INDIVIDUAL HEALTH EVALUATION

Question 1

During history taking, what are the main points that should be asked about?

Answer 1

Onset
Type
SIte
Pattern of pain
Pain radiation
Duration of symtpoms
Aggravating and relieving factors
Previous episodes
Associated symtoms
Weight loss
Muscle spasm
Red flags
Impact on daily functioning
Drug treatments
Risk factors

Question 2

What are some potential red flags for someone suffering with lower back pain?

Answer 2

Cauda equina syndrome
Spinal fracture
Cancer
Infection

Question 3

How should you take a history for someone with suspected sciatica?

Answer 3

Pain symptoms: onset, duration, location, radiation, character, progression, severity, aggravating and alleviating factors
Sensory and strength changes
Urinary retention?
A history of back pain or sciatica and any previous treatments
A history of malignancy
Recent trauma
Current medication and comorbidities
Work activities
Impact on family, social and work ability
Risk factors
Asssess for presence of red flags

Question 4

What are some risk factors for sciatica?

Answer 4

Smoking
Obesity
Occupation factors - whole body vibration, strenuous physical activities
General health and comorbidities
Older age
Genetic influences

Question 5

What are yellow flags?

Answer 5

Pshychological factors that afect a patient and their treatment
Beliefs, appraisals and judgements
Emotional response
Pain behaviour/coping
E.g.
Lack of support
History of depression
Innapproriate expectations regarding treatment and low expectations of active participation in treatment
High levels of stress
Belief that pain/activity are harmful
Sickness behaviours such as extended rest and/or avoidance of movement
Social withdrawal
Problems with claims or compensations or time off work

Question 6

What are red flags?

Answer 6

Specific attributes derived from a patient’s medical history and the clinical exam that are usually linked with a high risk f having a serious disorder like an infection, cancer r a fracture.

Question 7

What are some topics that should be covered when taking a history?

Answer 7

Introduction and explanation of the session
Presenting complaint
Aggravating and easing factors
24 hour pattern
Nature of pain
History of presenting complaint
Social history
Past medical history and general health
Drug history
Spinal red fags (eg questioning for cauda equina)
Other red flag questions
Concerns and expectations
Any other questions from the practioner and from the patient/chance to provide further information.

Question 8

What are orange flags?

Answer 8

Pshychiatric symptoms eg depression, anxiety, personality disorder

Question 9

What are blue flags?

Answer 9

Perceptions about relationships between work and health

Question 10

What are black flags?

Answer 10

System or contextual obstacles (insurance/injury claim, legislation restricting options for return to work)

Question 11

What is the SOCRATES aconym?

Answer 11

Site, onset, character, radiation, associations, time course, exacerbating and relieving factors, severity

Question 12

What steps should you go through when taking a history? abbreviations

Answer 12

HPC - history of presenting complaint
PC - present complaint
SOCRATES
PMH - past medical history
GH - general health
SH - social health
DH - drug history
SQs - special questions

Question 13

Name the sections involved in a physical examination?

Answer 13

Observation - to gain a general overview of how your patient sits, stands, lays and moves
Movement testing - specific test and observations to get a more detailed look at your patients range and quality of movement
Palpation - using touch to assess the patients join motion and muscle tone
Muscle function - specific tests to assess the strength or power of your patient
Neurological examination - tests which assess the integrity of your patients sensory and motor pathways
Functional tests - bespoke replications of the specific everyday tasks that your patient reports troublesome
Cardiovascular/cardiorespitory examination - tests to assess your patient’s blood pressure and breathing function
Abdominal examination - using your hands to assess structures of your patient’s anterior torso.

Question 14

Give some examples of sensory tests (neurological)

Answer 14

Light touch
Pin-prick
Joint positioning

Question 15

Give some examples of motor tests (motor)

Answer 15

Muscle tone
Muscle bulk
Reflex
Muscle power

Question 16

What is overpressure?

Answer 16

A passive range of movement which excedes its available range

Question 17

What is end feel and end of range?

