subjective examination

Question 1

What are general tips for effective communication with patients?

Answer 1

• introduce yourself & ur role
• keep language simple and jargon free (ie no abbreviations or complicated words)
• ask open ended questions - eg can you describe your pain for me ? rather than is ur pain stabbing?
• be empathetic and respectful
• listen
• allow them time to respond or ask questions

Question 1

what is subjective exam / history taking?

Answer 1

• first point of contact between you and your patient
• follows logical order/ flow to gain a deeper understanding of a patients condition
• ask questions but LISTEN

Question 2

what do we ask about in our subjective exam?

Answer 2

• reason for attendce - ie about present condition (PC)
• body chart - draw where pain is
• PAIN NB
• any other symptoms eg pins and needles, weakness, swelling, giving way
• history of their present condition (HPC)
• past medical history (PMH)
• family history (FH)
• drug history (DH)
• social history (SH) - work and lifestyle considerations
• patient goals and expectations

Question 3

what are the main aims of the subjective exam?

Answer 3

• identify if it is a MSK problem that physio can help with
• identify contributing factors
• identify the potetial soruce of the problem
• identify any red flags or serious pathoogy
• identify important terms to assess during physical exam
• identify any contraindications or precautions to exam / treatment

Question 4

what are ‘red flags’?

Answer 4

• clinical indicators of a potential serious pathology
• often picked up in the subjective exam

Question 5

what is referred pain?

Answer 5

• when pain is percieved in a region away from where the painful source is
• note pain normally moves from proximal to distal -

Question 6

distinguish between somatic, visceral and neural pain

Answer 6

• somatic - joint or soft tissues around the joint are referring the pain - eg pain in the hip but there is somatic referral down into the knee
• visceral pain - eg pain in the abdomen, mid back from kidneys or chest pain
• nueral pain - pain from nerves from spine or if the nerves are compressed

Question 7

what is the nerve root?

Answer 7

where the nerve emerges from the spinal cord

Question 8

what is important to note when asking about pain?

SIN

Answer 8

• S- severity - how bad is it
• I - irritability - how easy or hard is it to bring the pain on and then to settle it?
• N - descriptors of type of pain

Question 9

what is the VAS/ NRS method in relation to pain?

NRS = numerical rating scale and VAS - visual analogue scale

Answer 9

• reliable and valid measurement of pain
• scale of 0-10 - where 0 is no pain and 10 is as bad as it could possibly be .. what would you give your pain right now/ or at night etc?

Question 10

Describe constant vs intermittent pain

Answer 10

1. constant
   * unremitting pain 24/7, can be indicative of cancer pain
   * remitting pain - can vary in intensity
2. intermittent
   * comes and goes
   * specific aggravating and easing factors

Question 11

Describe the** depth of pain** in relation to bones, muscles, tendons etc

Answer 11

• deeper pain may be referred
• bone pain is commonly a deep pain
• joint pain and muscle and tendon pain can be felt more superficially

Question 12

what is paraesthesia?

Answer 12

the feeling of pins and needles

Question 13

what does it mean when we describe a joint as ‘giving way’?

Answer 13

• the joint is suddenly and unexpectedly unable to support the person
• instability

Question 14

what is crepitus (grating)?

Answer 14

a grating sound or sensation produced by friction betwen bone and cartilage or other parts of the fractured bone

Question 15

what should you do if there is more than one pain?

Answer 15

• try to establish if they are from the same source
• hierarchy - which is worse?
• temporal relationship - does one come on before other or at the same time?

Question 16

what are aggravating factors?

Answer 16

• activities or positions that may make the pain worse or bring the pain on eg standing, walking stairs, sitting positions , running etc

Question 17

what are the easing factors?

Answer 17

• activities positions or drugs / heat /cold that help to ease pain symptoms

Question 18

take walking as an example of an aggravating factor.. what kind of questions would you ask to establish the irritability of the pain?

Answer 18

• how long can you walk for before the pain comes on? - distance or time
• how long can you walk for before you have to stop because of the pain?
• how long does it take for the pain to settle once you stop walking

Question 19

what questions would you ask the patient in relation to their history of present condition?

Answer 19

• chronic/ sub acute/ acute / or recurrent
• how is ur function?
• any other MSK probs?
• any similar episodes?
• if this is a reoccurance - what is the rate of reoccurance - ie how often does it happen?
• rate this episode relative to the past
• did you recieve treatment in the past, if so who? what treatment ? and was it effective?

Question 20

what questions would you ask in relation to social history?

Answer 20

1. WORK
   * are you able to do your job?
   * have you modified your duties?
   * how long have you been off for?
   * what does your work involve?
   * any other work stressors
2. SPORTS
   * are you able to play sports?
3. HOBBIES
   * are you able to enjoy your usual hobbies?

Question 21

after completig the subjective exam of a patient, what should you reflect on?

Answer 21

1. is the problem musculoskeletal or not?
2. generate hypothesis for MSK diagnosis - and structures involved - joint / muscle/ nueral systems
3. plan physical exam - base it on the severity and irritability of the problem, think of any tests to be included and any precautons or contra indications
4. its ok to ask again if you have forgotton something