DD Chapter 1

Red flags that suggest the need for further screening.

1) Personal/Family Hx of cancer 2) Recent (last 6 weeks) infection: UTI, URI, streptococcal/staphylococcal, measles, hepatitis followed by neurological symptoms 1-3 week post infection (Guillian-Barre Syndrome), joint paint, back pain. 3) Recurrent cold or flu with cyclical pattern 4) Recent Hx of trauma, MVA, fall, fx, minor trauma with osteopenia/osteoporosis 5) Hx of immunosupression (steroids, organ transplant, HIV) 6) Hx of injection drug use 7) Insidious onset symptoms that are not relieved by PT interventions 8) Physical therapy interventions not changing clinical picture 9) Symptoms that improve after PT, but gets worse again 10) Significant weight loss or gain without effort (>10% client body weight in 10-21 days) 11) Gradual, progressive, or cyclical presentation of symptoms (worse/better/worse) 12) Unrelieved by rest or change in position, no position is comfortable 13) Symptoms that are out of proportion with injury 14) Symptoms persist beyond expected time for that condition 15) Unable to alter (provoke, reproduce, alleviate, eliminate, aggravate) the symptoms during the exam 16) Does not fit the expected mechanical or NM pattern 17) No discernible pattern of symptoms 18) Growing mass (painless or painful) is a tumor until proven otherwise; hematoma should decrease (not increase) in size over time

What is the difference between a yellow- and a red-flag symptom?

A yellow flag is a cautionary or warning symptom that signals, "Slow down, and think about the need for screening." A red flag symptom requires immediate attention, either to pursue further screening questions or tests, or to make an appropriate referral. The presence of a single yellow or red flag is not usually cause for immediate medical attention. Each cautionary or warning flag must be viewed in the context of the whole person, given his or her age, gender, past medical history, and current clinical presentation.

Direct access is the only reason physical therapists must screen for systemic disease. (T/F)

False

What are the major decision-making tools used in the screening process?

Past medical history, risk factor assessment, clinical presentation (including pain types and pain patterns), associated signs and symptoms, review of systems. Each client can be framed by these five components. Any suspicious finding or response in any of these areas warrants a closer look.

Physical therapy evaluation and intervention may be part of the physician's differential diagnosis.

True

Medical referral for a problem outside the scope of the physical therapy practice occurs when:

a. No apparent movement dysfunction exists b. No causative factors can be identified c. Findings are not consistent with neuromuscular or musculoskeletal dysfunction d. Client presents with suspicious red-flag symptoms (e.) Any of the above

A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is:

b. Did the physician (dentist, chiropractor) examine you?

Physical therapists are qualified to make a human movement system diagnosis regarding primary neuromusculoskeletal conditions, but we must do so in accordance with:

b. The State Practice Act

In the context of screening for referral, primary purpose of a diagnosis is

b. To guide the plan of care and intervention strategies The function of a diagnosis and diagnostic classifications is to provide information (i.e., identify as closely as possible the underlying neuromusculoskeletal [NMS] pathology) that can guide efficient treatment and effective management of the client.

Screening for medical disease takes place:

c. Throughout the episode of care