Week 2- Patient Interview Flashcards
PART 1: OSPRO
PART 1: OSPRO
What does OSPRO stand for?
Optimal Screening for Prediction of Referral and Outcome (OSPRO)
OSPRO-ROS:
- What is the purpose of the OSPRO-ROS?
- What areas of the body can it be applied to?
- ___-item screening tool identified 94.7% of red flag responders.
- ___-item screening tool identified 100% of red flag responders.
- Used in order to identify red flags. (systemic pathology)
- Neck, shoulder, low back, and knee
- 10-item
- 23-item
OSPRO-YF:
- What is the purpose of the OSPRO-YF?
- What areas of the body can it be applied to?
- What (3) main categories were looked at with the OSPRO-YF study?
- ___-item tool includes items representing all validated outcomes.
- Different from other multimodal assessments because of the inclusion of ___________/________ constructs.
- Used to assess for yellow flags. (psychosocial aspects)
- Neck, shoulder, low back, and knee
- Negative Mood, Fear Avoidance, Positive Affect/Coping
- 17-item
- positive affect/coping
- OSPRO-ROS = ____ flag
- OSPRO-YF = ______ flag
- red flag
- yellow flag
- OSPRO-YF predictive of _____ and ________ outcomes.
- OSPRO-ROS predictive of ______ and ________.
- pain and disability
- QOL and comorbidity
PART 2: INTERVIEW
PART 2: INTERVIEW
What is the single most important tool in screening for medical disease, includes 80% of info needed to identify cause of symptoms, and guides the exam?
INTERVIEW
- Do we want to use open-ended questions or closed-ended questions more often? Why?
- What can help the patient know that we are listening?
- Open-ended so as to not guide the patients answers.
- Paraphrase what the patient states.
Give some examples of open-ended questions.
- Tell me how I can help you?
- Tell me why you are here today?
- Tell me about your injury?
- What do you think is causing your problem/pain?
What are (4) DON’TS during the interviewing process?
- DON’T jump to conclusions based on answers from 1-2 questions.
- DON’T destroy open-ended questions with follow-up closed-ended questions.
- DON’T overreact to information gathered.
- DON’T use leading questions.
- During the subjective examination we want to make note of and have follow-up questions related to __________.
- Single red flags can be of concern, what is one that is of concern for cardiac issues?
- red flags
- SOB while lying down
What do we want to do at the ending of an interview?
Recap findings with patient and answer all of their questions.
PART 3: SCREENING
PART 3: SCREENING
List of things to screen for. (8)
- Depression
- Eating Disorder
- Substance Abuse
- Falls
- Domestic Abuse
- Elder Abuse
- Adverse drug events
- Work/Environmental
(SQ)
What (2) questions are essential to ask every patient in order to screen for depression?
- ) During the past month have you been feeling down, depressed, or hopeless?
- ) During the past month have you been bothered by having little interest or pleasure in doing things?
What are some common risk factors for Eating Disorders? (6)
- Female
- Caucasian
- Perfectionist personality traits
- Personal/family Hx of obesity and/or eating disorders.
- Sports/athletic involvement
- Hx of sexual abuse or other trauma
Consider the impact of anorexia on ______.
BMD
S/Sx of Eating Disorder. (13)
- Discolored/stained teeth from stomach acid.***
- Broken blood vessels in eyes from vomiting.***
- Dry skin and hair; brittle nails; hair loss/growth (lanugo).***
- Tooth marks, scratches, scars or calluses on back of hands from induced vomiting. (Russell’s sign)***
- Weight loss/gain.***
- Irregular/absent menstrual periods
- Inability to tolerate cold.
- Heartburn, abdominal bloating/gas, constipation or diarrhea
- Bradycardia or low BP
- Enlarged parotid glands from repeated contact with vomit
- Skeletal myopathy and weakness
- Chronic fatigue
- Dehydration or rebound water retention (pitting edema)
What is Lanugo? What is it a sign of?
- Lanugo is soft, feathery hair that can grow all over the body, most often on the back and shoulders.
- Sign of anorexia.
Behavioral S/Sx of Eating Disorder. (7)
- Preoccupation with weight, food, calories, fat grams, dieting clothing size, body shape.
- Mood swings.
- Frequent overweight comments despite looking very thin.
- Excessive exercise to burn off calories.
- Use of diuretics, laxatives, enemas, other drugs to induce urination, bowel movements or vomiting.
- Binging and purging.
- Food restriction.
Populations at Risk for Substance Abuse:
- Teens/adults with _____/______.
