Diff Dx Exam 1
CNII *sensory* vision
optic
disease marked by the softening of bone
osteomalacia
Referred pain patterns from GI tract:
( )
clues that perhaps the Genitourinary tract is involved in a patient's pain:
(Hx/chronic) urinary incontinence (not normal regardless of age), hypertension (long term bc kidneys have been affected due to their role in BP regulation), diabetes, Hx of cancer, trauma, men > 45 yrs (back/pelvic/femur pain), burning urination (fever, back pain), blood in urine, change in urinary control (pain, getting up in night frequently, inability to stop stream, protein in urine - BUN), non mechanical pain (hip, groin), constitutional Sx (fever, headache, etc)
what are risk factors for developing liver disease
(Pt history) injection, tattoo, exposure to body fluids (health care worker), occupational exposure to chemicals, alcoholism
______ controls and regulates all mental and physical functions
CNS
Hoffman sign (for CNS involvement)
(Testing for Cervical Myelopathy. 1) Support patient's forearm with non-dominant hand. 2) Lay patient middle finger over radial aspect of examiner's dominant hand. 3) Examiner places thumb on patient's 3rd fingernail and applies sudden downward form. 4) Slide thumb off the end of the patient's finger 5) Flick tip of patient's finger rapidly. Positive- sudden involuntary flexion of the patient's thumb and index finger immediately following flicking. This would indicate possible cervical myelopathy.)
the following list are risk factors for developing *what type* of cancer - - fair skin, blonde or red hair, blue eyes, freckles - brief, intense sun exposure - immunosuppression - tanning (indoor) - dysplastic nevus syndrome - Hx of the disease
(malignant) melanoma
Red flags of the spinal cord
(positive) babinski, (positive) clonus, hoffman test, Lhermitte's sign, spasticity, weakness, numbness, loss of proprioception, fasciculations, loss of B&B (bowel and bladder)
moderate to vigorous exercises reduces risk of which cancers?
(significant risk reduction) breast, colorectal, endometrial
Normal lab values for *Serum bilirubin* - Direct (conjugated): Indirect (unconjugated): Total amount (combo of direct and indirect): - Bilirubin testing checks for levels of bilirubin in your blood. Bilirubin is an orange-yellow substance made during the normal breakdown of red blood cells. Bilirubin passes through the liver and is eventually excreted out of the body. Higher than normal levels of bilirubin may indicate different types of liver problems. Occasionally, higher bilirubin levels may indicate an increased rate of destruction of red blood cells (hemolysis). - Lower than normal bilirubin levels are usually not a concern. Elevated levels may indicate liver damage or disease
0.1-0.3 mg/dL (direct), 0.2-0.8 mg/dL (indirect), 0.3-1.0 mg/dL (total)
what is a *normal* result for the BUN (blood urea nitrogen) test?
10-20 mg/dL (if test value is increased this means there is either hepatic or renal disease, dehydration, infection, steroid use, or a GI bleed) (elderly may have a slightly higher than normal value)
what is a normal result for a BUN (blood urea nitrogen) / Creatinine ratio?
10:1 to 20:1 (Increased ratio: fluid volume deficit, dehydration; Decreased ratio: fluid volume excess, malnutrition; No changes in the ratio with increases in both BUN and creatinine indicates renal impairment)
Normal lab values for *coagulation functions* - Prothrombin time (PT): Platelets: International normalized ratio (INR):
12-15 sec (PT) (prolonged time with liver damage; double for individuals taking anticoagulants), 150,000-400,000 (platelets) (may drop when spleen is enlarged from portal hypertension), 0.9-1.1 (INR) (healthy adults not on anticoagulation) (for indv on anticoagulation meds: > 2.5 = guard against falls; > 3.0 = risk for hemarthrosis; > 4.0 = potential contraindication for eval, therapy, or increased exercise; > 6.0 = may require bed rest until corrected)
Normal range for respiration rates in adults
12-20 (breath per min)
elevated BP for adults
120-129 / 80 mmHg
Normal BP for adults
120/80 mmHg
Stage I high BP for adults
130-139 / 80-89 mmHg
Stage II high BP for adults
140/90 mmHg
Normal lab values for *serum cholesterol*:
150-250 mg/dL (elevated when its excretion is blocked by bile duct obstruction; reduced when severe liver damage prevents its synthesis)
Cancer stats: - Generally healthy people have ~ 1 / _______ risk of developing a *fatal* tumor from a SINGLE CT scan of pelvis, chest, or abdomen (radiation exposure) - Latency period to malignancy from *radiation* as cancer therapy: ________ years for leukemia, ________ years from solid tumors - risk for males to develop cancer in their life: ________ - risk for females to develop cancer in their life: _____
2,000 , 2-5 (leukemia), 3-10 (solid tumors), 1 in 2, 1 in 3 (tho the lecturer said it's basically 1 in 2)
With the Fear Avoidance Beliefs Questionnaire (FABQ), in patients with *acute* back pain with a score of _____ or less, this predicts there will be a need for prolonged work sessions and predicts those who will not return to work by 4 weeks
29
Normal lab values for *serum albumin*:
