Primary Care Quiz 1

T/F: you can use diagnostic imaging in isolation

False

what are the indications for radiography

-disruption of cortical bone integrity

-bony lesions

-disruption of bony alignment

-edema

what are the indications for a CT scan

-superior to plain film for cortical bone disruption

-multiplanar capabilities

-can do 3D

indiciations for an MRI scan

-soft tissues characteries

-soft tissue injury

-soft tissue inflammation

in a T1 MRI, which substances will be brighter and have high signal intensity

-fat

-subacute hemorrhage

in a T2 MRI, which substances will be brighter and have high signal intensity

-fluid

-soft tissue

T/F: flowing blood is dark in both T1 and T2 MRI

true

indications for diagnostic ultrasound

-identify soft tissue integrity: muscle, tendon, ligament

-assess bony alignment at joints

-potential DVT

-soft tissue mass

what are the challenges of diagnostic ultrasound

-operator dependent

-require great understanding of anatomy

Ottawa Knee Rule Indicators

-patient older than 55

-tenderness at head of fibula

-isolated tenderness of patella

-inability to flex knee to 90 degrees

-inability to weight bear for 4 steps immediately after injury and in the ED

what is the exclusion criteria for the Ottawa Knee Rules

-patient younger than 18

-isolated superficial skin injury

-injuries older than 7 days

-recent injuries being reevaluated

-paraplegia or multiple injuries

what are the indications for Pittsburgh Decision Rule for Radiography

-patient younger than 12 or older than 50

-inability to walk more than 4 weight bearing steps in the ED

what are the exclusion criteria for Pittsburgh Decision Rule for Radiography

-knee injury sustained more than 6 days before presentation

-patients with only superficial lacerations and abrasion

-history of previous surgeries or fractures on affected knee

-patient being assessed for same injury

indications for Ottawa Ankle Rules

-bone tenderness at posterior edge or tip of lateral malleolus

-bone tenderness at posterior edge or tip of medial malleolus

-inability to bear weight immediately and in ED

indications for Ottawa Foot Rules

-bone tenderness at base of 5th metatarsal

-bone tenderness at navicular

-inability to bear weight immediately and in ED

according to the Canadian C Spine Rules, what are the high risk factors that would indicate a patient should be referred to a radiograph

-65 or older

-dangerous mechanism of injury

-paraesthesias in the extremities

what are considered dangerous MOIs for Canadian C Spine Rules

-fall from elevation of 3' or higher

-axial load to the head

-high speed MVA (>65 MPH)

-rollover with ejection from vehicle

-bicycle collision

if you're evaluating a patient, and they present with no high risk factors but do have a low risk factor present according to the Canadian C Spine Rules, what is the next step?

a. Refer to Radiography

b. No Radiography Indicated - Proceed with Exam as Normal

c. No Radiography Indicated - Terminate Exam for PCP referral

d. Proceed with ROM to determine if radiography is indicated

Proceed with ROM to determine if radiography is indicated

what are considered low risk factors for Canadian C Spine Rules

-simple rear end MVA

-delayed pain onset

-able to assume sitting position int he ED

-ambulatory at any time

-absence of midline C-spine tenderness

what ROM should an individual achieve bilaterally to indicate no radiography needed according to the Canadian C Spine Rules

rotation of 45 degrees bilaterally

how is the NEXUS criteria used

an individual must meet all 5 components of criteria for imaging to considered unnecessary

what are the components of the NEXUS criteria

-no posterior midline cervical tenderness

-no evidence of intoxication

-normal level of alertness and consciousness

-no focal neurologic deficit

-no painful distracting injuries that could "distract" the patient from their neck pain

what are some serious medical pathologies that PTs should monitor for red flags of

-cancer

-infections

-fractures

-cardiovascular pathology

-neurological pathology

define red flag

warning signs that referral to another provider might be warranted

what are some red flags that might indicated cancer

-persistent night pain

-constant pain anywhere in the body

-unexplained weight loss

-loss of appetite

-unusual lumps or growths

-unwarranted fatigue

-history of cancer

what are some cardiovascular red flags

-abnormal shortness of breath experienced at rest or with minimal exertion

-dizziness (worse with standing and better when lying down)

