Exam 1-- week 1-2

Question 1

Characteristics of Primary Care

Answer 1

Comprehensive
Coordination
Continuity
-safe
-effective
-timely
-efficient
-equitable
-patient-centered

Question 2

Characteristics of Secondary Care

Answer 2

Consultative
Short term
disease oriented
assisting PCP
historically what PT was considered

Question 3

List of Primary Care providers

Answer 3

Family physicians/general practitioners
osteopathic physicians
general internists
nurse practitioners
physician assistants
physical therapists

Question 4

Family/Osteopathic Physicians/GPs

Answer 4

Graduation from med school
minimum of 3 years post-grad training
at least 1 month learning MSK conditions
Shadowing orthopedist/sports medicine

Question 5

General Internist

Answer 5

Graduate of med school
complete minimum of 3 years post-grad training
Focus of expertise in internal medicine (viscera)
Focus on chronic conditions–Cardiac disease, hypertension, diabetes, chronic pulmonary disease, etc.
(Treat mostly older population)
No requirement for training with orthopedist or SM to treat MSK conditions
knowledge of MSK conditions and treatment is limited

Question 6

Physician assistants

Answer 6

Two years of training
- 1 yr classroom
-1 yr rotations in various IP and OP clinical settings
BS and MS degrees
PAs never practice completely independently
clinical focus depends on supervising physician’s expertise

Question 7

Nurse Practitioners

Answer 7

Graduates of RN training program
length and focus of training is variable
Not typically a general practitioner–more focused on a specification
Generally VERY good primary care practitioners because of their background of patient-centered care and patient interaction

Question 8

Physical Therapists

Answer 8

Postgraduate degrees–BS > MS > DPT (as of 2016)
CAPTE accreditation
content required in basic science
general practitioners upon graduation
eligible to apply for post-grad residency programs and specialty certifications

Question 9

Physical therapy specialties

Answer 9

Cardiovascular and Pulmonary (CCS)
Clinical Electrophysiology (ECS)
Neurology (NCS)
Orthopedics (OCS)
Pediatrics (PCS)
Sports (PCS)
Women's Health (WCS)
Geriatrics
Oncology
Wound management

Question 10

T/F All 50 states have achieved some sort of form of direct access

Answer 10

True

Varying from Eval Only to unrestricted care

Question 11

Potential benefits of Primary Care PT

Answer 11

more efficient use of health care resources
care being delivered in a more timely manner
interdisciplinary collaboration

Question 12

US Army Model

Answer 12

Preparation for primary care practice
neuromusculoskeletal evaluation (triage model)
privileges
outcomes

Question 13

US Army prerequisites and competencies

Answer 13

National selection through military review board
strong academic background
adapt to variable clinic environments
commitment to serve
Advanced training in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and acute MSK injuries
Completion of ongoing CE

Question 14

Kaiser Permanente Model

Answer 14

Largest not-for-profit HMO in US
PT services are primary care in most regions
PTs work with medical providers
Outcomes

Question 15

Kaiser PT prerequisites and competencies

Answer 15

Strong foundation in orthopedic PT
4-6 years of OP PT
Required CE
competency in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and acute MSK injuries

Question 16

VA PT services and access

Answer 16

MSK, neuromuscular, integumentary, cardiovascular/pulmonary systems
PTs screen patients in the ED
primary care clinic– triage by a nurse
Direct: overweight patients or those who wish to improve their general health

Question 17

Mercy Model prereqs and competencies

Answer 17

strong foundation in orthopedic PT
demonstrated competency in differential diagnosis, diagnostic imaging, pharmacology, laboratory values common in primary care, and chronic MSK injuries
Ability to work in collaboration with medical residents

Question 18

Mercy Model educational program for medical residents

Answer 18

PT instructs medical residents in low back, neck, shoulder, and knee
Rotations
MSK examination performed by medical residents 
Case presentations--clinical reasoning
residents observe a PT
Benefits: 
enhanced use of resources
multidisciplinary approach
better utilization of resources
more efficient access

Question 19

Elements of the patient-centered interview

Answer 19

• exploring pt’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

Question 20

Dimensions of the illness experience

Answer 20

• patient profile
• patient goals
• functional limitations
• patient’s perception about the disorder
• patient’s feelings about the disorder

