Screening in Pt interview

Question 1

what are 2 essentially questions to include when screening a pt for depression?

Answer 1

1. During the past month have you been feeling down, depressed, or hopeless?
2. During the past month have you been bothered by having little interest or pleasure in doing things?

Question 2

list prominent signs that someone may have an eating disorder

Answer 2

1. discoloration or staining of the teeth from contact with stomach acid
2. broken blood vessels in eyes from vomiting
3. dry skin and hair; brittle nails; hair loss and growth of downy hair all over the body (lanugo), including the face
4. tooth marks, scratches, scars or calluses on the backs of hands from inducing vomiting (Russell’s sign)
5. Weight loss/gain

Question 3

other less prominent signs that someone may have an eating disorder

Answer 3

1. irregular or absent menstrual periods
2. inability to tolerate cold
3. reports of heartburn, abdominal bloating or gas, constipation or dirrhea
4. bradycardia or low BP
5. enlarged parotid gland from repeated contact with vomit
6. skeletal myopathy and weakness
7. chronic fatigue
8. dehydration or rebound water retention (pitting edema)

Question 4

behavioral S/S of an eating disorder

Answer 4

1. preoccupation w/weight, food, calories, fat, grams, dieting clothing, size, body shape
2. mood swings
3. frequent comments about being far or overweight despite looking very thin
4. excessive exercise to burn off calories
5. use of diuretics or other meds to induce urination, bowel movements or vomiting
6. binging and purging
7. food restriction

Question 5

why is it important that PT’s screen for smoking?

Answer 5

1. Tobacco use causes vasoconstriction and delayed wound healing
2. smoking has been linked with disc degernation and acute lumbar/cervical disc herniation

Question 6

performance-based tests for fall risk pts

Answer 6

1. functional reach test
2. BERG balance scale
3. TUG

Question 7

scales for balance confidence/fear of falling in pts that are fall risk

Answer 7

1. Activities-specific balance confidence scale (ABC)
2. Falls efficacy scale (FES)
3. Survey of activities and fear of falling in the elderly (SAFE)

Question 8

List warning signs of elder abuse

Answer 8

1. multiple trips to the ER
2. depression
3. “falls”/fractures
4. bruising/suspicious sores
5. malnutrition/weight loss
6. pressure ulcers
7. changing MDs/therapists often
8. confusion attributed to dementia

Question 9

common MSK side-effects associated with antibiotics

Answer 9

1. skin reactions
2. noninflammatory joint pain
3. tendinopathy/tendon rupture

Question 10

common MSK side-effects associated with NSAIDs

Answer 10

1. back and shoulder pain

Question 11

common MSK side-effects associated with statins

Answer 11

myalgia

Question 12

S/S of NSAID complications relating to GI

Answer 12

1. indigestion/heartburn/epigastric or abdominal pain
2. esophagitis, dysphagia, odynophagia
3. nausea
4. unexplained fatigue lasting more than 1-2 weeks
5. ulcers, perforations, bleeding
6. melena

Question 13

S/S of NSAID complications relating to MSK

Answer 13

1. increased symptoms after taking the med
2. symptoms linked with ingestion of food
3. midthoracic back, shoulder or scapular pain
4. muscle weakness
5. restless leg syndrome
6. paresthesia

Question 14

2 questions should be asked to screen for suicide risk

Answer 14

1. are you having thoughts of attempting to harm yourself?
2. do you have a plan in place?

Question 15

compare and contrast fatigue and insufficiency fractures

Answer 15

• insufficiency fracture → abnormal bone with normal stress
  
  • associated with osteoporosis
• fatigue fracture → abnormal stress on normal bone
  
  • associated with overload
  • stress fractures

Question 16

List risk factors for femoral head and neck fractures

Answer 16

1. female gender
   
   • hormones
   • menstrual irregularities
2. involvement in running, jumping and marchign activities
3. change in training program or routine
4. nutritional deficiencies
5. LLD
6. diminished muscle strength
7. osteoporosis

Question 17

Describe clinical manifestations of femoral head and neck fractures

Answer 17

1. pain in groin, greater trochanter and/or buttock
2. referred pain to anteromedial thigh may be chief complaint
3. provoked with increased WBing
4. relieved with reduced WBing
5. insidious onset
6. Hip ROM reveals minor if any pain provocation
7. Plain films often negative

Question 18

what physical exam techniques would you utilize if you suspect a femoral head or neck fracture?