3.5-4.8 g/dL (decreased in liver damage / may be seen with conditions in which the body does not properly absorb and digest protein, such as Crohn disease or celiac disease, or in which large volumes of protein are lost from the intestines.; decreases with age; increased levels associated with dehydration or diets rich in protein)
Normal clinical lab values for hematocrit - - Males: - Females:
43-49% (males), 38-44% (females)
Normal lab values for *serum total protein*:
6-8 g/dL (decreased in different clinical conditions is associated with nephrotic syndromes, malnutrition, cirrhosis of the liver, and other liver disorders; increased values may be found in multiple myeloma and conditions associated with high globulin concentration)
Normal range for HR in adults (> 8 yrs)
60-100 bpm
Normal value range for O2 saturation (measured by pulse oximeter sensor)
90-100% (may be lower in people with chronic pulmonary issues) (Pulse ox and EKG must correlate for accurate reading)
Normal lab values for *blood ammonia*:
< 75 mcg/dL (increased in severe liver damage; liver unable to break down ammonia)
Fasting Plasma Glucose test values: Normal: Pre-diabetes: Diabetes:
<100 mg/dl (normal), 100-125 mg/dl (pre), >125 mg/dl (diabetes)
2-hour Oral Glucose Tolerance test values: Normal: Pre-diabetes: Diabetes:
<139 mg/dl (normal), 140-199 mg/dl (pre), >200 mg/dl (diabetes)
Asthma is a respiratory condition that is: a) obstructive. b) restrictive. c) inflammatory. d) infectious.
A (Asthma is part of the COPD triad which defines this syndrome. This condition causes narrowing of the bronchial lumen, causing an obstructing airflow.)
Auscultation of heart sounds is listening to the: a) timing, quality of the opening and closing of the bicuspid, tricuspid, pulmonic, and aortic valves during the cardiac cycle. b) timing, quality of the opening and closing of the tricuspid, pulmonic, and aortic valves during the cardiac cycle. c) quality of the opening and closing of the bicuspid, tricuspid, pulmonic, and aortic valves during the cardiac cycle. d) quality of the opening and closing of the tricuspid, pulmonic, and aortic valves during the cardiac cycle.
A (Not only does one listen to the timing but also the quality of the opening and closing of the all 4 of the heart valves during the cardiac -lub-dub- cycle.)
Comparison of the blood pressure in the leg (LE) vs. the arm (UE); normal ratio is greater than 1
ABI (ankle brachial index)
a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control; often called Lou Gehrig's disease, after the baseball player who was diagnosed with it. - Fasciculations (potentially key for Dx this condition in a PT clinic): twitching - difficulty walking / doing ADLs, tripping, falling - weakness in leg, feet or ankles; hand weakness or clumsiness - slurred speech, trouble swallowing - muscle cramps, inappropriate crying, laughing, or yawning - cognitive and behavioral changes
ALS
chronic, progressive arthritis with stiffening of joints, primarily of the spine
AS (ankylosing spondylitis)
Wells Criteria for Diagnosing DVT -
Active cancer (+1), recently bedridden (> 3 days) / major surgery (within past 12 wks) (+1), asymmetrical calf swelling (> 3 cm difference) (+1), Collateral (nonvaricose) superficial veins present (+1), entire leg swollen (+1), localized tenderness (+1), asymmetric pitting edema (+1), recent immobilization of LE (+1), previous DVT (+1), alternative Dx more likely (-2)
a condition that occurs when the adrenal glands do not produce enough cortisol or aldosterone, possibly due to endocrine dysfunction hypofunctional adrenals
Addison's Disease
what are the ABCDEs of detecting melanoma
Asymmetry, Border (irregularity), Color (one vs multiple colors), Diameter (larger than 1/4 inch), Evolving (or enlarging; changing in size, shape, and color)
A sequel to having cerebral palsy causes a respiratory condition that is: a) obstructive. b) restrictive. c) mechanical. d) infectious.
B (In those with cerebral palsy, poor posture and altered physical development causes postural structural deformities such as scoliosis, a cause of the restrictive lung conditions.)
A physical therapist examines a patient who reports right shoulder pain. Range of motion is full and changes in arm or body position do NOT alter the pain. Which of the following actions should the therapist take next? a) examine the patient's eyes for signs of jaundice due to a renal dysfunction b) examine the patient's eyes for signs of jaundice due to a hepatic dysfunction c) auscultate the patient's lungs for lung dysfunction d) auscultate the patient's heart for cardiac dysfunction
B (The patient MOST LIKELY shows a hepatic dysfunction because even auto-splinting does not alter the pain; the pain is at the right shoulder; ROM is full and changes in position does not alter the pain.)
What tests can be used to see if the CNS is involved in a patient's condition
Babinski (pictured), Clonus, Hoffman Sign, Lhermitte's sign
The purpose of patient use of a Holter monitor in physical therapy is to monitor the: a) heart beat during PT activities. b) heart rhythm during PT activities. c) cardiac nodal conductivity throughout 24 hour cycle, PT being one activity. d) heart beat throughout 24 hour cycle, PT being one activity.
