Clinical Assessment Flashcards
(123 cards)
1
Q
Define diagnosis
A
A term denoting the disease or syndrome a person has or is believed to have
Identification and naming of a disease
2
Q
What are some ways to gather information in order to make a diagnosis?
A
Identification of a disease by history, physical examination, laboratory studies, and radiological studies.
3
Q
What act are diagnosis protected under?
A
Regulated Health Professions Act
4
Q
What is a requirement in order to be permitted to give a diagnosis?
A
Professions able to communicate a diagnosis have access and training to interpret diagnostic tests.
5
Q
Define Assessment
A
An appraisal or evaluation of a patient’s condition
An educated evaluation of a clients condition and physical basis for their symptoms.
6
Q
What is the goal of an assessment?
A
A means to fully understand that patients problems, from the patients perspective as well as the clinicians, and the physical basis for the symptoms that have caused the patient to complain.
7
Q
Define Impairment
A
Any loss or abnormality of psychological, physiological, or anatomical structure or function.
Impairment of the client’s body structure or function.
8
Q
What are some ways impairment occurs?
A
Medical condition, Pathology or injury
9
Q
Can an impairment be treated using a wellness model of care?
A
Yes
10
Q
What are the 5 reasons it is required we assess?
A
- Safe treatment plan
- Effective treatment plan
- Monitor progress/ effectiveness
- A means to communicate with other health professionals.
- Required by law
11
Q
What four things a therapist should know in order to carry out a safe treatment plan?
A
- Identify red flags (Serious underlying pathologies)
- Previous injury
- Medications
- Underlying health condition or pathology that may contraindicate the treatment.
12
Q
What information should be gathered in order to carry out an effective treatment?
A
- Identify clients goals
- Identify impairments
- Establish goals for treatment
- Facilitates treatment that has direction and intent
- ensures that you are treating the cause of the complaint, otherwise treatment will yield poor results.
13
Q
What are SOAP notes?
A
Soap notes are an acronym that stands for: Subjective information Objective Information Assessment Plan
14
Q
What information should be included in Subjective Data?
A
Patients perception of current symptoms
Health history
15
Q
If a client is returning for the second time what information should be collected to be put under subjective data?
A
Have their symptoms changed? and did they comply with self care.
16
Q
What information should be included in objective data?
A
Practitioners observations, testing, and physical findings.
17
Q
What are some ways to find objective data?
A
Postural observations
Palpation
Functional/ROM testing and special orthopedic tests
18
Q
The assessment portion of the intake process should include?
A
- what you believe the cause of the complaint to be
- an interpretation of the subjective & objective data
- concise statement that can include more then one finding.
19
Q
Your interpretation of the subjective and objective information in student clinic would be known as?
A
A clinical impression
20
Q
The planning portion of the intake process should include?
A
- What the therapist will do to treat the problem
- Treatment aims/ goals are stated along with the strategies to attain them.
- Techniques used i.e type of massage, stretching, TrT therapy, self care, hydrotherapy, client education)
- what structure those techniques were applied to and for how long
- number and frequency of future treatments & when to re-examine.
21
Q
What are the 6 steps to the evaluation process during intake?
A
Step 1: Conduct Subjective Examination
Step 2: Generate preliminary Clinical Hypothesis
Step 3: Conduct Objective Examination
Step 4: Confirm the clinical Hypothesis
Step 5: Summarize Clinical Findings
Step 6: Determine Appropriateness for Treatment
22
Q
What is involved in conducting a Subjective examination?
A
- Determine if there is a specific diagnosis
If so ask relating questions to the diagnosis
23
Q
What happens if while conducting a subjective examination no prior diagnosis has been given?
A
elicit general information that serves to clarify the presenting problem and suggest a clinical diagnosis.
24
Q
What is involved when conducting an objective examination?
A
- Observe Client
- Select Tests & Measures
- Examine the client
25
Generally what sequence should an assessment protocol follow?
1. Case History
2. Observation
3. Palpation
4. Rule outs
5. Functional tests
6. Special Tests
7. Muscle Tests
8. Neurological Tests
9. Joint Play examination
10. Lesion site palpation
26
Which tests of the assessment protocol involve ROM/ AF/ PR/ AR?
Functional tests
27
What are the 8 guide lines of clinical assessment?
1. Observe bilaterally
2. Test unaffected side first
3. Do the most painful test last
4. If pain is reported during a test stop and identify location and nature of the pain.
5. Take a thorough case history
6. Always support the limp in a secure neutral position
7. Rule out the proximal and distal joints
8. Be aware of referred pain
28
Describe the position High seated?
Hips and knees are at 90 degree flexion
29
Describe Long seated position?
Hips at 90 degree flexion, knees extended
30
Describe the position Hook lying?
