Mastering DD Exam 1: Key Concepts and Preparation
Three key factors that create a need for screening - correct answer ✔✔-side effects of medications
-comorbidities
-visceral pain mechanisms
Red flag - correct answer ✔✔warning signs of possible need for medical evaluation
-possible serious pathology present
-know examples from box 1.2
yellow flag - correct answer ✔✔psychological risk factors, beliefs about pain, emotional responses, or
fear avoidance behaviors
Three pillars of evidence based-practice on which clinical decisions should be based - correct answer
✔✔-clinical experience
-client's values and preferences
-best available research evidence
reasons to screen in PT setting - correct answer ✔✔-Direct access
-Early detection and referral
-Quicker and sicker patient/client base
-Signed prescription
-Medical specialization
-Disease progression
-Patient/client disclosure
-Client does not report symptoms or concerns to the physician because of forgetfulness, fear, or
embarrassment
-Presence of one or more yellow (caution) or red (warning) flags
-Natural history: screening process my identify S/S that have developed as a result of a primary condition
,Four roles of PT in disease prevention - correct answer ✔✔-primary prevention
-secondary prevention
-tertiary prevention
-health promotion and wellness
Direct access/self-referral - correct answer ✔✔legal right of the public to obtain examination, evaluation,
and intervention from a licensed PT without previous examination by, or referral from a physician
six components of the Goodman Screening for Referral Model - correct answer ✔✔-past medical hx
-personal and family hx
-risk factor assessment
-clinical presentation
-associated s/s of systemic diseases
-review of systems
sign - correct answer ✔✔-observable findings found by the therapist in an objective examination
-can be seen, heard, measured, photographed, or documented in some way
symptom - correct answer ✔✔reported by the patient but can not be observed by someone else
elements of PCM model - correct answer ✔✔-examination
-evaluation
-diagnosis
-prognosis
-intervention
-outcomes
medical diagnosis - correct answer ✔✔-recognition of disease
,-determination of the cause and nature of pathologic conditions
-DD: comparison of symptoms of similar disease and medical diagnostics
PT diagnosis - correct answer ✔✔-comparison of NMS s/s to identify the underlying human movement
dysfunction so that treatment can be planned as specifically as possible
in context of screening for referral, the purpose of the diagnosis - correct answer ✔✔-treat as
specifically as possible by determining the most appropriate POC and intervention strategy for each pt
-recognize the need for a medical referral
What are two important questions a physical therapist should ask themself throughout the evaluation
process? - correct answer ✔✔-is this an appropriate physical referral?
-is there a hx or cluster of s/s that raises a yellow or red flag?
The presence of risk factors and yellow or red flags alert the therapist to the need to do what? - correct
answer ✔✔screening examination
Do all 50 United States have some form of direct access? - correct answer ✔✔yes
What are some examples of variations of direct access that might appear in different states? - correct
answer ✔✔-some states enact a two or three tiered restricted/provisional direct access system
--ex: pt can only see a PT w/ 3 yrs of experience, services only provided for a certain amount of days w/o
referral
-additional criteria could be in place
--ex: pt must have been referred in the last 2 yrs or PT must notify pt's PCP
-some states require a minimum level of liability insurance coverage by each PT
Primary Care - correct answer ✔✔coordinated, comprehensive, and personal care provided on a first-
contact and continuous basis
, In the primary care delivery model, what is the physical therapist responsible for? - correct answer
✔✔as a patient advocate to see that the patient's NMS and other health care needs are identified and
prioritized, and a POC is established
autonomous practice - correct answer ✔✔described as independent, self-determining professional
judgement and action
Four attributes of autonomous practice - correct answer ✔✔-direct and unrestricted access
-professional ability to refer to other health care providers
-professional ability to refer to other professionals
-professional ability to refer for diagnostic tests
What are two good, final, open-ended questions to close out the subjective examination? - correct
answer ✔✔1. Are you having any other symptoms of any kind any-
where else in your body we have not talked about yet?
2. Is there anything else you think is important about
your condition that we have not discussed yet?
