Week 2 Flashcards
Define patient history
information obtained from the patient regarding past and present conditions related to why the patient is seeking the services of a PT
Why is patient history along with the review of systems important?
Because they are crucial for differential diagnoses and decision making to decide if the PT will: treat, refer, or co-manage the patient
What does a PT interview establish?
1) Insight into medical diagnosis
2) A working hypothesis
3) Plan of action for the remainder of the encounter
4) Establish rapport and display competency
5) Empower the patient to play an active role in rehab
List some interviewing techniques
1) Open ended questions
2) Closed ended questions
3) Funnel questions
4) Paraphrasing technique
5) Follow up questions
List important categories to cover in the patient interview
1) General demographics (age, gender, occupation…)
2) Chief complaint, pain type, and pain level (why they are here)
3) Medical history & functional status (personal and environmental)
4) goals with PT
5) Any questions or topics I as a PT may have missed
Give examples of different types of pain
1) Vascular: throbbing, pulsing
2) Neurogenic: Sharp, stinging
3) Musculoskeletal: Sore, deep
4) Emotional: Tiring, exhausting
What is a systems review?
1) “Vitals” brief examination of the anatomical and physiological status of the cardio/pulm, integumentary, musculoskeletal, and neuromuscular systems “movement system”
2) Examination of communication ability, cognition and learning style/needs of the patient
What is the role of a PT in screening?
It is NOT to diagnose medical disease, but to gather signs and symptoms to decide if the patient needs to be referred (proper documentation is a must)
What is the purpose of a systems review?
1) Look beyond the chief complaint
2) Overview of the whole person
3) Determine if a consultation/referral is needed
4) Guide the PT in selecting tests and measures
Give examples of Cardio/Pulm system tests
1) Heart rate
2) BP
3) Respiratory rate
4) Oxygen saturation
5) Edema
Give examples of integumentary systems tests
1) Scars
2) Skin color (pale, cyanosis, redness)
3) Integrity (wound, moles)
Give examples of musculoskeletal system tests
1) Height
2) Weight
3) Gross ROM
4) Gross strength
5) Gross symmetry (posture)
Give examples of neuromuscular system tests
1) Gross coordinated movements (balance, transitions)
2) Motor function (fine movement, reflexes)
3) Sensation (touch, pain/temperature)
What do you look for when checking mental status?
1) Alertness (alert, lethargic, obtunded, comatose)
2) Orientation (the patient knows their name, place, time, and situation)
Define posture (biomechanics)
A composite of the positions of all joints at a given point in time
What is a correct posture?
position in which minimum stress is applied to each joint & muscles work most efficiently
*Viewed as a kinematic chain
*A state of equilibrium
What is a faulty posture?
any position that increases stress to the joints, muscles, and tendons.
What are the objectives of a postural assessment?
1) Determine if a person assumes a habitual position(s) that place strain on musculoskeletal system.
2) Does the posture represent an underlying pathology
3) Formulate objectives for further examination
4) Determine if habitual postures limit a patient’s function and their ability to engage in necessary or desired activities
Define center of gravity
The center of an object’s weight distribution, where the force of gravity can be considered to act. (Just anterior of S2 in humans, but changes when position changes)
Static equilibrium
Total forces acting on the body are equal
Describe the effects for gravity on posture
*When the line of gravity falls through a joint axis, no motion occurs (it is stable).
*When the center of gravity of a body segment falls anterior to the joint axis, body segment moves in an anterior direction.
*When the center of gravity of a body segment falls posterior to the joint axis, body segment moves in a posterior direction.
Describe how gravity falls in the joint axis (Hip and downwards) in normal alignment
gravity falls anterior to ankle and knee joint axes and posterior to hip, creating ankle dorsiflexion, knee extension, and hip extension moments
How are gravitational moments acting on the spine are normally?
Passively unless they are chronic spinal misalignments which needs increased mm activity
Describe base of support
The area beneath an object or person that includes every point of contact that the object or person makes with the supporting surface. (Increasing BOS helps stabilize posture and balance)
List some factors that affect posture
1) structural factors
2) age
3) physiological
4) pathological
5) social/cultural
How would you describe the primary cervical curve while developing in the uterus?
Kyphotic
(The secondary lordotic and cervical curves develop with head raising and kneeling/standing developmental milestones)
Is Femoral Anteversion is normal in infants?
Yes, it causes Toeing in and Genu Varus but both (typically) decrease with age
What are some common postural changes associated with aging?
1) Loss of height due to dehydration of vertebral discs causes increased thoracic kyphosis and lumbar lordosis.
2) Combined with abdominal weakness these changes result in an abdominal protrusion
List some common postural deviations during pregnancy
1) increased lordosis and kyphosis
2) Increase pelvic tilt
3) Center of gravity shifts forward
When we observe the person from the front (anterior view) or the back (posterior view), what are we looking for?
we’re standing in the sagittal plane to observe asymmetries/deviations in the coronal or frontal plane.
What does the plumb line (line of gravity) do?
Dissect the body into symmetrical halves
When observing the person from the frontal plane, list the major landmarks in the plumb line goes through (in normal, optimal alignment)
*Through External Auditory Meatus
*Anterior to Atlanto-Occipital Joint
*(skull to 1st cervical vertebrae)
*Through Cervical vertebral bodies
*Through the Acromion Process of the shoulder
*Anterior to Thoracic vertebrae
*Through Lumbar vertebral bodies and anterior to Sacrum
*Slightly posterior to axis of hip (through Greater Trochanter)
*Slightly anterior to axis of knee (just behind the patella
*Slightly anterior to ankle (lateral malleolus)
How would you assess leg length?
Measure from ASIS of pelvis to Medial Malleolus of ankle. Then have the pt bend their knees while in a prone position to differentiate between a shortened tibia or a shortened femur
How would you measure normal patellar alignment?
Q angle:
1) Draw a line from the ASIS to the midpoint of the patella, extend the line distally
2) Draw a line from the midpoint of the patella to the tibial tuberosity
(Normal Q angle in females is 15-20 while in males its 5-10)
How would you check for normal foot alignment?
Assess the normal arch of foot represented by the FEISS line which connects lower border of medial malleolus and head of 1st metatarsal bone.
The Navicular bone normally falls on this line in NWB position
*Below (distal to line = pronated foot
*Above line (proximal to) = supinated foot
What are these postural deviations?
B) kyphotic scoliosis
C) flat back
D) sway back
Name these 4
1) Thoracic curve
2) Thoracolumbar curve
3) Lumbar curve
4) Double major curve
What are these 2 conditions?
1) Patella Baja
2) Patella Alta
Describe the knee alignments here
1) Genu Valgus “knock knees”
2) Normal
3) Genu Varus “bow legged”
What is Genu Recurvatum?
Knee hyperextension
Name these foot misalignments
1) Pes Cavus
2) Pes Planus
What are these toe conditions?
A) Claw toes
B) Hammer toes
C) Mallet toes
What are these toe conditions?
1) Morton’s toes
2) Hallux valgus
