1
Q
Proximal
A
- toward the trunk of the body, to the point or origin
2
Q
Ipsilateral
A
- Same side
3
Q
Contralateral
A
- Opposite side
4
Q
Coronal/ Frontal Plane
A
- Passing Longitudinally through body from one side to the other diving the body into ANTERIOR and POSTERIOR portions
5
Q
Sagittal Plane
A
- Passing Longitudinally through the body from front to back and dividing it into the RIGHT and LEFT portions
6
Q
Transverse/ Horizontal Plane
A
- Passing HORIZONTALLY through the body dividing the it into UPPER and LOWER portions
7
Q
Axis
A
- Imaginary line about which motions occur
- In reference position, axes are PERPENDICULAR to the ANATOMIC PLANE!!!
8
Q
Anterior- Posterior Axis
A
- Runs PERPENDICULAR to the CORONAL/ FRONTAL Plane (Divides the front half and the back half)
- SIDEBENDING Left/ Right
9
Q
Transverse Axis (Right-Left Axis)
A
- Runs PERPENDICULAR to the SAGITTAL PLANE (Divides the Right Half and Left Half)
- FLEXION (Forward Bending) and EXTENSION (Backward Bending)
10
Q
Longitudinal Axis (Superior- Inferior Axis)
A
- Runs PERPENDICULAR to the TRANSVERSE PLANE (divides the Top Half and Bottom Half)
- ROTATION (Circular or twisting)
11
Q
Gravitational Line
A
- Viewing patient from the side, an Imaginary line in a CORONAL PLANE which starts at:
1) Slightly Anterior to the LATERAL MALLEOLUS
2) Passes across the LATERAL CONDYLE of the KNEE
3) The GREATER TROCHANTER
4) Through the LATERAL HEAD of the HUMERUS at the Top of the Shoulder
5) To the EXTERNAL AUDITORY MEATUS
6) If the plane is through the BODY, would intersect BODY of THIRD LUMBAR VERTEBRA (L3 or L2)
7) And ANTERIOR 1/3 of SACRUM
12
Q
Posture
A
- Postion of the body distribution of body mass in relation to gravity
- Ideal posture and alignment in relation to the Gravitational Line
- Static/ Structural Symmetry
- Dynamic/ Functional
13
Q
Postural Compensation
A
- Occurs in all THREE PLANES of Body Motion to keep the body balanced and eyes level
- The result of HOMEOSTATIC mechanisms working through the ENTIRE BODY unit to MAXIMIZE FUNCTIOn
- The CENTRAL NERVOUS SYSTEM prioritizes vision and Balance Functions, while Spinal Compensation involved PROPRIOCEPTION from TENDONS and MUSCLES as well as Vestibular Information from the SEMICIRCULAR CANALS and integrates this info with the INFORMATION from the Eyes
14
Q
Postural Compensation
A
- Structural compensation allows function even with Musculoskeletal imbalances
- Compensation
1) Genetic
2) Traume
3) Habitual Activity
15
Q
Postural Decompensation
A
- Distribution of Body mass away from IDEAL when POSTURAL HOMEOSTATIC mechanisms are OVERWHELMED, occurs in all Planes
- FAILURE of the BODY to ALIGN
- Which plane is Affected?
