subjective assessment MSK week 1

Question 1

what is the most important part of patient history

Answer 1

Social history - gives insight towards ADLs, living conditions, support system, hobbies or activities they would like to get back to, things they struggle with, etc

Question 2

What is the body/symptom chart

Answer 2

chart of the body where Pt can point to areas of pain

helps with describing area of pain accurately

determines consistancy of pain

quality of symptoms

intensity of symptoms so you know what to prioritize

relationship between the symptoms (could be compensatory)

Question 3

What are some qs you would ask for HPC

Answer 3

when/how did pain start

how long has it been going on for/is it getting better or worse (progression)

24hr pattern of symptoms

duration of symptoms

visual analogue scale 0-10

Question 4

What are some qs you would ask for DH

Answer 4

what are you prescribed and how long have you been taking

have they made a difference

NSAIDS = nociceptive pain
Analgesics = neuropathic
sleeping tablets/muscle relaxants = muscle pain

anticoagulants = be gentle (bruise easily and cuts means lots of bleeding

Question 5

what is MJTHREADS Ca and when should it be used

Answer 5

past medical history

Myocardiac infarction
Jaundice
Tuberculosis
Hypertension
Rheumatic fever
Epilepsy
Asthma
Diabetes
Stroke
Cancer (and treatment if so)

Question 6

What are the red flag qs that should be asked for all pts

Answer 6

History of malignancy - cancer

unexplained weight loss

unremitting pain

biological or disperse neurological Signs or Symptoms

cauda equina symptoms (bladder disturbance and/or saddle anaesthesia)

Question 7

What are yellow flags

Answer 7

psychological or behavioural factors

includes beliefs, coping strategies, willingness to change

Question 8

what are blue flags

Answer 8

social/economic factors

includes family reinforcement, work status, health benefits

Question 9

what are black flags

Answer 9

occupational factors

includes work satisfaction, working conditions, social policy

Question 10

what are orange flags

Answer 10

relating to mental health

Question 11

what are pink flags

Answer 11

factors that contribute to a good and healthy recovery

Question 12

what are the 3 factors to treatment of a pt

Answer 12

biological (pathology, tissues, pain, sensation)

social (support, status, education)

Psychosocial (anxiety, depression, fear avoidance)

all 3 should be used, and often some pts are lacking/needing additional support in different areas than others

Question 13

What is catastrophising

Answer 13

fearing the worst, and creating increased anxiety

Question 14

What is the fear avoidance model

Answer 14

people get hurt, then they spend time catastrophising about it, leading to fear of the movement due to fear of reinjury, and this causes disuse/disability

they then get hurt again due to this and reinforces their fear

ideally want to lower fear and get them exposure to recover fully

Question 15

what is self efficacy

Answer 15

perception that an individual can be effective in a certain task or action

believing that you can do something

Question 16

What is the S in SIN

Answer 16

severity of symptoms

does it cause sleep disturbance, functional restrictions, how often

Question 17

What is the I in SIN

Answer 17

most important

Irritability

how long to aggravate symptoms and how long to ease them

latency of symptoms?

high irritabilty results in less tests being able to be performed physically

Question 18

What is the N in SIN

Answer 18

Nature

what is the source of the symptoms and what kind of pain do they feel

Question 19

How many hypotheses should you have after the subjective assessment

Answer 19

on average, 4

Question 20

How should your objective assessment be planned out

Answer 20

subjective and background info make up info, and this info after analysis creates a hypothesis

the hypothesis should then be tested, and then the results analyzed

if correct, you have your diagnosis, if incorrect, go back to initial analysis and come up with another hypothesis

Question 21

What is clinical reasoning

Answer 21

cognitive processes used in the evaluation and management of a patient

Question 22

what are the components of clinical reasoning

Answer 22

knowledge
metacognition (thinking about ur own biases/self-reflection)
clinical reasoning processes

Question 23

What are the 3 types of knowledge

Answer 23

personal - life experience
propositional - knowing what (academic knowledge)
professional - practical clinical skills

Question 24

What are the different clinical reasoning processes

Answer 24

hypothetico-deductive - testing around hypothesis

pattern recognition - diagnosing based on symptoms that fit a pattern of a pathology (high bias and lots of potential error)

diagnostic - interpretation of pt data

collaborative - working with other healthcare workers

narrative - listening to the story of the pt

Question 25

What kind of notes should be used for subsequent visits

Answer 25

SOAP

Subjective reassessment
Objective reassessment
Assessment/analysis of pt problem
Plan for management/treatment

Question 26

What are you supposed to ask and in what order during the subjective assessment

Answer 26

Introduce

identity confirmation

explain the plan/ask for consent

demographics

why they here (present complaint)

HPC

PMH

DH

SH

FH