Answer 17

End feel - a type of sensation or feeling that the examiner experienced when the joint is at the end of its available passive range of motion in assessment
End of range - the point where a joint cannot be moved any further actively or passively.

Question 18

What is hypertension?

Answer 18

High blood pressure.
Blood pressure is recorded with 2 numbers: the systolic pressure is the force at which your heart pumps blood around your body. The diastolic pressure is the resistance to the blood flow is the blood vessels between heart beats (when the heart is at rest)
They are both measured in mmHg (milimetres of mercury)
High blood pressure is considered to be from 140/90
Normal blood pressure is considered to be 90/60 and 120/80.
If you have high blood pressure, there are some associated risks:
- heart disease, heart attacks, stroke, heart failure, aortic aneurysms, kidney disease, vascular dementia

Question 19

What does SOCRATES stand for?

Answer 19

Site
Onset
Character
Radiation
Associated symptoms
Time course
Exacerbating and relieving factors
Severity

Question 20

What is the medical research council dyspnea scale?

Answer 20

1 - breathless during strenuous exercise onlu
2 - breathless when hurrying or walking up a slight incline
3 - walks slower than people of the same age due to dyspnea
4 - pauses for breath after walking 100m
5 - too breathless to leave the house, or breathless when dressing

Question 21

What should be asked in a systems review in a respiortiory history taking?

Answer 21

Cardiovascular eg chest pain, palpitations
Gastrointestineal eg dyspepsia, nausea/vomiting
Genitourinary - oliguria, polyuria
Neurological - visual disturbance, sensory symptoms, headchae
MSK - joint pain
Dermatological - rashes

Question 22

What does ICE stand for?

Answer 22

Ideas - what do you think the problem is
Concerns - is there anything that’s worrying you
Expectations - what were you hoping I would be able to do for you today
Fluid throughout the history taking, natural

Question 23

What are the catergories of medications you might come across when taking a drug history for cardiorespitory diseaes?

Answer 23

Inhalers - beta 2 agonists, muscarinic antagonists, inhaled steroids
Oral steroids - prednisolone
Theophylline -
Mucolytics
Leukotriene receptor antagonists
Antibiotics

Question 24

What is dyspnoea?

Answer 24

The subjective wareness of the sensation of uncomfortable breathing
Mechanisms - respiratory, acrdiac, deconditioning, anaemia, obesity

History:
onset, duration and timing, what are they unable to do, orthopneoa (pillow number), paroxysmal nocturnal factors, the modified medical research council dyspenoea scale

Question 25

Questions regarding coughing during history taking?

Answer 25

Acute, sub acute, chronic Proublesome/peristsant Morning or nocturnal After eating or drinking Stress inconinence Dry/productive Sound - weak, barking, bovine Rib fractures, hernias Some causes of cough: - acute infection chronic infection nasal/sinus infection parenchymal disease irritant pleural disease cardiovascular gastrointenstineal central nervous system drug induced

Question 26

Questions about sputum during the history?

Answer 26

Amount and description Colour Conistency Quality Odour Haemoptysis Examples: Clear = normal White = chronic bronchitis without infection Slightly discoloured - cyctic fibrosis, bronchiectasis Thick, yellow, dark green, brown, rusty = infected, pseudomonas, haemophilius Pink or white - pulmonary odema Blood - infection, carcinoma, vasculitis, trauma, coagulation disorders Black - smoke inhalation, coal dust

Question 27

Questions to ask about wheezing during a history?

Answer 27

A wheeze is the muscial sound produced by turbulent flow through narrow small airways Aggravtaing factors eg allergies, exercise, dust or pollen Medication Stridor Home circumstances eg birds, feathers, exposure to allergens Relieving factors Severity

Question 28

Questions to ask about chest pain during a history?

Answer 28

Pleuritic pain - inflammation of the perietal pleura, severe, sharp, stabbing on inspiration. Not produced on palpation MUSK (chest wall pain) - from muscle, bone or joints. Often caused by chronic coughing or fractured ribs. Palpation of chesk and/or arm movement often increases the pain NB constant pain - pleural infection or malignancy Angina - major symptoms of cardiac disease. Dull, central retro-ternal gripping sensation that radiates into the jaw, arm and neck Trachetis - (narrowing of the upper respiritory tract) burning central chest pain on breathing Gasto-oespholgal reflex disease (GORD) - heartburn Chest pain can lead to reduced ventilation (hypoventilation) and retained secretions.