C (The Holter monitor is a portable ECG whose purpose is to monitor the conductivity of the nodal tissue which sets the cardiac cycle. It is an indirect measure on how the heart responds to different workloads brought on by tasks during a 24-hour period. Used with people who are suspected of having a cardiac condition.)
After a person inhales a substance which causes dyspnea and wheezing, the therapist should considers this to be a respiratory condition which is: a) obstructive. b) restrictive. c) inflammatory. d) infectious.
C (This is an example of reactive or inflammatory lung condition, which typically causes wheezing and shortness of breath.)
DTRs, the following structures correlate with which spinal segments - Biceps: Brachioradialis: Triceps: Plantar reflex: Achilles:
C5/6 (biceps), C6 (brachioradialis), C7 (triceps), L4 (plantar relfex), S1 (Achilles)
this lung condition is a hereditary disorder characterized by lung congestion, infection, and malabsorption of nutrients by the pancreas - The body produces thick and sticky mucus that can clog the lungs and obstruct the pancreas
CF (cystic fibrosis)
_______ represents a wide variety of conditions that all are characterized by being obstructive or having blockage that keeps us from getting air into the lungs to be used by the CV system Some conditions under this term are: chronic bronchitis, emphysema, asthma, CF, and bronchiectasis (*all* of these decrease the size of the bronchial lumen causing an increase in airflow turbulence) Symptoms: chronic cough, dyspnea, increased sputum production Systemic Sequelae (consequences): weight loss, metabolic dysfunction, sarcopenia/muscle wastingRisk factors: smoking, environmental exposure, occupational dusts & chemicals, family Hx, allergies & asthma, poor nutrition, gestational & childhood factors, Periodontal disease
COPD
Using a lumbar puncture we can analyze ______ for conditions like meningitis, hemorrhage, MS, neurosyphilis, malignancy, and/or abscess factors evaluated include: appearance, cells, inorganic compounds, organic compounds (e.g. proteins, glucose, amino acids, etc)
CSF
the function of this system is to take up deoxygenated blood, pump it through the lungs, and pump out oxygenated blood to the periphery - dysfunction of this system can include muscular problems (statin meds for reducing cholesterol can effect the mm), conductivity (problems with impulse travel), pump failure, hypertension, valve failure (heart murmur), PVD, PAD, etc
CV (system)
this element of a systems review involves HR, respiratory rate, BP, edema, and pulse rate in extremities
CV pulmonary (system review)
bone and joint destruction secondary to a neuropathy and loss of sensation
Charcot joint
A chronic inflammatory bowel disease that affects the lining of the digestive tract. - cannot be cured. Medications such as steroids and immunosuppressants are used to slow the progression of disease - Pain areas: in the abdomen, *joints*, lower abdomen, or rectum
Crohn's disease (GI disease)
disorder with physical and mental changes that result from having too much cortisol in the blood for a long period of time, possibly due to endocrine dysfunction hyperfunctional adrenals
Cushing's Syndrome
A physical therapist examines a patient who reports intermittent pain in the central low back in the morning, at mid-day, and in the evening. Changes in position or movements do not alter the pain. Which of the following questions SHOULD the therapist pose to clarify the MOST LIKELY system from which the patient's pain originates? a) Does bending or reaching alter your pain? b) Does sneezing or coughing alter your pain? c) Does running up one flight of stairs alter your pain? d) Does eating a meal alter your pain?
D (Due to the non-mechanical patient presentation - Changes in position or movements do not alter the pain. PLUS the onset and cessation coincides with meals, it would be BEST for the therapist to inquire about the timing of eating meals and the pain cessation.)
A physical therapist should mobilize a patient following surgery to prevent respiratory conditions such as pneumonia that are: a) obstructive. b) restrictive. c) inflammatory. d) infectious.
D (Pneumonia is an infection of the lung tissue and can be prevented in post-operative patients with early mobilization.)
A physical therapist wishes to determine the efficiency of the blood flow in a person with peripheral vascular disease. Which of the following devices best measures distal blood flow efficiency? a) sphygmomanometer b) stethoscope c) ECG d) pulse oximeter
D (of the devices listed, the pulse oximeter is best because it measures the oxygen carried by the RBCs in the distal circulation, in indicator of blood flow efficiency.)
this test measures the electrical activity of the heart during cardiac cycles (records the amplitude and timing of conductive events within the heart) - indirect measure of the heart's condition
ECG
This performance tool (outcome measurement) describes a patient's level of functioning in terms of their ability to care for themself, daily activity, and physical ability classifies how disease is progressing in terms of functional ADLs
ECOG (Eastern cooperative oncology group performance status scale)
Gordon Waddell developed this outcome measure (generally used with back pain) Scoring: 2 subscales (Physical Activity & Work) - if low (<19) = increased probability of success with LBP due to sacroiliac joint (SIJ) dysfunction Valid and reliable in chronic population, useful for those patients with LBP who will not return to work by 4 weeks
FABQ (fear avoidance beliefs questionnaire)
Key signs/symptoms of cancer:
FATIGUE (not proportional to recent activity AND interferes with usual functioning), unexplained weight LOSS/gain (generally Pts lose weight unless it's a gynecologic cancer or breast cancer), fever (without infection; with night sweats), PAIN (night pain not relieved by position change, can't go back to sleep, insidious onset, non-MSK pain, difficult to localize Sx, Neuro Sx), Cancer Hx
This is a chronic disease that occurs when stomach acid or bile flows into the food pipe and irritates the lining. Acid reflux and heartburn more than twice a week may indicate this condition being present - Symptoms include burning pain in the chest that usually occurs after eating and worsens when lying down.
