Module 2: Medical Screening

Intro:

• Many Visceral problems will mimic _____ dysfunctions

• Many MSK problems will take on the characteristics of _____ pathology.

• MSK

• Visceral

PT’s Role in Disease Prevention: Direct Access > Prevention

• In Primary Prevention, a PT should aim at stopping the disease process that leads to development of disease, illness and other pathological heath conditions through what 3 factors?

• Education

• Risk Factor Reduction

• General Health Promotion

PT’s Role in Disease Prevention: Direct Access > Early Detection

• In Secondary Prevention:

  • Early detection of diseases, illnesses, and other pathological health conditions through what?

    • This does not ____ the condition but may decrease ____ and/or ____ of the disease

    • This can improve outcome, including improved what?

• Regular Screening

  • Prevent the condition but may Duration and/or Severity

  • QOL

PT’s Role in Disease Prevention: Direct Access » Improve QOL

• In Tertiary Prevention:

  • Providing ways to limit ___ __ ___ while improving _____ in pts w chronic and/or irreversible disease

• Degree of Disability while improving in Function

Intro:

• The focus of this class and PT as a profession is NOT what?

• Is it within our scope of practice, nor we trained properly to make diagnosis?

• NOT the diagnosis of pathology

• NAUR

Intro:

• What approach is taken because it allows us to make decision based on possible system breakdowns?

• Based on these decisions, it affords us the opportunity to decide what?

• Systems Approach

• Whether the pt is appropriate for PT OR whether physician referral is required

Systems Based Approach:

• Bosissonnault suggests that the main difference between PT screening and medical screenings lies where?

• He suggests that:

  • Physicians approach a problem from a ____ level

  • PT approaches the disease process on a ____ approach

• Lies in their approach to assessing and categorizing findings

• Suggests

  • Physician: Disease Level (Ex: Mitral Valve Prolapse)

  • PT: Systems Approach (Ex Cardiovascular System Dysfunction)

Neuromusculoskeletal Symptoms:

• To understand what is NOT a MSK issue, you must first understand what?

• Neuromusculoskeletal Issue

MSK Problems:

• What are 4 aspects of MSK Pathology?

• Reacts to movement and changes in position

• Are often related of a specific MOI

• Symptoms change in intensity and duration based on mechanical factors

• Rest should relieve symptoms

NON-MSK Problems:

• What are 4 aspects of NON-MSK Pathology?

• DO NOT react to movement and changes in position

• Are NOT related to specific MOI

• Symptoms DO NOT change in intensity and duration based on mechanical factors

• Rest DOES NOT relieve symptoms

What are the 5 main topics to ask during Subjective Assessment?

• Location of Pain

• Description of Pain

• Behavior of Symptoms

• Hx of Symptoms

• Family Hx

• Special Considerations

Location of Symptoms:

• Does area of symptoms in and of itself aid us in determining whether symptoms are of MSK or visceral origin?

• There is great ___ in visceral and MSK pain referral patterns.

• Symptom locations aid us in:

  • Determining….

  • Guiding….

• Naur

• Overlaps

• Symptom Location

  • Determining regions to focus examination

  • Guides in determining further directions our testing must take in order to make accurate dx

Organ Pain Locations:

• Organ refer pain…

  • ____ to the side they are located

  • Within the ____ they are located

• Ipsilateral

• Quadrant

What are the 9 Quadrants of the Body?

Q1-Q9

Where are the Areas of Referral for each organ?

Referred Pain and Convergence:

• Various systemic and visceral disorders may be the origin of what?

• The proposed neurological mechanism of these phenomena what?

• Origin of symptoms referred to other areas of the body

• Convergence of visceral and somatic afferent nerve fibers

Description of Symptoms:

• T/F: Descriptor may vary from person to person and should NOT be utilized soley in the determination of possible visceral involvement

True

Description of Symptoms:

• Visceral Pain has been described as what?

• Sharp

• Severe

  • Poorly Localized and Vague

Description of Symptoms:

• If a pt describes this type of pain, what structure or system could be affected?

