SUBJECTIVE EXAM Flashcards
what is a PT?
primary health care professionals with a significant role in health promotion and treatment of injury and disease
what is the goal of a PT?
to combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury and disability
how do PTs assess a patient?
- history taking
- specific tests and measures
- analyze the findings and use clinical reasoning to set diagnosis
- plan a treatment that is consistent with patient goals and incorporate approaches and techniques by the best evidence
how do PTs treat patients?
- EDUCATION and health promotion/prevention services
- creates personalized programs
- soft tissue technique and manual therapy techniques
- cardiorespiratory techniques
- skin and wound care
- management of incontinence and pelvic floor rehab
- functional activity and tolerance testing and training
- prescription, fabrication and application of assistive, adaptive and supportive devices
- environmental changes focusing on the removal of barriers to function
what are some mannual therapy techniques used by PTs?
massage joint mobilization manipulation dry needling electrotherapy
what are some qualitites a PT should possess?
assessment management communication documentation professional, legal and ethical components
what are some skills a PT should possess?
diagnostic and analytic skills teching negotiating listening counseilling
what are the steps in the evaluation process for a patient?
inital eval history subjective exam objective exam analysis plan
what is evaluated in the analysis part of patient evaluation?
the hypothesis thus use of the problem list and clinical impression along with ST and LT goals
why is proper documentation needed as a PT?
- ensure PTs againsts claims made by the patient
- have official documentation and record/reference for future treatments
- provides documentation in the case of absence of PT
- communication between other disiplines on an interdisiplinary team
- associated with good decisions, clear analysis
- helps in the analysis of the situation and better understanding
what does proper communication depend on?
use of common language
shared vocabulary of specialized terms
what is clinical reasoning?
the sum of the thinking and decision-making process associated with clinical practice.
ensures to make decisions that are based on an evaluation of the availible information gathered from the examination
what is clinical reasoning portrayed as being?
a multidimensional, hypothesis orientated, collaborative and reflective way of thinking
what is the goal behind clinical reasoning?
provided improved patient outcome by itilizing the patients values and expectations, with the best clinical evidence and individualized clinical expertise
what is the CRW form?
form created by the school to help students develop their clinical reasoning skills
how to establish a proper relationship between the patient and the therapist?
- begin with introduction and strong handshake
- show confidence
- proper verbal and non-verbal communication
- patient confidentiality
what is the purpose of the patients history in the subjective exam
- helps develop a working relationship with the patient and establish lines of communication with the patient
- ellicits a reports of potentially dangerous symptoms and red flags
- helps determine the chief complaint, MOI, severity and impact on function
- determine location and nature of symptoms
what can be gathered through the history portion of the subjective exam?
-baseline measurement
-information of past history of current condition/complaint
-gather relevant medical history
-determine goals of expectivations of the patient
helps to determine prognosis and guide the intervention
what statistic is said about the efficency of the subjective exam?
Estimated that 80% of the necessary information to explain the presenting problem can be provided through a thorough histor
how should the initial subjective exam be generated?
- begins with open ended questions and ends with more specific questions
- avoids leading the patient with questions, want to keep them as neutral as possible
which of the following is a proper way of asking a patient about pain?
- does it hurt when you walk?
- which activities cause you pain or increase your symptoms?
2 is the proper way
what are some aspects that need to be considered in the patient history?
- patient identification ensures not to confuse with another patient
- know if it was a referal
- date of medical evaluation
- family MD
- age, sex and comorbidities
- hand dominance
- reason of consultation
- date of onset of injurt
- acute vs chronic
what age group tends to heal quicker?
younger age groups <20 years old
what types of complications are often seen in older populations?
degenerative processes such as OA and osteoporosis
when do degenerative and overuse symptoms generally arise?
after the age of 40
provide examples of conditions more common in males? in females?
males: osgood shlatters, ankylosis spondylitis
female: patella femoral pain, osteoporosis
do diabetics have a faster or slower healing process?
slower
what risks increase in aging population?
cardiovasculat and neurological disease/implication
why is it important to know about hand dominance?
generally impact function
why is it important to know the reason of consultation?
impoortant to adress the chief complaint in order for the patient to come back
why is it important to know when the event happened?
provides information about what phase of healing the patient is in?
what are the different phases of healing?
- inflammatory
- proliferative
- remodeling
what is the inflammatory healing phase?
occurs during the first 48-72H
considered to be the acute phase
tissue will be red, swollen, painful
significant decrease in function
what is the goal of the inflammatory phase?
protect the tissue
what is the proliferative phase of healing?
begins from day 3 subacute phase overlaps the inflammatory phase healing process has begun and scar tissue is being created can resume normal activities (ADLs) can last 3-6 weeks
what is the goal of the proliferative phase?
reestablish normal movement without stressing healing tissues to much
when does pain generally occur during the proliferative phase?
during activity and motion of the involved area
what is the remodeling phase of healing?
starts at day 9 and can last 6 weeks to 12 months
chronic phase
patient can return to normal function
when does pain occur during the remodeling phase?
after the activity
how does the PT assess the stage of pathology?
