PT Fundamentals - Exam 1, Week 3 Flashcards
Subjective exam steps:
- Review baseline info/chart review (decide if pt intervention is appropriate course of action)
- est. rapport w/ pt
- gather general info
- analyze that info/dev. hypothesis
- gather specific info
- plan objective exam
Details concerning step 1 (baseline info/chart review)
- medical screening form, body chart
- I.D. red/yellow flags
- “Does this pt even belong in my clinic?”
What are red/yellow flags?
red: warning signs that suggest that physician referral may be warranted (vomiting, fever, unexplained weight loss, etc.); may suggest serious pathology
yellow: inc. risk of poor prognosis; other factors like depression, anxiety, fear avoidant behavior, pain catatrophizing
Intheinitialphaseofdifferentialdiagnosis,whichofthe
followingdoesthePTneedtoanswer?
A. Doespatienthaveinsurancetocovermedicalcosts?
B.Whendidsymptomsstart?
C.Doespatientbelonginmyclinic/care?
D.Alloftheabove.
C.Doespatientbelonginmyclinic/care?
Key Characteristics of Pain on Body Chart:
- location of symptoms
- quality/type of symptoms
- depth
- frequency
- rel. b/t areas of symptoms
- clear relevant areas
Youaremeetingwithapatientforaninitialevaluation.
Whichofthebelowisnottypicallydocumentedonabodychart?
A. Qualityandmagnitudeofsymptoms
B.Hypothesisofcauseofpain
C.Relationshipbetweenpaininspineandextremities
D.Patient’sreportoftypeofpain
B.Hypothesisofcauseofpain
Bestdefinitionofchiefcomplaint?
A. PT’sunderstandingofproblem
B.Assigneddiagnosis,incorrectmedicalterminology
C.Representationonbodychart,withnotations
D.Patient’sproblemintheirlayterminology
D.Patient’sproblemintheirlayterminology
Details concerning step 2, est. rapport w/ pt
- communication is key:
- verbal: open- vs. close-ended questions
- nonverbal: PT always observant of pt/vice versa
- written: critical that record is accurate
Whichoneiscorrect,regardingwhenpatientsare
interruptedwhenprovidingtheirinformationinthesubjectiveexam?
A.MostarenotasPTwaitsuntiltheyhavecompletedtheiranswer.
B.Afterapproximately5minutes,duetolimitonevaluationtime.
C.Usuallywithin1‐2minutesofstartingtoanswerPT’sfirstquestion.
D.At18‐23secondsintotheinterview
D.At18‐23secondsintotheinterview.
Whichofthefollowinghasbeenshowntooccurwhenthe
PTdevelopsagoodrapportwiththepatient?
A. Increasedpatientdependencyontherapist.
B.Decreasedchangeofbeingsuedformalpractice.
C.Decreasedtreatmentplansduetofasterrecoverytime.
D.Extendedtreatmentplansduetosocialaspect.
B.Decreasedchangeofbeingsuedformalpractice.
Estimatedthat____%oftheinformation
neededtodeterminemakeadiagnosis
iscontainedinthesubjectiveexam!
80%
Regarding step 4, hypothesis dev. is a _____ process
continuous, dynamic
Details concerning step 5 (gather specific info)
- date onset
- mode of onset, method of injury (MOI)
- symptoms better/worse?
- any treatment to date? effect?
- disability/functional status (Oswestry Index–Assesses symptoms and severity of low back pain and the degree to which pain impacts functional activities)
- aggravating/easing factors
- quantify pain (visual analog scale)
- 24-hr beh. of symptoms
- current activities that have stopped due to symptoms?
- goals?
- general health
- weight change
- medications
- diagnostic tests
- PSHx
In step 5, gathering specific info, you finish by conducting a systems review of what 4 systems?
- cardiopulmonary
- integumentary
- musculoskeletal
- neuromuscular
“The Four Habits Model”
- invest in the beginning
- elicit pt’s perspective
- demonstrate empathy
- invest in the end
Describe each letter in SINSS
S: severity; intensity
non-severe: 0-3/10, minimal pain
moderate: 4-7/10, 40-70% reduction in act.; some pain/guarding
severe: 8-10/10, stop act., definite pain/guarding
I: irritability; provocation of pain; time from onset-subside
non-irritable: tolerates pain/con’t act., *pain eases quickly
moderate: tolerate brief/light act. <10 min, eases in ~ same timeframe
severe: avoid act., pain is limiting, takes long to ease
N: nature; type of pain; descriptors (tissue type)
bone pain: deep, localized, nagging
vascular: diffuse/radiates, throbbing, aching
muscle: dull, aching, cramping, MOI
nerve: sharp, bright, lightning-like
S: stage; time since onset of symptoms
acute: 0-6 wks
subacute: 6-12 wks, later stages of healing
chronic=>3 mos., usually past expected recovery time
S: stability; symptom progression
get better
get worse
stay same
Whywoulditbeimportanttoestablishtheirritabilityofa
patient’sconditionduringthesubjectiveexamination,withcontinual
reassessmentthroughouttheevaluation?
A. Decideifpatient’sgoalsareappropriate.
B.Determine how constantlythe symptoms present.
C. Assesswhattheappropriatevigoroftheobjectiveexamshouldbe.
D. Predictpatient’sabilitytodoadvancedskills.
C. Assesswhattheappropriatevigoroftheobjectiveexamshouldbe.
Yourpatientestimatesthattheirkneepainisabout
a2/10.Itdoesbother them but theyhavebeenabletocontinuetheirjob
asacashier.Whatistheseverityinthiscase?
A. Moderatelysevere
B.Non‐severe
C.Chronic
D. Moderatelyirritable
B.Non‐severe
Truckdriverpresentingwithcervicalpain,statingthatthe
paincangetashighasa7/10whenturning head to clear blind spot. Shenotes
that pain subsideswhengazereturnsforwardandshehasneverhadtostop
driving.Whatdo you rate the irritabilitylevel?
A. Non‐irritable
B.Moderatelyirritable
C.Severeirritability
D. Chronic,aggravated
A. Non‐irritable
Highschooltennisplayerinjuredtheirkneeduringa
tournamentovertheweekend.Youareabouttoseethemforyour9amappointment
onMondaymorning.Inreviewingtheirmedicalhistoryform,youseethattheyhave
injuredthatsameLEpreviously.Theappropriatestagefortheirinjuryis:
A. Chronic
B.Exacerbation
C.Sub‐acute
D. Acute
D. Acute
Which aspects of SINSS could limit your exam? What won’t limit your exam?
S/I: severity/irritability
if severe/irritable, don’t want to exacerbate symptoms
*Non-irritable: no limit to exam, can try to reproduce symptoms
PT Roles as Communicator
- historian
- pt/family educator
- motivator
- confidant/counselor
- role model
- leader/supervisor
Reasons to medical screen:
- sicker pt; more comorbidities
- shorter stay in hospital
- medical specialization
- disease progression
- presence of red/yellow flags
