Clinical Therapeutics Review Flashcards

Introduction to Clinical Assessment

  • OSCE Preparation: A guide for preparing for Objective Structured Clinical Examinations (OSCE).
    • Initial Steps: Always remember to:
    • Introduce yourself by name and role.
    • Validate patient details: name, address, and date of birth.
    • Obtain consent for assessment.
    • Assess the environment: access, privacy, comfort.
    • Consider the patient’s condition, needs, abilities, and understanding.

Pain Assessment (SOCRATES)

  • SOCRATES Acronym: A framework to ensure thorough pain assessment.
    • Site: Identify where the pain is located.
    • Onset: Determine when the pain started.
    • Character: Describe the type of pain (sharp, stabbing, aching, etc.).
    • Radiation: Check if the pain radiates to other areas (e.g., chest pain radiating to the left arm).
    • Associated Symptoms: Note any other symptoms (e.g., nausea, stiffness).
    • Timing: Investigate how long the pain lasts and if it worsens at specific times.
    • Exacerbating or Relieving Factors: Identify factors that worsen or relieve the pain (e.g., movement, heat, cold).
    • Score: Assess pain on a scale of 0-10 or other suitable scoring tools.

Musculoskeletal (MSK) Assessment

  • Key Aspects to Evaluate:

    • Pain: Ensure patient comfort.
    • Swelling: Check for inflammation or fluid accumulation.
    • Stiffness: Assess possible causes like pain or swelling.
    • Deformity: Look for chronic changes or acute injuries.
    • Discoloration: Examine for bruising or signs of poor blood supply.
    • Warmth/Erythema: Indicates infection or inflammation.

  • Assessment Techniques:

    • Gait Test: Patient walks a short distance to evaluate gait.
    • Power Test: Assess leg strength by having the patient flex/extend against resistance.

Additional Assessment Techniques

DEXA Scan

  • Purpose: Assess bone density.

Infection Assessment

  • Systemic Signs: Vital signs indicating possible infection.

    • Increased pulse rate, respiratory rate, fever, fatigue, confusion (especially in elderly).

  • Localized Assessment: Look for:

    • Pain, swelling, heat, redness, and any discharge (color and odor).

Neurological Assessments

Parkinson’s Disease Assessment

  • Evaluation Areas:
    • Gait: Observe walking patterns.
    • Tone: Check for increased or decreased muscle tone.
    • Power: Conduct finger grip and resistance tests.
    • Reflexes: Assess tendon reflexes (increased in upper motor neuron disease, decreased in lower motor neuron disease).
    • Coordination: Conduct various tests (e.g., finger to nose test, rapid movements).

Multiple Sclerosis (MS) Assessment

  • Evaluation Components:
    • Movement and Coordination: Observe limb strength, balance, and coordination.
    • Vision: Check for changes or weakness in vision.
    • Speech and Reflexes: Conduct reflex tests and assess the patient's speech abilities.
    • Sensory Testing: Test ability to feel pain, light touch, temperature, and vibration.