Question 21

Goals of patient history

Answer 21

• establishing rapport
• identifying any barriers to communication
• identifying the patient’s preferred learning style
• establishing the patient’s goals for physical therapy in addition to our functional based goals
• SINSS

Question 22

Communication strategies

Answer 22

• ask one question at a time
• periodic restatement or summarization
• avoid medical jargon
• use patient’s line of thought
• avoid assumptions
• self-assessment

Question 23

Keys for patients with hearing deficits

Answer 23

• utilize a quiet area for the interview
• patient should use hearing and visual aids when available
• clinician should position themselves to facilitate lip reading
• use of interpreter (ASL) may be needed

Question 24

Manifestations and cautions for angry patients

Answer 24

Manifestations:
-obvious
-use of sarcasm or cynicism
-negativity
-lack of compliance
-non-verbal forms of communication
-escalation
Be cautious:
-patient tensely moving toward edge of chair
-patient tensely gripping arm rests
-loud, forceful speech
-restless agitation, pacing, and inability to be still

Question 25

Signs of depressed patients

Answer 25

- impaired concentration - poor compliance with home instructions - clinician should acknowledge the situation - explore potential reasons - recognize potential for suicide

Question 26

Important keys to a thorough exam

Answer 26

1. differential diagnosis 2. safe delivery of physical exam 3. review patient's list of medications 4. assess potential impact of co-morbidities

Question 27

Patient health history data

Answer 27

1. patient demographics - age, sex, race, marital status, level of education - Body chart 2. social history - cultural customs, religion, occupation, living environment, family/social support 3. current medical situation 4. past medical history--illness, allergies, surgeries, injuries, medications 5. social habits - exercise frequency/intensity, use of tobacco, alcohol, caffeine 6. family medical history

Question 28

CAGE (questions for alcoholism)

Answer 28

have you ever felt you should Cut down on your drinking? have people Annoyed you by criticizing your drinking? have you ever felt bad or Guilty about your drinking? have you ever had a drink first thing in the morning to steady your nerved or get rid of a hangover? (Eye-opener)

Question 29

presentation of caffeine withdrawal

Answer 29

``` headache lethargy fatigue dysphoric mood muscle pain/stiffness ```

Question 30

Pertinent documents for health history information

Answer 30

medical records patient self-reports screening questionnaires

Question 31

Do not want to miss list

Answer 31

``` major depression suicide risk femoral head/neck fracture cauda equina syndrome cervical myelopathy AAA DVT PE atypical myocardial infarction ```

Question 32

Clinical manifestations of major depression

Answer 32

Yes to one/both of the following: 1) felt down, depressed or hopeless and/or 2) little interest or pleasure in doing things Noting 3-4 of the following: 1) significant weight change, 2) insomnia or hypersomnia, 3) psychomotor agitation, retardation, 4) fatigue, 5) feelings of worthlessness and/or guilt, 6) difficulty concentrating, thinking ot 7) recurrent thoughts of suicide

Question 33

risk factors associated with major depressive disorder

Answer 33

- current or previous history of major depressive episodes - women, especially during pregnancy or postpartum - significant medical history such as DM, MI, cancer, CVA, chemical dependency - suffering from significant loss - positive family history from immediate relative

Question 34

common risk factors associated with suicide

Answer 34

- gender (males higher completion rate, females higher attempt rate) - widowed, divorced, living alone - history of psychiatric illness - previous suicide attempts - history of chronic progressive illness - recent significant loss - unemployment - sense of hopelessness - family history of suicide completion or attempt

Question 35

risk factors for femoral fractures

Answer 35

- female - hormonal menstruation irregularities - involvement in running, jumping, marching activities - change in training program or routine - nutritional deficiencies - leg length discrepancy - diminished muscle strength - loss of general function and mobility

Question 36

clinical manifestations of femoral neck/head fractures

Answer 36

- pain and local tenderness - deformity - edema - ecchymosis - loss of general function and mobility

Question 37

what % of those suffering a hip fx die within a year?

