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MSK II > Decision Making > Flashcards

Decision Making Flashcards

1
Q

5 things to consider when trying to figure out a diagnosis

A
  • Does this pt belong in PT
  • Common conditions present atypically more often than uncommon conditions prestent at all
  • Dx and assessment should not stop after the initial eval
  • monitor response to ongoing rx
  • Know when to progress/regress your treatments
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2
Q

Case Study: 25 yr old patient w/ PFP.

What factors should you consider when developing a treatment plan for this pt

A

Hx and PE

  • Dx
  • Prognosis
  • Comorbidities
  • Phases of Healing
  • Stage of injury
  • irritability estimate
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3
Q

What is a Dx

A

Process and result of evaluation info from the Hx and PE

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4
Q

What does the Dx typically drive

A

The hypothesis, treatment plan, and outcomes assessment, but all other factors are considered bc not all pts w/ the same dx are the same

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5
Q

Case Study: 25 yr old F with knee pain and your dx is PFP

What else do you need to know

A

Eval findings –> to develop hypothesis

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6
Q

What are ICD-10 codes

A

Guide that lists corresponding codes for dx impairments

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7
Q

What is the goals of an ICD-10 code

A

To select the code that describes treatment dx and not the medical dx

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8
Q

What is prognosis

A

Determining the level of optimal improvement that might be attained, and the amount of time requried

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9
Q

Case Study: 25 yo F with PFP

Consider these 2 scenarios:

  • PMH: experienced runner, first episode of pain, onset of pain 2 wks ago
  • PMH: Trying to get back into running, previous lateral release (surgery to lateral retinaculum) continued pain since, but most recently worsened over the past 2 wkss

Would your prognosis be the same?

  • with PT rx
  • without PT rx
A

The prognosis would not be the same because the patient that is an expereinced runner would most likely have a much shorter prognosis

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10
Q

What effect can comorbidities have

A

They can directly affect the severity of the diagnosis, thereby altering the prognosis

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11
Q

Case Study: 25 yo w/ PFP

Consider 2 scenarios

  • PMH: runs 2-3x wk
  • PMH: smoking 1 pack a day x 5 years, no regular excursive, 30lbs overweight

Would your treatment differ for these 2 people given the comorbidities

A

The treatment would differ because the pt that has the substantial comorbities would not be able to handle the same workload as the pt the has no comorbities

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12
Q

What is the first phase of healing

A

Inflammatory

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13
Q

Describe the Inflammatory phase

A
  • 0-5 days
  • Exudative phase
  • Generic process that occurs - applies to any and all tissues
  • qualitatively always the same
  • Quantitatively variable based on extent of the injury and the ability of the body/tissue to respond
  • critical first step of repair
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14
Q

What is the second phase of healing

A

Fibroplasia

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15
Q

Describe the fibroplasia phase

A
  • 3-(21-28) days
  • proliferative or repair phase
  • new vessel formatino
  • Collagen synthesis/lysis
  • immature and weak cross links
  • Random fiber orientation
  • Gradual increase in tensile strength
  • predominantly type III collagen
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16
Q

What is the 3rd phase of healing

A

Maturation

17
Q

Describe the Maturation phase

A
  • 28 days-(1-2 years)
  • remodeling phase
  • Collagen synthesis = lysis
  • slowing of collagen synthesis
  • mature stronger cross links
  • fiber orient according to tensile strength
  • Increase in tensile strength
  • Type I collagen is predominant
18
Q

Case Study: 32 yr old M with lateral epicondlytis, postal worker

Consider 2 scenarios

  • pain started 2 wks ago
  • pain started 12 wks ago

What phase of healing and how would treatment differ

A

Fibroplasia
Maturation

ask Martin

19
Q

What are the stages of injury

A

Acute (0-10 days)
Subacute (10 days-7wks)
Chronic (>7 wks)

20
Q

Case Study: 32 yr old M with lateral epicondlytis, postal worker

Consider 2 scenarios

  • pain started 2 wks ago
  • pain started 12 wks ago

What phase of injury and how would treatment differ

A
  • Subacute
  • Chronic

Ask martin

21
Q

What is the irritability estimate

A
  • How easily “set off” is the pt

- Classifies how high or low irritability’s is

22
Q

What are the considerations for determining irritability

A
  • Phases of healing
  • Stage of injury
  • Sequence of pain and limitation (pain prior to limitation (empt end feel) or pain with limitation)
  • Severity and duration of pain for a known stress
23
Q

What is the Maitland Approach

A

Severity, Irritability, Nature, and stage of condition (SINS

24
Q

What is severity in the Maitland approach

A

Intensity of sx related to an activity

25
Q

What is irritability in the Maitland approach

A

The Amt of activity needed to provoke sx and the time needed for sx to subside

26
Q

What is nature in the Maitland approacn

A

The type of pathology

27
Q

What is Stage in the Maitland Approach

A

Is the problem getting better, getting worse, or staying the same

28
Q

What does

A
29
Q

What is an example of high irritability

A

Ankle sprain - inflammatory phase, sub acute stage, pain 8/10 during gentle inversion AROM that lasted for 15 mins (what would treatment focus on???)

30
Q

What are factors to consider when making a rx treatment plan

A
  • Age
  • Cognition
  • Gender
  • Ethnicity
  • Family hx
  • past hx of condition
  • functional status: current and past
  • disability: current and past
31
Q

How does age influence treatment

A

Older people tend to take longer to heal???

32
Q

How does cognition influence rx

A

Difficulty following commands could increase how long it takes a pt to get better and how well

33
Q

How does gender impact rx plan

A

Hormones can sometimes effect the healing process which influences how we can treat patients

34
Q

How can ethnicity impact patients

A

Certain ethnicities are prone to certain diseases

35
Q

How can family hx influences rx planning

A

Certain diseases can run in families

36
Q

How can past hx of the condition affect rx

A

??? ask martin

37
Q

What are the components of a functional and disability assessment

A
  • Questioning the pt

- usually done with forms (Outcome Measures)

38
Q

What are usual factors that lead to poor prognosis and more treatment visits

A
  • Older Age
  • Longer duration of sx
  • Higher level of duration prior to rx
  • Longer disease duration prior to rx
  • Higher level of pain at IE

MSK II (10 decks)

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