Screening basics for LQS

Question 1

why do we screen?

Answer 1

to ensure the pt is appropriate for PT- musculoskeletal problem falls within our clinical practice
look for for yellow or red flag indicators

Question 2

what do we screen for as yellow flags?

Answer 2

cautionary signs or symptoms that require further investigation
ex) difficult with coping mechanisms, anxiety, depression, dizziness, abnormal sensation patterns, fainting, progressive weakness, and circulatory or skin changes

Question 3

what do we screen for as red flags?

Answer 3

raise one’s level of suspicion that there is a serious medical condition that could be presenting as a common musculoskeletal condition

Question 4

what should we do as a PT if we identified a red flag with a patient?

Answer 4

refer them out to allow for further diagnostic testing

Question 5

what is a sign?

Answer 5

an observable, objective finding related to a person’s condition. often able to be quantified by using valid and reliable measurement instruments

Question 6

what is a symptom?

Answer 6

how a person experiences a condition. a subjective finding, often difficult to measure accurately

Question 7

where should we screen if the patient complains of an upper extremity symptom?

Answer 7

screen cervical spine

Question 8

where should we screen if the patient complains of a lower extremity symptom?

Answer 8

screen lumbar spine

Question 9

where should we do if the patient complains of a thoracic region symptom?

Answer 9

if symptoms are not affected by movement, this area should arouse suspicion

Question 10

T/F: certain movements should relieve pain for musculoskeletal injuries and they should follow a pattern?

Answer 10

True

Question 11

is this a red flag?:
pain that is not made worse or better by anything

Answer 11

yes

Question 12

what are Stoddard’s warning signs?

Answer 12

previous malignancy
late onset in life
serious loss of function
intense pain
areas other than cervical and lumbar
constitutional signs
gross weakness
loss of bowel/bladder
continuous pain
blood work

Question 13

what are constitutional (red flag) signs

Answer 13

fever
diaphoresis
(night) sweats
nausea/vomiting
diarrhea
pallor
dizziness
fatigue
unexplained weight loss

Question 14

what may shortness of breath indicate?

Answer 14

a cardiac or pulmonary dysfunction

Question 15

what may dizziness or nystagmus indicate?

Answer 15

not associated or resolving with vestibular treatment

Question 16

what may unilateral, bilateral, or quadrilateral paresthesias indicate?

Answer 16

cord compression or myelopathy

Question 17

what should we look for with ambulation?

Answer 17

changes in gait, pattern, difficulty with stairs, or loss of balance.

Question 18

what should we look for with posture when the patient is standing?

Answer 18

spinal curves- lateral view and posterior view
lateral shifts
boney landmark levels (iliac crests, ASIS, PSIS, greater trochanter, patella)

Question 19

what are the single active ranges of motion in the trunk for standing?

Answer 19

flexion
extension
sidebend
rotation
slide glide

Question 20

what are the repeated movement testing for the trunk?

Answer 20

flexion in standing
extension in standing
side glides in standing

Question 21

what are some standing screening tests for the LQS?

Answer 21

heel walking/toe walking (L4/S1 involvement)
heel drop test (gross compression test)
trendelenberg- SLS vs walking vs lowering from step

Question 22

what can heel drop test indicate?

Answer 22

appendicitis- in combination with WBC
spinal- compressive load intolerance, schmoral’s node
peritonitis- severe abdominal inflammation

Question 23

what should we look for with posture when the patient is sitting?

Answer 23

head alignment
spinal curves

Question 24

when should we assess the pulse during activity?

Answer 24

resting
periactivity
recovery

Question 25

how do we calculate a persons maximum HR?

Answer 25

estimated maximum HR = 220 - person’s age

Question 26

how do we calculate a persons target HR?

Answer 26

estimated target HR for aerobic training = maximum HR x desired intensity (%)

Question 27

where are some locations to manually assess HR when seated?

Answer 27

radial artery in adults
brachial artery in infants and when preparing for BP assessments in adults
carotid artery for self-monitoring and during CPR

Question 28

what are the single active ranges of motion and repeated active range of motion movements in the trunk when supine?

Answer 28

trunk flexion

Question 29

where are some locations to manually assess HR when supine?

Answer 29

radial
femoral
popliteal
dorsal pedal

Question 30

what are the single active ranges of motion and repeated active range of motion movements in the trunk when prone?

Answer 30

trunk extension

Question 31

what are some additional observations to look for?

Answer 31

Fawn’s beard
Café Au Lait Spot

Question 32

what is Fawn’s beard?

Answer 32

patch of hair on low back
indicative of spina bifida

Question 33

what is Café Au Lait Spot?

Answer 33

neurofibromatosis
birthmarks with focal region to lumbar spine
may be present with scoliosis

Question 34

What are some CNS impairments that are considered red flags that we do screening tests for?

Answer 34

gait deficits
romberg test
babinski sign
clonus test
cauda equina sequelae

Question 35

what are some musculoskeletal impairments that are considered red flags that we do screening tests for?

Answer 35

fracture (people with advanced age + corticosteroid use + trauma = consider serious risk)

Question 36

what are some cardiovascular and pulmonary impairments that are considered red flags that we do screening tests for?

Answer 36

constitutional S/S
intermittent claudication
anginal symptoms- typical and atypical
shortness of breath

Question 37

what are some integumentary impairments that are considered red flags that we do screening tests for?

Answer 37

skin changes, rashes, itching
wounds