-dizziness with visual disturbances or hemiparesis

-pain or feeling heaviness in the chest

-pulsating pain anywhere in the body

-constant and severe pain in the lower leg, calf, or arm

-discolored or painful feet

-swelling with no history of injury

what are some GI red flags

-frequent or severe abdominal pain

-frequent heartburn or indigestion

-frequent nausea or vomiting

-change in or problem with bowel and/or bladder function (UTI)

-unusual stool changes

-unusual menstrual irregularities

what are some signs of a UTI

-increase in confusion

-fever

-pain while urinating

what are some miscellaneous red flags to monitor for

-fever or night sweats

-recent severe emotional disturbances

-swelling or redness in any joint with no history of injury

-pregnancy

what are some neurological red flags

-changes in hearing

-frequent or severe headaches with no history of injury

-problems with swallowing or changes in speech

-changes in vision, blurriness or loss of sight

-problems with balance, coordination, or falling

-fainting spells or drop attacks

-sudden weakness (foot or wrist drop)

what type of pain descriptors might indicated a vascular disorder

-throbbing

-pounding

-pulsating

what type of pain descriptors might indicate a neurologic disorder

-sharp

-lancinating

-shocking

-burning

-pins and needles

-numb

what type of pain descriptors might indicate a visceral disorder

-aching

-squeening

-gnawing

-burning

-cramping

what are some red flag conditions that are related to low back pain

-tumor

-spinal infection

-vertebral fracture

-cause equina syndrome

-abdominal aneurysm: 4cm or greater

what findings during the history or physical examination might indicate an individual has cancer

-age > 50

-hx of cancer

-unexplained weight loss

-failure of conservative therapy

-no relief with bed rest

-pain is worse at night

-constant pain unaffected by position or activity

-pain is worse with weight bearing

what findings during the history or physical examination might indicate an individual has a back related infection

-recent infections; UTI or skin infection

-intravenous drug use

-concurrent immunosuppressive disorder

-deep constant pain

-pain increases with weight bearing

-fever, malaise, swelling

-spine rigidity - accessory motion may be limited

if you suspect a patient has cancer, what type of referrals should be made

-refer to MD for CBC or other blood testing

-CT scan best for cancer

-bone scan

-MRI

if you suspect a patient has vertebral osteomyelitis, what type of referrals should be made

-elevated sedimentation rate testing

-plain film radiograph (rule out other conditions)

-MRI

-CT

what findings during the history or physical examination might indicated vertebral fracture

-hx of trauma

-long term steroid use

-age 70 or greater

-very tender to palpation over fracture site

-increased pain with WB

-edema in the area of fracture

what findings during the history or physical examination might indicate cauda equina syndrome

-hx of spinal stenosis

-hx of degenerative intervertebral disc disease

-urine retention or incontinence

-fecal incontinence

-saddle anesthesia

-global or progressive weakness in the LEs

-sensory deficits in the feet

-weak ankle DF/PF and toe extension

what are findings during the history or physical examination that might indicate an abdominal aortic aneurysm

-back, abdominal, or groin pain

-hx of HTN or DM

-hx of smoking

-family hx of AAA

-age >70

-non-caucasian

-female

-abdominal girth

what is a normal Hemoglobin (Hgb) value

-females: 12-16

-males: 14-18

what HgB value is PT contraindicated

HgB < 8

what Hgb value would you suspect a patient will have low exercise tolerance

8-10

what do you suspect if an individual has low Hgb levels

-anemia

-hemorrhage

what do you suspect if an individual has high Hgb levels

-dehydration

-CHF

-COPD

what values are assessed during a complete blood count

-hemoglobin [Hgb]

-white blood cells [WBC]

-platelets [PLT]

-hematocrit [Hct]

what is the normal levels of white blood cells

5K-11K

what do you suspect if an individual has low WBC

bone marrow issues

what do you suspect if an individual has high WBC

infection or inflammation present

what is the normal values for platelets

150K-450K

what platelets levels would contraindicate PT

<5000

individuals with a platelet level of 5-20K are approved for what activities

AROM/ADLs

individuals with a platelet level of 20-50K are approved for what activities

light PREs

individuals with a platelet level of 50-150K are approved for what activities

Moderate PREs

if an individual has low platelet levels, what might you suspect

spontaneous bleeds

what are the normal levels for hematocrit

-males: 42-52%

-females: 33-48%

what hematocrit level would PT be contraindicated at?

