Clinical Skills II Exam #1

What is the primary role of a physical therapist?

To diagnose and manage movement dysfunction and promote optimal physical functioning.

What three constructs define physical therapy practice?

Evidence-based practice, quality assessment and outcomes, and professional values.

What does the ICF model in physical therapy address?

It embraces all outside factors that can affect a medical problem, promoting a holistic approach to patient care.

What is the significance of the year 2008 for the ICF model?

It was adopted by the House of Delegates to enhance clinical practice, education, and research in physical therapy.

Define 'health condition' in the context of physical therapy.

Any health problem that an individual may experience.

What are 'impairments' in physical therapy?

Significant deviations or losses of function or structure in body systems.

What is meant by 'activity limitation'?

Restrictions in executing functional tasks, such as dressing or walking.

What does 'participation' refer to in physical therapy?

Involvement in life situations, such as work or social activities.

What are 'contextual factors'?

Environmental and personal factors that influence an individual's health and functioning.

What does the Patient and Client Management Model include?

Examination, referral/consultation, evaluation, diagnosis, prognosis, and intervention.

What is the purpose of the 'examination' phase in physical therapy?

To collect history, perform physical examinations, and conduct tests and measures.

What is the role of 'evaluation' in physical therapy?

To interpret examination findings to establish a diagnosis and develop a management plan.

What does 'SINSS' stand for in physical therapy assessment?

Severity, Irritability, Nature, Stage, and Stability of the condition.

How are physical therapy diagnoses different from medical diagnoses?

They are impairment-based and focus on movement impairments rather than medical conditions.

What is the goal of 'prognosis' in physical therapy?

To determine the predicted optimal level of improvement in function over a designated time frame.

What are SMART goals in physical therapy?

Goals that are Specific, Measurable, Achievable, Relevant, and Time-limited.

What types of interventions are used in physical therapy?

Neuromuscular re-education, gait training, therapeutic activity, manual therapy, and therapeutic exercise.

What is the purpose of 'outcomes' in physical therapy?

To reflect the efficacy of treatment interventions and demonstrate progress.

What is 're-examination' in the context of physical therapy?

The application of selected items from the initial examination to assess progress and adjust the management plan.

What should be done before conducting a patient interview?

Review pertinent information and observe the patient.

What is the importance of hand hygiene in physical therapy?

To reduce the spread of sickness and diseases.

What type of information is obtained during a patient interview?

Relevant demographic information such as age, sex, and education status.

What are procedural interventions in physical therapy?

Procedural interventions include various techniques such as neuromuscular re-education, gait training, modalities, therapeutic activities, manual therapy, and therapeutic exercise.

What does neuromuscular re-education involve?

Neuromuscular re-education involves techniques like electrical stimulation (estim) and LSVT BIG.

What is the purpose of gait training?

Gait training focuses on improving walking-related skills.

What are examples of modalities used in physical therapy?

Examples of modalities include treadmills and stairs.

What is therapeutic activity in the context of physical therapy?

Therapeutic activity involves working on functional skills such as bed transfers or picking up objects.

What does manual therapy encompass?

Manual therapy includes soft tissue work, mobilizations, and joint manipulation.

What is therapeutic exercise?

Therapeutic exercise refers to structured physical activities aimed at improving strength, flexibility, and overall function.

What are outcomes in physical therapy?

Outcomes are the actual results from the management plan that indicate the impact on functioning and reflect the efficacy of treatment interventions.

Why is re-examination important in physical therapy?

Re-examination is important to compare current findings with initial examination results and to assess progress towards short-term and long-term goals.

What are 'red flags' in patient assessment?

Red flags are symptoms that are associated with serious medical conditions and may require additional investigation or referral.

What are 'yellow flags' in patient assessment?

Yellow flags signal caution and indicate that while the situation does not warrant immediate investigation, it requires careful monitoring.

What should be included in the verbal review of systems?

The verbal review of systems should include questions about unexplained weight loss, fever, nausea, numbness, and other significant symptoms.

What is the purpose of establishing a patient's goals?

Establishing a patient's goals helps to align treatment with their expectations and desired outcomes.

What types of questions should be asked regarding current medications during a patient interview?

