in Diagnosis

Answer 25

• Formulate PT diagnoses
• Recognize need to refer to another discipline
• Under what circumstances might we refer to another health care professional?
• Communicate and collaborate with other health care professionals, and others

Question 26

Differential Diagnoses

Answer 26

The determination of which one of several conditions may be producing symptoms (i.e. the other possible pathologies)

Confirm or disprove the “working” hypothesis. . . .

Finding the underlying problem.

Question 27

Changing Model of Healthcare Delivery

Answer 27

• Escalating costs
• Limited access to health care providers and services
• Limited training by primary care physicians in musculoskeletal disorders
• quality of health care
• patient satisfaction
• Increasingly complex patient population

Question 28

Primary Prevention/Care

Answer 28

-Aimed toward removing or reducing disease risk factors ex: Heart disease

Question 29

Secondary Prevention/Care

Answer 29

Promote early detection of disease and intervene to avoid further complications Ex: osteopenia

Question 30

Tertiary Prevention/ Care

Answer 30

Aimed at limiting the impact of established disease ex: spinal cord injury

Question 31

Why Are PTs Being Viewed as Primary Care Practitioners?

Answer 31

• Exploding patient population demanding quick and easy access to care
• Increased number of patients with greater complexity of symptoms and co-morbidities
• Yet, decreased  appointment times due to need for increased productivity
• Physicians: limited time and training to deal with patient’s musculoskeletal problems
• Use of PTs as “physician extenders” decreases unnecessary MD visits and frees up MDs to focus on non-musculoskeletal complaints brings cost down

Question 32

Physical Therapists as Primary Care Providers: How and Why

Answer 32

-Direct access laws –> PT as a potential first contact

• PT training includes conducting a systems review and medical screening
• Recognize disorders that fall outside of our scope of practice – make referrals

-PTs are able to address prevention and wellness issues as a primary care provider

Question 33

Rationale For Lab Tests

Answer 33

Prevention
Diagnosis
Developing plan of care

Question 34

Interpretation Criteria for Laboratory Results

Answer 34

Physical therapist use laboratory test samples most commonly to:
-Determine appropriateness for treatment
-Make necessary adjustments to the plan of care
-Use of a reference range
Important variations:
-Reference ranges vary among labs
-Response to abnormal values varies among physicians and facilities

Question 35

Validity

Answer 35

Does the test measure what it purports to test?

Does it measure what it says it measures?

Question 36

Reliability

Answer 36

How consistent is the test?

Question 37

Sensitivity

Answer 37

• true +
• Proportion of people w/ a + test result who have the condition
• People who actually have the condition are identified by the test as having the condition.

Question 38

Specificity

Answer 38

• true –
• Proportion of people w/ a negative test result who do not have the condition
• People who don’t have the condition who have a negative test result.

Question 39

snOUT

Answer 39

high Sensitivity, a Negative test rules OUT the diagnosis
Majority of people without the condition correctly identified
-Few false –
-Sensitivity

Question 40

spIN

Answer 40

-high Specificity a Positive test rules IN the diagnosis.
Majority of people with the condition correctly identified
-Few false +
- Specificity