<20%

if an individual has low hematocrit levels, what would you suspect

-anemia

-hemorrhage

if an individual has a high hematocrit level, what would you suspect

-dehydration

-COPD

-altitude exposure

what values are assessed on a basic metabolic panel

-sodium [Na+]

-potassium [K+]

-chloride [Cl-]

-carbon dioxide [CO2]

-Blood Urea Nitrogen [BUN]

-Creatinine [CRE]

-Glucose [GLU]

what is a normal sodium level

136-145

what would you suspect to seeif an individual has low sodium levels

-weakness

-confusion

what would you suspect to see if an individual has high sodium levels

-thirst

-agitation

what are the normal values for potassium levels

3.5-5.0

what potassium levels would PT be contraindicated at

- <3.2

- >5.1

what would you suspect to see if an individual has low potassium levels

altered mm contraction

what would you suspect to see if an individual has high potassium levels

increased contractility of heart

what are the normal values for chloride

36-107

what would you expect to see if an individual has low chloride levels

-vomiting

-potassium deficiency

what would you expect to see in an individual with high chloride levels

-anxiety

-dehydration

what are the normal levels of carbon dioxide

24-30

at what CO2 levels would PT be contraindicated

- < 10

- > 40

what would you expect to see in an individual with low CO2 levels

hyperventilation

what would you expect to see in an individual with high CO2 levels

acidosis

what are the normal BUN levels

10-21

what would you expect to see in an individual with low BUN levels

-malnutrition

-liver damage

what would you expect to see in an individual with high BUN levels

-dehydration

-kidney damage

what are the normal levels of creatinine

0.5-1.4

what are the normal levels of glucose

70-125

what GLU levels would contraindicated PT

- < 60

- > 300

what symptoms would you see in a patient with hyperglycemia

-extreme thirst

-hunger

-frequent urination

-dry skin

-nausea

-drowsiness

-blurred vision

what symptoms would you see in a patient with hypoglycemia

-headache

-nervousness and shakiness

-sleepiness

-feeling anxious or weak

-confusion

-difficulty speaking

-perspiration

-dizziness/lightheadedness

-hunger

-NMS incoordination

what symptoms would you see in an individual with diabetic ketoacidosis

-fruity or acetone breath

-dehydration

-weak/rapid pulse

-labored respiration

what symptoms would you see in an individual in a diabetic coma

-unconsciousness

-seizures

-respiratory arrest

-cardiac arrest

what does INR indicate

clotting ability of blood

what is the normal INR value

0.8-1.1

what is the therapeutic range for INR

2.0-3.5

what INR levels would put an individual at an increased risk of bleeding

3.6 or higher

at what INR level is a patient at relative risk for spontaneous bleeding

>5

what populations are typically considered vulnerable and at risk for abuse

-children

-individuals with disability

-elderly individuals

-intimate partner abuse

what are the types of abuse

-neglect

-physical

-sexual

-emotional

-financial

T/F: abuse affects 1 in 8 children before they are 18 years old

true

what are the signs of child abuse

-unexplained injuries such as bruises

-extreme behaviors such as excessive crying, truancy, or running away

-poor hygiene and unsuitable clothing

-excessive fear of parents, caregivers, or going home

-depression or excessive crying

-poor peer relationships or inability to relate to children of the same age

-sudden change in behavior

-constant hunger, tiredness, or lack of energy

-attention-seeking behaviors

-frequent absences from school

-self harm or attempts at suicide

T/F: 1 in 3 women will experience abuse by an intimate partner

true

what percentage of intimate partner abuse victims are men?

17%

what are the signs of intimate partner abuse

-excuses for injuries

-personality changes (low self esteem in someone who is always confident)

-constantly checking in with their partner

-never having money on hand

-overly worried about pleasing their partner

-skipping out on work, school, or social outings for not clear reasons

-wearing clothes that don't fit the season (long sleeves in summer)

what percentage of the elderly population will experience abuse?

10%

signs of elder abuse

-unexplained injuries

-history of repeated injuries

-patient is referred to as "accident prone"

-delay in time from injury/illness onset to seeking medical treatment

-recurrent visits to ED for similar injuries

-signs of despair, fear, poor eye contact

-poor hygiene

-signs of dehydration, malnutrition, inappropriate use of prescription medications

How is primary care defined by the World Health Organization

essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford