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NMSKI > Subjective Examination > Flashcards

Subjective Examination Flashcards

1
Q

calgary cambridge consultation model

A 
initiating session
gather info
physical examination
provide structure to consultation
build relationship
explain and plan 
closing the session
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2
Q

purpose of initiating session

A

establish rapport

reason for consult is identified

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3
Q

purpose of gathering info

A

find patients problem

understand patient

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4
Q

purpose of providing structure to the consultation

A

organisation

attend to flow

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5
Q

purpose of building a relationship

A

appropriate non verbal behaviour
develop rapport
involve patient

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6
Q

purpose of explaining and planning

A

provide right info
aid accurate recall and understanding
shared understanding - incorporate patient’s perspective
plan -shared decision making

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7
Q

closing session purpose

A

Forward planning

Ensuring appropriate point of closure

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8
Q

assessment - cyclical process

A

subjective examination
physical examination
treatment
repeat

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9
Q

purpose of subjective examination

A

more than getting patient’s history
hear their story
use structured format
small part of solving puzzle

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10
Q

aim of subjective examination

A

find source of issue
find severity
identify contributing factors
identify important items to assess in physical examination
contraindications/precautions in examination and treatment
identify red flags(serious pathology. e.g. undiagnosed fracture, inflammatory arthritis)

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11
Q

somatic structures

A

body not mind

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12
Q

referred pain

A

when pain manifests itself at a distance to the actual tissue source
more central the source, the more extensive possible area of referral
(someone experiences pain in one location but the source of the pain is in another location)

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13
Q

example of referred pain

A

posterior leg pain referred to the back

osteoarthritis - knee pain hip is referring pain to the neck

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14
Q

example of viscera referral

A

heart attack - shoots down the arm

kidney infection - manifests as back pain

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15
Q

viscera (internal organs)

A

spine

or spin refer to viscera

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16
Q

transmission of sensory info to spinal cord

A 
receptor 
dorsal root ganglion (sensory neuron)
association neuron in integrating centre 
motor neuron ventral root
effector
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17
Q

Convergence-Projection Theory of Referral-Somatic structures example

A

hip and knee both converge at lumbar 2-3

brain does not where exactly pain is located

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18
Q

Convergence-Projection Theory of Referral-Somatic structures

A

sense from 2 different locations converge at the same time and brain cannot interpret where source of pain is

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19
Q

radicular pain

A

nerve root pain

comes from 1 or more spinal nerve root

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20
Q

radicular pain and referred pain difference

A

radicular pain - from spinal nerve root

referred pain - from somatic structure e.g. joint/muscle

21
Q

dermatomes

A

An area of the skin supplied by nerves from a single spinal root.
Nerve Root is where nerves emerges from spinal cord

22
Q

example of dermatomes

A

: pain in the thumb could be due to C6 nerve root emerging from spinal cord in neck

23
Q

subjective exam overview

A 
Reason for attendance 
Body chart
Behaviour of Symptoms
Special Questions
History of Present Condition (HPC)
Past Medical History (PMHx)
Medications
Social (Soc Hx) & Family History (FHx)
Patient’s goals / expectations
24
Q

what will be assessed in the body chart

A 
current symptoms (swelling, pain etc.)
map on body chart - for area 
tick symptom free area
ask for depth (superficial or deep) or quality of pain
frequency of pain - non stop (red flag), occasional, intermittent
intensity
abnormal sensation
relationship of symptoms
25
Q

Rating pain

A

Visual analogue scale (VAS)
NRS - Numerical Rating Scale (NRS)
To quantify pain
both reliable and valid

26
Q

deep nagging dull pain is is found in

A

bone

27
Q

dull ache pain is found in

A

muscle

28
Q

Sharp, shooting pain is in

A

nerve root

29
Q

Sharp, lightning-like pain is in

A

nerve

30
Q

Burning, pressure-like, stinging, aching pain is in

A

Sympathetic Nerve

31
Q

Throbbing, diffuse pain is in

A

Vascular

32
Q

behaviour of pain

A

If more than pain - hierarchy, temporal relationship
24 Hour PATTERN - night pain - concerning
Aggravating factors
MECHANICAL-
Easing factors

33
Q

examples of aggravating factors

A

activities/positions
how quick to come on and ease
severe enough to stop activity

34
Q

easing factor examples

A

activities/position
drugs
heat
cold

35
Q

OTHER Behaviour symptoms

A 
stiffness
weakness
locking
clicks
crepitus (grating)
parasthesia
numbness
swelling
36
Q

serious red flags

A

Severe, unremitting pain

Night Pain

37
Q

ways to investigate red flags

A

X-ray, MRI, CT scan, US, bone scan

38
Q

red flag pathologies

A 
Inflammatory disorders 
RA, AS
Spinal Cord compression 
Fracture 
Cancer (primary or secondary) 
Infections (bone, joint etc)
39
Q

HPc

A

History of present complaitn

40
Q

history of present complaint (HPc)

A

onset - sudden (traumatic or non trauamtic)
gradual (past trauma, trigger)
sequence of symptoms
MOI (Mechanism of Injury)
Stability: worsening, improving, ISQ (In Status Quo)
Work / Sport participation

41
Q

PMHx

A

Past Medical History

42
Q

Past Medical History

A

past similar episodes – explore - recurrency, rate past episode, recovery
Past medical (or surgical hx) – surgeries, broken bones, hospitalisation
Ongoing Medical conditions

43
Q

medication

A 
analgesics
NSAID 
steroids - risk of osteoporosis
Anti-coagulation
diuretics/anti hypertensives
anti-depressant
resp meds
44
Q

SocHx

A

social history
work
sports - biomechanics, aggravating activity
hobbies

45
Q

FHx

A

family history

genetics

46
Q

patients goals/expectations

A

Symptomatic
Functional
Social

47
Q

subjective examination session

A 
rate pain
behaviour of symptoms
quality of pain
red flags
history of present complaint
past medical history
medications
social history
family history
patient goals/expectations
48
Q

lumbar spine red flags

A

Cauda Equina syndrome – gait, saddle anaesthesia, B&B symptoms

49
Q

cervical spine red flags

A

Vertebrobasilar insufficiency – 5 D’s; dizziness, diplopia, dysphagia, drop attacks, dysarthria

NMSKI (38 decks)

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