ppts 1-4 Flashcards
Name some general risk factors for disease
age race gender lifestyle Family and personal hsitory
Systems Review vs Review of Systems
Systems review: Brief exam of anatomical & physiological status of all systems
Review of systems: A tool to recognize clusters of associated signs and symptoms and possible need for referral - check list
The interview consists of ___% of the information needed to make a PT diagnosis
80
T or F: During the initial interview you should start with yes or no questions first
F: start with open ended questions and then narrow in on yes or no –> this is called a funnel sequence
*make sure to paraphrase throughout the process
What is the primary symptom or reason for referral to PT?
pain
What are the 8 questions you should ask about pain ?
location description intensity duration frequency pattern aggravating and relieving factors associated symptoms
Which of the following is not a sign of musculoskeletal pain? A) Insidious onset of pain B) Position and movement change pain C) Knife-like/ gnawing pain D) Achy and tenderness
C)
systemic: insidious onset of pain, knife/gnawing pain, constant and unrelieved by rest/position, bilateral, night pain, unusual vitals
Musculo: insidious OR moi , achy, tenderness and stiffness, constant or intermittent (position and movement change pain), mechanical pain
Chronic pain is > than __ months
3
What is the cause of radicular pain?
Irrigation of spinal nerve of dorsal root ganglion
Which of the following is not on the general health checklist of review of systems? A) fever/chills and sweats B) recent rash C) hoarseness/ voice change D) dizziness
B) recent rash
under the Integ section
general questions include: fever, chills, sweats. Appetite loss, nausea, vomiting. Fatigue, weakness, malaise. Excessive unexplained weight loss or gain. Vital signs. Insomnia. Irritability. Hoarseness or change in voice. Dizziness
True or False: The patient does not have signs of any yellow flags and only has presence of ONE red flag, therefore there is no cause for immediate medical attention
true. 1 red or yellow flag is not cause for immediate medical attention
T or F: Symptoms that are not relieved by rest or PT are considered red flags ?
True
To be considered a red flag, weight loss/gain needs to be between __&__ % of body weight
5-10% of body weight
Which is not a constitutional symptom? A) Fever B) Appetite loss C) Nausea D) Coughing
d) coughing
constitutional symptoms include: fever, chills, sweating, appetite loss, nausea, vomiting, fatigue, malaise
When do constitutional symptoms become red flags?
when MD unaware of them
become worse since last MD visit
no explanation/ apparent
When is core temperature considered a red flag?
when > or = to 99.5 for >2 weeks
or > 98.9 in the elderly
Fatigue becomes a red flag when tiredness impedes ….
ability to perfrom normal ADL nad IADL
Persists for > 2 weeks
Define Malaise
Discomfort, uneasiness, or indisposition,often indicative of infection
- would not ask a patient if they have this
- PT deduction
Name some reasons a patient may present with dizziness/ light headedness
- cardiovascular problems
- vestibular condition
- Meniere’s disease
- Vertebral basilar artery insufficiency
What are the 2 keys to make the Review of Systems manageable ?
use the general checklist first and then add in the appropriate checlists based on symptoms
What are the 5 vital signs used
BP HR RR Temperature (core) Pain **additional include: walking speed, pulse ox and skin temp
What are the best tools for PT in the out patient setting?
Vital signs
Observation
Symptoms
Sings
What are the 4 reasons for change in HR?
fever, meds, pain and anxiety
What are some reasons for change in BP?
anxiety, caffeine, smoking
If your patient has a BMI of 35.2 what is their classification?
Obesity class II
25-29.9 –> Overweight
30.0-34.9 –> Obesity Class I
35-39.9 –>Obesity class II
> or = 40 –> Obesity class III
A wasit circumference of __ for a female and __ for a male is considered a risk factor
35
40
T or F: confusion is a normal part of aging?
false
In Arthritis, Heberden’s nodes are found at the __ and Bouchard’s nodes are found at the ___
Herb: DIP
Bouchard: PIP
Finger clubbing is a sign of ___
oxygen deprivation
-possible early sign of some cancers
Normal time for a capillary refill test is …
3 seconds
Edema is ____
Swelling is ___
Edema : fluid in the interstitial space (outside of joint)
Swelling: effusion (within a joint)
What are the ABCDE for malignant melanoma
A - asymmetry B- border C- color D - diameter E - evolving
Petechiae vs Ecchymoses
Petechiae: Small, purplish, hemorrhagic spots on the skin that appear in certain severe fevers and are indicative of great prostration, as intyphus. They may be due to an abnormality of the blood-clotting mechanism
Ecchymoses: A skin discoloration consisting of large, irregularly formed
hemorrhagic areas caused by extravasation of blood into skin or mucous membrane
Best to observe skin on ___ and ___ of patients with darker skin
palms and soles
- show changes more clearly
When considering abuse, slash marks or scald burns most often occur on the _ and ___
buttocks and distal extremities
What is one of the most common injuries from abuse?
bruising from squeezing and shaking
If suspect abuse you should ..
take a picture, doccument date and provide detailed descriptions and report.
What is one of the most common disorders mistaken for abuse?
Mongolian spots
-congenital
Lymph nodes should normally be ….
How to tell lymph node vs trigger point
contract the muscle - for a superficial lymph node there should be no change
If a patient cannot distinguish tastes in the back of the tongue, which CN is impaired ?