- CORORNAL: Scoliosis
- HORIZONTAL: Rotation
- SAGITTAL: Kyphosis/ Lordosis
16
Q
Kyphosis
A
- Normal AP curve of the THORACIC Spine with CONCAVITY ANTERIORLY and CONVEXITY POSTERIORLY
- Degree can vary with age, POSTURAL HABITS, and OSTEOPOROSIS. Can be exaggerated
17
Q
Lordosis
A
- Normal ANTEIOR CONVEXITY in the CURVATURE of the LUMBAR and CERVICAL SPINE as viewed from the side
- Degree can vary. Can be exaggerated
18
Q
Scoliosis
A
- Lateral curvature in the CORONAL/ Frontal plane can create a C or S shaped deviation
19
Q
Kypholordotic
A
- Head forward
- Exaggerated Kyphosis/ Lordosis
- Ant Pelvic Shift
- Abdomen Anterior
- Hips slightly Flexed
20
Q
Swayback
A
- Head forward
- Decreased Lumbar lordosis
- Post tilt of Pelvis
21
Q
Flat Back
A
- Head forward
- Lower Thoracic Kyphosis Flattening
- Lumbar Lordosis Flattened
22
Q
Pectus Excavatum
A
- Funnel Chest
- Abnormally depressed
- Compression of structures
23
Q
Pectus Carinatum
A
- Pigeon Chest
- Abnormal prominence of Sternum Anteriorly
- AP diameter Increased
24
Q
Osteopathic Pastural Examination
A
- The part of the Osteopathic Musculoskeletal examination that focuses on the Static and Dynamic responses of the body to Gravity while in the ERECT POSTION
- Patient stands on a level surface, without shoes. All extremities should be in full EXTENSION. The feet are placed 6-8 Inches apart with the heels in the same frontal plane and the toes abducted about 15 Degrees
- Physician stands facing the aspect of the patient to be evaluated (front, back, side) and at a sufficient distance to permit a complete body view. During the evaluation, the physician will step closer to observe local areas of Interest
- The examiners eyes should be at the LEVEL of the part being viewed, which may entail crouching or kneeling during the evaluation of lower body portions
- Light palpation may be used to confirm anatomic landmarks or observations
25
Observations prior to Palpation
- Insepct Color changes, Pallor or Erythema (Redness)
- Increase erythema may indicate:
1) Infection
2) Inflammation
3) Somatic Dysfunction
Inspect for Trauma:
1) Scars
2) Bruises
3) Lacerations
4) Abrasions
5) Swellings
6) Blemishes
26
Patient Centered Skills
1) Set the stage for the interview
2) Obtain the Pateint's Agenda
3) Obtain the HPI ("just the facts, ma'am")
4) Obtain MORE about the HPI
27
History of Present Illness
- Mnemonics are helpful until you get the hand of it
- OLD CAAARTS
- Overview of Physical Symptoms
- Personal or Psychosocial context
- Emotional Context
- Address emotions with NURS!!!!!!
N: NAME the patient's expressed Emotion
U: Make an UNDERSTANDING statement
R: RESPECT the patient (Praise them, acknowledge plight)
S: offer SUPPORT
- Deepend the Patient's Story
28
OLD CAAARTS
O- Onset
L- Location
D- Duration
```
C- Characteristics
A- Aggravating Factors
A- Alleviating Factors
A- Associated Symptoms
R- Radiation
T- Timing
S- Severity
```
29
Nonverbal Communication
- Patients rated high in art of medicine docs who read nonverbal well, and even higher the docs who used nonverbal well themselves
30
Gestures
- Uncrossed Legs
- Shifting Forward in the Seat
- Receptivity to what is going on in the Interview
31
Paralanguage
- Speech rate
- Pauses
- Pause to Speech Ratio
- Tone or Voice Quality
- Pitch
- Volume
- Articulation
32
Functions of Pausing
- Absolute Recall Time
- Language Formation Time
- Censorship of Material
- Create an Effect (Timing)
- Preparing to Lie
33
Word Choice
- Professional
- Anatomic terms
- Clear
- Avoid Medicates:
1) Statin urine stream versus Micturition
2) Belch versus eruct
3) Heavy menstrual bleeding versus Menorrhagia
34
Descriptive Words
- You may suggest some terms, give the patient a menu of sorts, but do not lead in one way or another
35
Symptoms for "Hurt"
- Aching
- Bruised
- Chaffing
- Crushed
- Lacerated
- Marred
- Scratched
- Tender
36
Notetaking
- Clipboard mechanics
- Few Word vs Whole Sentences
- Just need to remember what your notes mean for 15 mins
- TRUST your memory!!
37
Abbreviations
- Commonly used abbreviations are fine to use
- Your own abbreviations may make sense to you, but i may have no idea wha you mean
- A list of some commonly used abbreviations are in you Ultimate Medical Scribe Handbook
38
Chief Complain
- Why the patient came into the office!!!
39
Onset/ Duration
- Four days ago...
40
Location
- Mostly on the outside part of my ankle....
41
Duration/ Timing
- Can you describe the pain?
| - So its worse when you walk on it?
42
Characterization
- How would you characterize the pain?
| - Describe the pain, like tingling or burning...
43
Severity
- Scale of 0 to 10 with 0 no pain and 10 so bad you might pass out
- Does it hurt that bad all the time?
- How is the pain affecting your daily life?
44
Timing
- What time of the day is the pain at its worst?
45
Aggravating Factors
- What makes it worse?
46
Alleviating Factors
- What makes the pain better?
47
Associated Factors
- Did you ever experience swelling or bruising of this ankle before?
- Have you noticed anything else, like fever, weakness or any other symptoms?
48
Summary
- Summarize what i heard, is that alright?
49
Past Medical/ Surgical History
- Medications (Rx, OTC, herbals, Vitamins)
- Allergies (to meds)
- PMH: Other active problems, or problems in the past
PSH: Operations or invasive procedures in the past
PCM
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