Patient History & Systems Review - National Physical Therapy Examination NPTE
- Which past medical history item most strongly alters exercise prescription due to hypoglycemia risk?
- Diabetes treated with insulin or insulin secretagogues. Insulin or secretagogues increase hypoglycemia risk during exercise, requiring monitoring and prescription adjustments.
- What is the primary reason to ask about falls history during the initial interview?
- Identify fall risk and guide balance, safety, and referral needs. Falls history identifies balance deficits and injury risk, informing targeted interventions and referrals.
- Which history pattern most suggests inflammatory back pain rather than mechanical back pain?
- Morning stiffness improving with activity and pain at night. This pattern indicates inflammatory processes like ankylosing spondylitis, differing from mechanical pain responses.
- What is the primary purpose of the patient history within the physical therapy examination?
- Identify impairments, activity limits, participation restrictions, and red flags. Patient history guides the PT exam by revealing functional issues and screening for serious conditions per the ICF model.
- Identify the most appropriate next step: patient has new saddle anesthesia and urinary retention.
- Activate urgent/emergent referral for possible cauda equina syndrome. These findings indicate cauda equina syndrome, a medical emergency needing immediate neurosurgical evaluation.
- Identify the most appropriate next step: patient has calf swelling, warmth, and recent long flight.
- Hold treatment and refer for urgent DVT evaluation. These signs suggest DVT, contraindicating PT until cleared to avoid embolization risks.
- Which symptom cluster in history is most consistent with myocardial ischemia rather than musculoskeletal pain?
- Chest pressure with exertion plus diaphoresis, nausea, or jaw/arm pain. This cluster indicates cardiac ischemia, differentiating it from MSK pain and prompting medical referral.
- What is the most concerning history indicator of possible spinal infection (discitis/osteomyelitis)?
- Fever or chills with constant severe spinal pain and immunosuppression. These symptoms in at-risk patients suggest infection, a red flag for spinal pathology needing medical referral.
- What is the best single history question to screen for vertebrobasilar insufficiency symptoms?
- Have you had dizziness, diplopia, dysarthria, dysphagia, or drop attacks. The 5 Ds screen for vertebrobasilar insufficiency, critical before cervical manipulation to prevent stroke.
- What does OPQRST stand for when characterizing a symptom during patient history?
- Onset, Provocation/palliation, Quality, Region/radiation, Severity, Time. OPQRST is a mnemonic for systematically characterizing symptoms to inform differential diagnosis in PT history.
- What is the most important medication history item to note before manual therapy due to bleeding risk?
- Anticoagulant or antiplatelet use (for example, warfarin, DOACs). These medications elevate bleeding risk, necessitating precautions or contraindications for manual techniques.
- Which history factor most increases suspicion for pulmonary embolism in a symptomatic patient?
- Sudden dyspnea with pleuritic chest pain after recent DVT risk/exposure. This pattern raises high suspicion for PE in at-risk patients, requiring urgent evaluation to rule out embolism.
- Which patient history element best captures the patient's perceived functional limitation?
- Chief complaint in the patient's own words (functional impact). The chief complaint directly reflects the patient's subjective view of how symptoms impair daily function.
- Which history question most directly screens for symptom irritability and severity over time?
- How long does it take for symptoms to ease after stopping the activity. This question assesses symptom recovery time, helping gauge irritability for safe exam and treatment planning.
- Which history finding most strongly suggests cauda equina syndrome requiring urgent referral?
- New urinary retention or incontinence with saddle anesthesia. These symptoms indicate potential cauda equina compression, a neurosurgical emergency requiring immediate referral.
- What is the most appropriate interpretation of a patient report of "night pain unrelieved by position"?
- Potential serious pathology; requires medical referral consideration. Night pain unrelieved by position suggests non-mechanical pathology, warranting screening for serious conditions like cancer.
- What is the key distinction between a symptom description and an aggravating factor in history?
- Symptom = what is felt; aggravating factor = what increases it. Symptoms describe subjective experiences, while aggravating factors identify specific triggers that worsen them.
- What history finding is a key red flag for possible deep vein thrombosis?
- Unilateral calf swelling and pain with recent immobility or surgery. These findings align with Wells criteria for DVT risk, necessitating screening to prevent pulmonary embolism.
- What is the key systems review question for screening new or progressive neurologic deficits?
- Any new weakness, numbness, gait change, or bowel/bladder changes. This question screens for myelopathy or radiculopathy, guiding neurologic exam and referral decisions.
- Which functional history question best differentiates activity limitation from participation restriction?
- What daily tasks can you not do, and which life roles are affected. This distinguishes inability to perform tasks (limitation) from broader role impacts (restriction) per ICF.
- Identify the best initial systems review focus: patient reports exertional dyspnea and ankle edema.
- Cardiovascular/pulmonary systems review and medical referral consideration. These symptoms suggest cardiopulmonary issues like heart failure, prioritizing systems review and referral.
- Which social history factor most directly affects discharge planning and safety at home?
- Living situation and availability of caregiver support. Social support influences home safety and adherence, directly impacting discharge and rehabilitation planning.
- Which option best interprets: pain is constant, nonmechanical, and not eased by rest or position?
- Nonmechanical pain pattern; consider serious pathology and referral. Constant non-mechanical pain suggests serious pathology like tumor or infection, warranting medical evaluation.
- Identify the most appropriate next step: patient reports unexplained weight loss and fatigue.
- Initiate medical referral and document as constitutional red flags. Unexplained systemic symptoms are red flags for pathology like cancer, requiring documentation and referral.
- Which option best interprets: pain decreases with repeated movement and returns with sustained posture?
- Likely mechanical pain with directional preference/postural component. This indicates centralization or directional preference, typical of mechanical pain responsive to movement therapy.