Week 1 Study Qs

Question 1

What is the difference between recording the location of the patient’s reported complaint vs having them point to the area?

Answer 1

Pts don’t always know the name of their painful body part

Question 2

If symptoms radiate into an extremity, what 3 key characteristics should you chart regarding the location?

Answer 2

where,
how far,
quality of the radiation

Question 3

In trauma cases what are the two key components regarding the forces involved that you should seek to get information on and analyze?

Answer 3

Did the patient brace (more force into muscles) or were they caught unaware (more force into ligaments)

Question 4

What are some additional facts you need to find out in a trauma case like a slip and fall?

Answer 4

vectors
patient position
magnitude of trauma (speed, size/make of vehicles
amt damage) force amplifiers on the neck (seat belt, foot on brake) and dampeners (air bag deployed, seat broke, head rest position)

Question 5

When a patient doesn’t know what caused their back pain, what kind of questions should you ask relative to etiliogy?

Answer 5

Have you changed your fitness routine, your pillows, your bed, your desk or chair or shoes?

Question 6

What is the “imaginary” line that separates the onset questions from the chronology and timing questions?

Answer 6

Chronology includes the Sx patterns.

Onset is all about what happened and when it happened.

Question 7

What is best to find out first when beginning the chronology and time set of questions?

Answer 7

Intermittent or constant?

Question 8

What is the complete line of questioning that comprises the chronology and timing line of
inquiry?

Answer 8

Intermittent (% of day)/constant?
Worse in the morning or end of day?
Progressing or staying the same?
Night pain?
Has this ever happened before?

Question 9

Before measuring ADLs, what questions should be asked regarding the impact of the patient’s condition on their life?

Answer 9

Are you missing work? How much work have you missed? Are there any activities or chores around the house or at work they are now having difficulty with?

Question 10

What questions should be asked regarding modifying factors?

Answer 10

Is there anything that increases your pain? What makes it better? Avoiding/changing/resting/medication?

Question 11

What are the 5 constitutional symptoms?

Answer 11

Fever, malaise, weight loss, loss of appetite, fatigue

Question 12

What are the main facts that you need to get regarding each of the various practitioners whom the patient may have seen before seeing you?

Answer 12

Who, when, tests, dx, treatment, better?

Question 13

What are some of the key prognostic yellow flags to be alert for during your interaction with the patient?

Answer 13

Catastrophizing, fear avoidance, depression, anxiety, poor sense of health

Question 14

Generally, what is thought to be the most worrisome red flag for cancer from the history?

Answer 14

D/t risk of recurrence, Hx of cancer is the most sig single red flag.

Question 15

What is the story of night pain relative to being a red flag for serious diseases?

Answer 15

Night pain used to be listed. However there is no correlation with serious disease. There may still be concern when the P is severe, progressive or unabated by position.

Question 16

Your patient‘s low back pain is significantly increased when they lie down and so they are forced to try to sleep in a semi-seated position. What diseases can this suggest?

Answer 16

Malignant retroperitoneal lymphadenopathy

Question 17

Malignant retroperitoneal lymphadenopathy can be d/t 1˚ ______ cancers or 2˚ to __________ and __________ cancers both of which can respond to early Tx.

Answer 17

1˚ renal

2˚ lymphomas and testicular

Question 18

What would be three different features of a patient’s sciatica that would increase your
concern that the cause may be a disease?

Answer 18

• Bilateral sciatica pt >50 yo
• Sciatica with bizarre, non dermatomal sensory Sx
• Sciatica non-responsive to Tx or neuro deficits but no back pain

Question 19

What condition might worry you in a patient with low back pain who is taking a drug like warfarin?

Answer 19

Back pain may result from retroperitoneal hemorrhage or, less likely, from spinal epidural hematoma

• Internal bleeding -

Question 20

Your 70-year-old patient who has been taking corticosteroid for his inflammatory bowel disease has sudden newly onset severe low back pain after sneezing. What is your top concern in this case?

Answer 20

Pathological compression fracture.

Osteoporosis occurs in >50% of long term corticosteroid users. Corticosteroids increase risk for spinal infections as well as a vascular necrosis.

Question 21

What are 4 cancers that can return even after 5 years of being cancer free?

Answer 21

Breast cancer, Hodgkin’s disease, lymphoma, leukemia