Podcast
Questions and Answers
Which of the following conditions is associated with a sudden worsening of intermittent claudication?
Which of the following conditions is associated with a sudden worsening of intermittent claudication?
What is typically indicated by the presence of McBurney's point or rebound tenderness?
What is typically indicated by the presence of McBurney's point or rebound tenderness?
A patient with diabetes presents as confused and lethargic. Which of the following is a potential cause?
A patient with diabetes presents as confused and lethargic. Which of the following is a potential cause?
Which of the following conditions is NOT directly indicated by unexplained weight loss?
Which of the following conditions is NOT directly indicated by unexplained weight loss?
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What should be assessed first with a patient presenting with signs of abuse?
What should be assessed first with a patient presenting with signs of abuse?
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Which of the following is NOT considered a 'red flag' requiring immediate medical referral?
Which of the following is NOT considered a 'red flag' requiring immediate medical referral?
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A patient experiencing which of these signs should be suspected of a diabetic coma?
A patient experiencing which of these signs should be suspected of a diabetic coma?
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Which of these findings is most suggestive of cauda equina syndrome?
Which of these findings is most suggestive of cauda equina syndrome?
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What is the primary concern when a physical therapy patient presents with McBurney's point tenderness?
What is the primary concern when a physical therapy patient presents with McBurney's point tenderness?
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Which symptom, if present, should raise concern for a possible thromboembolism?
Which symptom, if present, should raise concern for a possible thromboembolism?
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What is the primary reason for physical therapists to identify 'red flag' symptoms?
What is the primary reason for physical therapists to identify 'red flag' symptoms?
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A patient reports a significant, unexplained weight loss. Which of the following conditions is NOT a likely cause?
A patient reports a significant, unexplained weight loss. Which of the following conditions is NOT a likely cause?
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What is the main purpose of recognizing 'yellow flag' symptoms during a physical therapy assessment?
What is the main purpose of recognizing 'yellow flag' symptoms during a physical therapy assessment?
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Which of these questions would be most appropriate for a therapist to ask given potential 'other flag' signs?
Which of these questions would be most appropriate for a therapist to ask given potential 'other flag' signs?
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What immediate action should a physical therapist take if a patient shows symptoms of anaphylactic shock?
What immediate action should a physical therapist take if a patient shows symptoms of anaphylactic shock?
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Which of these is the MOST appropriate first step when taking a patient's history?
Which of these is the MOST appropriate first step when taking a patient's history?
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What is the primary purpose of taking a patient's history, according to this content?
What is the primary purpose of taking a patient's history, according to this content?
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Which of these is considered a 'don't' during a patient interview?
Which of these is considered a 'don't' during a patient interview?
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What is the recommended approach to questioning a patient during a musculoskeletal (MSK) examination history?
What is the recommended approach to questioning a patient during a musculoskeletal (MSK) examination history?
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A physical therapist notes a patient answers all questions with a 'yes' or 'no.' What should be the next best step?
A physical therapist notes a patient answers all questions with a 'yes' or 'no.' What should be the next best step?
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Which of the following is MOST likely to contribute to a diagnosis of shoulder impingement in an individual over 40?
Which of the following is MOST likely to contribute to a diagnosis of shoulder impingement in an individual over 40?
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A patient presents with pain. What information should a therapist obtain about the pain during the patient history?
A patient presents with pain. What information should a therapist obtain about the pain during the patient history?
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During a patient interview, what aspects of communication should a clinician be conscious of?
During a patient interview, what aspects of communication should a clinician be conscious of?
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Why is it important to inquire about a patient's living environment during a history taking?
Why is it important to inquire about a patient's living environment during a history taking?
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Which of the following is the BEST reason to ask a patient about their last physical, eye, hearing and dental exams during their history?
Which of the following is the BEST reason to ask a patient about their last physical, eye, hearing and dental exams during their history?
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Which of the following is considered a 'red flag' symptom that warrants further investigation?
Which of the following is considered a 'red flag' symptom that warrants further investigation?
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Bilateral root signs and symptoms are most indicative of which of the following conditions?
Bilateral root signs and symptoms are most indicative of which of the following conditions?
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Which of the following findings would be considered a 'yellow flag' during a patient examination?
Which of the following findings would be considered a 'yellow flag' during a patient examination?
