Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced clinical practice: examining the complex patient > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What are the integration of care concepts that primary care is distinguished by?

A
  • Comprehensiveness
  • Coordination
  • Continuity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What form of healthcare is physical therapy commonly/traditionally practiced in?

A

Secondary care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

According to the WHO, what is secondary healthcare?

A

Consultative, short term and disease oriented, for the purpose of assisting the primary care practitioner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The role of PT in primary care is quickly evolving, in what expertise is the role of PT in primary care specifically in?

A

In the management of patients with NMS(neuromuscular) conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the aims for improving the quality of care in the US?

A

Care must be:

  • Safe
  • Effective
  • Timely
  • Efficient
  • Equitable
  • Patient centered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the characteristics of a family physician?

A
  • 3 years of training aPer graduation from medical school
  • At least one month spent in MSK conditions
  • Shadowing an orthopedist or sports medicine physician
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the characteristics of a general internist?

A
  • 3 years of training aPer graduation from medical school
  • Focus of expertise in the area of hospitalized pa:ents (e.g. Cardiac or Medically intensive health problems)
  • Small percentage of outpatient services
  • No requirement for training with orthopedist or sports medicine to treat MSK conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the characteristics of physician assistants?

A

• Two years of training
– One year spent in the classroom
– One year involved in various IP and OP clinical experiences
• Degrees: BS and MS
• PAs never practice independently
• Clinical focus depends on supervising physician’s expertise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the characteristics of nurse practitioners?

A
  • Graduates of a registered nurse training program
  • Length of training: Variable
  • Clinical focus: variable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the possible specialties of a PT?

A
  • Cardiovascular and Pulmonary (CCS)
  • Clinical Eletrophysiology (ECS) • Neurology (NCS)
  • Orthopedics (OCS)
  • Pediatrics (PCS)
  • Sports (PCS)
  • Women’s Health (WCS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the potential benefits of the inclusion of PTs in primary care?

A

– A more efficient use of health care resources
– Care being delivered in a more timely manner
– Interdisciplinary collaboration resulting in increased quality of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what capacity do army PTs practice?

A

In direct access settings as non physician healthcare providers or in physician extender roles when practicing on patients with NMS issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Wha are the priviledges that army PTs have that others don’t?

A
  • Diret referral for appropriate imaging studies
  • Ability to restrict patients to their quarters for 72 hours
  • Restrict work and training for 30 days
  • Refer patients to all medical specialty clinics
  • In certain clinics, they are allowed to order certain analgesics, and NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the advantages of having PTs perform NMS exams, evals, and treatments in the roles of non-physician primary care providers?

A
  • Prompt eval and treatment for patients with NMS complaints
  • Promotion of quality healthcare
  • Decreased in sick call visits
  • More appropriate use of physicians
  • More appropriate use of PT education and experience
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the other PT model is found in the primary care environment?

A

Kaiser Permanente Model

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the characteristics of the Kaiser Permanente Model?

A
  • Largest not-for-profit HMO in USA
  • PT services are primary care in the Northern California Region
  • PTs work with medical providers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who are the practitioners included in the Kaiser Permanente Model?

A
  • Physicians
  • Nurse practitioners
  • Medical assistants
  • Health educators
  • Behavioral medicine
  • PTs
  • In some cases, pharmacist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the requirements for a PT to work in a Kaiser Permanente Model clinic?

A
  • Strong foundation in orthopedic PT
  • 4-6 years of outpatient PT
  • Required CE
  • Competency in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and acute MSK injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What interventions are PTs in the veterans affairs(VA) model responsible for?

A 
Everything that affects mobility:
•  Integumentary
•  Musculoskeletal
•  Neuromuscular
•  Cadiovascular/pulmonary systems.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the requirements for a PT to work in a veterans affairs(VA) model?

A
  • Differen:al diagnosis
  • Orthopedic examina:on and evalua:on
  • Primary and secondary disease preven:on
  • Effect of the four body system on movement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In what aspects does a PT act in the veterans affairs(VA) model?

A
  • PTs screen patients in the ED
  • Primary care clinic and triage by a nurse
  • Overweight pa:ents or who wish to improve their general health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the requirements for a PT to work in a Mercy model?

A
  • Strong foundation in orthopedic PT(3-5 years)
  • Demonstrated competency in differential diagnosis, diagnostic imaging, pharmacology, and laboratory values common in primary care and acute and chronic MSK injuries.
  • Ability to work in collaboration with medical residents.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does the Mercy model focus on?

A

Small group education and mentoring of physicians by PTs during the clinical care of patients with NMS conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the most common body regions that PTs instruct medical students on in a Mercy model?

A

– Low back
– Neck
– Shoulder
– Knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the most common non MSK conditions that causes patients to experience pain in their lower back?

A
  1. Tumors
  2. Spinal infections
  3. Vertebral fracture
  4. Cauda equina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the additional questions to ask a patient when a spine tumor is the suspected cause of their LBP?