  • Cramping and Colicky Pain (Craping Last Several Min)

  • Throbbing, Pressure, Tightness, Heaviness, Restless Leg

  • Weakness, Poor Balance, Numbness

  • Deep and Poorly Localized Constant Pain

• Cramping and Colicky Pain (Craping Last Several Min)

  • Visceral Smooth Muscle

    • GI, Ureter, Gallbladder

• Throbbing, Pressure, Tightness, Heaviness, Restless Leg

  • Cardiovascular System

• Weakness, Poor Balance, Numbness

  • Nervous System

• Deep and Poorly Localized Constant Pain

  • Cancer or Stones

Behavior of Symptoms: Aggs and Eases for Visceral Conditions

• Easing Factors: (2)

• Agg Factors: (2)

• Easing Factors: (2)

  • Rest should NOT relieve symptoms

  • Positions should NOT ease symptoms

• Agg Factors: (2)

  • Position should NOT aggravate symptoms

  • Nocturnal Pain

Behavior of Symptoms:

• What type of pain pattern is common for pts w Visceral conditions?

  • It is common complaint of pts w visceral or non MSK involvement that their pain is what 2 things?

  • Complaints of what are also indicators of visceral involvement?

  • What 3 activities are commonly required to return to sleep?

• 24 hr pattern

  • Constant and Non Varying Pain

  • Increases in Pain at Night

  • Activities:

    • Walking

    • Pacing

    • Sitting Up

Personal Hx of Symptoms:

• Visceral disease processes usually CANNOT be attributed to what 2 occurrences?

• They are ___ in nature.

• Traumatic Injury OR Certain Repetitive Strains or Activities

• Insidious

Fam Hx:

• It is wise to question pts regarding what when considering visceral structures as source of pain?

• T/F: Often, parents or siblings will have pathology that may help in the diagnosis of the pt’s problem

• What 6 conditions have Genetic Predispositions?

• Fam Hx of Disease and Visceral Pathology

• True

• 6 Conditions

  • Autoimmune

  • Cardiovascular

  • Pulmonary

  • Endocrine

  • GI

  • Cancer

Red Flags:

• Red Flags are clinical indicators of what?

  • Thus requiring further what?

• Possible serious underlying pathology

  • Urgent medial intervention

Red Flag Category 1: Immediate Medical Attention

• What are the 6 main S/S?

• STOP AND REFER OUT

  • LOC (loss of consciousness)

  • AMS (altered mental status)

  • Shock

  • Severe non mechanical pain

  • Progressive neurological deficits (the faster the more dangerous they are)

  • Angina and heart related symptoms

Red Flag Category 2: Requires Questioning and Precautionary Exam/Tx

• What are the 9 main S/S?

• PROCEED W CAUTION

  • Trauma

  • Clonus

  • Gait Deficits

  • Hx of Cancer

  • Long Term Corticosteroid Use

  • Non-Healing Sores or Wounds

  • Recent Unexplained Weight Loss

  • Unremitting and Unchanging Pain

  • Nocturnal Pain

Red Flag Category 3: Requires Further Physical Testing and Differentiation

• What are 7 main S/S?

• PROCEED NORMALLY

  • Chronic or Persistent Pain

  • Reoccuring Pain

  • Abnormal Reflexes

  • Bilateral or Unilateral Radiculopathy or Parethesias

  • Unexplained Referred Pain

  • Unexplained Significant Weakness

  • No MOI

Yellow Flags:

• Yellow Flags can relate to the pt’s what? (7)

• It is often a reference to what?

• Pt’s

  • Attitudes

  • Emotion

  • Beliefs

  • Behaviors

  • Family

  • Judgement

  • Workplace

• Fear Avoidance Behavior

Blue Flags:

• Blue Flags can be considered in terms of what?

• Employees often has fears and misconceptions about what of their own previous experiences?

• Employee and Workplace

• Misconceptions about work and health