Questions should focus on how medications might affect the patient's condition and their experience during appointments.

What is the significance of understanding a patient's life and environment?

Understanding a patient's life and environment helps identify factors that may affect their mobility and overall health.

What should be assessed regarding pain location during an interview?

Patients should be asked to point to the pain location and describe if it radiates or moves.

What is the importance of the 24-hour pattern of pain?

Assessing the 24-hour pattern of pain helps understand how symptoms fluctuate throughout the day and their impact on sleep and activities.

What types of symptoms are associated with musculoskeletal issues?

Musculoskeletal symptoms may include joint pain, swelling, stiffness, muscle weakness, and pain that does not change.

What are common symptoms to inquire about for cardiovascular/pulmonary issues?

Common symptoms include heart palpitations, chest pain, shortness of breath, and coldness in extremities.

What signs should be monitored for systemic illness?

Signs of systemic illness include rashes, new or changing moles, sores that won't heal, and changes in nail beds.

What is the purpose of open-ended questioning in patient interviews?

To invite the patient to answer with a narrative response.

What type of questioning requires a definitive 'yes' or 'no' response?

Closed-ended questioning.

What is graded response questioning used for?

To provide a better illustration of the patient's condition or ability through specific numerical responses.

How do multiple-option questions assist patients?

They offer options to help the patient better describe their condition.

What is the role of paraphrasing in patient communication?

To use your words to describe something the patient says, ensuring mutual understanding.

What does reflective feeling acknowledge in patient responses?

It acknowledges the patient's emotions related to their responses.

Why is summarizing important at the end of a patient interview?

It provides a compressed version of the conversation and allows the patient to clarify or add details.

What are prompters in the context of patient interviews?

Techniques used to encourage the patient to keep talking and reassure them that you are listening.

What should be avoided when asking questions during patient interviews?

Avoid asking multiple questions at once, leading questions, and questions that begin with 'why'.

What is the significance of non-verbal communication in patient interactions?

It includes facial expressions, hand gestures, and body posture, which convey messages to the patient.

What is the purpose of motivational interviewing?

To encourage behavioral changes related to chronic health conditions.

What are the four spirits of motivational interviewing?

Collaboration, acceptance, evocation, and compassion.

What are the key skills used in motivational interviewing?

Open-ended questions, affirmations, reflections, and summaries.

What does effective communication in physical therapy involve?

Expressive components like talking and body language, and receptive components like active listening.

What is the importance of the environment during patient interviews?

To ensure the patient's comfort, privacy, and minimize distractions.

What are red flags in the context of patient symptoms?

Symptoms that interfere with daily activities, last for an extended period, or have no clear explanation.

What does a review of systems (ROS) provide?

Information about major body segments to identify symptoms that may require referral to a healthcare provider.

What are common symptoms included in a review of systems?

Fatigue, malaise, fever, weight changes, nausea, dizziness, paresthesia, weakness, and cognitive changes.

What constitutes a red flag for unexplained weight loss?

A loss of 5-10% of body weight without explanation.

What should a physical therapist check for in cases of unexplained weight gain?

Edema in extremities, face, and neck region.

What is the significance of dizziness in patient assessments?

It can indicate disorders across multiple body systems and may require different management approaches.

What is referred pain?

Pain perceived from a distant location of the actual anatomical pain.

What are common conditions associated with high mortality and morbidity risk?

Major depression, suicide risk, femoral head/neck fracture, cauda equina syndrome, cervical myelopathy, abdominal aortic aneurysm, deep venous thrombosis, pulmonary embolism and abnormal myocardial infarction

What questions are used for initial screening of major depression?

Have you felt down, depressed, or hopeless? Have you had little interest or pleasure in doing things?

What are some significant signs of major depression?

Weight change, insomnia/hypersomnia, psychomotor agitation, fatigue, feelings of worthlessness or guilt, difficulty concentrating, recurrent thoughts of suicide.

What should be evaluated if responses fit criteria for major depression?

Refer/consult with another provider.

What are some risk factors for suicide?

Being widowed, divorced, living alone, history of psychiatric illness, previous suicide attempts, sense of hopelessness, unemployment, recent significant loss, chronic progressive illness.

What initial screening question should be asked for suicide risk?