Answer 37

30%

Question 38

disorders that may compromise bone density

Answer 38

``` chronic renal failure GI malabsorption rheumatoid arthritis ankylosing spondylitis hyperparathyroidism hypogonadism T2 DM MS chronic alcohol dependency Cushing's syndrome ```

Question 39

medication/substance use or abuse that may compromise bone density

Answer 39

``` aluminum anticonvulsants corticosteroids cytotoxic drugs excessive thyroxine heparin, warfarin (coumadin) methotrexate caffeine (> 3 cups daily) tobacco soft drinks ```

Question 40

risk factors for cauda equina syndrome

Answer 40

``` low back injury, central disk herniation congenital or acquired spinal stenosis spinal fx ankylosing spondylitis tuberculosis, Pott's disease ```

Question 41

clinical manifestations of cauda equina syndrome

Answer 41

``` urinary dysfunction bowel dysfunction sexual dysfunction sensory deficits (perineum, "saddle" region, LE paresthesia) motor deficits (LE--multiple spinal levels) ```

Question 42

risk factors for cervical myelopathy

Answer 42

spondylotic changes in cervical spine Age mid 50-60s and older previous neck trauma (MVA, sports injury) rheumatoid arthritis

Question 43

clinical manifestations of cervical myelopathy

Answer 43

``` History: -impaired hand dexterity -gait, balance difficulties -numbness/paresthesia in UE/LE -neck stiffness -urinary dysfunction physical exam: -hand--intrinsic atrophy -muscle weakness, often triceps; hand intrinsic -muscle weakness of LE -UMN signs (hyperreflexia, clonus,, Babinski's, Hoffman's) ```

Question 44

Risk factors of Abdominal Aortic Aneurysm (AAA)

Answer 44

``` Age male hx of smoking hypercholesterol hx of coronary heart disease family hx of AAA ```

Question 45

clinical manifestations of AAA

Answer 45

usually asymptomatic, but may produce pain in lumbar region, back, hip and buttock, groin, abdominal region satiety, weight loss, and nausea palpable abdominal mass

Question 46

Signs of AAA vessel dissection

Answer 46

``` LBP described as: sudden, severe intense, persistent hot, searing ripping or tearing sensation *medical emergency* ```

Question 47

risk factors for DVT

Answer 47

``` previous hx of DVT hx of cancer or chemotherapy hx of CHF hx of SLE major surgery or other trauma immobility hormone changes in women age > 60 yrs ```

Question 48

clinical manifestations of DVT

Answer 48

ache, tightness, tenderness general pitting edema prominent superficial venous plexus increased local skin temperature

Question 49

Modified Wells criteria for detecting probability of DVT

Answer 49

active cancer paralysis, paresis, recent immobilization of LE recently bedridden for 3 days or major surgery in last 12 weeks localized tenderness along deep venous system entire leg swollen calf swelling > or = 3 cm larger than asymptomatic side pitting edema confined to symptomatic leg collateral superficial veins previously documented DVT alternative diagnosis at least as likely as DVT

Question 50

Risk factors of Pulmonary Embolism

Answer 50

``` previous hx of PE or DVT immobility hx of abdominal, pelvic surgery total hip or knee replacement late-stage pregnancy LE fx malignancy in pelvis or abdomen ```

Question 51

clinical manifestations of PE

Answer 51

``` dyspnea tachypnea pleuritic chest pain pain with respiration, cough persistent cough apprehension, anxiety tachycardia palpitations ```

Question 52

risk factors for atypical myocardial infarction

Answer 52

``` Modifiable: -smoking -high cholesterol -HTN -DM -obesity -sedentary -excessive alcohol non-modifiable: -age: >55 yr for women, >45 yr for men -family hx -ethnicity: highest in African Americans ```

Question 53

clinical manifestations of atypical MI

Answer 53

``` 50% experience chest pain with out without left UE pain shortness of breath fatigue sleep disturbance nausea with or without vomiting palpitations dizziness diaphoresis anxiety ```

Question 54

Descriptive words for vascular disorders

Answer 54

throbbing pounding pulsating

Question 55

descriptive words for neurologic disorders

Answer 55

sharp lancinating shocking burning

Question 56

descriptive words for visceral disorders

Answer 56

``` aching squeezing gnawing burning cramping ```