- History of _______.
- Individual with ________ disorders.
- Individuals with ________/________ disorders.
- ADD/ADHD
- PTSD
- sleep disorders
- depression/anxiety disorders
What are some red flag patterns in Substance Abuse patients? (5)
- Consistently missed appointments
- Noncompliance with HEP and poor self-care
- Shifting mood patterns
- Excessive daytime sleepiness or unusual excessive energy
- Deterioration of appearance/hygiene
- Tobacco use causes vaso________ and delayed _____ ________.
- Smoking has been linked with disc _________/________.
- vasoconstriction and delayed wound healing
- degeneration/herniation
What are some Performance-Based Outcome Measures used to screen for falls? (3)
- Functional Reach Test
- Berg Balance Scale
- TUG
What are some Balance Confidence/Fear of Falling Questionnaires (Outcomes) used to screen for falls? (3)
- ABC (Activities-Specific Balance Confidence) Scale
- FES (Falls Efficacy Scale)
- SAFE (Survey of Activities and Fear of Falling In the Elderly)
What are the (5) most common factors in falls?
- Vision/hearing
- Balance
- BP regulation
- Medications/substances
- Elder abuse
Risk Factors/Red Flags for Domestic Violence:
- Women with _________.
- _________ impaired adults.
- Chronically ill and dependent adults (esp >__yo).
- _______ pain patients.
- ______/______ abuse Hx.
- Daily _____.
- Previous Hx of many injuries and accidents.
- Injury seems inconsistent with client’s explanation.
- disabilities
- cognitively impaired
- (>75 yo)
- chronic pain
- physical/sexual
- daily HA (issue related to stress)
What are the (3) categories of cues that can be seen with S/Sx of Domestic Abuse?
- Physical Cues
- Social Cues
- Psychological Cues
What patient populations are we required to report abuse?
- Minors
- Elderly
- Cognitively impaired
(SQ)
Elder Abuse S/Sx. (8)
- Multiple trips to ER
- Depression
- “Falls”/fractures (spiral)
- Bruising/suspicious sores
- Malnutrition/weight loss
- Pressure ulcers
- Changing MDs/therapists often
- Confusion attributed to dementia
- What are the most common side effects of Adverse Drug Events? (4)
- What are some more severe reactions? (4)
Common
- Constipation
- N/V/D
- Abdominal pain
- Sedation
Severe
- Confusion
- Drowsiness
- Weakness
- Loss of coordination
What are the (4) Ds associated with OTC drug use?
- Dizziness
- Drowsiness
- Depression
- Visual Disturbance
Adverse Drug Events Risk Factors:
- ____/_____
- Small physical size
- _____pharmacy
- Prescribing ________
- Taking meds prescribed for someone else
- _______ impairment/dysfunction
- Concomitant _______ consumption
- ____ of ADE (adverse drug event)
- Mental deterioration/dementia
- Unable to read/understand directions
- Herbal/home remedies
- age/sex
- polypharmacy
- prescribing cascade (pt given drug to treat symptom of initial medication)
- cognitive impairment/dysfunction
- alcohol consumption
- Hx of ADE
(SQ)
What are some common MSK side effects associated with antibiotics?
- TENDINOPATHY/TENDON RUPTURE
- skin reactions
- noninflammatory joint pain
(SQ)
What are some common MSK side effects associated with NSAIDs?
-BACK/SHOULDER pain
(SQ)
What are some common MSK side effects associated with statins?
-MYALGIA
NSAIDs can also cause damage to the __ ______ and is related to thousands of hospitalizations and deaths anually.
-GI tract
What are the (4) biggest risk factors for NSAID Gastropathy?
- > 65 yo
- Hx of peptic ulcer disease, GI disease, or RA
- Chronic use of NSAIDs (>3m)
- Use of acid suppressants
(SQ) NSAID GI S/Sx: -Indigestion/heartburn/epigastric or abdominal pain -Esophagitis, dysphagia, odynophagia -Nausea -Unexplained \_\_\_\_\_ lasting more than 1-2 weeks -Ulcers/ perforations, bleeding -Melena
-fatigue
(SQ) NSAID MSK S/Sx: -Increased symptoms \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ med and with \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_ -\_\_\_\_\_/\_\_\_\_\_\_ pain -muscle \_\_\_\_\_\_\_\_ -restless leg syndrome -paresthesias
- Increased symptoms after taking med and with ingestion of food***
- back/shoulder pain
- muscle weakness
