Review of Systems and Systems Review Flashcards
Purpose of Review of Systems
medical screening and differential diagnosis
identify specific symptoms (other than chief complaint), co-morbid conditions, occult disease, adverse drug reactions
determine whether patients presenting with musculoskeletal pain have evidence of systemic involvement
determine whether there are symptoms that suggest that need for referral for additional medical evaluation
medical diagnosis
recognition of disease/disorder
determination of cause and nature of pathology
ex: knee pain
medical diagnosis: osteoarthritis
medical differential diagnosis
comparison of signs and symptoms similar diseases and medical diagnoses
comparing to other things that are going on in the area that could potentially give the same signs and symptoms
ex: knee pain
medical differential dx: meniscal tear, infection, ligament sprain, etc.
physical therapy diagnosis
comparison of nuero-musculoskeletal signs and symptoms
identity movement dysfunction(s)
ex: knee pain
PT dx: inability to walk, squat, climb stairs, due to impairments or pain, going irritability, and loss of range of motion at the knee
signs
observable findings detected by physical examination
what we can see or measure
ex: runny nose, fever, fatigue
symptoms
reported indications of disease perceived by patient
ex: they said they feel hot
musculoskeletal complaint
often worse with a specific activity, and will subside with cessation of that activity
not typically associated with systemic signs/symptoms
non-musculoskeletal complaint
symptoms usually independent of position or activity, frequently described as constant
can present with fever, chills, unexplained weight loss, night pain, etc.
why does a PT need a review of system
direct access, referral without exam from MD, systemic involvement may affect patient outcomes in PT
review of systems components
body systems checklist
- recommended at each individual evaluation/initial visit
general health questions
- identifies symptoms that could result from 1) many diseases in different body systems, 2) multisystem disorders, 3) systemic illness, 4) adverse drug reactions
body systems checklist
- cardiovascular/pulmonary
- endocrine
- eyes, ear, nose, throat
- gastrointestinal
- genitourinary/reproductive
- integumentary
- neurologic/musculoskeletal
general health questions
- fatigue
- malaise (general “bleh” feeling)
- fever, chills, sweats (>99.5* for >2 weeks)
- weight loss/gain (5-10% BW inc or dec unexplained)
- nausea, vomiting
- dizziness, lightheadedness
- parasthesias, numbness
- weakness
- change in mentation, cognitive abilities
if they answer “yes” to any general health questions
does the complaint represent something new, different, or unusual for them?
is there an explanation for it that would minimize concern?
has the patient mentioned this to a physician?
if a physician is aware of it, has it become worse?
flag system categories
red= clinical yellow= psychosocial
reg flag
identification of non-musculoskeletal involvement
- requires communication with another caregiver
- possibly indicative of serious pathology (fracture, infection, cancer)
- mental health: excessively high levels of distress, major personality disorders, PTSD, drug or alcohol abuse/addiction, clinical depression
yellow flag
- psychological social and environmental risk factors for prolonged disability and failure to return to work as a consequent of musculoskeletal symptoms
- beliefs, judgements, emotions, coping strategies, work perceptions, contextual obstacles
how to identify and decide if it is a yellow or red flag
appropriate follow-up questions, and cluster information together
most common sites of referred pain from systemic disease
back and shoulder
other: scapular area, pelvis, hip, groin, sacroiliac joint
depression
a mood disorder that causes a persistent feeling of sadness, hopelessness, and loss of interest
associated with chronic pain, worse functional outcomes
prolongs recovery and intensifies pain
diplopia
double vision
dysarthia
slurred speech
dysphagia
difficulty speaking
nystagmus
eye twitching
ataxia
impaire coordination
anhidrosis
lack of facial sweating
perioral dysthesia
altered sensation around mouth
photophobia
hypersensitivity to light
Systems Review
brief or limited examination of
- anatomical and physiological status of cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular systems
- communication ability, affect, cognition, language and learning style
items are identifies as impaired or unimpaired