GERD (gastroesophageal reflux disease)
___________ system involvement - Shoulder pain: Kehr's sign (acute pain in the tip of the -Left- shoulder when px is laying down with legs elevated) Chest pain: acid reflux
GI (Kehr's sign in L shoulder considered a classic symptom of a ruptured spleen)
a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints
Glasgow coma scale
basically, the entire powerpoint labeled "management of patients in PT" wants you to go through what *acronym* when learning about a patient's pain
LOCIDAA (location, onset, intensity, duration, aggravating, alleviating)
this is a screening tool for distinguishing a central cause of vertigo from an acute peripheral vestibulopathy (APV), such as benign paroxysmal positional vertigo or vestibular neuritis - Dizziness screening
HINTs test (Ask the patient to relax his/her head and maintain his/her gaze on your nose. Gently move the patient's head to one side, then rapidly move it back to the neutral position. The patient may have a small corrective saccade.)
a hereditary disease marked by progressive degeneration of the brain cells and causing chorea and progressive dementia. Genetic disorder that causes progressive deterioration of brain cells. caused by a dominant allele. symptoms do not appear until about the age of 30. Signs: abnormal body movement (chorea), abnormal eye movement, decreased cognition, difficulty with emotion regulation, anxiety, OCD
Huntington's disease
An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. - cause not well understood - Some people can control their symptoms by managing diet, lifestyle, and stress. Others will need medication and counseling.
IBS (irritable bowel syndrome)
this test identifies dysfunction of spinal cord and/or an upper motor neuron lesion. Patient is long sitting on table. Have patient actively or you passively flex patient's head forward. (+) TEST: pain/electric sensation down the spine or into LE
Lhermitte's sign (myelopathy, MS)
this element of a systems review involves gross symmetry, gross ROM, gross strength, weight, height, and examining the head, axial skeleton and extremities
MSK (musculoskeletal system review)
Characteristics of _____________ pain include: decreases with rest movements, positions of aggravation, alleviation of symptoms sharp can cease when stressful action is stopped associated signs and symptoms (usually none, trigger points)
MSK (musculoskeletal)
____________ system involvement - Shoulder pain: rule out C spine, positive provocative tests, capsular pattern; px avoids sleeping on it Chest pain: rule out thoracic disc, rib with patient history, rule out systemic with history, vital signs Low back pain: mechanical eval; rule out SI via provocative tests and hip (scour); negative Murphy's test; supported by Px history
MSK (musculoskeletal)
Ronald Melzack developed this outcome measure that is designed to provide quantitative measures of pain and tries to see if an intervention has changed a patient's pain may be used with any pathology Words used to describe pain are brought together and categorized Score: pain word descriptors have ranking values to give a pain index rating; Low (0-10), Moderate (11-17), High (18-78) limiting factor: patient's vocabulary
McGill Pain Questionnaire
this test is also known as costovertebral angle tenderness (CVAT) and is used to rule out kidney involvement in pain. When performing this test the patient can either be in prone or sitting. The examiner places one hand over the costovertebral angle (CVA) of the patient's back. Next, the examiner provides a percussive thump with the other hand, allowing the kidney to vibrate. A *positive test* is noted by either costovertebral tenderness or reproduction of back/flank pain signaling a red flag for renal involvement. If the patient experiences *no pain* after the thump is performed, then *renal involvement is ruled out*
Murphy's percussion (test)
This outcome measure is used to measure disability due to neck pain Scoring identical to the Oswestry (Each area scored from 0-5; bottom potential score = 50; score is doubled for a total percentage score) Usefulness: Dionne finds it very useful, she uses it with the initial eval, then every 2-3 visits, and finally once more with discharge
NDI (neck disability index)
Upper airway structures
Nose (Nasopharynx), Mouth (Oropharynx), Throat (Pharynx), Epiglottis (prevents food/liquid from entering trachea)
An involuntary eye movement which may cause the eye to rapidly move from side to side, up and down, or in a circle, and may slightly blur vision. - Can have causes that aren't due to underlying disease. Examples include family history of this condition, looking out the window of a train or car, spinning in circles, or intoxication.