A

• Do you have a history of cancer?
– If so, what type of cancer (e.g., lung, breast, prostate)?
• Have you recently lost weight, even though you
have not been attempting to eat less or exercise more?
– If so, how much?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the additional questions to ask a patient when a spine infection is the suspected cause of their LBP?

A
  • Have you recently had a fever?
  • Have you recently taken antibiotics or other medicines for an infection?
  • Have you been diagnosed with an immunosuppressive disorder?
  • Does your pain ease when you rest in a comfortable position?

Negative response to the 1st 3 questions helps rules out a spine infection and the 4th hints that the pain is not as a result of a MSK problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the additional questions to ask a patient when a spine fracture is the suspected cause of their LBP?

A
  • Have you recently had a major trauma, such as a vehicle accident or a fall from a height?
  • Have you ever had a medical practitioner tell you that you have osteoporosis or other disorders that could cause “weak bones”? These include hyperparathyroidism, renal failure, chronic GI disorders, and long-term use of corticosteroids.
29
Q

What are the additional questions to ask a patient when cauda equina is the suspected cause of their LBP??

A
  • Have you noticed a recent onset of difficulty with retaining your urine or starting urine flow?
  • Have you noticed a recent need to urinate more frequently?
  • Have you noticed a recent onset of numbness in the area of your bottom where you would sit on a bicycle seat?
  • Have you recently noticed your legs becoming weak while walking or climbing stairs?
30
Q

What other body areas should their functions be investigated if a patient still complains of LBP and is not related to the common non MSK causes?

A
  • GI
  • Urogenital
  • Vascular system
31
Q

What are some additional questions that can be asked if a patient is suspected to have colon cancer?

A

• Age older than 50 years
• History of colon cancer in an immediate family member
(first-degree relative)
• Bowel disturbances
(e.g., rectal bleeding or black stools)
• Unexplained weight loss
• Back or pelvic pain that is unchanged by positions or movement

32
Q

What are the different ways we can try to diagnose a patient?

A
  • Location of symptoms

- Nature of complaint

33
Q

____ is the most common mono-articular joint condition

A

Osteoarthritis is the most common mono-articular joint condition

34
Q

Primary OA of the cervical spine mostly affects what levels?

A

C5-C7

35
Q

What levels of the C-spine does RA mostly affects?

A

The entire C-spine

36
Q

What are some of the conditions associated to non-joint limb pain?

A
  • Hypothyroidism
  • Lyme disease
  • Polymyalgia rheumatica
  • Statin-related myopathies or myalgias
  • Vascular and neurogenic claudica@on
  • Tibial stress reaction injury (stress fracture)
  • Deep venous thrombosis
  • Compartment Syndrome
37
Q

The initial symptoms of hypothyroidism are fleeting and can cause the diagnosis process to take long. What are the dominating symptoms of hypothyroidism?

A
  • Pain
  • Stiffness
  • Fatigue
  • Slow and steady weight gain
  • Constipation
  • Dry skin
  • Cold intolerance
38
Q

What is polymyalgia rheumatica marked by?

A

Pain and stiffness most commonly in the bilateral and symmetric shoulder girdle and pelvis thigh regions

39
Q

What are the characteristics of lyme disease?

A
  • Primarily found in NE coastal areas, upper midwest states, coastal oregon and northern cali
  • Classic erythema, migraine, and rash is not present in all
  • Rash may have disappeared prior to pt seeking medical attention
  • Incubation period of up to 32 days
40
Q

What are the characteristics of polymyalgia rheumatica?

A
  • Early morning stiffness, lasting an hour or longer

- Impaired mobility, transitional movements and ambulation

41
Q

What are all the possible causes of dizziness for a patient?

A
  • Vestibular
  • Cardiovascular
  • Craniovertebral junction disorders
  • Neurologic
  • Psychiatric
42
Q

What are the different aspects of the nature of dizziness?

A

• Onset: Acute vs. gradual onset
• Duration: Seconds, Minutes, Hours, or Days
• Positional changes
• Other associated complaints:
– Hearing loss
– Tinnitus
– Aural pressure
– Central nervous system or cerebellar signs
• Emergency medical situations that could manifest with dizziness:
– Intracranial bleeds
– Cardiac arrhythmias

43
Q

What are the clinical manifestations of dysequilibrium and function?

A

Impaired:
– Walking
– Hearing
– Vision

44
Q

What are the cardinal signs that should be examined if a patient experiences dizziness after a head trauma?

A
  • Bilateral or quadrilateral limb paresthesia
  • Perioral (lip) numbness
  • Nystagmus
  • Drop attacks
45
Q

What are the fracture tests that can be done to rule out head and neck fractures?

A
  • Canadian cervical spine rules
  • Gross loos of active or passive range of motion
  • Observation of mastoid or facial ecchymosis
  • Light cranial compression painful
  • Abnormal end feel on ligamentous testing
  • Painful weakness on resisted isometric contraction
  • Tuning fork (pain with vibration)
46
Q

What are the important neurologic tests to be done when a patient complains of dizziness?

A
  • CN signs

- Long tract signs

47
Q

What are the long tract signs to be done when a patient complains of dizziness?