rule IN vs. rule OUT
rule IN= systems review
rule OUT = review of systems
purpose of systems review
- determine reason patient is seeking care (and if PT is appropriate or not)
- develop a “working hypothesis” regarding cause of chief complaint
- forms foundation for more specific tests and measures
- identify possible problems requiring medical consultation
communication in systems review
- ability
- affect
- cognition (alert and oriented- person, place, time, context)
- languages
- learning style
affect
external expression of emotion attached to ideas or mental representations of objects
ex:
- blunted
- flat
- inappropriate
- labile
- restricted
blunted affect
severe reduction in the intensity of affect
common symptom of schizophrenic disorders
flat affect
lack of emotional expression
inappropriate affect
affect that is incongruent with situation or context of patients ideas or speech
labile affect
rapid changes in emotion unrelated to external events or stimuli
restricted affect
reduction in intensity of affect, to a somewhat lesser degree than is characteristic of blinded affect
cardiopulmonary system
- heart rate
- respiratory rate
- blood pressure
- edema
ask, observe, palpate
integumentary system
- skin integrity
- any wounds or breaks in skin - skin texture
- any soft tissue lumps or skin lesions, changes in hair growth - skin color
- any bruising, areas of discoloration, changes in pigmentation - scars
- injury or surgical
musculoskeletal system
- hight and weight
- posture
- observe overall posture, asymmetry of extremities, compare bilaterally - gross range of motion
- cervical spine
- upper extremities
- lower extremities
- spine/trunk
cervical range of motion
flexion
extension
(side bend)
rotation
upper extremities range of motion
hands reach back/neck- flexion, abduction, external rotation
hands behind back- extension, adduction, internal rotation
elbow and wrist movements with elbow extended- elbow flexion/extension, wrist flexion/extension, forearm pronation/supination, radial/ulnar deviation
lower extremities range of motion
knee extension with ankle dorsiflexion/plantarflexion
tailor sit- hip flexion, abduction, external rotation
sit to stand
supine/trunk range of motion
forward bend- extension
rotating trunk- rotation of both sides
back bend- flexion
gross strength
- neck flexion, extension, side flexion
- shoulder shrug- abduction
- elbow flexion, extension
- wrist flexion, extension
- finger flexion, extension, abduction, adduction
- hip flexion, abduction, adduction
- knee flexion, extension
- ankle dorsiflexion, plantar flexion, eversion
- toe and great toe extension
neuromuscular/motor system
- gross coordinated movements
2. gross motor function
gross coordinated movements
balance
- romberg (feet together): eyes open (30s) and eyes closed (30s)
locomotion
- observe gait pattern
- normal, tandem, heel walk, toe walk
transfers/transitions
- observe sit to stand and sit/supine
coordination
- rapid alternating movements
- heel-shin slide
sensation- dermatomal patterns
- follow ASIS key points
- light touch testing “same or different” (from cheek)
BMI numbers for underweight
below 18.5
normal or health weight BMI
18.5-24.9
overweight BMI
25-29.9
obese BMI
30 and above
anterior view landmarks for posture
eyes acromion processe iliac crests ASIS greater trochanters patellae malleoli
posterior view landmarks for posture
ears shoulders inferior angles of scapulae iliac crest PSIS greater trochanter gluteal crease popliteal line malleoli
lateral view landmarks for posture along plum line
external auditory meatus acromion greater trochanter just posterior to patella about 2 cm anterior to lateral malleolus
myotome C/2
neck flexion/extension
myotome C3
neck later flexion
myotome C4
scapular elevation
myotome C5
shoulder abduction
myotome C6
elbow flexion, wrist extension
myotome C7
elbow extension, wrist flexion
myotome C8
finger flexion
myotome T1
finger abduction
myotome L2
hip flexion
myotome L3
knee extension
myotome L4
ankle dorsiflexion
myotome L5
great tow extension
myotome S1
ankle planar flexion, ankle eversion
myotome S2
knee flexion
cervical flexion/extension
C1/2
cervical lateral flexion
C3
shoulder shrug
C4
shoulder abduction
C5
elbow flexion
C6
elbow extension
C7
wrist flexion
C7
wrist extension
C6
finger flexion
C8
finger extension, abd and adduction
T1
hip flexion
L2
hip abd and adduction
L2
knee flexion
S2
knee extension
L3
ankel dorsiflexion
L4
ankle plantarflexion, eversion
S1
great toe extension
L5