Systems Review - correct answer ✔✔-brief or limited examination of the anatomic and physiologic status
of cardiopulm, integumentary, MSK, and NMS systems
Review of Systems - correct answer ✔✔-useful tool in recognizing clusters of associated s/s and the
possible need for medical referral
The client has come to physical therapy without a medical referral (i.e., self-referred) and the physical
therapist recommends medical follow-up, PT refers pt to who? - correct answer ✔✔PCP
If the patient/client does not have a current physician, PT refers pt to who? - correct answer ✔✔PT
provides a list of recommended physicians
Three key factors that create a need for screening - correct answer ✔✔-side effects of medications
-comorbidities
-visceral pain mechanisms
Red flag - correct answer ✔✔warning signs of possible need for medical evaluation
-possible serious pathology present
-know examples from box 1.2
yellow flag - correct answer ✔✔psychological risk factors, beliefs about pain, emotional responses, or
fear avoidance behaviors
Three pillars of evidence based-practice on which clinical decisions should be based - correct answer
✔✔-clinical experience
-client's values and preferences
-best available research evidence
reasons to screen in PT setting - correct answer ✔✔-Direct access
-Early detection and referral
-Quicker and sicker patient/client base
-Signed prescription
-Medical specialization
-Disease progression
-Patient/client disclosure
-Client does not report symptoms or concerns to the physician because of forgetfulness, fear, or
embarrassment
-Presence of one or more yellow (caution) or red (warning) flags
-Natural history: screening process my identify S/S that have developed as a result of a primary condition
,Four roles of PT in disease prevention - correct answer ✔✔-primary prevention
-secondary prevention
-tertiary prevention
-health promotion and wellness
Direct access/self-referral - correct answer ✔✔legal right of the public to obtain examination, evaluation,
and intervention from a licensed PT without previous examination by, or referral from a physician
six components of the Goodman Screening for Referral Model - correct answer ✔✔-past medical hx
-personal and family hx
-risk factor assessment
-clinical presentation
-associated s/s of systemic diseases
-review of systems
sign - correct answer ✔✔-observable findings found by the therapist in an objective examination
-can be seen, heard, measured, photographed, or documented in some way
symptom - correct answer ✔✔reported by the patient but can not be observed by someone else
elements of PCM model - correct answer ✔✔-examination
-evaluation
-diagnosis
-prognosis
-intervention
-outcomes
medical diagnosis - correct answer ✔✔-recognition of disease
,-determination of the cause and nature of pathologic conditions
-DD: comparison of symptoms of similar disease and medical diagnostics
PT diagnosis - correct answer ✔✔-comparison of NMS s/s to identify the underlying human movement
dysfunction so that treatment can be planned as specifically as possible
in context of screening for referral, the purpose of the diagnosis - correct answer ✔✔-treat as
specifically as possible by determining the most appropriate POC and intervention strategy for each pt
-recognize the need for a medical referral
What are two important questions a physical therapist should ask themself throughout the evaluation
process? - correct answer ✔✔-is this an appropriate physical referral?
-is there a hx or cluster of s/s that raises a yellow or red flag?
The presence of risk factors and yellow or red flags alert the therapist to the need to do what? - correct
answer ✔✔screening examination
Do all 50 United States have some form of direct access? - correct answer ✔✔yes
What are some examples of variations of direct access that might appear in different states? - correct
answer ✔✔-some states enact a two or three tiered restricted/provisional direct access system
--ex: pt can only see a PT w/ 3 yrs of experience, services only provided for a certain amount of days w/o
referral
-additional criteria could be in place
--ex: pt must have been referred in the last 2 yrs or PT must notify pt's PCP
-some states require a minimum level of liability insurance coverage by each PT
Primary Care - correct answer ✔✔coordinated, comprehensive, and personal care provided on a first-
contact and continuous basis
, In the primary care delivery model, what is the physical therapist responsible for? - correct answer
✔✔as a patient advocate to see that the patient's NMS and other health care needs are identified and
prioritized, and a POC is established
autonomous practice - correct answer ✔✔described as independent, self-determining professional
judgement and action
Four attributes of autonomous practice - correct answer ✔✔-direct and unrestricted access
-professional ability to refer to other health care providers
-professional ability to refer to other professionals
-professional ability to refer for diagnostic tests
What are two good, final, open-ended questions to close out the subjective examination? - correct
answer ✔✔1. Are you having any other symptoms of any kind any-
where else in your body we have not talked about yet?
2. Is there anything else you think is important about
your condition that we have not discussed yet?
Systems Review - correct answer ✔✔-brief or limited examination of the anatomic and physiologic status
of cardiopulm, integumentary, MSK, and NMS systems
Review of Systems - correct answer ✔✔-useful tool in recognizing clusters of associated s/s and the
possible need for medical referral
The client has come to physical therapy without a medical referral (i.e., self-referred) and the physical
therapist recommends medical follow-up, PT refers pt to who? - correct answer ✔✔PCP
If the patient/client does not have a current physician, PT refers pt to who? - correct answer ✔✔PT
provides a list of recommended physicians