Question 29

What should one look for during the observation of the respiritory system?

Answer 29

Pallor (anaemia) Central cyanosis Hypercapnic flush Engorged neck veins Accessory muscles of respiroation active Pursed lip breathing Respiratory rate Inspiration to expiration ratio Chest shape (Barrel COPD, kyphosoliosis, pigeon shaped, pectus excavatum), scars Breathing pattern Peripheries - cyanosis, clubbing, temors/flap, nicotine stains, sputum

Question 30

What should be palpated during a cardioresp examination?

Answer 30

Thoracic expansion Hi-Lo test Percussion note Hydration Tectile fremitis Surgcal emphysema Capillary refill Abdomen

Question 31

Discuss the different breathes sounds heard using a stethoscope?

Answer 31

Normal breath sounds (vesicular) - generated by turbulent airflow in the proximal airways, shorter and softer expiration than inspiration Bronchial - a hollow blowing phase, long expirtaory phase, inspiration equal to expiration in duration Diminished breath sounds Wheeze - caused when the bronchus is narrowed to the point of closure, characterised by muscial high pitched noises, bronchospasm, tumour Pleural rub - low pitched, creaky, leathery sounds, roughening or inflammation if the pleural surfaces Stridor - caused by large airway or tracheal obstruction, loud musical note at a constant pitch.

Question 32

Explain the objective assessment for hip?

Answer 32

Observation Gait: pattern, ease of movement, pain, walking aids Posture: general comfort, soft tissues (muscle bulk/spasm/tone) Palpation (bony landmarks eg ASIS/PSIS/iliac crests, greater tonchanter) Active range of movement: flexion, extension, abduction, adduction, internal/external rotation Passive range of movement (same movement as active) Strength: flexors/extensors, abductors, adductors, internal/external rotators Special tests: FADDIR, Trendelenburg.

Question 33

Explain the objective assessment for the knee?

Answer 33

Gait: pattern, ease of movement, pain, walking aids Posture: general comfort, bony lnadmarks (patella, tibial tuberosity) Soft tissues (muscle bulk, spasm/tone) Palpation (joint line, tibial tuberosity, patella tendon, collateral ligaments) Active range of movement: flexion/extension, tibial internal/external rotation Passive range of movement Strength (flexors/extensors) Special tests: Ligaments - ACL/PCL and MCL/LCL Menisci - McMurrays, Thessalys Balance test, inverted Y

Question 34

What is osteoarthritis?

Answer 34

Causes the cartilidge in your knee to thin and the surfaces of the joint to become rougher, so the knee does not move as smoothly as it should.

Question 35

What are the Ottawa ankle rules?

Answer 35

1. Bone tenderness at the base of the fifth metatarsal OR 2. Bone tenderness at the navicular bone OR 3. An inability to bear weight both immediately and in the emergency department for four steps. If positive in any of these things, go for an xray as fracture risk 35% specificity (low)

Question 36

Describe the steps in an ankle and foot objective assessment?

Answer 36

Observation - gait, alignment, weight bearing, swell/bruise, deformity Vascularity - capillary refill, pulses Functional assessment - squatting, leg squat, heel raise, jump, hop, run Palpation - maleoli, collateral ligaments, achilles, calcaneus, medial arch, navicular tubercle, base of 5th metatarsal. Active range of movement - dorsi and plantar flexion, inversion, eversion Passive range of movement Goniometry Muscle strength - everters, invertors, toe strength Muscle length Neurological assessment Orthopaedic tests - anterior draw, talar tilt, thompson test, ottawa ankle rules Accessory glides - AP/PA, lateral glides, distal tib/fib, talo-crural, sub talar, talo navicular, mid tarsal, MTPs. Proprioception eg single foot eyes open and closed

Question 37

What are the early motor development stages for children during months 1-3?