Nystagmus
______ is the relay system to the CNS (afferent and efferent)
PNS
what is the common lab test done to clinically check men's prostate health
PSA (Prostate-Specific Antigen = a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man's blood; PSA levels are often ELEVATED in men with prostate cancer)
a bone disease of unknown cause (potentially metabolic) characterized by the excessive breakdown of bone tissue, followed by abnormal bone formation
Paget's Disease
__________________ is the breakdown of damaged skeletal muscle. Muscle breakdown causes the release of myoglobin into the bloodstream. Myoglobin is the protein that stores oxygen in your muscles. If you have too much myoglobin in your blood, it can cause kidney damage. - relative to liver dysfunction this condition may be a result of taking *statins* (Lipitor, Zocor, etc = reduce blood cholesterol), or alcohol abuse/poisoning - characterized by muscle aches, cramps, soreness, and weakness - lab results will show creatine kinase (CK) levels more than 10x the upper limit of normal
Rhabdomyolysis
hearing acuity test performed with a vibrating tuning fork that is first placed on the mastoid process and then in front of the external auditory canal to test bone and air conduction - screening for temporal bone Fx
Rinne test
besides DVT, what patient presentation relating to the CV system requires *immediate* medical attention
S&S of thrombocytopenia (decreased thrombocytes; = excessive bruising, spontaneous bleeding)
This outcome measure is a multi-purpose, short form survey that consists of 36 questions. 8 scale profile on health and well-being (2 subscales = physical health and mental health) Summary measures of physical and mental health generic measure used widely by many disciplines takes 40-45 min to administer
SF-36
Screening for a concussion - _______________ Testing the ability of the eyes to move quickly between targets. Examiner holds two single points (fingertips) horizontally at a distance 3 ft from the patient, 1.5 ft to the R and one 1.5 ft to the L of the midline. Examiner instructs Pt to move their eyes quickly as possible from point to point. Repeat test in the vertical direction.
Saccades
Screening for a concussion - ________ ____________ Testing the ability to follow a slowly moving target. The Pt and the examiner are seated. Examiner holds a fingertip at a distance of 3 ft from the Pt. Pt is instructed to maintain focus on the target as the examiner moves it smoothly in the horizontal direction. Then repeat the test in the vertical direction. Pt's eyes should move but their head should not.
Smooth Pursuits
mneumonic device to remember cranial nerve *function* (sensory/motor/both)
Some Say Marry Money But My Brother Says Big Brains Matter More
this is a bacterial *infectious* disease transmitted by the gram-positive, acid-fast bacillus mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. It spreads through the air when a person with the condition of the lungs or throat coughs, sneezes, or talks - Risk factors: health care workers, being older, overcrowded housing, being incarcerated, immigrants, dependent on chemicals (like alcohol) with malnutrition/debilitation/poor health, infants/children under 5 y/o, immunosuppressed, malnourished - S&S: fatigue, malaise, anorexia/weight loss, low-grade fever (esp. in late afternoon), night sweats, frequent productive cough, dull chest pain/tightness/discomfort, dyspnea
TB
this is a motor outcome measure of 25-35 mins carried out usually to assess the posture and selective control of movement needed by infants under four months of age for functional performance in daily life. Very important outcome measure for infants at risk for cerebral palsy or at risk for developmental delay Scoring: very intricate (RAACSCH analysis)
TIMP (test for infant motor performance)
_______ lesions have spasticity that is not rigidity, but may have resistance to FAST passive movement - one direction - velocity dependent - weakness - associated with basal ganglia - clasp knife type
UMN (upper motor neuron)
this is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra - caused by the bacterium E. coli, usually found in the digestive system (sometimes other bacteria are responsible) - serious consequences can occur if this spreads to your kidneys. - typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder - usually treated with antibiotics - in some cases pain from this can refer to the hip (according to Dionne)
UTI (urinary tract infection)
Screening for a concussion - ____________ Tests visual motion sensitivity and the ability to inhibit vestibular-induced eye movements using vision. Pt stands with feet shoulder width apart, facing a busy area of the clinic. Pt holds arm outstretched and focuses on their thumb. Maintaining focus on their thumb, patient rotates L and R.
VMS (vision motion sensitivity)
Screening for a concussion - _____________ Assesses the ability to stabilize vision as the head moves. Examiner holds a target in front of patient at a distance of 3 ft. Pt asked to move head in horizontal and vertical planes while maintaining focus on the target.
VOR (vestibular ocular reflex)
also created by Gordon Waddell this is a group of physical signs in patients with LBP thought to be indicators of psychological components to pain; historically used to detect malingering patients with LBP Signs = superficial tenderness, non-anatomic tenderness, axial loading, pain on simulated rotation, distracted straight leg raise, regional sensory change, regional weakness, and overreaction *Not* diagnostic for "malingering", but used to indicate a possible need for psychological intervention
Waddell's Nonorganic signs
this test screening for temporal bone Fx is done by placing the stem of a vibrating tuning fork *on top* of the patient's head and having the patient indicate in which ear the tone can be heard - distinguishes between conductive vs sensorineural hearing loss
Weber test
Which of the following cancers could be virtually eradicated by a vaccination that already exists? a) cervical b) prostate c) lung d) breast e) oropharyngeal
a (cervical; vaccine = Gardasil)
when is an immediate medical attention necessary in a patient relating to respiratory disorders: (when presenting with...)
