Subjective Ax

Question 1

Describe the structure of a subjective hx:

Answer 1

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

Question 2

What is asked about in the PC?

Answer 2

• Location, Type and Severity (NPRS)?
• Intermittent or Constant?
• Sensation differences?
• Aggs & Eases?
• Diurnal Pattern? (+Night Pain)

Question 3

What is asked about in the HPC?

Answer 3

• Time & Mechanism of Injury?
• History of symptomatic area (acute or chronic, improving)?
• Prior Injuries & any Investigations?

Question 4

In the PMH, why may it be significant to ask about Respiratory Diseases?

Answer 4

COPD can predispose to osteoporosis and muscular weakening disorders.

Question 5

What is asked about in the DH?

Answer 5

• Current medications (analgesia / NSAIDs)
• Dosage, Regularity, Effect?

Question 6

What is asked about in Special Questions / Red Flags (for the Lx spine / Low Back)?

Answer 6

Cauda Equina Syndrome:
- Bladder & Bowel
- Saddle Anaesthesia
- Gait Issues
- Sexual Dysfunction

Question 7

What is asked about in the PMH?

Answer 7

• General Health
• Current Medical Problems (THREAD-SOC)
• Hx of major surgeries

Question 7

What is asked about in the SH?

Answer 7

• Occupation?
• Hobbies & Sports?
• Smoking & Drinking?
• Expectations & Goals?
• Hand Dominance?

Question 8

In the PMH, why may it be significant to ask about the Heart?

Answer 8

Can explain some symptoms:
- Chest pain
- SOB
- Weakness
- Fever, Nausea, Fainting
- Blood in stool
- Pain in the arms

Question 9

What is the acronym THREAD-SOC for past medical history?

Answer 9

Thyroid
Heart
Rheumatoid Arthritis
Epilepsy
Asthma
Diabetes
Steroids
Osteoporosis
Cancer

Question 10

What is asked about in Special Questions / Red Flags (for the Cx spine / neck)?

Answer 10

5Ds & 3Ns

Question 11

What is asked about in Special Questions / Red Flags (for rheumatological / inflammatory conditions)?

Answer 11

• Morning Stiffness >2hours
• Swelling of small joints (hands & feet)
• IBS / Crohn’s
• Uveitis (eye inflammation)

Question 12

What are the 3Ns?`

Answer 12

Cx Red Flags:
- Numbness
- Nystagmus (black spots in vision)
- Nausea

Question 13

What is asked about in Special Questions / Red Flags (for systemic problems e.g. Cancers, Infections etc.)?

Answer 13

• Unexplained weight loss
• Night Sweats
• Unrelenting Pain
• General Unwellness

Question 14

What is asked about in Special Questions / Red Flags (for the knee)?

Answer 14

• Clicking
• Locking
• Giving Way
• Redness / Bruising
• Swelling

Question 15

What are the 5Ds?

Answer 15

Cx Spine Red Flags:
- Dizziness
- Diplopia (double vision)
- Dysphagia (swallowing)
- Dysarthria (speech)
- Drop Attacks

Question 16

In the PMH, why may it be significant to ask about Thyroid Dysfunction?

Answer 16

May cause MSK conditions such as:
- Adhesive Capsulitis (Frozen Shoulder)
- Dupuytren’s Contracture
- Trigger Finger
- Restricted Joint Mobility
- Carpal Tunnel Syndrome

Question 17

In the PMH, why may it be significant to ask about Steroid usage?

Answer 17

Long Term Steroid use can weaken soft tissue and bone.
Increased likelihood of Avascular Necrosis, Tendon Rupture, Tendinopathy, Muscle Weakness, Osteoporosis

Question 18

In the PMH, why may it be significant to ask about Osteoporosis?

Answer 18

Pre-dispose to fractures and back pain including wedge fractures of the spine.

Question 19

In the PMH, why may it be significant to ask about Epilepsy?

Answer 19

Can predispose to some conditions:
- Arthritis 8x more likely with Epilepsy
- Linked with Autoimmune disease

Question 20

In the PMH, why may it be significant to ask about Diabetes?

Answer 20

• Increased likelihood of CRPS, Carpal Tunnel, Adhesive Capsulitis, Tenosynovitis & Neuropathic pain.
• Can explain symptoms of cramps and increased night pains.