A 
Neurologic systems 
•  Sensation
–  Light touch
–  Pain
–  Temperature
•  Mechanoreception
–  Conscious proprioception
–  Vibration
–  Stereoagnosis)
•  Motor
–  Strength
–  Spasticity,
–  Coordination)
–  Deep tendon reflexes
–  Clonus
•  Nociceptive reflex tests 
–  Babinski
–  Oppenheimer 
–  Hoffman
48
Q

What are the patient personal factors that can contribute to patient dizziness?

A
  • PMH
  • Medications
  • Lifestyle(smoking, alcohol, exercise, and sleep hygiene)
49
Q

What is the dizziness handicap inventory(DHI) do?

A

Can be a helpful outcome tool to a certain baseline, monitor symptoms and differentiate physical, functional and emotional factors associated with dizziness

50
Q

What are the categories of dizziness?

A
  • Vertigo: peripheral vs central vestibular dizziness
  • Dysequilibrium: sensation of imbalance
  • Presyncope: sensation of “fainting” CV vs non- CV causes
  • Nonspecific: psychophysiologic, multifactorial
51
Q

What do the categories of dizziness best represent?

A

The pt’s CC, not their differential diagnosis. And they are not mutually exclusive

52
Q

What is cervicogenic dizziness characterized by?

A

By dizziness and dysequilibrium associated with neck pain in patients with conditions like:
– WAD
– Atlanto-axial instability
– Degenerative changes of the cervical spine

53
Q

What are the key identifiers of mechanical pain?

A
  • Pain onset is usually marked by trauma
  • Consistently vary based on time of day, and associated activities with assumption of specific postures, movements and activities
54
Q

What are the usual pain descriptors of vascular disorders?

A

– Throbbing
– Pounding
– Pulsating

55
Q

What are the usual pain descriptors of neurologic disorders?

A

– Sharp
– Lancinating
– Shocking
– Burning

56
Q

What are the usual pain descriptors of visceral disorders?

A 
–  Aching,
–  Squeezing 
–  Gnawing 
–  Burning
–  Cramping
57
Q

What are the symptom history questions that are important to acquire from a patient?

A
  • Identify actual date of onset of most recent episode and work backwards chronologically
  • Identify mechanism of injury
  • Compare and contrast current and events
58
Q

What behaviors and patterns of a pt’s symptoms are of note?

A
  • Rest
  • Activities
  • Time of day (morning, midday, evening, or night) Positions and postures
  • Constancy
  • Frequency
  • Duration of symptoms
  • Fluctuations in intensity
  • 24-hour behavior
59
Q

What are the follow up questions to ask if a patient complains of night pain?

A
  • How many nights per week?
  • Is there a consistent time when you wake up?
  • How does the intensity of the night pain compare with the pain experienced at other times of the day
  • What do you have to do to fall back asleep?
60
Q

What are the interactive components of a patient-centered interview?

A

Exploring the patient’s disease/diagnosis and its
effect on his or her life.
• Understanding the whole person.
• Finding common ground regarding intervention or
management.
• Advocating prevention and health promotion.
• Enhancing the patient-provider relationship.
• Providing realistic expectations.

61
Q

What are the dimensions of the illness experience of a patient?

A
  1. Patient profile
  2. Patient’s goals
  3. Functional limitations
  4. Patient’s perception about the disorder
  5. Patient’s feelings
    about the disorder
62
Q

What are the goals of acquiring a patient’s history?

A
  1. Establishing rapport
  2. Identifying any barriers to communication
  3. Identifying the patient’s
    preferred learning style
  4. Establishing the patient’s goals for physical therapy
  5. SINSS
63
Q

What are some general communication strategies to utilize with your patient?

A
  1. Ask one questions at a time.
  2. Periodic restatement or summarization.
  3. Avoid medical jargon.
  4. Use patient’s line of thought.
  5. Avoid assumptions.
  6. Self-assessment.
64
Q

What are some strategies to use while working with patient with hearing deficits?

A
  1. Utilize a quiet area for the interview
  2. Patient should use hearing and visual aids when available
  3. Clinician should allow lip reading.
  4. Use of interpreter may be needed.
65
Q

What are the common manifestations of an angry patient?

A
  • Obvious
  • Use of sarcasm, cynicism, or negativism
  • Lack of compliance
  • Non-verbal forms of communication
66
Q

What are the things to be cautious of when working with an angry patient?

A
  • Patient tensely moving to the edge of the chair
  • Patient tensely gripping the arm rests
  • Loud, forceful speech
  • Restless agitation, pacing, and inability to sit still
67
Q

What are the common manifestations of a depressed patient?

A
  1. Impaired concentra+on.
  2. Poor compliance with home instructions.
  3. The clinician should acknowledge the situation.
  4. Explore potential reasons.
  5. Recognize potential for suicide.
68
Q

Specific training on patient-centered care, empathy, and humanism leads to..?

A 
– Improved patient	satisfaction	
– Improved clinician	satisfaction	
– Patient	outcomes	
– Diagnostic efficiency	
– Decreased malpractice claims

Advanced clinical practice: examining the complex patient (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions