Medical Screening

Question 1

Red Flag Definition

Answer 1

Signs and symptoms associated with a serious medical condition that require immediate medical attention or referral within 0-24 hours

Question 2

Yellow Flag Definition

Answer 2

Signs and Symptoms associated with a potential serious condition but must attempt to rule in/out with both subjective and objective exam

Question 3

Medical Screening Questions

Answer 3

Refer to Questionnaire for general medical screening

Potential health problems

For all patients

Question 4

Unexplained Weight Loss/Gain

Answer 4

Yellow Flags:
Unexplained Weight Loss >5-10% over 4-6 Months (Unexplained)
-Depression, Cancer, GI Disease, Eating Disorder

Unexplained Weight Gain >5-10% over 4-6 Months (Unexplained)
-Depression, Congestive Heart Failure, Liver or Renal Disease, Hypothyroidism

Question 5

Fever/chills/sweats

Answer 5

Normal: 98.6
Ranges from: 97-99.5

Red Flag concerns:
Exceeds greater than 10-14 days with no MD intervention OR >102 (esp. In post surgery and in elderly)
Temp exceeds range following surgery (infection)

Potential yellow flag concerns
Infection (w/o surgery)
Cancer
Connective Tissue Disorder (Ex: RA)
Special concerns with elderly

Question 6

Loss of appetite, nausea and/or vomiting

Answer 6

Yellow flag
Adverse medication reactions (NSAIDS)
GI disturbance
Systemic illness
Neuro disorders
Pregnancy

Question 7

Dizziness/Lightheadedness/Blurred Vision

Answer 7

Red Flag
Sudden onset – CVA

Yellow Flag
Neuro disordrs
-Cannot relieve symptoms or unpredictable
Meds interactions
Cardiac and vascular disorders

Treatable by PT
Symptoms occur only with head motions
Short durations
Pt able to inhibit symptoms with visual fixation

Question 8

Fatigue

Answer 8

Fatigue

Yellow

Serious fatigue: interferes with ability to carry out daily activities and lasts greater than 2-4 weeks

Psychological conditions (Depresison)

Infection

Cancer

Endocrine disorders

Side effect of meds

Question 9

Fatigue

Answer 9

Yellow Flag:
Serious fatigue: interferes with ability to carry out daily activities and lasts greater than 2-4 weeks
Psychological conditions (Depresison)
Infection
Cancer
Endocrine disorders
Side effects of meds

Question 10

Malaise - “Just don’t feel right”

Answer 10

Yellow Flag:
Cancer
Infection
Cardiac Condition
Depression

Question 11

Paresthesia, numbness or weakness

Answer 11

Red Flag:
Progression of weakness, reflexes or paresthesia
Saddle anesthesia/numbness (perianal region)
Associated with balance/gait disturbances
Potential Concerns
Central cord compression or cauda equina syndrome

Yellow flag:
Glove and stocking distribution
Bilateral symptoms
UE and LE symptoms
Potential Concerns
-Chronic renal failure
-MS
-Diabetes
-Hypothyroidism

Question 12

Change in congnition

Answer 12

Red Flag
Rapid Change
Progression of changes
Associated with balance/gait disturbances/clumsiness
Immediate Red Flags
-Head Injury/Stroke
-Drug Reactions
-Infections

Yellow Flag
Dementia

Question 13

During 24-hour period – Night pain worst

Answer 13

Yellow flag
Waking up and unable to return to sleep. Potential concerns:
Infection
Cancers
Non-mechanical nature to pain (systemic)

Not significant
Waking up due to pain but able to return to sleep when changing position

Question 14

Bowel and bladder dysfunction

Answer 14

Red Flag
Incontinence associated with back and radiating pain
Concern with Cauda equina syndrome

Yellow
Constipation or diarrhea
Change in shape or color of stool
Change in color of urine
Incontinence in elderly
“Leaking” in female patient
Potential concerns
-GI disturbance
-Med interaction
-Pelvic Floor disorders

Question 15

Dyspnea

Answer 15

Shortness of breath

Red Flags: Acute difficulty or pain with breathing
Sudden onset not explained by activity level
History of recent surgery/immobilization/trauma
Potential Concerns
-Pulmonary embolism
-Collapsed Lung

Yellow Flags:
Associated with visible signs of low oxygen
Related to activity or body position
Potential concerns
-Chronic heart and long disease

Question 16

Syncope

Answer 16

Fainting

Red Flag
Sudden loss of consciousness followed by spontaneous recovery
Concerns: altered blood flow to the brain

Yellow
Concerns:
-Metabolic and psychogenic origins
-Eating disorders

Question 17

Risk Factors for suicide

Answer 17

History of suicide attempts
Medical seriousness of previous attempts
Acute suicidal ideation
Severe hopelessness
Attraction to death
Family History of suicide
Acute overuse of alcohol
Loss/separations

Question 18

Possibility of Cancer?

Answer 18

Non-mechanical pain. Unable to reproduce it.

Items of history that were significant for possible cancer (100% sensitivity if Negative on all 4
Age >50 years old
Previous history of cancer
Unexplained weight loss
Failure to improve with conservative treatment (4-6 Weeks, you may not choose to wait that long before referral.

We are much better at ruling cancer out than ruling it in

Most Specific: Previous history of cancer
Most Sensitive: Failure to relieve symptoms with bed rest

Question 19

If you think your patient might have Cancer what do you do?

Answer 19

Red Flags
1. Contact another health provider for consultation
2. Refer to urgent care or ER
Provide concerns with the health care provider (SBAR)
Situation: What is the situation?
Background: Clinical background of the patient?
Assessment: What is the problem?
Recommendation: What do you recommend/request be done?

Yellow Flags
Is there an explanation?
Trying new meds
Has the patient mentioned it to a health care provider?
Has it changed or worsened?
History of symptoms
Current episode
Onset how/when
Symptoms better, worse, or the same
Specific tests to perform?

If no immediate concerns, but have some curiosity: How does the patient respond to intervention?

Question 20

ChLORIDE PA

Answer 20

• Character (patients persception of condition) •
• Location •
• Onset •
• Radiation/Referral •
• Intensity •
• Duration
• Events ○
  
  • Provocative events ○
  • Alleviating events

Question 22

Questions

Function: Loss of ROM, swelling pain

Do you feel stiffness, swelling, pain?

Is you pain in a specific location?

Is there any radiating pain?

Has the pain spread locations?

Activity: ADL, chores, dressing oneself

Any chances in your day to day movement?

Do you have any difficulty getting dress?

Any specific movement that aggrevates your symptoms?

Is there anything that eleviates your pain?

Participation:

How does this effect your work?

How does this effect your hobbies?