Role of Primary Care

Question 1

Primary Care

Answer 1

-accessible, comprehensive, coordinated and coonntinual care by providers of public health

Question 2

PT in Primary Care

Answer 2

-triage
-determine if they should be there
-referral
-immediate or emergency care

Question 3

Red/Yellow Flags

Answer 3

1. Major Depression
2. Suicide Risk
3. Femoral Fx
4. Cuada Equina Syndrome
5. Cervical Myelopathy
6. Abdominal Aortic Aneurysm
7. Deep Vein Thrombosis
8. Pulmonary Embolism
9. Atypical Myocardial Infarction

Question 4

Major Depression

Answer 4

RK:
-past/current
-female (pregnancy)
-Hx of disease
-Family Hx
-loss

CM:
Answers yes to
-have you felt down, depressed or hopeless in the last 2 weekd
-have you had little pleasure or interest doing things

Question 5

Suicide Risk

Answer 5

RK:
-living salone
-hx of psychiatric illness
-previous suicide attempts
-Hx of chronic illnes

CM:
-expressing thoughts of death or wishing
-says yes to attempting to harm themselves (ask if they have a plan and the resources)

Question 6

Femoral Fx

Answer 6

RK:
-osteoporosis
-female
-stress/trauma
-medicines
-running/jumping
-muscle strength

CM:
-pain in groin, ant-med thigh, greater trochanter, buttock
-deformity
-loss of function
-brusing/edema
-fulcrum test or pattellar-pubic percussion test

Question 7

Cauda Equina Syndrome

Answer 7

RK:
-LBI
-spinal stenosis
-spinal fx
-ankylosing spondylitis
-TB

CM:
-LB/LE pain
-B/B issues
-saddle anesthesia
-urinary retention
-ataxia

Question 8

Cervical Myelopathy

Answer 8

RK:
-c spine spodylosis/instability
-most common cause of quadriparesis/paraparesis
-old age

CM:
-slow steps
-hand dexterity
-gait issues
-paresthesias
-urinary retension
-UMNL signs

Question 9

Abdominal aortic Aneurysm

Answer 9

• aneurysm distal to renal srteries (>3cm
  -risk for rupture @ 5-6cm

RK:
- >60
-male
-smoking
-CAD or hyper cholesteroma
-family Hx

CM:
-back, abdominal, hip or butt pain
-no mechanical pain behaviors
-palpable mass
-bounding/visible pulse
-hearing bruits
-stop if tearing, hot, searing pain

Question 10

Deep Vein Thrombosis

Answer 10

RK:
-hx of DVT
-hx of cancer, SLE
-infection
-chemo
-major surgery/trauma
-immobility
-post patrtem

CM:
- ache or tightness near site
-edema
-increase in skin temp

Question 11

Pulmonary Embolism

Answer 11

-most associated with DVT, air, fat or bone marrow embolism

RK:
-hx of PE or DVT
-immobility
-hx of surgery
-late stage pregnancy
-fx

CM:
-dyspnea
-tachypnea
-chest pain
-cough
-anxiety
-palpitations

Question 12

Atypical Myocardial Infarction

Answer 12

RK:
-smoking, high cholestrol, htn, DM, obesity
-women >55, Men >45
-family hx
-ethnicity

CM:
-SOB
-fatigue
-sleep issues
-nausea
-chest pain
-anxiety
-upper abdominal, jaw neck or tooth pain

Question 13

Clinical Desicion Rule for DVT

Answer 13

-1 point for each

-activtive cancer (w/in 6m)
-paralysis or immobilization
-bedridden for 3 day or major surgery (12w)
-localized tenderness along venous
-entire leg swollen
-calf swelling >3cm
-pitting edema
-collateral superficial veins
-previous DVT
-alternative dx as likely (-2)

Question 14

Clinical Desicion Rule for PE

Answer 14

-Clinical signs of DVT (3)
-tachycardia (1.5)
-immobilization 3 or surgery 4w (1.5)
-hix of PE and DVT (1.5)
-hemoptysis (coughing up blood) (1)
-cancer ttreatment, 6m (1)
-Alternative less likely (3)