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Flashcards in Lecture 02-Review Of Systems Deck (32)
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What are the steps of the diagnostic process?

1. Identify the pt’s chief concern
2. Identify barriers to communication
3. Identify special concerns
4. Create symptom timeline
5. Create a diagnostic hypothesis list (remote + local pathology)
6. Sort the list by epidemiology and specific case characteristics
7. Ask specific Q’s to rule out specific conditions or pathological categories less likely
8. Re-sort the list based on pt’s response to Q’s from step 7
9. Perform tests to differentiate among the remaining diagnostic hypotheses
10. Re-sort the diagnostic hypothesis list based on the pt’s response to specific tests
11. Decide on a diagnostic impression
12. Determine the appropriate pt disposition


The following describes which part of the subjective examination/diagnostic process?
-series of checklists or questions of common symptoms relevant to major body symptoms
-not intended to identify or rule out specific diseases
-part of the subjective screening process (medical model for pre-examination screening)

The Review of Systems


What is the purpose fo the review of systems?

-identify symptoms that may have been overlooked
-identify symptoms related to a principle complaint
-identify existing co-morbid conditions
-identify occult disease
-identify adverse drug reactions (ADR)


When should a PT complete a review of systems?

-Pt’s medical history or health risk reveals several red flags
-unable to determine that the source of the symptoms is mechanical
-pt doesn’t respond appropriately to the developed POC
-something changes during the course of the treatment making it appropriate


What is screened during a review of systems?

-general health
-cardiovascular system
-pulmonary system
-gastrointestinal system
-genitourinary system
-nervous system
-endocrine system


True or False: the general health screen should be completed the screen that is most often completed in clinical practice.



When does fatigue become a red flag?

-it interferes with the pt’s ability to carry out typical daily activities at home, work, social settings, school, or rehabilitation
-it lasts for 2-4 wks or more


What is malaise and when does it become concerning?

Malaise = sense of uneasiness or general discomfort or an “out of sorts” feeling
-you should ask the pt if the feeling of malaise occurred at/around the same time that the pain began OR does the pt feel it after aggravating movement/factors
-malaise becomes concerning when there is no clear connection between it no the presenting problem


When does a fever become a red flag?

- 99.5 F (37.5 C) > 2 wks without seeing MD
- 102 F (39 C)


When is weight loss/gain concerning?

-if the pt has experienced unexplained weight loss/gain (5-10% of body weight) over the last 6 months
-note; weight gain is associated with fluid retention (seen with CHF)


When does nausea and vomiting become a red flag?

-if the physician is not aware
-if symptoms have worsened since the pt’s last visit
-if there is an unexplained cause

-note; consider going back 6 months in the pt’s history to discuss incidences of nausea and/or vomiting
-also note; headaches originating from the neurovascular system often involve nausea and vomiting while those originating from the MSK system typically do not


What can you ask a pt about concerning medications and experiencing dizziness/lightheadedness?

If the symptoms began within 4-6 wks of taking the medication(s).


Is a pt more likely to experience tunnel vision with lightheadedness or fatigue?



When does paresthesia and/or numbness become a red flag?

If the pt is experiencing
-“Stocking-and-Glove” distribution
- “Saddle” distribution
-progressive deficits such as urinary problems (retention, incontinence) and bilateral extremity deficits or UE/LE combination


If a pt presents with changes in mentation, their examination should include assessment of:

-level of consciousness (alertness)
-attention (ability to focus)
-memory (short-term vs long-term)
-orientation (person, place, time)
-thought process (logical and coherent)
-judgement (evaluate alternatives and follow appropriate values while choosing a course)


What are the definitions of the following terms?

-orthopnea = difficulty breathing when lying supine
-Trepopnea = difficulty breathing when in side-lying on one side, but then relieved when lying on the other side
-platypnea = difficulty when breathing upright

-note; platypnea is very rare and associated with some neurological diseases, S/P pneumonectomy


What is syncope?

A sudden loss of consciousness (fainting)


When is diaphoresis (excessive and unexplained seating) considered serious?

When accompanied by pain at the
-Neck, jaw, and teeth
-left shoulder
-epigastium or mid-thoracic


When is a cough considered to be “chronic”?

-lf it’s duration is > 3 wks
-can be associated with asthma, pneumonia, heart failure, lung cancer


What are some integumentary signs that can be assessed for as part of a screen of the cardiovascular system?

-cold hands/feet (poor circulation)
-open wounds (venous insufficiency, diabetes)
-ski discoloration (venous insufficiency, diabetes, poor circulation)
-hair loss

-note; having cold hands/feet + hair loss around the area + skin that is blue in color = concern, not just having cold hands/feet alone


Who is most at risk of developing a thrombosis?

The most significant clinical risk factors for development of a thrombosis are age over 70 and previous thromboembolism.


Where do DVTs most commonly occur in the body?

In the LEs
-popliteal and thigh veins = proximal
-tibial and calf veins = distal

-note; DVTs have the greatest occurrence in pt’s who have been recently immobilized, undergone surgery, and/or have had an MI


What does TIM VaDeTuCoNE stand for?



What are some things to assess for as part of a screen of the pulmonary system?

-Chronic cough
-clubbing of the nails (often accompanies cyanosis)
-edema (i.e., pulmonary hypertension)


___ is the loss of coordinated local muscle control that affects swallowing.

___ is also know as indigestion (the body may be unable to digest fatty foods, etc.)

-dysphasia: can be caused by MS, PD, stroke, etc.
-Dyspepsia: often associated with food intolerance and can cause heartburn symptoms (fatty foods => Gall Bladder disease)


With concern to the GI system, when is constipation considered a red flag?

When it occurs with a change in mental status or confusion.


__ is urination at night at least 2-3 times, which is a common complaint in diabetes mellitus.
__ = can a a sign of infection/irritation.
___ can be caused by blockage (prostate) or can be a central cord sign (spastic bladder).



The following problems concerning urination can be signs of what condition(s):
1. dysuria (painful urination)
2. reduced caliber or force of urination or difficulty initiating urine stream
3. incontinence
4. color (reddish or dark brown)

1. Inflammation, infection, and/or distension
2. Associated with obstructive disorders (enlarged prostate)
3. Central cord sign, pelvic floor dysfunction
4. Acute rhabdomyolysis, hydration


The following are clinical signs that the ___ system is pathological:
-muscle weakness and atrophy
-progressive joint degeneration
-altered cardio respiratory function
-changes in skin pigmentation
-changes in body temperature
-changes in reproductive function
-mental changes

The endocrine system
-note; if the endocrine system is involved, if effects everything => changes in hormone levels will have a negative impact on homeostasis


The following are signs of which thyroid condition:
-multi-region joint or muscle pain
-dry, scaly skin
-brittle hair and nails
-cold intolerance
-hoarseness of voice
-weight gain
-muscle weakness