The Patient History

Question 1

What information do you need to get out of a patient history (L.M.N.O.P.Q.R.S.T)

Answer 1

L: location of symptoms & level of functional impairment
M: medications & mechanism or injury
N: neurological symptoms
O: occupation including limitations
P: palliating & provocations symptoms
Q: quality of symptoms/pain
R: radiation of symptoms
S: severity of symptoms
T: timing of symptoms

Question 2

What to ask about location

Answer 2

• be specific about general or localized
• does it radiate
• does it move

Question 3

Questions to ask about level of functional impairment

Answer 3

• what does the patient avoid doing
• what activities have they adapted
• do the limitations or adaptations change based on level of symptoms

Question 4

What to ask about mechanism of injury

Answer 4

• when/how did it happen
• what position were you in
• was there a pop or click

Question 5

What is a red flag for mechanism of injury

Answer 5

• no incident or accident with onset severe pain or weakness

Question 6

What are some neurological symptoms

Answer 6

• numbness or tingling
• burning or electrifying
• constant or intermittent
• associated with position of the extremity/back

Question 7

What is a red flag for neurological symptoms

Answer 7

• glove or sock like numbness (i.e. multiple dermatomes)

Question 8

What to ask for palliating & provocation of symptoms

Answer 8

• what decreases the symptoms
• what increases the symptoms
• once aggravated how long does it take for the pain to calm down

Question 9

Red flag for palliating & provocation of symptoms

Answer 9

• are symptoms constant/unrelenting (verify with patient and if constant then it is probably not a musculoskeletal problem)

Question 10

Examples of quality of symptoms

Answer 10

• sharp
• dull
• stabbing
• ache
• electric shock like

Question 11

What to ask about radiating symptoms

Answer 11

• where do they radiate
• is it constant or is it provocative by activity/position
• how long does it radiate

Question 12

Red flag for radiating symptoms

Answer 12

• multiple dermatomes

Question 13

Red flag of severity of symptoms

Answer 13

• sudden onset of severe pain

Question 14

Red flag for timing

Answer 14

• interrupting sleep/worse at night
• constant

Question 15

List the constitutional symptoms (systemic)

Answer 15

• fever
• night sweats
• day sweats
• nausea/vomiting
• change in bowel & bladder habits
• weight loss
• fatigue
• sleep pattern changes
• syncope (faint feeling/dizziness/falls)
• shortness of breath
• changes in cognition/mental status