Answer 18

1. Fulcrum Test
2. Patellar-Pubic Percussion test

Question 19

list the risk factors for CES

Answer 19

1. low back injury, central disc herniation
2. congenital or acquired spinal stenosis
3. spinal fracture
4. anklyosing spondylitis
5. TB, Pott’s disease

Question 20

describe the clinical manifestation of CES

Answer 20

1. urinary dysfunction
   
   • retention, incontinence
2. bowel dysfunction
   
   • incontinence, loss of anal tone
3. sexual dysfunction
   
   • reduced sensation during intercourse, impotence
4. sensory deficits
   
   • perineum and “saddle” regions
   • LEs
5. motor deficits
   
   • lower limbs (multiple spinal level weakness

Question 21

list risk factors for cervical myelopathy

Answer 21

1. cervical spondylosis
2. spinal degeneration from neck trauma (MVA, sports injury)
3. RA

Question 22

describe the clinical manifestations of cervical myelopathy (history)

Answer 22

1. impaired hand dexterity
2. gait, balance difficulties (legs weak, stiff)
3. numbness, paresthesia-extremities (upper and possibly lower)
4. neck stiffness
5. urinary dysfunction
   
   • retention and possible urgency and frequency

Question 23

describe the clinical manifestations of cervical myelopathy (physical exam)

Answer 23

1. hand-intrinsic atrophy
2. muscle weakness
   
   • often triceps and hand intrinsic
   • proximal muscles of LE
3. UMN signs

Question 24

Cook cluster for cervical myelopathy

Answer 24

1. Gait abnormality
2. +Hoffman’s Test
3. Inverted Supinator sign
4. +Babinski test
5. age >45 years

Question 25

how do you interpert Cook's cluster

Answer 25

* 1/5 present = ability to rule out myelopathy (sensitivity 0.94) * 3/5 present = ability to rule in myelopathy (specificity 0.99)

Question 26

list the risk factors for abominal aortic aneursym (AAA)

Answer 26

1. age 2. male gender 3. history of smoking 4. history of hyper cholesterol and coronary heart disease 5. family history of AAA

Question 27

describe the clinical manifestation of AAA

Answer 27

1. asymptomatic in most 2. if pain present, most likely back pain 3. abdominal, hip, groin or buttock pain also possible 4. nonmechanical properties 5. insidious onset 6. may report early satiety, weight loss and nausea 7. vascular dissection must be considered with pain

Question 28

list risk factors for DVT

Answer 28

1. previous history of DVT 2. history of cancer 3. history of CHF 4. history of SLE 5. recieving chemo 6. major surgery 7. major trauma 8. immobility 9. limb paralysis 10. women during pregnancy 11. women taking oral contraceptives, hormone replacement therapy 12. age \>60 years

Question 29

describe the clinical manifestations of DVT

Answer 29

1. ache, tightness, tenderness 2. general edema 3. pitting edema 4. prominent superficial venosu plexus 5. increased local skin temp

Question 30

how to interpret the Wells Clinical Prediction rule for DVT

Answer 30

1. high probability if score \> 3 (75%) 2. moderate if score 1-2 (17%) 3. low if score is 0 (3%)

Question 31

list the risk factors for PE

Answer 31

1. previous history of PE 2. history of DVT 3. immobility 4. history of abdominal, pelvic surgery 5. total hip, knee replacement 6. late-stage pregnancy 7. lower limb fractures 8. malignancy of pelvis or abdomen

Question 32

describe the clinical manifestations of PE

Answer 32

1. dyspnea 2. tachypnea 3. pleuritic chest pain, intensified w/deep respiration and cough 4. persistent cough 5. apprehension, anxiety 6. tachycardia 7. palpitations

Question 33

T/F: it is typical for women to present with the classic symptoms of an MI

Answer 33

FALSE less typical for women than men only 50% of women experience chest pain thus cardiac death leading cause of death in women all ages

Question 34

modifiable risk factors of an atypical MI

Answer 34

1. cigarette smoking 2. high cholesterol levels 3. HTN 4. DM 5. Obesity 6. Sedentary lifestyle 7. Excessive alcohol consumption

Question 35

Nonmodifiable risk factors for an atypical MI

Answer 35

1. age \> 55 in women 2. age \> 45 in men 3. family history 4. ethnicity * highest in AA

Question 36

describe the clinical manifestation of an atypical MI

Answer 36

1. SOB 2. Fatigue 3. Sleep disturbance 4. Nausea (with or without vomiting) 5. Palpitations 6. Dizziness 7. Diaphoresis 8. Anxiety 9. Pain

Question 37

pain locations for an atypical MI

Answer 37

1. upper abdominal/epigastric 2. neck, jaw and tooth 3. interscapular and mid to lower thoracic 4. R arm pain (possibly isolated in biceps)