Flashcards in Lecture 02-Review Of Systems Deck (32)
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?
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
- “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
-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)
-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?
-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
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
The endocrine system
-note; if the endocrine system is involved, if effects everything => changes in hormone levels will have a negative impact on homeostasis