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Ortho > Screening > Flashcards

Screening Flashcards

1
Q

Categorical classification of red flag findings: factors that require immediate medical attention

A

Category 1:

  • bowel/ bladder changes
  • patterns not compatible with mechanical pain
  • blood in sputum
  • numbness or paresthesia in perianal region
  • progressive neuro deficit
  • pulsatile abdominal masses
  • neuro deficit not explained by monoradiculopathy
  • elevated sedimentation rate
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2
Q

Categorical classification of red flag findings: factors that require subjective questioning or contraindications to selected manual therapy techniques

A

Category 2:

  • age >50
  • cancer history
  • metabolic bone disorder history
  • corticosteroid use
  • unexpected weightloss
  • failure of conservative management
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3
Q

Categorical classification of red flag findings: factors that require further physical testing and differentiation analysis

A

Category 3:

  • bilateral or unilateral radiculopathy or paresthesia
  • unexplained significant lower or upper limb weakness
  • abnormal reflexes
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4
Q

the purpose of a manual therapy clinical examination is to outline the movements, positions, or activities that produce, reduce, or selectively modify the patient’s “familiar signs and symptoms”, AKA:

A

Concordant signs

- “familiar signs”

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5
Q

involves the careful identification of potential contributors to the patient’s impairments

A

observation

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6
Q

involves careful examination both physical and nonphysical contributors to the impairment; includes outwardly apparent info with selected psychological and social factors potentially related to the patient’s condition

A

introspection

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7
Q

purpose of this is to examine visible static and movement related defects for analysis during the subjective and objective examination; skin, posture, and body symmetry

A

general inspection

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8
Q

What are the three major goals of a patient history?

A
  1. to characterize the problem and to establish potential causes
  2. determine the effect of the problem on pt lifestyle
  3. monitor the response to treatment for examination of effectiveness
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9
Q

the provocation of a apian that is unlike the pain for which the patient sough treatment

A

discordant sign

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10
Q

what are the three aspects of the “nature of the condition” (a reflection of the internalization of the patients condition)?

A
  1. severity
  2. irritability
  3. stage
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11
Q

subjective identification of how significantly the problem has affected the patient; may be associated with unwanted alterations or lifestyle changes

A

severity of the disorder

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12
Q

term used to define the stability of a present condition; denotes how quickly a stable condition degenerates in the presence of pain-causing inputs

A

irritability

  1. what does the pt have to do to set this condition off
  2. once set off, how long do symptoms last and how severe are they?
  3. what does the patient have to do to calm the symptoms down?
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13
Q

the path or progression of the disorder; involves a snapshot of how the patient identifies their current level of dysfunction as compared to a given point in the past

A

stage

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14
Q

what are the three aspects of the “behavior” of pain?

A
  1. time (inflammatory = upon rest or movement, noninflammatory = worse with aggressive movement, sinister = pain worsening at night)
  2. response to movements
  3. area of pain
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15
Q

What are the indications for examination of the abdomen in PT?

A
  1. Pain in chest or abdomen
  2. trauma to the chest or abdomen
  3. diffuse pain in the back, shoulder, or chest not exhibiting musculoskeletal behavior (potential referred pain)
  4. pt who presents with concomitant illness or malaise
  5. pt with changes in appetite, digestion, bowel, or bladder function
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16
Q

flooding all over pain is indicative of

A
  1. perforated gastric ulcer

2. ruptured tubal gestation sac

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17
Q

Where is small intestine pain is felt?

A
  1. epigastric area

2. umbilical areas 9th-11th thoracic nerves

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18
Q

Where is appendicitis felt?

A

epigastric area

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19
Q

Where is large intestine pain felt?

A

hypogastrium area

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20
Q

What injury might result from a blow to the abdomen and pain shifts from upper to lower?

A

possible rupture of gut and gravitation of contents

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21
Q

what represents a shift in pain from epigastric to right iliac fossa indicative of?

