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PHTH 450 > SUBJECTIVE EXAM > Flashcards

SUBJECTIVE EXAM Flashcards

1
Q

what is a PT?

A

primary health care professionals with a significant role in health promotion and treatment of injury and disease

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2
Q

what is the goal of a PT?

A

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

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3
Q

how do PTs assess a patient?

A
  • 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
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4
Q

how do PTs treat patients?

A
  • 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
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5
Q

what are some mannual therapy techniques used by PTs?

A 
massage
joint mobilization
manipulation
dry needling
electrotherapy
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6
Q

what are some qualitites a PT should possess?

A 
assessment
management
communication
documentation
professional, legal and ethical components
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7
Q

what are some skills a PT should possess?

A 
diagnostic and analytic skills
teching
negotiating
listening
counseilling
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8
Q

what are the steps in the evaluation process for a patient?

A 
inital eval
history
subjective exam
objective exam
analysis 
plan
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9
Q

what is evaluated in the analysis part of patient evaluation?

A

the hypothesis thus use of the problem list and clinical impression along with ST and LT goals

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10
Q

why is proper documentation needed as a PT?

A
  • 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
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11
Q

what does proper communication depend on?

A

use of common language

shared vocabulary of specialized terms

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12
Q

what is clinical reasoning?

A

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

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13
Q

what is clinical reasoning portrayed as being?

A

a multidimensional, hypothesis orientated, collaborative and reflective way of thinking

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14
Q

what is the goal behind clinical reasoning?

A

provided improved patient outcome by itilizing the patients values and expectations, with the best clinical evidence and individualized clinical expertise

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15
Q

what is the CRW form?

A

form created by the school to help students develop their clinical reasoning skills

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16
Q

how to establish a proper relationship between the patient and the therapist?

A
  • begin with introduction and strong handshake
  • show confidence
  • proper verbal and non-verbal communication
  • patient confidentiality
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17
Q

what is the purpose of the patients history in the subjective exam

A
  • 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
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18
Q

what can be gathered through the history portion of the subjective exam?

A

-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

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19
Q

what statistic is said about the efficency of the subjective exam?

A

Estimated that 80% of the necessary information to explain the presenting problem can be provided through a thorough histor

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20
Q

how should the initial subjective exam be generated?

A
  • 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
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21
Q

which of the following is a proper way of asking a patient about pain?

  1. does it hurt when you walk?
  2. which activities cause you pain or increase your symptoms?
A

2 is the proper way

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22
Q

what are some aspects that need to be considered in the patient history?

A
  • 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
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23
Q

what age group tends to heal quicker?

A

younger age groups <20 years old

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24
Q

what types of complications are often seen in older populations?

A

degenerative processes such as OA and osteoporosis

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25
Q

when do degenerative and overuse symptoms generally arise?

A

after the age of 40

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26
Q

provide examples of conditions more common in males? in females?

A

males: osgood shlatters, ankylosis spondylitis
female: patella femoral pain, osteoporosis

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27
Q

do diabetics have a faster or slower healing process?

A

slower

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28
Q

what risks increase in aging population?

A

cardiovasculat and neurological disease/implication

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29
Q

why is it important to know about hand dominance?

A

generally impact function

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30
Q

why is it important to know the reason of consultation?

A

impoortant to adress the chief complaint in order for the patient to come back

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31
Q

why is it important to know when the event happened?

A

provides information about what phase of healing the patient is in?

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32
Q

what are the different phases of healing?

A
  • inflammatory
  • proliferative
  • remodeling
33
Q

what is the inflammatory healing phase?

A

occurs during the first 48-72H
considered to be the acute phase
tissue will be red, swollen, painful
significant decrease in function

34
Q

what is the goal of the inflammatory phase?

A

protect the tissue

35
Q

what is the proliferative phase of healing?

A 
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
36
Q

what is the goal of the proliferative phase?

A

reestablish normal movement without stressing healing tissues to much

37
Q

when does pain generally occur during the proliferative phase?

A

during activity and motion of the involved area

38
Q

what is the remodeling phase of healing?

A

starts at day 9 and can last 6 weeks to 12 months
chronic phase
patient can return to normal function

39
Q

when does pain occur during the remodeling phase?