- time is generally the best clue
- response to anti-inflammatory meds and ice/heat can provide an idea if responsive = inflammatory phase
- subjective exam can provide evidence
What does the nature of pain evaluate?
it compares the reason causing pain; either inflammatory or mechanical pain
what is inflammatory pain?
constant pain
responsive to anti-inflammatory medication and ice
pain and stiffness in the AM lasting >1H
most movements of the involved structure will hurt
swollen, hot, redness
pain wakes them up at night
what is mechanical pain?
intermittent pain
pain is associated with a specific type of stress on the tissue
little to no pain when resting
no change in pain when applying ice or with anti-inflammatory medications
morning stiffness and pain lasts < 1H but pain worsens as the day progresses
what needs to be determined if the MOI is traumatic?
the specifics of the mechanism including the direction and force and how these may relate to the present symptoms
what are the different types of MOI?
insidious or traumatic
why is it important to know when the onset of injury began?
provides a timeline to determine phases of healing
what needs to be looked at if the MOI is insidious?
predisposing factors
changes in daily routines or exercise program
what does insidious onset of pain generally arise by?
results from inflammation, early degeneration, repetitive activity or sustained postures
what is the natural progression of symptoms?
generally should be improving and reduced pain as healing progresses
what happens if the injury becomes worse over time?
patient may be aggravating injury, or injury may be more serious than initially expected
why is it important to know how the patient is managing pain up to date?
- are they doing so in the correct way?
- how is the treatment effective
- provides information as how the therapist should proceed with the treatment
why is it important to know past medical history?
for the current condition may indicate reoccurance, which can have a detrimental effect on recovery
allows us to know if physio was done previously
what needs to be considered when taking patient history
- previous treatments
- medical history
- meds
- exam and diagnostic tests
what needs to be accounted for in patients social history?
- social environments and support system
- physical environment; transportation and home llayout
- occupation and ergonomics
- leisure activities
- goals
why is it important to know more about the patients job and hobbies?
- patients return to work?
- aspects of work which may worsen the patients current conditions and should be modified/changed
- sport or hobby that may require to be stopped
- is the patient a competitive athlete who may be inclined to return to sports at a too early stage?
in the subjective exam how is each pain site described as?
- pain location P1,P2,P3…. needs to be identified on a chart
- how the location changes since the onset, better or worse
- type of pain (mucular, vascular, bone, somatic, nerve, etc)
what type of pain is decribed as “diffuse, aching and poorly localized and may refer to other areas of the body”
vasuclar
what type of pain is decribed as “hard to localize, dull and aching – when muscle contracts or stretches pain will increase”
muscle
what type of pain is described as “deep, boring and very localized”
bone
how is somatic pain described as?
musculoskeletal (joint pain, myofascial pain), cutaneous; often well localized
how is nerve pain described as?
sharp (shooting), burning, line of pain
what is radicular pain?
acute, sharp, shooting, throbbing, following a dermatome
associated to nerve pain
what is neuromeningeal pain?
burning, tingling, shooting, following a peripheral nerve path
what is VAS for pain?
scale of 0-10
how can pain be described as?
constant or intermittent
inflammatory or mechanical
acute, subacute or chronic
what questions may a PT ask a patient about pain?
what increases pain?
what decreases pain, how long it takes for it to be decreased?
in the CRW form, what can be observed about the pain pattern?
- idea of affected structures
- increase/decrease in pain
what is assessed when evaluating patients irritability?
- activities which provoke pain
- intensity of the pain provoked
- duration of pain onset; longer duration means more irritable
why is it important for the PT to know about the patients irritability?
allow to be gentle and provoke the movements during the treatment
what is severity?
its the effect of pain on the fucntion
how is severity established?
what is the minimum and maximum level of pain felt based on VAS
how does pain affect ADLs, IADLs, hobbies etc
-handedness of the patient
what is AM pain often related to?
AM pain is often related to the sleeping position build up of inflammation
why does pain generally increase through out the day?
due to inflammation
what are the different types of night pain?
- can be a red flag for cancer
- can be due to sleeping position
- can be caused by increased inflammation
what is a caution?
may proceed with objective exam but will have to be more careful
◦ eg. High irritability; suspect possible fracture – need to screen in objective exam
what is a contraindication?
– need to STOP evaluation will not be proceeding with Objective exam
◦ Serious pathology detected just from subjective exam – Red flags
◦ need to stop and refer to ER
◦ Outside scope of practice – refer to proper professional
what are some red flags associated to cancer?
- persistanc pain at night not caused by inflammation
- constant pain anywhere in the body not associated to inflammatory phase
- unplanned weight loss in a short time frame
- loss of appetite
- unusual lumps or growths
- unexplained fatigue
what are some red flags associated to cardiovascular system?
- shortness of breathe
- dizziness*
- pain or heaviness in the chest
- pulsating pain in the body
- constant and severe pain in the lower leg/arm
- discolored or painful feet
- swelling
what are some red flags associated to neurological dysfunction
- changes in hearing
- frequent or severe headaches
- problems with swallowing
- changes in speech
- vision changes
- balance, coordination problems
- drop attacks
- bilateral and quadrilateral spinal cord symptoms
- bowel or bladder dysfunction
