Screening in Pt interview Flashcards
what are 2 essentially questions to include when screening a pt for depression?
- During the past month have you been feeling down, depressed, or hopeless?
- During the past month have you been bothered by having little interest or pleasure in doing things?
list prominent signs that someone may have an eating disorder
- discoloration or staining of the teeth from contact with stomach acid
- broken blood vessels in eyes from vomiting
- dry skin and hair; brittle nails; hair loss and growth of downy hair all over the body (lanugo), including the face
- tooth marks, scratches, scars or calluses on the backs of hands from inducing vomiting (Russell’s sign)
- Weight loss/gain
other less prominent signs that someone may have an eating disorder
- irregular or absent menstrual periods
- inability to tolerate cold
- reports of heartburn, abdominal bloating or gas, constipation or dirrhea
- bradycardia or low BP
- enlarged parotid gland from repeated contact with vomit
- skeletal myopathy and weakness
- chronic fatigue
- dehydration or rebound water retention (pitting edema)
behavioral S/S of an eating disorder
- preoccupation w/weight, food, calories, fat, grams, dieting clothing, size, body shape
- mood swings
- frequent comments about being far or overweight despite looking very thin
- excessive exercise to burn off calories
- use of diuretics or other meds to induce urination, bowel movements or vomiting
- binging and purging
- food restriction
why is it important that PT’s screen for smoking?
- Tobacco use causes vasoconstriction and delayed wound healing
- smoking has been linked with disc degernation and acute lumbar/cervical disc herniation
performance-based tests for fall risk pts
- functional reach test
- BERG balance scale
- TUG
scales for balance confidence/fear of falling in pts that are fall risk
- Activities-specific balance confidence scale (ABC)
- Falls efficacy scale (FES)
- Survey of activities and fear of falling in the elderly (SAFE)
List warning signs of elder abuse
- multiple trips to the ER
- depression
- “falls”/fractures
- bruising/suspicious sores
- malnutrition/weight loss
- pressure ulcers
- changing MDs/therapists often
- confusion attributed to dementia
common MSK side-effects associated with antibiotics
- skin reactions
- noninflammatory joint pain
- tendinopathy/tendon rupture
common MSK side-effects associated with NSAIDs
- back and shoulder pain
common MSK side-effects associated with statins
myalgia
S/S of NSAID complications relating to GI
- indigestion/heartburn/epigastric or abdominal pain
- esophagitis, dysphagia, odynophagia
- nausea
- unexplained fatigue lasting more than 1-2 weeks
- ulcers, perforations, bleeding
- melena
S/S of NSAID complications relating to MSK
- increased symptoms after taking the med
- symptoms linked with ingestion of food
- midthoracic back, shoulder or scapular pain
- muscle weakness
- restless leg syndrome
- paresthesia
2 questions should be asked to screen for suicide risk
- are you having thoughts of attempting to harm yourself?
- do you have a plan in place?
compare and contrast fatigue and insufficiency fractures
- insufficiency fracture → abnormal bone with normal stress
- associated with osteoporosis
- fatigue fracture → abnormal stress on normal bone
- associated with overload
- stress fractures
List risk factors for femoral head and neck fractures
- female gender
- hormones
- menstrual irregularities
- involvement in running, jumping and marchign activities
- change in training program or routine
- nutritional deficiencies
- LLD
- diminished muscle strength
- osteoporosis
Describe clinical manifestations of femoral head and neck fractures
- pain in groin, greater trochanter and/or buttock
- referred pain to anteromedial thigh may be chief complaint
- provoked with increased WBing
- relieved with reduced WBing
- insidious onset
- Hip ROM reveals minor if any pain provocation
- Plain films often negative
what physical exam techniques would you utilize if you suspect a femoral head or neck fracture?
- Fulcrum Test
- Patellar-Pubic Percussion test
list the risk factors for CES
- low back injury, central disc herniation
- congenital or acquired spinal stenosis
- spinal fracture
- anklyosing spondylitis
- TB, Pott’s disease
describe the clinical manifestation of CES
- urinary dysfunction
- retention, incontinence
- bowel dysfunction
- incontinence, loss of anal tone
- sexual dysfunction
- reduced sensation during intercourse, impotence
- sensory deficits
- perineum and “saddle” regions
- LEs
- motor deficits
- lower limbs (multiple spinal level weakness
list risk factors for cervical myelopathy
- cervical spondylosis
- spinal degeneration from neck trauma (MVA, sports injury)
- RA
describe the clinical manifestations of cervical myelopathy (history)
- impaired hand dexterity
- gait, balance difficulties (legs weak, stiff)
- numbness, paresthesia-extremities (upper and possibly lower)
- neck stiffness
- urinary dysfunction
- retention and possible urgency and frequency
describe the clinical manifestations of cervical myelopathy (physical exam)
- hand-intrinsic atrophy
- muscle weakness
- often triceps and hand intrinsic
- proximal muscles of LE
- UMN signs
Cook cluster for cervical myelopathy
- Gait abnormality
- +Hoffman’s Test
- Inverted Supinator sign
- +Babinski test
- age >45 years
how do you interpert Cook’s cluster
- 1/5 present = ability to rule out myelopathy (sensitivity 0.94)
- 3/5 present = ability to rule in myelopathy (specificity 0.99)
list the risk factors for abominal aortic aneursym (AAA)
- age
- male gender
- history of smoking
- history of hyper cholesterol and coronary heart disease
- family history of AAA
describe the clinical manifestation of AAA
- asymptomatic in most
- if pain present, most likely back pain
- abdominal, hip, groin or buttock pain also possible
- nonmechanical properties
- insidious onset
- may report early satiety, weight loss and nausea
- vascular dissection must be considered with pain
list risk factors for DVT
- previous history of DVT
- history of cancer
- history of CHF
- history of SLE
- recieving chemo
- major surgery
- major trauma
- immobility
- limb paralysis
- women during pregnancy
- women taking oral contraceptives, hormone replacement therapy
- age >60 years
describe the clinical manifestations of DVT
- ache, tightness, tenderness
- general edema
- pitting edema
- prominent superficial venosu plexus
- increased local skin temp
how to interpret the Wells Clinical Prediction rule for DVT
- high probability if score > 3 (75%)
- moderate if score 1-2 (17%)
- low if score is 0 (3%)
list the risk factors for PE
- previous history of PE
- history of DVT
- immobility
- history of abdominal, pelvic surgery
- total hip, knee replacement
- late-stage pregnancy
- lower limb fractures
- malignancy of pelvis or abdomen
describe the clinical manifestations of PE
- dyspnea
- tachypnea
- pleuritic chest pain, intensified w/deep respiration and cough
- persistent cough
- apprehension, anxiety
- tachycardia
- palpitations
T/F: it is typical for women to present with the classic symptoms of an MI
FALSE
less typical for women than men
only 50% of women experience chest pain
thus cardiac death leading cause of death in women all ages
modifiable risk factors of an atypical MI
- cigarette smoking
- high cholesterol levels
- HTN
- DM
- Obesity
- Sedentary lifestyle
- Excessive alcohol consumption
Nonmodifiable risk factors for an atypical MI
- age > 55 in women
- age > 45 in men
- family history
- ethnicity
- highest in AA
describe the clinical manifestation of an atypical MI
- SOB
- Fatigue
- Sleep disturbance
- Nausea (with or without vomiting)
- Palpitations
- Dizziness
- Diaphoresis
- Anxiety
- Pain
pain locations for an atypical MI
- upper abdominal/epigastric
- neck, jaw and tooth
- interscapular and mid to lower thoracic
- R arm pain (possibly isolated in biceps)
