Evaluation and Diagnosis: Chapter 17

A 60-year-old woman with a history of left breast cancer (10 years postmastectomy) presents with pain in her midback. The pain is described as "sharp" and radiates around her chest to the sternum. She gets some relief from her pain by lying down. Her vital signs are normal, and there are no palpable or aberrant lymph nodes. She denies any changes in breast tissue on the right or the scar and soft tissue on the left. You do not have adequate training to perform a clinical breast examination, but the client agrees to visual inspection, which reveals nothing unusual. All other findings are within normal limits; you are unable to provoke or aggravate her symptoms. Neurologic screening examination is within normal limits. The client denies any history of trauma. What plan of action would you recommend? a. Refer her to a physician before initiating treatment. b. Carry out a plan of care, and reassess after three sessions or 1 week, whichever comes first. c. Document your findings, and contact the physician by phone or by fax while initiating treatment. d. Eliminate TrPs, and then reassess symptoms.

(a) Refer her to a physician before initiating treatment.

During examination of a 42-year-old woman's right axilla, you palpate a lump. Which characteristics most suggest the lump may be malignant? a. Soft, mobile, tender b. Hard, immovable, nontender

(b) Hard, immovable, nontender

A 55-year-old grocery store manager reports becoming extremely weak and breathless whenever stocking groceries on overhead shelves. What is the possible significance of this complaint? a. TOS b. Myocardial ischemia c. TrP d. All of the above

(b) Myocardial ischemia

You are evaluating a 30-year-old woman with left chest pain that starts just below the clavicle and extends down to the nipple line. The majority of test results point to thoracic outlet syndrome. Her blood pressure is 120/78 mm Hg on the right (sitting) and 125/100 on the left (sitting). She is in apparent good health with no history of surgeries or significant health problems. What plan of action would you recommend? a. Refer her to a physician before initiating treatment. b. Carry out a plan of care, and reassess after three sessions or 1 week, whichever comes first. c. Document your findings, and contact the physician by phone or by fax while initiating treatment. d. Eliminate trigger points, and then reassess symptoms.

(c) Document your findings, and contact the physician by phone or by fax while initiating treatment.

Chest pain of a pleuritic nature can be distinguished by: a. Increases with autosplinting (lying on the involved side) b. Reproduced with palpation c. Exacerbated by deep breathing d. All of the above

(c) Exacerbated by deep breathing

Cardiac pain in women does not always follow classic patterns. Watch for this group of symptoms in women at risk: a. Indigestion, food poisoning, jaw pain b. Nausea, tinnitus, night sweats c. Confusion, left biceps pain, dyspnea d. Unusual fatigue, shortness of breath, weakness, or sleep disturbance

(d) Unusual fatigue, shortness of breath, weakness, or sleep disturbance.

A 66-year-old woman has come to you with a report of anterior neck pain radiating down the left arm. Her past medical history is significant for chronic diabetes mellitus (insulin dependent), coronary artery disease, and peripheral vascular disease. About 6 weeks ago, she had an angioplasty with stent placement. Which test will help you differentiate a musculoskeletal cause from a cardiac cause of neck and arm pain? a. Stair climbing or stationary bike test b. Using arms overhead for 3 to 5 minutes c. TrP assessment d. All of the above

(d) all of the above (Stair climbing or stationary bike test, using arms overhead for 3 to 5 minutes, TrP assessment)

A client complains of throbbing pain at the base of the anterior neck that radiates into the chest and interscapular areas and increases with exertion. What should you do first? a. Monitor vital signs, and palpate pulses b. Call the physician or 911 immediately c. Continue with the exam; find out what relieves the pain d. Ask about past medical history and associated signs and symptoms

A. Monitor vital signs and palpate pulses.

Chest pain can be caused by trigger points of the: a. Sternocleidomastoid b. Rectus abdominis c. Upper trapezius d. Iliocostalis thoracis

A. Sternocleidomastoid

You are working with a client in his home who had a total hip replacement 2 weeks ago. He describes chest pain with increased activity. Knowing what could cause this symptom will help guide you in asking appropriate screening questions. Can this be a symptom of: a. Asthma b. Angina c. Pleuritis or pleurisy d. All of the above

d. all of the above (asthma, angina, pleuiritis/pleurisy)