Unit 1 Flashcards
what is the goal of a patient screening?
to shorten the timeframe for when the disease begins to when it is diagnosed
what is a “red flag” finding?
examination findings found during the history and physical examination that are new, unexplained, atypical for the patient, and suggest the presence of potentially serious pathology and communication with the pt’s medical doctor may be warranted
Which of the following statements best represent the physical therapist’s role related to medical screening?
a. The primary goal of medical screening is for the physical therapist to help get the patient to the right practitioner in a timely fashion
b. Medical screening is only necessary for patients who access physical therapists’ services via the direct access model
c. The primary goal of medical screening is for the physical therapist to make definitive diagnosis of pathological conditions
d. Medical screening is an advanced skill for experienced practitioners only
The primary goal of medical screening is for the physical therapist to help get the patient to the right practitioner in a timely fashion
When treating low back pain what etiologies do you have to look out for in case a referral to physician is needed?
spinal malignancy, infection, cauda equina syndrome and vertebral fracture
what is osteoporosis characterized by?
low bone mass, poor bone quality, decreased bone strength, and high risk for fracture
what are the most common fracture sites for those with osteoporosis?
vertebral bodies, proximal femur, ribs, and radius
what would you see in a patient history that may lead you to believe they may be at higher risk for an osteoporosis vertebral compression fracture?
post-menopausal women
women age >65, men > 75, or anyone >80
history of osteoporosis, corticosteroids use (>5mg over 3-months), previous history of cancer, previous history of falls
what is a common chief complain of someone with osteoporosis vertebral compression fracture?
central or midline back pain most commonly in the lower thoracic - upper lumbar spine
aggravated by trunk flexion especially in WB
alleviated by non-WB postures, trunk extension positions
what is the common MOI for an osteoporosis vertebral compression fracture?
severe trauma (fall, MVA)
minor trauma with trunk flexion (slip without fall, lifting, bending, cough/sneeze)
where does the greatest proportion of osteoporosis vertebral body bone loss occur?
anterior half of the vertebra in the anterior column
what is the gold standard imaging for an osteoporosis vertebral compression fracture?
x-ray particularly a lateral view
when would you refer for an MRI or CT scan when suspicious of a vertebral compression fracture?
if there is concern for association with spinal malignancy or infection
Which of the following scenarios carries high probability of an osteoporosis vertebral compression fracture?
a. Female, 30 years old, onset of midline back pain after working at her computer, back pain is aggravated only with prolonged sitting
b. Female, post-menopause, onset of midline back pain while reaching down to pick of shoes, back pain is aggravated with any trunk flexion activities
c. Female, 65 years of age, onset of low lumbar pain- patient had been sleeping on a soft mattress the past 2 weeks, back pain is aggravated with any sustained activity (sitting, Standing, lying down)
d. Male, 55 years of age, onset of R sided low back pain after doing yard work. He gets relief with trunk extension
b. Female, post-menopause, onset of midline back pain while reaching down to pick of shoes, back pain is aggravated with any trunk flexion activities
The patient responds, “I have a history of lung cancer in my family”.
The next best question to ask is:
1. Why did they get lung cancer?
2. Who in the family was diagnosed?
3. What type of lung cancer did they have?
4. What treatment did they get?
Who in the family was diagnosed? 1st degree relatives most relevant!
Patient health history information provides critical information that may:
- contribute to the patient diagnosis,
- support the decision for a patient referral to the medical
doctor, - Impact the treatment plan
- Impact the patient prognosis
what type of questions should be asked when investigating your patient’s current condition?
open ended
what brings you here today? how can I best help you today?
when do we need to think about the heart as the potential pain generator?
pts with L chest/shoulder/UE pain
throat, jaw, and/or teeth, upper abdominal, inter-scapular, right arm over biceps
what are the common pain descriptors in MSK population?
sharp/local, dull diffuse ache
what pain descriptors suggest a vascular origin of symptoms
throbbing or pounding
squeezing or pressure
what pain descriptors imply a neurological disorder or condition
shooting/radiating/burning
what pain pattern suggests a MSK impairment driven condition?
predictable and consistent pattern or movements/postures/positions that make pain better or worse
what pain pattern suggests a non-mechanical pathological origin?
no pattern
what are the two potential points of concern when discussing behavior of symptoms?
prolonged AM stiffness/soreness (30-60 min or longer)
PM pain that wakes the pt from a sleep
when is night pain concerning?
when it is the most intense pain of the 24-hr period, non-positional, challenging to fall back asleep
pt has a hx of malignancy, recent infection, ischemic heart disease and OA
Which of the following best represents a non-mechanical pain pattern?
1. Back pain that is present all of the time and increases with trunk flexion activities and improves with sitting
2. Intermittent back pain that is present all of the time and increases with trunk flexion activities and improves with sitting
3. Back pain that is always at an intensity level of 4/10 regardless of the patient position/postures or time of day
4. Back pain that wakes a patient from sleep
Back pain that is always at an intensity level of 4/10 regardless of the patient position/postures or time of day
what’s the difference between a systems review and a review of systems?
review of systems: during history; goal is to determine if referral is needed
systems review: during examination; physical screening of all systems
what is included on the general health checklist?
fatigue, malaise, fever/chills/sweats, unexplained weight change, nausea, paresthesia/numbness, weakness, dizziness/light headedness, change in mentation/cognition
when is fatigue a red flag?
a sense of weariness, loss of energy marked by an inability to function at home/work/school and/or socially; over a period of 2-4 weeks or longer and no explanation
what are some potential causes of fatigue?
depression, anxiety
infection and malignancy
endocrine/rheumatic disorders
heart failure
nutritional deficits
medication side effects
when is fever at red flag?
“unknown origin”, temp of 99.5-101F, duration of 2-3 weeks or longer
what are some potential causes of fever?
infection, malignancy, systemic disorders
what is the red flag threshold for weight change in the general population?
5-10% of body weight loss/gain, typically over 3-12 months
what are some potential causes of unexplained weight loss?
depression and anxiety
cancer
primary gastrointestinal disorders
hyperthyroidism
what are some potential causes of unexplained weight gain?
depression
hypothyroidism
congestive heart failure
renal disease
when is nausea a red flag?
more frequent, more intense, longer duration, needing higher dose of meds to get same relief
what are some potential causes of nausea?
hepatitis
migraine headaches
drug withdrawal
ketoacidosis
increase intracranial pressure
medications
when is paresthesia/numbness a red flag?
the area of skin becomes numb versus previous pins and needles
are of skin has gotten larger
additional extremities
quicker progression is occurring = more urgency
what are some potential causes of paresthesia/anesthesia?
spinal or peripheral nerve entrapment
MS
chronic renal failure
cauda equina
hypothyroidism
neurogenic claudication
what progression suggests that weakness is a red flag?
spreading to other muscle groups or additional extremities
loss of strength is increasing - difficulty with more ADLs
what are some potential causes of weakness?
SCI
MS
chronic renal failure
neurogenic claudication
when does dizziness become a red flag?
the intensity, frequency, and duration are rapidly increasing
accompanied by hearing loss, tinnitus, visual disturbance, hemiparesis, vomiting and falls
what are some potential causes of change in mentation?
head injury
stroke
dementia
infection
medication side effects
Which of the following statements would represent fatigue being a red flag?
1. I have been exhausted the past 2-3 weeks. The doctor was right this new medication has really wiped me out
2. I routinely get really tired when I am having my period
3. I don’t know why I have been so tired the past 3 weeks. In fact, I have come home from work early 3 of the last 4 days.
4. I am exhausted today
I don’t know why I have been so tired the past 3 weeks. In fact, I have come home from work early 3 of the last 4
days.
