The suggested screening questions for each of the physiological systems are presented in Tables 6 through 14. Included in each table is a list of the specific general health questions that may suggest to the therapist that the system is impaired. Note the considerable overlap of screening questions among the various systems. This overlap is a function of the interrelatedness of the physiological systems and the broad, nonspecific nature of screening questions. The presence of any of these signs and symptoms should prompt the therapist to ask follow-up questions to determine the significance of the findings and to learn whether the physician is aware of the problem(s). If the overall patient presentation is consistent with a disorder in one of the physiological systems and the physician is unaware of the problem, then the therapist should consider initiating a medical referral. Table 6: Cardiovascular Screening Questions Do you have…? Dyspnea, cough, palpitations, hypertension, syncope, chest pain, pain with sweating, limb pain with activity, pain that is pulsing/throbbing, edema, cold hands/feet, discoloration of the skin, open wounds. General health questions Positive answers suggest that the clinician should consider screening the cardiovascular system. Do you have…? Dizziness/lightheadedness, nausea/vomiting, unexplained weight loss/gain, fatigue. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders. Table 7: Pulmonary Screening Questions Do you have…? Dyspnea, onset/change in cough, sputum characteristics (onset/change, color, hemoptysis), night sweats, pleural pain, cyanosis, digital clubbing, and adventitious sounds (wheezing, rubbing or stridor). General health questions Positive answers suggest that the clinician should consider screening the pulmonary system. Do you have…? Fatigue, fever/chills/sweats, malaise. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders. Table 8: Endocrine Screening Questions Do you have…? Polyuria, polydipsia, polyphagia, cold/heat intolerance, change in the quality of the hair and skin, symmetrical arthralgias/myalgias (such as bilateral carpal tunnel symptoms), unexplained change in appetite, fruity breath odor, heart palpitations, tachycardia, edema, proximal muscle weakness, sleep disturbance. General health questions Positive answers suggest that the clinician should consider screening the endocrine system. Do you have…? Unexplained weight loss/gain, fatigue, paresthesia or unexplained weakness, nausea/vomiting. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders.
Table 9: Gastrointestinal Screening Questions Do you have…? Abdominal pain, specific food intolerance, change in appetite, difficulty swallowing, heartburn/indigestion, incontinence or difficulty initiating bladder or bowel movements, unusual bowel movement characteristics (color, frequency, shape, caliber, diarrhea, constipation, etc.), rectal bleeding or skin rash. General health questions Positive answers suggest that the clinician should consider screening the gastrointestinal system. Do you have…? Nausea/vomiting, unexplained weight gain/loss, fatigue. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders. Table 10: Urogenital Screening Questions Do you have…? Incontinence or difficulty initiating, change in frequency/ urgency/retention, reduced stream, unusual color, bleeding with urination, impotence, pain with intercourse, dysuria, genital lesions, unusual urethral discharge. General health questions Positive answers suggest that the clinician should consider screening the urogenital system. Do you have…? Unexplained weight gain/loss, nausea/vomiting, fatigue. ADDITIONAL QUESTIONS FOR FEMALES Do you have…? Symptoms of menopause, menstrual dysfunction or irregularity, vaginal discharge, dyspareunia (pain with intercourse), pain with menses, unusual vaginal discharge or itching. ADDITIONAL QUESTIONS FOR MALES Do you have…? Sexual dysfunction, unusual urethral discharge, dyspareunia. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders. TABLE 11: Nervous System Screening Questions Do you have…? Tremors, gross motor impairment, balance/coordination difficulty, frequent/severe headaches, changes in vision/ hearing, muscle atrophy, seizure, memory loss, change in cognition (confusion, irritability, mood swings). General health questions Positive answers suggest that the clinician should consider screening the nervous system. Do you have…? Nausea/vomiting, paresthesia or unexplained weakness, confusion, disorientation, change in emotional status. Note . Adapted from Differential Diagnosis in Physical Therapy (6th ed.), by C. C. Goodman, J. Heich, and R. T. Lazaro, 2018, Philadelphia, PA: W. B. Saunders.
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