Primary Care Week 1

Question 1

Dr. Arnold’s #1 most important question

Answer 1

Does the patient belong in front of me?

Question 2

Why is the need for primary care service increased and important? (3)

Answer 2

-population growth
-increased use of health care
-aging population

Question 3

How many days after initial evaluation can PTs in Texas treat?

Answer 3

10-15

Question 4

Benefits of primary care PTs (3)

Answer 4

-triage NMSK pts
-dec. health care costs for pts & providers
-inc. efficiency of care

Question 5

Primary Care PTs responsibilities (3)

Answer 5

-is the pt appropriate for PT
-does the pt require a referral to someone else
-does the pt require immediate/emergency care

Question 6

1st question that MUST be
answered prior to any others

Answer 6

(is the pt appropriate for PT?)
Do I a) refer b) refer & Tx c) Tx

Question 7

What are the 9 DO NOT MISS Items

Answer 7

1. Major depression
2. Suicide risk
3. Femoral Head & neck fx’s
4. Cauda equina syndrome
5. Cervical myelopathy
6. Abdominal aortic aneurysm (AAA)
7. Deep venous thrombosis (DVT)
8. Pulmonary embolism (PE)
9. Atypical myocardial infarction

Question 8

What % of PTs formally screen for depression

Answer 8

18%

Question 9

Inc risk of depression with a hx of ……. (6)

Answer 9

Hx of DM, MI, cancer, CVA, chemical dependency, 1st degree relative with depression

Question 10

2 question screen for depression

Answer 10

1. Over the past 2 weeks have you felt down, depressed or hopeless? AND/OR
2. Had little interest or pleasure in doing things?

Question 11

Suicide Risk Factors

Answer 11

-Hx of psychiatric illness
-unemployed
-family hx of suicide completion/attempts

Question 12

What was the 2nd leading COD in ages 10-14 & 20-34 y/o?

Answer 12

suicide

Question 13

Name some medicines/substances associated c compromised bone density

Answer 13

CS, anti-convulsants, cytotoxic drugs, blood thinners, aluminum, excessive thyroxine, methotrexate, caffeine, tobacco, soft drinks

Question 14

What risk factors are associated c fatigue fx’s

Answer 14

-female
-running, jumping, marching
-change in training/routine
-dec muscle strength
-nutritional deficiencies
-leg length discrepancy

Question 15

What test do you do first for a femoral head and neck fx?

Answer 15

patellar-pubic percussion test…. then do a fulcrum test

Question 16

Cauda Equina clinical manifestations

Answer 16

-urinary retention most frequently noted
-gait ataxia/poor balance
-legs ‘feel heavy/weak’
-onset of symptoms can be quick OR gradual

Question 17

Cervical Myelopathy is typically associated with ________ _________

Answer 17

c-spine spondylosis

Question 18

cervical myelopathy is the most common cause of what?

Answer 18

non-traumatic paraparesis & quadriparesis

Question 19

Take this time to review Slide 21 of Lecture 1A
AKA
The clinical manifestations of cervical myelopathy

Answer 19

Now name one neurologic compromise without looking

Question 20

AAA is distal to the renal arteries greater or equal to ___cm

Answer 20

3 cm; risk for rupture increases with 5-6cm

Question 21

Most pts w/ AAA are _____________

Answer 21

asymptomatic

Question 22

T/F Back pain AND early satiety are clinical manifestations of AAA

Answer 22

True

Question 23

Immobility, severe infection, central venous catheter are all risk factors for ?

Answer 23

DVT

Question 24

DVT results in (inc/dec) of local skin temp

Answer 24

Increase

Question 25

about ___% of individuals c DVT are asymptomatic in early stages

Answer 25

50%

Question 26

Can you name 4 Clinical Decision Rule for DVT characteristics without looking?

Answer 26

-Swollen leg -localized tenderness along distribution of deep venous system -active cancer -recently bedridden 3 days or longer (BONUS) recent plaster immobilization of LEs

Question 27

>_____% of deaths related to PE are potentially preventable if dx earlier

Answer 27

greater than 50%

Question 28

Pulmonary embolism is most associated with (4)

Answer 28

-DVT -embolism (3 types) ------air ------fat ------bone marrow

Question 29

> ____% of deaths related to PE are potentially preventable if dx earlier

Answer 29

>50%

Question 30

T/F Late-stage pregnancy AND chemo are risk factors for PE

Answer 30

False chemo is DVT risk factor

Question 31

Well's Criteria, name 3

Answer 31

-heart rate >100 bpm -surgery in past 4 weeks -cancer pts

Question 32

about ____% of women experience chest pain c MI

Answer 32

50%

Question 33

what is the leading COD in women at all ages?