Supine, hips at 45 degrees flexion, knees at 90 degree flexion
31
Is it ever ok to ask closed ended questions?
Yes at times it will help you gather important information and keep the interview focused.
32
What general information should be gathered during the intake?
```
Presenting Complaint
General Health
Occupation
M.D & Meds
Previous Injury
Pain
Function
Therapies
Current Symptoms
```
33
What are the two types or causes of pain?
Inflammatory
| Mechanical
34
What causes pain during an inflammatory response?
Pain results from chemical irritants of inflammation
| Pain as a result of swelling
35
What causes a mechanical response to pain?
Pain results from the stretch or compression of pain and sensitive structures
These structures contain nociceptors, when they are stimulated, produce painful sensations.
36
Define Acute pain?
Pain provoked by a harmful stimulation produced by injury or disease
37
Define chronic pain?
Pain that persists beyond the usual course of healing
38
Chronic pain syndrome?
A clinical syndrome in which clients present high levels of pain that is chronic in duration.
39
Define neurogenic Pain?
Pain as a result of non inflammatory dysfunction of the peripheral or central nervous system that does not involve nociceptors stimulation or trauma
40
Define referred Pain?
Pain that is felt at another location of the body that is distant from the tissues that have caused it.
41
Why does referred pain occur?
occurs because the same or adjacent neural segments supply the referred site
42
Radiculopathy is also know as?
Radicular or nerve root pain
43
What is radiculopathy?
Pain that is felt in a dermatome, myotome, or sclerotome
44
What does radiculopathy involve?
Spinal nerve or nerve root
45
What is a dermatome?
an area of the skin supplied by one dorsal nerve root
46
What can cause dermatome pain?
Injury can cause sensory alteration to the skin, or pain (usually burning or electric)
47
What is myotome?
A group of muscles supplied by one nerve root
48
What is sclerotomal?
An area of bone or fascia innervated by a nerve root.
49
Define visceral pain?
Pain that can be felt in a dermatome as a result of visceral injury
50
What is trigger point pain?
referred pain arising from a trigger point
51
What are some pain syndromes untreated trigger points can cause?
radiculopathy
tension headaches
frozen shoulders
tennis elbow
52
What does the acronym LOFDSAQ stand for?
```
Location
Onset
Frequency
Duration
Severity
Aggravating/ relieving
Quality
```
53
What is Peripheralization?
As lesions worsens, the area of pain enlarges and moves distally from the original lesion this is known as peripheralization
54
As the pain resolves it becomes more localized this is known as?
centralization
55
What does it mean when pain is coming from a local area?
Usually indicates a lesion to a superficial structure such as muscles or tendons
56
What does it mean when pain is diffused?
Pain that is not coming from one localized area
57
What kind of injuries can cause diffused pain?
```
Injury to a deep neural somatic structure
Joint subluxation or dislocation
Severe hematoma
Fractures
Trigger Points
```
58
What are some questions that need to be answered when it comes to onset?
Was there a mechanism of injury (MOI)
| How quickly did the pain or dysfunction begin
59
What does insidious onset mean?
It means it happens gradually
60
When someone reports of experiencing pain in an area all the time what might that indicate?
Usually indicates a severe injury or still in an active inflammatory state
61
When do ligaments cause pain?
When they are overstretched
62
When do muscles cause pain?
When contracted or stretched
63
What can sometime cause pain in the morning?
Sometimes caused by adaptive shortening
64
What does pain and stiffness in the more sometimes indicate?
Intrascapular swelling that builds overnight due to inactivity
65
Pain at night often indicates?
suggest inflammation due to overuse/ excessive stress
| Postural strain
66
What does pain during weight bearing often indicate?
Pain only with weight bearing suggests articular (joint surface) or muscular injury
67
What are three ways to measure the severity of pain?
Verbal pain scale
Visual Analogue scale
mild/ moderate/ severe
68
What is something to look for when discussing aggravating factors of an injury?
any specific movements or positions that reproduce the pain
69
When pain is associated with feeling sharp if frequently means that the pain typically is coming from what part of the body?
```
The Skin and fascia
Superficial muscle
superficial ligament
acute inflammation
periosteum (tennis elbow)
Radicular pain
```
70
When pain is felt as being dull it is usually coming from what part of the body?
```
Joints
deep muscle
Chronic muscles injuries
subchondral bone
chronic inflammation
deep or peripheral nerve
trigger points
reffered pain
```
71
When pain is felt as tingling or parasthesia it usually comes from?
Nerve injury
| Circulatory problems
72
What can cause numbness?
Can be caused by damage or impingement of nerve innervating a particular area.
73
What does the sensation of a twinge pain feel similar to?
plucking on a string
74
What can cause a twinge?
Could be due to a local injury to a muscle or ligament
75
What can cause snapping or clicking?
