Week 1 Flashcards
starting in ____ U.S. military health care system included PTs as an entry point
1970s
the IOM defines primary care as ____, ____, ____, and ___ care delivered by accountable providers of personal health services.
accessible
comprehensive
coordinated
continual
by ___, all 50 states had some form of direct access
2015
WHAT IS THE 1ST QUESTION THAT SHOULD BE ANSWERED PRIOR TO ANY OTHERS?
Do you belong?
Are they appropriate and safe to begin and/or continue PT?
what 9 conditions are on the do not miss list (refer pt out)?
major depression
suicide risk
femoral head and neck fx
cauda equina syndrome
cervical myelopathy
abdominal aortic aneurysm
deep vein thrombosis
pulmonary embolism
atypical myocardial infarction
what is the 2 questions to screen for depression?
1) over the past 2 weeks have you felt down, depressed, or hopeless?
2) had little interest or pleasure in doing things?
_____% of PTs formally screen for depression
18%
what is the 2nd leading cause of death in ages 10-14 and 20-34?
suicide
which test should be conducted first to test for femoral head or neck fx?
patellar-pubic percussion test
urinary retention is most frequently noted in what condition?
cauda equina syndrome
what condition is suspected when a pt says their legs feel heavy and weak?
cauda equina syndrome
what is the most common cause of non-traumatic paraparesis and quadriparesis?
cervical myelopathy
what is suspected: UMN signs, impaired hand dexterity, and proximal LE weakness
cervical myelopathy
T/F: most patients with an AAA are asymptomatic.
T
if a patients reports hot, searing, ripping or tearing pain, what should be done?
STOP all activity d/t possible AAA
DVT has a ___ edema
pitting
___% of pts with DVTs are asymptomatic in early stages
50%
a score of >/= ____ on the DVT clinical decision rules indicates DVT likely
2
criteria for clinical decision rule for DVT
- active cancer
- paralysis, paresis, or recent plaster immobilization of LE
- recently bedridden 3 days or longer, or major surgery in past 12 weeks requiring general anesthesia
- localized tender along distribution of deep venous system
- entire leg swollen
- calf swollen >3cm more than asymptomatic side
- pitting edema
- collateral superficial veins (non-varicose)
- previously documented DVT
- alternative dx at least as likely as DTV (-)
what comprises about 70% of PEs?
proximal LE DVTs
> ___% of death related to PE are potentially preventable if dx earlier
> 50%
a Well’s Criteria of _____ is moderate risk for a PE
2-6 points
a Well’s Criteria of _____ is high risk for a PE
> 6
Well’s Criteria for PE
- clinical signs of DVT
- heart rate >100 bpm
- immobilized >/= 3 days, or surgery in previous 4 weeks
- hemoptysis
- cancer receiving treatment, treatment stopped in past 6 months, or palliative care
- alternative dx less likely than PE
what is the leading cause of death in women of ALL AGES?
cardiac death
(ex: atypical myocardial infarction)
women aged ____ and men aged ____ are at an increased risk of atypical myocardial infarction
F: >55
M: >45
what is reliability?
does the tool/test measure what it claims to measure
what is validity?
the test/tool is free of error
what is a gold standard?
the test that other tests are compared to
what is a true positive?
test is positive and condition is present
what is a true negative?
test is negative and the condition is absent
what is a false negative?
test is negative but condition is present
what is a false positive?
test is positive but condition is absent
what factor rules out? in?
sensitivity - out (snOUT)
specificity - in (spIN)
formula for sensitivity
a / (a+c)
a = true positive
c = false negative
formula for specificity
d / (b+d)
d = true negative
b = false positive
sensitivity or specificity? given that the individual has the condition, probability that the test will be positive
sensitivity
sensitivity or specificity? given that the individual does NOT have the condition, probability that the test will be negative
specificity
a test with high ___ helps rule out a condition when negative
sensitivity
a test with high ____ helps rule in a condition when positive
specificity
a good diagnostic test has a high
specificity
a good screening test has a high
sensitivity
predictive values depend on
condition prevalence
what are predictive values?
of true negatives / # of all negatives
of true positives / # of all positives
____ combines sensitivity and specificity values
likelihood ratios
useful tests should produce _____ in probability given a certain test result
large shifts
what is the most powerful tool for quantifying the importance of a particular test?
likelihood ratios
which should be higher MCID or MCD?
MCID
equation for positive likelihood ratio
LR+ = sensitivity / (1-specificity)
equation for negative likelihood ratio
LR- = (1-sensitivity) / specificity
which likelihood ratio is desirable to be small?
negative LR
what is a stat used to represent the amount of change needed to exceed measured error of a test?
minimal detectable chance (MDC)
what stat is the smallest difference detected that represents an important improvement from the perspective of individuals with the condition?
minimal clinical important change (MCID)
increased reliability of a test _____ the MCD value in that population
decreases
subjective data can tell what about a disease
severity
irritability
nature
stage
stability
(SINSS)
red flag for cauda equina syndrome
saddle anesthesia
B/B dysfunction
LE neurological deficit
how long can a pt see a PT in TX without a physician’s order?
10-15 days
which subjective data describes the clinician’s assessment of intensity of pt’s symptoms as they relate to a functional activity?
severity
which subjective data describes clinician’s assessment of ease with which symptoms can be provoked or stirred up?
irritability
which subjective data describes the amount of activity needed to trigger pt’s symptoms?
irritability
which subjective data describes the severity of the symptoms provoked?
irritability
which subjective data describes what activity and amount of time before pt’s symptoms subside?
irritability
what does the nature of the complaint describe?
- hypotheses of structures, syndrome, classification, or pathoanatomic structure
- anything that warrants caution with physical exam
- character of presenting pt or problem
(ex: psychological, personality)
which subjective data describes the clinician’s assessment of a condition being in acute, subacute, or chronic?
stage
which subjective data describes the progression of pt’s symptoms over time?
stability