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A patient reports arm pain lasting over 3 months. What serious condition should be considered?
A patient reports arm pain lasting over 3 months. What serious condition should be considered?
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What does 'saddle anesthesia' generally indicate during a physical examination?
What does 'saddle anesthesia' generally indicate during a physical examination?
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Which testing category would include assessing a patient via active motion?
Which testing category would include assessing a patient via active motion?
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In musculoskeletal examinations, why are resisted isometric tests performed?
In musculoskeletal examinations, why are resisted isometric tests performed?
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What is the primary intention of 'Provocation tests' in musculoskeletal examinations?
What is the primary intention of 'Provocation tests' in musculoskeletal examinations?
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What does the 'Joint Play' category of musculoskeletal testing focus on?
What does the 'Joint Play' category of musculoskeletal testing focus on?
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Which of the following would fall under the 'Functional Assessment' category during a musculoskeletal exam?
Which of the following would fall under the 'Functional Assessment' category during a musculoskeletal exam?
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Progressive gait disturbances, especially rapid onset, are a red flag for what condition?
Progressive gait disturbances, especially rapid onset, are a red flag for what condition?
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Visual disturbances are found to be a yellow flag and can potentially indicate?
Visual disturbances are found to be a yellow flag and can potentially indicate?
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What is the primary focus of 'Selective Tension' in musculoskeletal testing?
What is the primary focus of 'Selective Tension' in musculoskeletal testing?
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Which is most likely to cause frequent nausea and vomiting as a common symptom?
Which is most likely to cause frequent nausea and vomiting as a common symptom?
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If a patient presents with SOB
, what systems/conditions should you be considering?
If a patient presents with SOB
, what systems/conditions should you be considering?
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Flashcards
MSK Assessment
MSK Assessment
A systematic approach to evaluating a patient's musculoskeletal system by considering their medical history, physical examination, and functional limitations.
Cyriax Method
Cyriax Method
A method of evaluating musculoskeletal pain and dysfunction by identifying and addressing the specific tissues that are causing the problem.
Selective Tension
Selective Tension
The amount of tension or force that can be applied to a muscle or joint without causing pain or worsening the symptoms.
Red Flag
Red Flag
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Yellow Flag
Yellow Flag
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Pain Assessment
Pain Assessment
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Boissonnault Examination Scheme
Boissonnault Examination Scheme
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Review of Systems
Review of Systems
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Predisposing Factors
Predisposing Factors
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Patient Profile
Patient Profile
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Sudden worsening of intermittent claudication
Sudden worsening of intermittent claudication
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Unexplained weight loss
Unexplained weight loss
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Changes in mental function
Changes in mental function
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Patient Assessment Factors
Patient Assessment Factors
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Angina Pain Not Relieved in 20 Minutes
Angina Pain Not Relieved in 20 Minutes
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Angina Pain with Nausea and Sweating, Especially at Night
Angina Pain with Nausea and Sweating, Especially at Night
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Bowel/Bladder Incontinence and/or Saddle Pain Unaffected by Anesthesia, Medication, or Position
Bowel/Bladder Incontinence and/or Saddle Pain Unaffected by Anesthesia, Medication, or Position
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Anaphylactic Shock
Anaphylactic Shock
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Signs and Symptoms of Inadequate Ventilation
Signs and Symptoms of Inadequate Ventilation
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Sudden Worsening of Intermittent Pain
Sudden Worsening of Intermittent Pain
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Diabetic Coma
Diabetic Coma
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Observation
Observation
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Inspection
Inspection
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Active Movements
Active Movements
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Passive Movements
Passive Movements
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Resisted Isometrics
Resisted Isometrics
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Neuromuscular Testing
Neuromuscular Testing
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Special Tests
Special Tests
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Provocation Tests
Provocation Tests
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Joint Play
Joint Play
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Palpation
Palpation
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Functional Assessment
Functional Assessment
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Testing Related Areas
Testing Related Areas
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Imaging/Diagnostic Tests
Imaging/Diagnostic Tests
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Study Notes
MSK Assessment
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Overview of Cyriax: Concept of selective tension and interpretation of findings important.
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MSK Examination Components: History taking and physical examination are crucial.
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History: Includes yellow flags, red flags, immediate medical referral, pain types (acute, chronic), sources, patterns, and assessment. Boissonnault Examination scheme is a method for reviewing medical history, patient profile, and functional limitations.