A

appendicitis

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22
Q 
When determining the character of pain;
Burning = 
agonizing acute =
tearing =
Gripping =
A

Burning = perforated gastric ulcer
agonizing acute = pancreatitis
tearing = dissecting aneurysm
Gripping = intestinal obstruction

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23
Q

Radiation of pain;
Biliary colic =
renal colic =
upper abdominal and lower thoracic =

A

Biliary colic = inferior R scapula (8th dorsal segment)
renal colic = ipsilateral testicle
upper abdominal and lower thoracic = ipsilateral shoulder

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24
Q

What conditions are pain symptoms are influenced by respiration

A
  1. pleuritis
  2. inflammation gall bladder
  3. intestinal obstruction
25
Q

What causes pain with urination?

A
  1. kidney or ureter stone
  2. pelvic abscess
  3. inflamed appendix
26
Q

When auscultating all 4 quadrants during abdomen exam, what are you listening for?

A
  1. bowel sounds that are clicks and gurgles 5-35 mins

2. Absence means no sounds for 5 minutes

27
Q

During an abdominal exam, where do you listen for bruits?

A
  1. Abdominal aorta: midline inferior to xiphoid process
  2. Renal arteries: mid-clavicular line, upper quadrant
  3. Iliac arteries: mid-clavicular line, upper aspect of lower quadrant
28
Q

Where do you listen for liver friction rub?

A

R side of abdomean

- indicates inflammation of peritoneum, tumor, infection, or infarct

29
Q

What does a venous hum over umbilicus indicate?

A
  1. Increased portal vein pressure

2. Liver disease

30
Q

Percussion sounds:

  1. high pitched; air filled viscera
  2. short duration, solid organs, masses, fluid or feces filled organs
  3. heard in lungs/hollow organs
A
  1. tympani
  2. dullness
  3. resonance
31
Q

Where would you palpate the follwoing:

  1. liver
  2. gall bladder
  3. spleen
  4. aorta
  5. abdominal reflexes
  6. kidneys
A
  1. right side, 11 and 12 costal margin
  2. right side below liver
  3. left side, normally not palpable
  4. left midline, pulse should be 2 finger widths or smaller
  5. stroke from umbilicus to each quadrant, umbilicus should follow stroke
  6. R and L, more medial than spleen; percussion poster costo-vertebral angle while pt sitting, should be nontender
32
Q

if the gall bladder is enlarged and tender, this indicates ____ while enlarged and nontender indicates ____

A

Cholecystitis; bile duct obstruction

33
Q

Inspect abdominal muscles as patient raises head to detect presence of the following:

A
  1. Masses
  2. Hernia
  3. Separation of muscles
34
Q

Auscultate with stethoscope diaphragm for the following:

A
  1. Bowel sounds

2. Friction rubs over liver and spleen

35
Q

Inspect the abdomen for the following:

A
  1. Skin characteristics
  2. Venous return patterns
  3. Symmetry
  4. Surface motion
36
Q

Percuss the abdomen for the following:

A
  1. Tone in all four quadrants
  2. Liver borders to estimate span
  3. Splenic dullness in left midaxillary line
  4. Gastric air bubble
37
Q

Lightly palpate in all quadrants for the following:

A
  1. Muscular resistance
  2. Tenderness
  3. Masses
38
Q

Deeply palpate all quadrants for the following:

A
  1. Bulges and masses around the umbilicus and umbilical ring
  2. Liver border in right costal margin
  3. Gallbladder below liver margin at lateral border of the rectus muscle
  4. Spleen in left costal margin
  5. Right and left kidneys
  6. Aortic pulsation in midline
  7. Other masses
39
Q

the process of differentiating between two or more conditions that share similar signs or symptoms

A

differential diagnosis

40
Q

the evaluation of signs and symptoms to assess suitability for physical therapy treatment

A

Screening

41
Q

What do we need to consider in the decision making process in whether we treat or refer a patient?

A
  1. Client History
  2. Pain Patterns/Pain Types
  3. Associated Signs and Symptoms of Systemic Diseases
  4. Systems Review – Integumentary, Cardiac, Gastro-Intestinal, etc
42
Q

as the PT assesses the patient during the initial exam and goes through the patient history they are looking for any signs/symptoms that alert to the fact that something could be seriously wrong with a system other than the musculoskeletal system.