Are you having thoughts of attempting to harm yourself?

What follow-up questions should be asked if a patient has suicidal thoughts?

Do you have a plan in place? Do you have access to supportive resources? Is there someone you would like me to contact?

What are common risk factors for femoral head and neck fractures?

Female gender, running, jumping, diminished muscle strength, changes in training program, nutritional deficiencies, leg length discrepancy.

What are the symptoms of femoral head and neck fractures?

Pain, local tenderness, deformity/shortened limb, edema, ecchymosis, loss of function and mobility.

What is the Patellar Pubic Percussion Test used for?

To assess for femoral neck fractures.

How is the Fulcrum Test performed?

Patient sits and leans back on hands; forearm is placed under the thigh while pressing down gently on the thigh.

What is Cauda Equina Syndrome?

Severe compression of the nerve roots in the thecal sac of the lumbar spine.

What are the symptoms of Cauda Equina Syndrome?

Urinary dysfunction, bowel dysfunction, sexual dysfunction, sensory deficits, motor deficits of lower limbs.

What are the risk factors for Cervical Myelopathy?

Age, male gender, arthritis of the spine, spinal cord trauma, history of bone spurs.

What are the symptoms of Cervical Myelopathy?

Impaired hand dexterity, gait and balance difficulties, numbness, paresthesia, neck stiffness, urinary dysfunction.

What are the risk factors for Abdominal Aortic Aneurysm (AAA)?

Smoking, age, male gender, family history, high cholesterol, coronary artery disease.

What symptoms are associated with AAA?

Pain in abdomen, groin, buttock, early satiety, weight loss, nausea.

What is the significance of finding a pulse in AAA examination?

A lateralized pulse is abnormal and may indicate an AAA.

What is Deep Venous Thrombosis (DVT)?

A blood clot formed in a deep vein.

What are the signs and symptoms of DVT?

Ache, tightness, tenderness, general edema, pitting edema, prominent superficial venous plexus, increased local skin temperature.

What are some risk factors for DVT?

Age, cancer, congestive heart failure, severe infection, oral contraceptives, pregnancy, immobility.

What is Pulmonary Embolism?

A thrombus that migrates to the lungs and blocks an arterial vessel.

What are the signs and symptoms of Pulmonary Embolism?

Dyspnea, tachypnea, pleuritic chest pain, persistent cough, apprehension, anxiety, tachycardia, palpitations.

What are modifiable risk factors for atypical myocardial infarction?

Excessive alcohol use, obesity, cigarette smoking, diabetes, hypertension, high cholesterol.

What are common symptoms of atypical myocardial infarction in women?

SOB, fatigue, sleep disturbance, nausea/vomiting, palpitations, dizziness, anxiety, diaphoresis.

What are common symptoms of atypical myocardial infarction in men?

Chest tightness, left arm weakness, tooth pain, indigestion/heartburn.

What are general indicators for a mental status screen?

Confusion, memory issues, attention, concentration, irritability, anxiety, depression, sleep habits.

What are the types of communication disorders?

Dysarthria, dysphonia, aphasia (Wernicke's, Broca's, Global).

What should be observed in a communication assessment?

Gaps or hesitancy in speech, lack of speech inflection, excessive filler words, circumlocutions.

What is the purpose of the Mini-Cog screening?

To rapidly screen for cognitive impairment in older adults using a 3-item test and a clock-drawing task.

What does A&O x3 assess?

Alertness and orientation regarding person, place, and time.

What are common physical signs of anxiety?

Cold or sweaty hands, heart palpitations, numbness or tingling in hands or feet, shortness of breath, dry mouth, nausea, and muscle tension.

What are common mental signs of anxiety?

Feeling panic, fear, uneasiness, nightmares, repeated thoughts or flashbacks of traumatic experiences, and uncontrollable obsessive thoughts.

What behavioral signs may indicate anxiety in patients?

Inability to be still and calm, ritualistic behaviors, trouble sleeping, and being very self-conscious.

What is the GAD-7 screening tool used for?

To screen for anxiety symptoms that can affect pain, participation, and recovery in adults.

What initial questions are included in the PHQ-9 screening for depression?

Have you felt down, depressed, or hopeless? Have you had little interest or pleasure in doing things?