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Pain Assessment: Consider the presenting complaints, functional limitations, and relevant medical history.
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History Interview: Begins with family and personal history, noting any consistent "yes" or "no" answers needing further exploration. Determine the chief complaint (C/C), mechanism of injury (MOI), if the issue is acute, subacute, or chronic, and general irritability. Assess contraindications for physical therapy, including red flags, yellow flags, or immediate referral. Establish a baseline, determine past medical history and discuss, and agree upon patient goals. Identify potential diagnoses (DDx) and necessary tests/measures.
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Do's and Don'ts of Interviewing: Create a comfortable atmosphere using eye contact, appropriate distance, open-ended questions rather than close-ended ones, paraphrasing, active listening, patience, and avoiding interruptions.
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Communication: Pay attention to tone, eye contact, body language, personal space, and facial expressions both verbal and non-verbal. Practice cultural competency and compassion.
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General Principles: Age, gender, and race can affect disease prevalence (e.g., osteoarthritis in older individuals, shoulder impingement in 15-35-year-olds). Important to consider past medical history (PMHx) for general health, major illnesses, surgeries, accidents, injuries, allergies, and medications (present, past). Family history (FHx) includes heredity, familial illnesses, such as achondroplasia and mental health issues. Assess growth development, dominance, development and congenital problems. Ask about occupation, school, recreational activities, and last physical, eye, hearing, and dental exams. Lifestyle factors such as smoking, drug use, nutrition and sexual history must be investigated. Explore the immediate living environment (home, who they live with) and social history (personal characteristics, current fitness level, knowledge of exercise, functional status/activity level).
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Immediate Medical Referral: 911 is required in emergencies.
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Red Flag Symptoms: Indicate possible urgent medical conditions requiring attention from a medical provider before physical therapy.
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Examples of Red Flags: Chest, back, or abdominal pain worsening with exertion; sudden worsening of intermittent claudication. Angina lasting longer than 20 minutes; angina with nausea, sweating; bowel/bladder incontinence/saddle anesthesia; anaphylactic shock; signs of inadequate ventilation, patient with DM who is confused, lethargic, or has a change in mental function; McBurney's point or rebound tenderness; severe, unrelenting pain, especially at night; pain unaffected by medication; severe pain with no MOI; pain unaffected by position; severe spasm; psychological overlay; loss of appetite; unexplained weight loss; weight gain; dizziness; frequent nausea or vomiting; soB or congestive heart failure.
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Yellow Flag Symptoms: These symptoms suggest a need for a more comprehensive examination.
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Examples of Yellow Flags: Abnormal symptoms, bilateral symptoms, peripheralizing symptoms, neurological symptoms, abnormal sensations, saddle anesthesia, upper motor neuron (UMN) signs, fainting, progressive weakness, progressive gait disturbances, multiple inflamed joints, psychosocial stresses, circulatory or skin changes.
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Additional Flags: Signs of abuse, safety questions.
MSK Examination-Test and Measures
- Observation: Assess the patient's posture, gait and overall appearance.
- Inspection: Visually assess the affected area for any deformities or abnormalities.
- Active Movements: Evaluate the patient's ability to move the joint through a full range of motion.
- Passive Movement: The therapist actively moves the joint to assess range of motion.
- Resisted Isometrics: Test muscle strength by applying resistance during isometric contractions.
- Neuromuscular Testing: Assess neurological function including reflexes and sensation.
- Special Tests: Specific tests to identify specific conditions (e.g., impingement tests).
- Provocation Tests: Further assess the injury by eliciting symptoms through specific provoking actions.
- Joint Play: Assess the joint's mobility.
- Palpation: Examine the affected area for tenderness, swelling, and other abnormalities.
- Functional Assessment: Evaluate how the patient functions in daily activities.
- Testing Related Areas: Assess other areas of the body that might be related to the issue.
- Imaging/Diagnostic Tests: Imaging and diagnostics such as X-rays, MRI etc. are included for cases where further medical investigation is necessary.
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Description
This quiz covers the essential components of MSK assessment, focusing on Cyriax's selective tension concept and the importance of taking thorough medical history. It highlights the key aspects of physical examination, pain assessment, and the identification of red and yellow flags in patient history. Test your understanding of these critical skills for effective MSK evaluations.