Week 2- Patient Interview

Question 1

PART 1: OSPRO

Answer 1

PART 1: OSPRO

Question 2

What does OSPRO stand for?

Answer 2

Optimal Screening for Prediction of Referral and Outcome (OSPRO)

Question 3

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.

Answer 3

• Used in order to identify red flags. (systemic pathology)
• Neck, shoulder, low back, and knee
• 10-item
• 23-item

Question 4

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.

Answer 4

• 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

Question 5

• OSPRO-ROS = ____ flag

- OSPRO-YF = ______ flag

Answer 5

• red flag

- yellow flag

Question 6

• OSPRO-YF predictive of _____ and ________ outcomes.

- OSPRO-ROS predictive of ______ and ________.

Answer 6

• pain and disability

- QOL and comorbidity

Question 7

PART 2: INTERVIEW

Answer 7

PART 2: INTERVIEW

Question 8

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?

Answer 8

INTERVIEW

Question 9

• 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?

Answer 9

• Open-ended so as to not guide the patients answers.

- Paraphrase what the patient states.

Question 10

Give some examples of open-ended questions.

Answer 10

• 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?

Question 11

What are (4) DON’TS during the interviewing process?

Answer 11

• 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.

Question 12

• 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?

Answer 12

• red flags

- SOB while lying down

Question 13

What do we want to do at the ending of an interview?

Answer 13

Recap findings with patient and answer all of their questions.

Question 14

PART 3: SCREENING

Answer 14

PART 3: SCREENING

Question 15

List of things to screen for. (8)

Answer 15

• Depression
• Eating Disorder
• Substance Abuse
• Falls
• Domestic Abuse
• Elder Abuse
• Adverse drug events
• Work/Environmental

Question 16

(SQ)

What (2) questions are essential to ask every patient in order to screen for depression?

Answer 16

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 17

What are some common risk factors for Eating Disorders? (6)

Answer 17

• Female
• Caucasian
• Perfectionist personality traits
• Personal/family Hx of obesity and/or eating disorders.
• Sports/athletic involvement
• Hx of sexual abuse or other trauma

Question 18

Consider the impact of anorexia on ______.

Answer 18

BMD

Question 19

S/Sx of Eating Disorder. (13)

Answer 19

• 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)

Question 20

What is Lanugo? What is it a sign of?

Answer 20

• Lanugo is soft, feathery hair that can grow all over the body, most often on the back and shoulders.
• Sign of anorexia.

Question 21

Behavioral S/Sx of Eating Disorder. (7)

Answer 21

• 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.

Question 22

Populations at Risk for Substance Abuse:

• Teens/adults with _____/______.
• History of _______.
• Individual with ________ disorders.
• Individuals with ________/________ disorders.

Answer 22

• ADD/ADHD
• PTSD
• sleep disorders
• depression/anxiety disorders

Question 23

What are some red flag patterns in Substance Abuse patients? (5)

Answer 23

• Consistently missed appointments
• Noncompliance with HEP and poor self-care
• Shifting mood patterns
• Excessive daytime sleepiness or unusual excessive energy
• Deterioration of appearance/hygiene

Question 24

• Tobacco use causes vaso________ and delayed _____ ________.
• Smoking has been linked with disc _________/________.

Answer 24

• vasoconstriction and delayed wound healing

- degeneration/herniation

Question 25

What are some Performance-Based Outcome Measures used to screen for falls? (3)

Answer 25

- Functional Reach Test - Berg Balance Scale - TUG

Question 26

What are some Balance Confidence/Fear of Falling Questionnaires (Outcomes) used to screen for falls? (3)

Answer 26

- ABC (Activities-Specific Balance Confidence) Scale - FES (Falls Efficacy Scale) - SAFE (Survey of Activities and Fear of Falling In the Elderly)

Question 27

What are the (5) most common factors in falls?

Answer 27

- Vision/hearing - Balance - BP regulation - Medications/substances - Elder abuse

Question 28

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.

Answer 28

- disabilities - cognitively impaired - (>75 yo) - chronic pain - physical/sexual - daily HA (issue related to stress)

Question 29

What are the (3) categories of cues that can be seen with S/Sx of Domestic Abuse?

Answer 29

- Physical Cues - Social Cues - Psychological Cues

Question 30

What patient populations are we required to report abuse?

Answer 30

- Minors - Elderly - Cognitively impaired

Question 31

(SQ) | Elder Abuse S/Sx. (8)

Answer 31

- Multiple trips to ER - Depression - “Falls”/fractures (spiral) - Bruising/suspicious sores - Malnutrition/weight loss - Pressure ulcers - Changing MDs/therapists often - Confusion attributed to dementia

Question 32

- What are the most common side effects of Adverse Drug Events? (4) - What are some more severe reactions? (4)

Answer 32

Common - Constipation - N/V/D - Abdominal pain - Sedation Severe - Confusion - Drowsiness - Weakness - Loss of coordination

Question 33

What are the (4) Ds associated with OTC drug use?

Answer 33

- Dizziness - Drowsiness - Depression - Visual Disturbance

Question 34

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

Answer 34

- age/sex - polypharmacy - prescribing cascade (pt given drug to treat symptom of initial medication) - cognitive impairment/dysfunction - alcohol consumption - Hx of ADE

Question 35

(SQ) | What are some common MSK side effects associated with antibiotics?

Answer 35

- TENDINOPATHY/TENDON RUPTURE - skin reactions - noninflammatory joint pain

Question 36

(SQ) | What are some common MSK side effects associated with NSAIDs?

Answer 36

-BACK/SHOULDER pain

Question 37

(SQ) | What are some common MSK side effects associated with statins?

Answer 37

-MYALGIA

Question 38

NSAIDs can also cause damage to the __ ______ and is related to thousands of hospitalizations and deaths anually.

Answer 38

-GI tract

Question 39

What are the (4) biggest risk factors for NSAID Gastropathy?

Answer 39

- >65 yo - Hx of peptic ulcer disease, GI disease, or RA - Chronic use of NSAIDs (>3m) - Use of acid suppressants

Question 40

``` (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 ```

Answer 40

-fatigue

Question 41

``` (SQ) NSAID MSK S/Sx: -Increased symptoms _______ _______ med and with _________ ______ -_____/______ pain -muscle ________ -restless leg syndrome -paresthesias ```

Answer 41

- Increased symptoms after taking med and with ingestion of food*** - back/shoulder pain - muscle weakness