A

clinical flags

43
Q

Pain-associated psychological destress symptoms that adversely influence outcomes for patients with musculoskeletal pain; Chronic pain patient with fear avoidance belief

A

yellow flag

44
Q

Clinical findings that increase the level of suspicion that there is a serious medical condition presenting as common musculoskeletal conditions

A

red flag

45
Q

Physical therapy evaluation must include each of the following components

A
  1. Past Medical History
  2. Risk Factor Assessment
  3. Associated Signs and Symptoms
  4. Review of Systems
46
Q

Why is it necessary for us to perform medical screening?

A
  1. Direct Access
  2. Referral for past complaint without seeing the physician
  3. Disease progression
  4. Client failed to report symptoms to physician
47
Q

What are the sources of pain?

A
  1. Cutaneous
  2. Deep Somatic - subcutaneous tissues such as muscle, tendon, joint capsule, and ligaments. The term excludes viscera
  3. Visceral
  4. Referred - back and shoulder most common locations
48
Q

What are characteristics of musculoskeletal pain?

A
  1. Decreases with rest
  2. Sharp
  3. Ceases when stressful action stopped
  4. Reproducible
49
Q

What are main characteristics of systemic pain?

A
  1. Deep throbbing
  2. Reduced by pressure
  3. Constant or waves/spasm
  4. Hx of infection
  5. Recent meds (6 wks)
  6. Pain accompanied by full and painless range of motion
  7. Pain accompanied by signs and symptoms associated with a specific viscera or system
50
Q

What are Waddell’s non-organic signs?

A
  1. Tenderness- Superfiscial, Nonanatomic
  2. Simulation tests- Axial loading, Acetabular rotation
  3. Distraction - Straight-leg-raise discrepancy, Double leg raise
  4. Regional disturbances- Weakness, Sensory disturbances
  5. Overraction - disproportionate verbalization, facial expression, muscle tension and tremor, collapsing or sweating
51
Q

What are the vertebral fx red flags?

A
  1. Age > 75 yrs
  2. Trauma
  3. Osteoporosis
  4. Back pain intensity score > or = 7
  5. Thoracic pain
52
Q

What are the compression fx red flags that can be clustered to include into screening?

A
  1. Age > 52 yrs
  2. No presence leg pain
  3. BMI < or = 22
  4. Doesn’t exercise regularly
  5. F gender
53
Q

What are the symptoms of cauda equine syndrome?

A
  1. Low back pain
  2. Loss of sensation in the lower extremities
  3. Muscle weakness and atrophy
  4. Bowel and/or bladder changes
  5. Perineal pain
  6. Saddle and perineal hypoesthesia or anesthesia
  7. Unilateral or bilateral sciatica
  8. Change in deep tendon reflexes (reduced or absent in lower extremities)
54
Q

What are the symptoms of cervical myelopathy?

A
  1. Wide-based spastic gait
  2. Clumsy hands
  3. Visible change in handwriting
  4. Difficulty manipulating buttons or handling coins
  5. Hyperreflexia
  6. Positive Babinski test
  7. Positive Hoffman sign
  8. Lhermitte’s sign
  9. Urinary retention followed by overflow incontinence (severe myelopathy)
55
Q

What are the 5 clustered signs that point to cervical myelopathy?

A
  1. Gait deviation
  2. +Hoffmann’s
  3. Hyperreflexia of Brachioradialis
  4. +Babinski
  5. Age > 45 yrs
56
Q

What yellow flags should you evaluate when goal writing for outcome measures?

A
  1. catastrophizing
  2. fear of harm
  3. composite psychological prognosis factors
57
Q

believing that the body will get better; questionnaires can identify who is more focused on pain and will result in slower results from therapy

A

self efficacy

58
Q

What should be included in history taking when performing an abdominal exam?

A
  1. “What were you doing when this pain began”, “Have you ever had a pain like this before?”
  2. Establish moment of onset
  3. Establish distribution of pain
  4. determine character of pain
  5. radiation of pain
  6. symptoms influenced by respiration
  7. pain with urination
  8. determine if pregnant, trauma, infectious disease, nutrition/diet, alcohol use, medications, stool and urine characteristics

Ortho (10 decks)

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