IX Glossopharyngeal
The spleen is found in which quadrant
LUQ
Ascending colon found in the ___
RLQ
All of the following are found in the LUQ except : A) spleen B) pancreas C) small intestine D) descending colon
D) descending colon
LUQ = spleen, stomach, pancreas, L kidney & adrenal gland, L ureter, transverse colon and SI
When doing abdominal auscultation you should listen with the __ but when listening to vessels you should you the ___
- diaphragm for 3 mins
- bell
When doing abdominal percussions you hear a tympanic sound. This means you are over ___
a hollow organ, gas
dull = solid organ, deces, mass
What is a special test for abdominal hernias ?
have patient lie supine and raise both arms above head and observe for bulge
What are the 3 special tests for appendicitis ?
1) Rebound tenderness
- RLQ
- (+): pain on withdrawl
2) Rovsing’s Sign
- LLQ
- (+): pain at RLQ
3) Pinch and Inch
- McBurney’s point
- (+): pain with release
Special test for gallbladder
Murphy’s sign
- hook fingers under lower R costal border
- have patient breath in and palpate liver
Which is not a risk factor for AAA A) low BMI B) smoking C) male D) age > 65
A) low BMI
The width of abdominal aorta is typically ___cm
2
Special tests for the kidneys
Murphy’s Percussion Test
- palm of one hand over costovertebral angle (T12 - L3)
- Percuss back of hand with ulnar border of opposite fist
(+) response: reproduction of pain
Epigastric region is from …
mid sternum to xiphoid process
Innervation of epigastric region is __
T3 - T5 (sympathetic )
stomach
esophagus
duodenum
pancreas
Periumbilical region innervated by ___
T9 - T11
Small intestine
pancreas
appendix
Hyogastrium innervated by ___
T10 - L2 (sympathetic)
large intestine
colon
In the lower abdominal region differential diagnosis shold be =between __ and ___
bladder and uterus
In epigastric region, differential diagnosis is between
heart
liver
gall bladder
What is a good indication of visceral pain?
pain in abdominal and back at the same level
Which of the following is not a sign of GI problem A) dysphasia B) diplopia C) Odynophagia D) Bright red blood
B - diplopia
What is Kehr’s sign
left shoulder pain when the patient is lying down with legs elevated. Due to presence of blood or other irritants in the peritoneal cavity
Special tests for iliopsoas abscess
heel tap
hop test
active SLR
palpation at 90/90
-1/3 distance from ASIS to umbilicus
WHat is the 3rd most common cancer?
colorectal
- 3rd most common cause of death from malignancy
- most common among non smokers
- M > F
What is the action of an NSAID
analgesic, anti-inflammatory
Which of the following is not an adverse reaction from NSAID use A) renal failure B) hair loss C) CNS problems D) increased blood pressure
B
What is the ANS innervation of liver ___. Where is referred pain felt ?
ANS: T5 - T11
felt: T 7 -T10
- right shoulder and upper trap
what is the #1 cause of sudden liver failure in USA
acetaminophen
ANS innervation of gallbladder is __. Pain is felt ___
ANS: T5-T11
felt: Right shoulder and upper trap
right inter scap (T4-T8)
Right subscap
Cholelithiasis vs Cholecystitis
1) gallstones
2) blockage of cystic duct by gallstones
T or F: Rhabdomyolysis is a hepatic and billary disease?
True
T or F: carpal tunnel syndrome can be a symptom of Rhabdomyolysis
true
How to test for Asterixis (liver flap)
have patient flex shoulder to 90 with elbows extended and pronated - add wrist extension with finger extension - observe for large amplitude tremors
Where would you see first signs of jaundice ?
sclera of eyes
In biliary and hepatic diseases stool will be the color of __ and urine will be ___
light gray or clay colored
urine: tea/cola color
When should you immediately refer to physician ?
when should you refer but not immediately ?
immediate: new onset of myopathy
refer: bilateral carpal tunnel + bilateral tarsal tunnel , obvious signs with no history,
1) Polypharmacy vs 2) Hyperpharmacotherapy
1) multiple medications ( or multiple pharmacies to fill prescriptions)
2) excessive drugs to treat disease
WHat are the most common drug side effects
constipation diarrhea nausea abdominal pain sedation
- others include: confusion, drowsiness, weakness, incoordination, falls, anorexia, incontinence
Which is not a risk factor for adverse drug reactions A) Age of 50 B) Polypharmacy C) small stature D) alcohol consumption
A)
risk factors include:
age >65, polypharm, hyperpharm, alcohol, small, dementia
The upper urinary tract includes:
kidneys and ureters
What is the innervation of upper urinary tract
T10 - L1
Where are the symptom locations for upper urinary tract?
posterior subcostal and costovertebral angle regions
- ipsilateral flank into the LQ/groin/proximal anterior thigh and across lover back
kidney: possible ipsilateral shoulder
The lower urinary tract includes
bladder and urethra
The innvervation for lower urinary tract is
S2- S4 (parasympathetic)
above T9 = sympathetic
Where are the symptom locations for lower urinary tract
suprapubic or lower abdomen, lower back
Who is more likely to get baldder/renal cancer?
males older than 40
The most common age to get testicular cancer is
15-35
prostate age: >65
One sign of urogenital disease is hypersensitivity in T__ - L __
T10 - L1
T or F: ipsilateral shoulder pain could indicate urogenital disease
true, but not the only one
What are two tests performed in the urogenital category?
murphy’s percussion - kidney
abdominal rebound test
- peritoneum inflammation
How do you diagnosis urogential disease
lab tests
- urianlysis
- renal function blood study
Imaging
-MRI
What is the difference between a differential diagnosis vs screening?
DD: diagnosis based on comparison of symptoms of two or more similar diseases to determine which the patient is suffering from
Screening: The process of evaluating patient examination data for the purpose of deciding whether a patient referral is warranted