abrupt onset of dyspnea accompanied by weak and rapid pulse and fall in BP (pneumothorax; esp following a MVA, chest injury, or other traumatic event), chest/rib/shoulder pain with neurologic Sx (following recent recreational or competitive scuba diving), Sx of inadequate ventilation or CO2 retention (pulse ox lower than 90), red flags (cancer)
CN XI *motor* test = shoulder shrug (trapezius), head turn (sternocleidomastoid)
accessory
this condition is characterized by an abnormal enlargement of the extremities, possibly due to endocrine dysfunction
acromegaly
what are the risk factors for developing gallstones
age (incidence increases with age), women (affected more than men before 60 y/o), elevated estrogen levels, obesity (or rapid weight loss; poor diet; fasting), statin meds (reduce cholesterol), diabetes, ethnicity/genetics (native americans, hispanics), family Hx (of having gallstones)
what are clues to screening for pulmonary disease that should make a therapist suspicious
age (over 40 yo), smoker, PMH, MSK pain aggravated by respiratory movements, respiratory movements decreased on one side, dyspnea (esp when accompanied by unexplained weight loss), Sx do not change with movement, Sx increased with recumbency (lying supine)
functions of the upper GI tract
aids ingestion and digestion
what are common causes of *pancreatic* dysfunction
alcohol abuse, autoimmune disease, CF, diabetes, cancer
temporary cessation of breathing, especially during sleep - risk factors of having this condition during sleep include: age and obesity (& more common in men) - linked to risk in high BP, mental confusion, memory loss, stroke, increased insulin resistance, and cardiac problems
apnea
when is an immediate medical attention necessary in a patient relating to GI disorders: (when presenting with...)
appendicitis, obturator abscess, positive McBurney's (tenderness over point over the right side of the abdomen that is 1/3 of the distance from the ASIS to the umbilicus. This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum), rebound tenderness, traumatic Hx (Kehr's sign - acute pain in the tip of the shoulder - in the L shoulder = classic sign of ruptured spleen; suspect ectopic pregnancy)
this condition is characterized by a variable and reversible decrease in diameter in upper airway lumens caused by a hypersensitive/hyperactive inflammatory response or bronchospams (muscle spasms creating a contraction and reducing lumen space) - variety of triggers (including exercise and environmental) - medications based on response - proper warm-up and cool-down may prevent or reduce the incidence of exercise-induced versions of this condition - primary area affected: bronchioles (small airways)
asthma
this movement disorder is characterized by irregular, uncoordinated movements caused by a change to the *cerebellum*. - potential causes: brain tumors, stroke, cerebellar atrophy - this disorder (or its symptoms) clues to something being centrally wrong and that you should refer out
ataxia
a condition in which abnormal muscle contractions cause involuntary writhing/twisting movements. It affects some people with cerebral palsy, impairing speech and use of the hands. Causes: degeneration of the basal ganglia. This degeneration is most commonly caused by complications at birth or by Huntington's disease, in addition to rare cases in which the damage may also arise later in life due to stroke or trauma.
athetosis
the P wave on an ECG represents
atrial depolarization
A decrease in serum albumin is common with a pathologic condition of the liver because albumin is produced in the liver. The reduction in serum albumin results in some easily identifiable signs. Which of the following signs might alert the therapist to the condition of decreased albumin? a) Increased blood pressure b) Peripheral edema and ascites c) Decreased level of consciousness d) Exertional dyspnea
b (Albumin is a protein that is formed in the liver and that helps to maintain normal distribution of water in the body.)
An inpatient who has had a total hip replacement with a significant history of alcohol use/abuse has a positive test for asterixis. This may signify: a) Renal failure b) Hepatic encephalopathy c) Diabetes d) Gallstones obstructing the common bile duct
b (asterixis = neurologic symptom that may be present in a patient with hepatic dysfunction; "liver flap")
The most cancer *deaths* in men each year occur from which cancer: a) prostate b) lung c) colorectal d) none of the above
b (lung)
Which is the most important independent risk factor for developing cancer: a) having a sibling who had cancer b) older age c) inheriting a cancer gene mutation d) UV exposure
b (older age!!)
toe movement elicited by manipulation in a neurologic test performed on the sole of the foot to indicate injury to the brain or spinal nerves The toes flex upward when sole of foot is stimulated, indicating motor nerve damage
babinski
a collection of nuclei found on both sides of the thalamus - associated with a variety of functions, including control of voluntary motor movements, procedural learning, habit learning, eye movements, cognition, and emotion.