Answer 33

cardiac death

Question 34

Potential Solutions for Future Directions of PT in Primary Care (5)

Answer 34

1. Formalize and master skills 2. Est. & maintain relationships w/ pts and providers 3. Decrease healthcare disparities through effective engagement 4. Research 5. Advocacy for unrestricted access

Question 35

How do you determine if a pt is appropriate for PT?

Answer 35

-examine & evaluate -quality data (VITAL) -use evidence-supported best tests and measures -integrate data for pt management

Question 36

What are the 2 questions asked to select the BEST tests and measures?

Answer 36

1. What are the psychometric properties of this test? 2. How well do the properties of this test relate to my clinical situation?

Question 37

A responsive test has the ability to detect ????

Answer 37

change over time IN the measured construct

Question 38

what are 4 common PT constructs?

Answer 38

-ROM/Flexibility -Muscle strength -Pain -Outcome Measures

Question 39

Contingency Table variables: true positive is represented by: false positive: false negative: true negative:

Answer 39

true positive is represented by: a false positive: b false negative: c true negative: d

Question 40

Sensitivity definition:

Answer 40

Given that the individual has the condition, probability that test will be (+)

Question 41

Sensitivity formula

Answer 41

a / (a + c)

Question 42

Specificity definition

Answer 42

Give that the individual does NOT have the condition, probability that test will be (-)

Question 43

Specificity formula

Answer 43

d / (b + d)

Question 44

(+) Predictive Value definition

Answer 44

Given a (+) test result, the probability that the individual has the condition

Question 45

(+) Predictive Value formula

Answer 45

a / (a + b)

Question 46

(-) Predictive Value definition

Answer 46

Given a (-) test result, the probability that the individual DOES NOT have the condition

Question 47

(-) Predictive Value formula

Answer 47

d / (c + d)

Question 48

Useful tests should produce (large/small/no) shifts in probability given a certain test result

Answer 48

large

Question 49

What values do likelihood ratios combine?

Answer 49

sensitivity & specificity values

Question 50

likelihood ratios are used to _______ _____ in probability given a certain test result

Answer 50

quantify shifts

Question 51

Positive likelihood ratio (LR+) definition & implication

Answer 51

Given a (+) test result, ↑ in odds favoring the condition Implication: w/ a (+) test, the ↑ the LR+, the more certain that the individual HAS the condition

Question 52

Positive likelihood ratio (LR+) formula

Answer 52

LR+ = sensitivity / (1 – specificity) (Ratio of True + rate to False + rate)

Question 53

Negative likelihood ratio (LR-) definition & implication

Answer 53

Given a (-) test result, ↓ in odds favoring the condition Implication: w/ a (-) test, the ↓ the LR- (i.e. close to 0), the odds that the individual has the condition is LESS

Question 54

Now's your chance to review the Guide to Interpreting Likelihood Ratios on slide 20 of Lecture 1B

Answer 54

You're doin fantabulous

Question 55

Pre-test Probability % is based on _______ &/or _________

Answer 55

based on clinical info &/or previous research

Question 56

What is the MOST powerful tool for quantifying importance of a particular test?

Answer 56

LRs

Question 57

Name 2 reliability measures of change.

Answer 57

MDC & MCID

Question 58

Should MDC exceed MCID?

Answer 58

NO silly; MCID should exceed MDC

Question 59

If your test is VERY reliable, your MDC value in that population should be (inc/dec)

Answer 59

decreased

Question 60

MCID definition

Answer 60

Minimal Clinical Important Difference: Smallest difference detected that represents an important improvement from the perspective of individuals w/ the condition

Question 61

In EBP, the diagnostic process is based on _________ & the revision of ___________

Answer 61

probabilities & the revision of probabilities

Question 62

What are the 3 psychometric properties of tests?

Answer 62

-reliability -validity -responsiveness

Question 63

What 3 common statistics are used to evaluate tests?

Answer 63

-sensitivity & specificity -predictive values (+) & (-) -likelihood ratios (+) & (-)

Question 64

systematic reviews and meta-analyses of RCTs. reviews must meet specific criteria and are detailed enough to replicate

Answer 64

1a: systemic reviews/MA

Question 65

a SINGLE RCT study with a NARROW CONFIDENCE INTERVAL: a group of pt randomized into experimental group and a control group. These groups are followed up with variables/outcomes of interest

Answer 65

1B:randomized controlled trials

Question 66

All pt died before a Rx available, now some survive Some pt died before a Rx became available, now none die

Answer 66

1C: all or none

Question 67

involves the identification of two + groups (cohorts) of pts, one which did recieve the exposure of interest and one which did not and following these cohorts forward for the outcome of interest or TWO + cohorts of pts that receive the same txt

Answer 67

2A: systematic review of cohort studies