Subjective Ax Flashcards
Describe the structure of a subjective hx:
PC: Presenting Condition
HPC: History of Presenting Condition
PMH: Past Medical History
DH: Drug History
FH: Family History
SH: Social History
Special Questions / Red Flags
What is asked about in the PC?
- Location, Type and Severity (NPRS)?
- Intermittent or Constant?
- Sensation differences?
- Aggs & Eases?
- Diurnal Pattern? (+Night Pain)
What is asked about in the HPC?
- Time & Mechanism of Injury?
- History of symptomatic area (acute or chronic, improving)?
- Prior Injuries & any Investigations?
In the PMH, why may it be significant to ask about Respiratory Diseases?
COPD can predispose to osteoporosis and muscular weakening disorders.
What is asked about in the DH?
- Current medications (analgesia / NSAIDs)
- Dosage, Regularity, Effect?
What is asked about in Special Questions / Red Flags (for the Lx spine / Low Back)?
Cauda Equina Syndrome:
- Bladder & Bowel
- Saddle Anaesthesia
- Gait Issues
- Sexual Dysfunction
What is asked about in the PMH?
- General Health
- Current Medical Problems (THREAD-SOC)
- Hx of major surgeries
What is asked about in the SH?
- Occupation?
- Hobbies & Sports?
- Smoking & Drinking?
- Expectations & Goals?
- Hand Dominance?
In the PMH, why may it be significant to ask about the Heart?
Can explain some symptoms:
- Chest pain
- SOB
- Weakness
- Fever, Nausea, Fainting
- Blood in stool
- Pain in the arms
What is the acronym THREAD-SOC for past medical history?
Thyroid
Heart
Rheumatoid Arthritis
Epilepsy
Asthma
Diabetes
Steroids
Osteoporosis
Cancer
What is asked about in Special Questions / Red Flags (for the Cx spine / neck)?
5Ds & 3Ns
What is asked about in Special Questions / Red Flags (for rheumatological / inflammatory conditions)?
- Morning Stiffness >2hours
- Swelling of small joints (hands & feet)
- IBS / Crohn’s
- Uveitis (eye inflammation)
What are the 3Ns?`
Cx Red Flags:
- Numbness
- Nystagmus (black spots in vision)
- Nausea
What is asked about in Special Questions / Red Flags (for systemic problems e.g. Cancers, Infections etc.)?
- Unexplained weight loss
- Night Sweats
- Unrelenting Pain
- General Unwellness
What is asked about in Special Questions / Red Flags (for the knee)?
- Clicking
- Locking
- Giving Way
- Redness / Bruising
- Swelling
What are the 5Ds?
Cx Spine Red Flags:
- Dizziness
- Diplopia (double vision)
- Dysphagia (swallowing)
- Dysarthria (speech)
- Drop Attacks
In the PMH, why may it be significant to ask about Thyroid Dysfunction?
May cause MSK conditions such as:
- Adhesive Capsulitis (Frozen Shoulder)
- Dupuytren’s Contracture
- Trigger Finger
- Restricted Joint Mobility
- Carpal Tunnel Syndrome
In the PMH, why may it be significant to ask about Steroid usage?
Long Term Steroid use can weaken soft tissue and bone.
Increased likelihood of Avascular Necrosis, Tendon Rupture, Tendinopathy, Muscle Weakness, Osteoporosis
In the PMH, why may it be significant to ask about Osteoporosis?
Pre-dispose to fractures and back pain including wedge fractures of the spine.
In the PMH, why may it be significant to ask about Epilepsy?
Can predispose to some conditions:
- Arthritis 8x more likely with Epilepsy
- Linked with Autoimmune disease
In the PMH, why may it be significant to ask about Diabetes?
- Increased likelihood of CRPS, Carpal Tunnel, Adhesive Capsulitis, Tenosynovitis & Neuropathic pain.
- Can explain symptoms of cramps and increased night pains.