basal ganglia (BG)
temporary paralysis of the CN VII (facial) that causes paralysis only on the affected side of the face; condition of the brainstem Sx: rapid onset of mild weakness to total paralysis on one side of face, facial droop and difficulty making facial expressions (e.g. closing eyes, smiling), drooling, pain around jaw in or behind ear on affected side, increased sensitivity to sound on affected side, headache, decrease in ability to taste, changes in amount of tears and saliva you produce
bell's palsy
tumor that does NOT invade nor metastasize - name usually ends with "-oma" - well circumscribed border, may have capsule, does not spread out into tissue (non-invasive) - slower growth
benign
besides presented symptoms, what can you use (test) to differentiate between vascular vs spinal stenosis
bike test
the following are Symptoms of what *type* of cancer - - *fatigue*/malaise - *abnormal bleeding and bruising* - weakness / reduced exercise tolerance - decreased appetite and *weight loss* - *Bone* or joint pain - infection, fever, night sweats - *abdominal pain or "fullness* - enlarged spleen, liver - headaches - swelling: abdomen (esp. L) or in L shoulder - *Swollen lymph nodes* (axillary, inguinal)
blood (cancer)
when is an *immediate referral* warranted in a patient presenting with genitourinary symptoms:
blood in urine (& have not seen a physician about it), C spine pain at same time of urinary incontinence (v concerning!!), bowel/bladder incontinence with saddle anesthesia (cauda equina is involved)
what is a sphygmomanometer
blood pressure cuff (indirect measurement - measures the ratio of pressure against the arterial walls during systole and diastole)
what are the two most common types of cancers seen in *children* and *adolescents*
brain (+ CNS), Leukemia
The following are conditions of the _____________: stroke MS Chiari malformation Bell's palsy
brainstem
Cancers with affinity for bone = (B.L.T.) + (K.P.M.M.G.) lol
breast, lung, thyroid, kidney, prostate, melanoma, multiple myeloma, GI
this type of COPD obstructs airways through inflammation and a thickening of the walls/lumen of the bronchus and bronchioles - like using a coffee stir straw compared to a normal straw - tube gets smaller so it's harder to pull air in, less O2 going to the alveoli - primary area affected: membrane lining bronchial tubes
bronchitis
8. Preventing falls and trauma to soft tissues would be of utmost importance in the client with liver failure. Which of the following laboratory parameters would give you the most information about potential tissue injury? a) Decrease in serum albumin levels b) Elevated liver enzyme level c) Prolonged coagulation time d) Elevated serum bilirubin level
c
Screening for a concussion - ____________ Measures the ability to view a near target without double vision. Pt focuses on a small target at arm's length and slowly brings it toward the tip of their nose. Pt is instructed to stop moving the target when they see two distinct images or when the examiner observes an outward deviation of one eye. Distance is measured between target and tip of nose. *#1 test for concussion*
convergence
12 cranial nerves in order
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal
Referred pain patterns associated with hepatic and biliary pathologic conditions produce musculoskeletal symptoms in the: a) Left shoulder b) Right shoulder c) midback or upper back, scapular, and right shoulder areas d) thorax, scapulae, right or left shoulder
c (Technically, answer b. is also correct because referred shoulder pain may be the only presenting symptom of hepatic or biliary disease. However, when the overall referral pattern is viewed, answer b. leaves out the upper back and scapulae; answer d. refers to the part of the body between the neck and the abdomen and includes the primary pain pattern present in the right upper quadrant but not the mid or upper back associated with the referred pain pattern. Kehr's sign—left shoulder pain associated with blood or air in the abdominal cavity—is not part of the hepatic/biliary system.)
If a patient has a history of __________, suspect that 1st until ruled out by medical means
cancer
Neck pain could be due to various sources, name what non-musculoskeletal condition goes with each of the following descriptions - _____________: bone or spinal cord tumors ____________: angina _____________: Pancoast tumor (tumor of the pulmonary apex) _____: anterior neck pain, swallowing difficulty
cancer, cardiac, pulmonary, GI
Thoracic pain could be due to various sources, name what non-musculoskeletal condition goes with each of the following descriptions - ___________: red flags, breast cancer ____________: angina, pain aggravated by activity by not relieved by movement or change in position __________: pain with change in vital signs, pancoast tumor (tumor of the pulmonary apex) ____________: T9-L1 referral for pain, costo-vertebral angle tenderness _______: back pain referral, check history, pain associated with meals
cancer, cardiac, pulmonary, renal, GI
__________ system involvement - Shoulder pain: angina (vitals, hx, BP); rule out lymphedema Chest pain: angina (vitals, hx, BP); rule out pericarditis (with SLE) Low back pain: abdominal aorta; test for PVD (peripheral vascular disease), chronic heart failure (CHF), claudication (pain caused by too little blood flow to your legs or arms) - bike test
cardiovascular
this syndrome of the spinal cord is characterized by pain, LE weakness, loss of B&B (bowel and bladder, loss of perineal senses, decreased reflex - LMN (lower motor neuron) damage (NOT UMN), so it can regenerate - trauma of spinal stenosis; distal to conus medullaris
cauda equina syndrome
what structure of the brain functions in coordination, balance, and equilibrium
cerebellum
The following are conditions of the _________/________ - brain tumor TBI/concussion stroke Sub dural hematoma (SDH) (brain bleed) Sub arachnoid hematoma (SAH) (brain bleed) Trans ischemic attack (TIA) (mild stroke) Multiple Sclerosis (MS) (early sign: vision abnormalities) Meningitis (key sign: high fever)
cerebrum, cerebellum
Other associated signs and symptoms of cancer = (CA.U.T.I.O.N.)