A

after the activity

40
Q

how does the PT assess the stage of pathology?

A
  • 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
41
Q

What does the nature of pain evaluate?

A

it compares the reason causing pain; either inflammatory or mechanical pain

42
Q

what is inflammatory pain?

A

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

43
Q

what is mechanical pain?

A

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

44
Q

what needs to be determined if the MOI is traumatic?

A

the specifics of the mechanism including the direction and force and how these may relate to the present symptoms

45
Q

what are the different types of MOI?

A

insidious or traumatic

46
Q

why is it important to know when the onset of injury began?

A

provides a timeline to determine phases of healing

47
Q

what needs to be looked at if the MOI is insidious?

A

predisposing factors

changes in daily routines or exercise program

48
Q

what does insidious onset of pain generally arise by?

A

results from inflammation, early degeneration, repetitive activity or sustained postures

49
Q

what is the natural progression of symptoms?

A

generally should be improving and reduced pain as healing progresses

50
Q

what happens if the injury becomes worse over time?

A

patient may be aggravating injury, or injury may be more serious than initially expected

51
Q

why is it important to know how the patient is managing pain up to date?

A
  • are they doing so in the correct way?
  • how is the treatment effective
  • provides information as how the therapist should proceed with the treatment
52
Q

why is it important to know past medical history?

A

for the current condition may indicate reoccurance, which can have a detrimental effect on recovery
allows us to know if physio was done previously

53
Q

what needs to be considered when taking patient history

A
  • previous treatments
  • medical history
  • meds
  • exam and diagnostic tests
54
Q

what needs to be accounted for in patients social history?

A
  • social environments and support system
  • physical environment; transportation and home llayout
  • occupation and ergonomics
  • leisure activities
  • goals
55
Q

why is it important to know more about the patients job and hobbies?

A
  • 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?
56
Q

in the subjective exam how is each pain site described as?

A
  • 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)
57
Q

what type of pain is decribed as “diffuse, aching and poorly localized and may refer to other areas of the body”

A

vasuclar

58
Q

what type of pain is decribed as “hard to localize, dull and aching – when muscle contracts or stretches pain will increase”

A

muscle

59
Q

what type of pain is described as “deep, boring and very localized”

A

bone

60
Q

how is somatic pain described as?

A

musculoskeletal (joint pain, myofascial pain), cutaneous; often well localized

61
Q

how is nerve pain described as?

A

sharp (shooting), burning, line of pain

62
Q

what is radicular pain?

A

acute, sharp, shooting, throbbing, following a dermatome

associated to nerve pain

63
Q

what is neuromeningeal pain?

A

burning, tingling, shooting, following a peripheral nerve path

64
Q

what is VAS for pain?

A

scale of 0-10

65
Q

how can pain be described as?

A

constant or intermittent
inflammatory or mechanical
acute, subacute or chronic

66
Q

what questions may a PT ask a patient about pain?

A

what increases pain?

what decreases pain, how long it takes for it to be decreased?

67
Q

in the CRW form, what can be observed about the pain pattern?

A
  • idea of affected structures

- increase/decrease in pain

68
Q

what is assessed when evaluating patients irritability?

A
  • activities which provoke pain
  • intensity of the pain provoked
  • duration of pain onset; longer duration means more irritable
69
Q

why is it important for the PT to know about the patients irritability?

A

allow to be gentle and provoke the movements during the treatment

70
Q

what is severity?

A

its the effect of pain on the fucntion

71
Q

how is severity established?

A

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

72
Q

what is AM pain often related to?

A

AM pain is often related to the sleeping position build up of inflammation

73
Q

why does pain generally increase through out the day?

A

due to inflammation

74
Q

what are the different types of night pain?

A
  • can be a red flag for cancer
  • can be due to sleeping position
  • can be caused by increased inflammation
75
Q

what is a caution?

A

may proceed with objective exam but will have to be more careful
◦ eg. High irritability; suspect possible fracture – need to screen in objective exam

76
Q

what is a contraindication?

A

– 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

77
Q

what are some red flags associated to cancer?

A
  • 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
78
Q

what are some red flags associated to cardiovascular system?

A
  • 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
79
Q

what are some red flags associated to neurological dysfunction

A
  • 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

PHTH 450 (14 decks)

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