Can be caused by a tendon flipping over a bone, thickened bursa, meniscal tear, or synovial plica
76
What causes "grating"?
grating is most commonly caused by osteoarthritic changes to the joint
77
Sound of tearing during an injury may indicate what?
a muscle or ligament tearing
78
When a joint locks or catches what may this suggest about the injury?
That there is a loose body within the joint
79
What is a loose body?
Meniscal tear in which the part torn off stays within the joint capsule
80
When a joint gives way or is unstable what might this suggest?
severe joint injury damage especially to primary stabilizing ligaments
81
What causes popping in a joint?
caused by negative pressure within a tendon synovial sheath, a tendon flipping over a boney prominence, or possibly by rupture of ligament or tendon
82
When conducting an observation on a patient what are some things to look for?
```
Swelling
Altered function
Redness
Deformities
Imbalances
```
83
When palpating what is the most important T of the 4 T's?
Temperature
84
What are the four T's of palpation?
Texture
Tone
Tenderness
Temperature
85
When conducting rules what is a good starting point?
to assess the joints above and below the affected area
86
What is an active free test?
Amount of joint motion that can be achieved by the client during the performance of unassisted voluntary joint motion
87
What is an passive relaxed test?
Amount of joint motion available when an examiner moves a joint through its anatomical or physiological range, without assistance from the client, while the client is relaxed.
88
What is an active resisted test?
Used to determine the status of the contractile unit with the use of controlled isometric contractions, along the normal planes of movement of a given joint.
89
Resistance during an active resisted test should last for durations of how long?
5 seconds at a time
90
What range should your patient be in when conducting active resistance test?
Midrange
91
Which functional test typically should always be done first?
Active free test
92
How is the arrangement of testing done?
Most painful last
93
What kinds of tissues does passive testing engage?
Inert tissue and contractile tissue
94
What kinds of tissues does resisted testing engage?
engages contractile tissue only
95
What is the goal of functional testing?
To try and reproduce the pain/ dysfunction
96
What should be documented when conducting an active free test?
```
willingness to move the joint
clients mobility or available ROM
Amount of observable restriction
Pain
Quality of movement
Compensation
Noises
```
97
If a client comes in with a strained muscle what should be the order of testing?
Active free/ passive relaxed/ active resisted
98
If a client comes in with an injury to a ligament what should be the order of testing?
Active free/ Active resisted/ passive relaxed
99
How much force should be used during passive relaxed testing?
Enough force to determine the clients limitations
100
What does passive relaxed test test?
test the inert joint structures
101
What two tests can cause contractile tissue pain?
Passive relaxed and active resisted
102
What should be documented when conducting a passive relaxed test?
Hypermobility
Hypomobility
If, when, and where they feel pain
the end feel i.e bone on bone
103
what technique is used to feel the end feel or end range?
Over Pressure
104
What are Cyriax's six end feels?
1. Tissue approximation
2. bone to bone
3. Tissue Stretch
4. Muscle spasm
5. Capsular
6. Spring block
7. Empty end feel
105
what example off tissue approximation?
knee flexion
106
What is an example of bone to bone?
Elbow extension
107
What is an example of tissue stretch?
Internal rotation
108
What is an example of capsular?
Early stretch
109
What Cyriax notes four possible findings with resisted testing?
1. Strong and Painless
2. Strong and painful
3. Weak and painless
4. Weak and painful
110
What does strong and painless result from a resistance test usually mean?
1-2 degree muscle strain
| A minor lesion
111
What does weak and painless results from a resistance test usually mean?
Interruption of nerve supply/ compression syndrome
Complete rupture of a muscle tendon
Nerve torn off no pain
112
What does weak and painful results from a resistance test usually mean?
Partial rupture of a muscle tendon
| painful inhibition caused by pathology
113
What is Oxford Manual Muscle testing scale?
```
Rated 0-5
0 no contraction
1 slight
2 produce movement with gravity eliminated
3 overcome gravity
4 overcome some resistance
5 overcomes maximal resistance
```
114
When should palpation be performed?
at assessment points and through out the treatment
115
What questions should you be trying to answer while palpating?
```
What is the structure
what is the quality
how does it differ from others
how does this relate to clients history
How does the structure reflect clients function
```
116
What are the most common errors of palpation?
Lack of concentration/ too much pressure/ too much movement
117
What is a technique that can be used to asses the tissue when palpating?
Drag
118
What does turgor mean?
Fluid pressure
119
What is a physiological barrier?
range of motion of normal circumstances
| midrange is the range with least amount of resistance
120
What is a elastic barrier?
When tissue is passed its passive range
121
What is an anatomical barrier?
final resistance to normal range any further movement will cause damage to the tissue
122
What is a fasciculations?
They are localized subconscious muscle contractions that do not involve the who muscle
123
What does crepitus mean?
Clicks or crunchy
