EEO Midterm - Intro + Subjective Lecture

Question 1

Body language makes up what percentage of communication?

Answer 1

55%

Question 2

If a patient has low back pain, what is the proper way to seat them?

Answer 2

With their back supported and feet flat on the floor

Question 3

What is the biopsychosocial model?

Answer 3

A framework for assessing patients based on how their body works (biology), what their mindset is (psychology) and what their environment is (social).

Question 4

When should you use open-ended questions? What are the drawbacks?

Answer 4

Use:
-at the beginning of the eval
-when a patient has a hard time opening up

Drawbacks:
-Can take up too much time
-patients can give over-the-top answers

Question 5

When should you use closed-ended questions? What are the drawbacks?

Answer 5

Use:
-To clarify answers from open-ended questions
-to obtain specific information
-to narrow down a talkative patient

Drawbacks:
-can “cut off” a patients response
-potentially limits knowledge you would get form an open-ended question

Question 6

When should you use graded-response questions? What are the drawbacks?

Answer 6

Use:
-to quantify a patient’s experience
-to clarify obscure answers like “a lot”

Drawbacks:
-have to ask follow-up questions

An example would be a pain scale from 0-10

Question 7

When should you use multiple-option questions? What are the drawbacks?

Answer 7

Use:
-when patients have difficulty coming up with a description
-When trying to clarify information
-To help a patient remember

Drawbacks:
-can be used as a shortcut and become a bad habit

Question 8

Aching pain

Answer 8

Muscular problem

Question 9

Burning pain

Answer 9

Neural or muscular problem

Question 10

Shooting, lightning, or electrical pain

Answer 10

Nerve root irritation

Question 11

Coldness

Answer 11

Lack of blood flow

Question 12

Hotness

Answer 12

Localized inflammation or infection

Question 13

Clicking, snapping, or popping

Answer 13

Ligament or tendon dysfunction

Question 14

Joint locking

Answer 14

Cartilage tear, loose body, or joint malalignment

Question 15

Global weakness or fatigue with no clear pattern

Answer 15

Cardiovascular dysfunction

Question 16

Whole body pain

Answer 16

Central somatization, or “chronic pain”

Question 17

What five areas in the interview help to find out the chief complaint/s?

Answer 17

-Onset
-Description
-Location
-Intensity
-Behavior

Question 18

Joint paint or stiffness that is worse in the morning is indicative of what?

Answer 18

An inflammatory condition like RA. RA will affect the whole body!

Question 19

Joint pain that is fine in the morning but gets worse with activity is indicative of what?

Answer 19

Degenerative diseases like OA. OA will only affect specific joints

Question 20

Back pain that is worse in the morning but better after a few hours is indicative of what?

Answer 20

Disc pathology

Question 21

Pain that varies throughout the day or with changes in activity or position is indicative of what?

Answer 21

Muscular issues

Question 22

Constant, intense pain that gets worse in the night and waking up without relief is indicative of what?

Answer 22

Malignancy. Red flag!

Note: For some conditions, like a rotator cuff tear, in the night the patient may be less distracted from pain, so it may. not actually be malignancy ¯_(ツ)_/¯

Question 23

Why is sleep health important?

Answer 23

-Sleep disorders are associated with increased risk for chronic pain, HTN, DM, obesity, depression, heart attack, and stroke
-Sleep impairments are a strong predictor of pain
-Poor sleep = poor recovery

Question 24

What is pain neuroscience education? (PNE)

Answer 24

Essentially asking a patient how often they think about their pain, and what are their thoughts towards their pain.

Patient’s reactions to pain can make the condition worse! PNE tries to adjust the patient’s mindset to reduce the negative impact of the injury or condition

Question 25

What is question funneling?

Answer 25

Only ask questions if they confirm something. Ex. If patient says that they have fallen in the past 6 months, ask more questions about falling.

Question 26

True or false. Referred pain is reproduced with movements or position changes.

Answer 26

False! It is NOT reproduced with these changes

Question 27

True or false. Finding one red flag during the evaluation is a cause for immediate medical attention.

Answer 27

False! They should be fine. Probably ¯\_(ツ)_/¯

Question 28

Red flags that require IMMEDIATE medical attention

Answer 28

-anginal pain not relieved in 10-20 minutes -patient w/ angina who has nausea, vomiting, or profuse sweating -patient with DM who is confused, lethargic, changes in mental alertness and function -Onset of incontinence or saddle anesthesia -Anaphylactic shock symptoms (hives, asthma, tachycardia, hypotension, etc.)

Question 29

What does a yellow flag represent?

Answer 29

Something atypical with presumed condition but doesn't need immediate investigation or action Cognitive or psychosocial risk is a yellow flag!

Question 30

What are the ABC'S of a radiographic evaluation?

Answer 30

A = Alignment -General skeletal architecture and alignment with nearby bones. Ex. would be dislocation of a bone B = Bone density -also texture abnormalities, like osteoporosis or bone tumors C = Cartilage spaces -joint space width and presence of epiphyseal plates S = Soft tissues -fat pads and joint capsules

Question 31

What are some considerations for a patient's prior level of function?

Answer 31

-Helps to determine what interventions to do and what will motivate the patient -Helps to understand patients goals -Helps to create realistic a expectation or prognosis for therapy

Question 32

Why is it important to note a patient's current level of function?

Answer 32

-It helps to establish a baseline for therapy -Important for documentation and insurance purposes

Question 33

What mental health screen should be performed in every evaluation?

Answer 33

Depression screen

Question 34

What does AOx3 mean?

Answer 34

Alert orientation x 3 Patient knows: -Who they are -Where they are -What year/month we are in

Question 35

What question should be included at the end of an evaluation?

Answer 35

"Is there anything else you would like to share with me?" Also double check to make sure you recorded everything accurately!

Question 36

Questions to ask for follow-up appointment

Answer 36

1. How did the patient tolerate the first day of therapy? 2. Any changes since I last saw you? 3. Have you been doing your HEP? 4. Reassess the pain scales

Question 37

How often is a re-evaluation done for a patient?

Answer 37

About every four weeks of PT. Can be done sooner or later though

Question 38

What questions should you ask a patient during a re-evaluation session?

Answer 38

-Ask about perceived improvement and put on a 0-100% fully recovered scale -ask about their goals and update accordingly -update pain numbers -give self-report outcome measures again -update HEP (progressively more difficult) -update/modify the POC

Question 39

What is motivational interviewing?

Answer 39

Asking the patient from their perspective of what they need to recover. Basically trying to get the patient to be invested in their recovery and increase participation. Can also ask them why they believe they are NOT improving. Ex. "I noticed you answered 50% improvement since the start of physical therapy visits. I would love to hear from your perspective what is left to get you to 90%."

Question 40

What is considered the cutoff value to discharge a patient based on their goals?

Answer 40

If a patient hits 90% of their goals, they can be discharged.