Answer 37

No experience of gravity, light or sound Marked head lag when pulled supine to sit Random movement of extremities Little independent control of any body part Adopts fixed posture

Question 38

What are the early motor development stages for children at 3 months?

Answer 38

Head ;ag disappears Prone forearm propping Hips down Finger and hand play Supported standing, sags knees Independent head movement starts to activate balance response.

Question 39

What development has occurred up to 6 months for babies?

Answer 39

Hands to feet Good head control Prone to and from supine Palmer grasp and 2 hands to toy Held in stand will push up to floor with legs Good with strangers, but shyness emerges with new people Mouths everything Tuneful noises with vowel sounds Selective emotional response to familiar voices

Question 40

What development has occured at 9 months for babies?

Answer 40

Independent sitting (15 seconds) Rolling/crawling/crook lying Pulls to stand Manipulate toys Babies recognising key words Fixated with the wider environment.

Question 41

What development has occurred at 12 months for babies?

Answer 41

Lying to sitting independently Pull to stand Walking - high candence, walks with hands held, flat foot Crawling up stairs Deefing attempts, affection for family Babbling No dominant hand, pincer grip thumbs.

Question 42

What development has occurred at 15 months for babies?

Answer 42

Independent walk, independent to stand Controlled fall to descend Development of: kneeling, descent of stairs, fine precision grip Interested in what is happening around them Communicates what they want Helps with dressing, feeding using spoon Affectionate Physically curious, restless.

Question 43

What development has occurred at 18 months for babies?

Answer 43

Expert movers Confident walking Reducing base of support Carry objects whilst walking Run eyes down but no control Sits independently in small chair Squat to stand for toy Undress Favourite toys Plays Can get angry Emotionally dependent, clingy, resistent to being left.

Question 44

What development has occurred at 2-4 years for babies?

Answer 44

Running with stop/obstacles Evidence of spatial awareness Eye hand/ throw small ball Walks into ball for kick Sits on a small tricycle. Not great spatial awareness. Verbalising Demanding

Question 45

Why can we not think about children as mini adults?

Answer 45

Trauma and risk is different Fragility: internal organs are less well protected, developing skeletal system, hypotermia due to surface to volume ratio being high, burns faster and deeper. Metabolic rate is high in children, so CO2 levels are high (high RR, high HR, low systolic BP) Airway, narrow and lacks collateral ventilation, nose breath until 6 months Ribcage - poor support Endochondral ossification (replacement of hyaline cartilidge with bone) - structural points of weakness Nervous system is developing, and brain is fragile, synaptic connections developing Capacity to recover better than adult

Question 46

What are some stages of teenage brain development?

Answer 46

Proliferation - rapid growth of brain matter and formation of new connections within the brain Synaptic pruning - cutting away of unused or unimportant connections made in early childhood. Myelination - insulating the brain pathways to make them faster, more stable and strengthening the brain and its functions. Teenagers rely on limbic system whilst the prefrontal cortex develops

Question 47

Explain the order of brain development

Answer 47

Develops from the back to the front Limbic system (amygdala, hypothalamus, hippocampus) is well developed in childhood Pre frontal cortex develops last: impulse control and decision making, pros and cons, suppressing emotional urges, organising, rational thinking, social awareness, focus, working memory, impulsiveness, stronger reward response.

Question 48

Describe characteristics of the teenage brain during development?

Answer 48

Risk takers - poor compliance Self conscious - reluctant to engage Self absorbed - impatient Altered mood - communication difficulties Engage in high risk excessive behaviours Drive to be independent Ability to take in another person's perspective is developing.

Question 49

Explain considerations when assessing a child during the subjective assessment.

Answer 49

Subjective history - around 7/8 years a child can be involved. Check who is legal guardian, cultural considerations Child birth history, maternal history, family history, medical history, developmental history, parental concerns. Pshychological history: child express emotional states and certain behaviours, communications skills Age related questions: educational history, support level, services involved

Question 50

What physical assessment might be undertaken on a child?

Answer 50

ROM Developmental Tone Biomechanical alignment Strength Standardised assessment