changes in bowel and bladder habits/function, a sore that doesn't heal in 6 wks, unusual bleeding/discharge, thickening/lump, indigestion or difficulty swallowing, obvious change in wart/mole, nagging cough or hoarseness (+D.V.M. = DTR changes, Vital sign changes, Muscle weakness - proximal)
In (chronic/local) pain, the pain is mediated through different pathways if the pain generator is removed the pain does not dissipate preoccupation, drug use, constant unremitting, can cause depression, etc
chronic
Refer patients with GI problems to the physician when...
chronic laxative use, joint and skin involvement with GI symptoms, NSAID use with shoulder pain and peptic ulcer Hx, back pain with meals, back pain with previous Hx of cancer
this test is for a neurological condition that occurs when nerve cells that control the muscles are damaged. This damage causes involuntary muscle contractions or spasms. -flex foot into dorsiflexion -positive finding = foot keeps moving -conclusion: clonus (repeated muscle spasm) Flex the dorsal foot upward.Positive test = 5 or more uncontrollable shaking of the dorsal foot
clonus (test)
Refer patients with Genitourinary (GU) problems to the physician when...
cluster of S&S confirmed, back/shoulder pain with urinary/renal Sx, positive Murphy's with a Hx of renal info/UTI
what components are looked at during a routine urinalysis
color, turbidity (cloudiness), specific gravity (normal fluid intake), pH, glucose, ketones, blood bilirubin, blood cells
Refer patients with CV problems to the physician when...
combo of systemic Sx, women w/ family hx and has chest pain, palpitations, dyspnea when lying down, fainting without warning, post-CVA or TBI (susceptible to a cardiac event), throbbing abdominal pain/sensation (in cardiac Pts - change in angina pattern, nitro tabs not effective, etc)
this element of a systems review involves communication ability, cognition, and language
communication (system review)
lower airway structures
conducting airways, alveoli
what *neurologic* symptoms may be present in a patient with hepatic dysfunction
confusion, sleep disturbances, muscle tremors, bilateral "CTS", ascites (accumulation of fluid in the peritoneal cavity, causing abdominal swelling --> patient reports a sense of fullness), asterixis (tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterized by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist)
______________ symptoms refers to a group of symptoms that can affect many different systems of the body. Examples include weight loss, fevers, headache, fevers of unknown origin, hyperhidrosis, generalized hyperhidrosis, chronic pain, fatigue, dyspnea, and malaise.
constitutional
this syndrome of the spinal cord is characterized by loss of B&B (bowel and bladder), decreased LE sensation, and decreased Achilles reflex - the affected structure is located around S4 and S5
conus medullaris syndrome
CNI *sensory* sense of smell
olfactory (earliest signs of parkinson's is loss of smell)
the use of ___________ has a significant influence on PT; many patients with orthopedic dysfunction take these; long term use may lead to adverse effects (e.g. hyperglycemia, myopathy, etc); can cause GI distress and/or immunosuppression
corticosteroids
Clients with significant elevations in serum bilirubin levels caused by biliary obstruction will have which of the following associated signs? a) Dark urine, clay-colored stools, jaundice b) Yellow-tinged sclera c) Decreased serum ammonia levels d) a and b only
d
Percussion of the costovertebral angle that results in the reproduction of symptoms: a) Signifies radiculitis b) Signifies pseudorenal pain c) Has no significance d) Requires medical referral
d
Decreased level of consciousness, impaired function of peripheral nerves, and asterixis (flapping tremor) would probably indicate an increase in the level of: a) AST (aspartate aminotransferase) b) Alkaline phosphatase c) Serum bilirubin d) Serum ammonia
d (Your liver may not be working properly if you have high levels of ammonia in your blood. Ammonia is a chemical made by bacteria in your intestines and your body's cells while you process protein. Too much ammonia in your body can cause psychological problems like confusion, tiredness, and possibly coma or death.)
Important functions of the kidney include all the following except: a) Formation and excretion of urine b) Acid-base and electrolyte balance c) Stimulation of red blood cell production d) Production of glucose
d (kidneys are active in a-c but not d.)
During the ___________ process, the following elements should always be looked at and taken into consideration - client history pain patterns/pain types associated signs and symptoms of systemic diseases systems review
decision making
Persons with phantom or neurogenic pain have (increased/decreased) *CSF endorphin* levels.
decreased
What could be the root problem in the following patient example - a 35 y/o female reports dizziness and muscle cramping following running the memorial marathon
dehydration (metabolic)
patient __________ = age, gender, lifestyle, culture, work
demographics
what disease can be related to the following conditions/incidents - neuropathy (peripheral, autonomic) Charcot joints skin lesions peripheral vascular abnormalities more prevalent in px who have nontraumatic LE amputations
diabetes
functions of the lower GI tract
digestion, absorb nutrients (& water), prep waste for elimination
this movement disorder is characterized by abnormal movement caused by a change in function of the basal ganglia
dyskinesia
Smoking cigarettes increases your risk of which of the following cancers? a) pancreatic b) cervical (gynecologic) c) lung d) none of the above e) all of the above
e
Which of the following cancers is on the *rise* in the US: a) pancreatic b) colorectal in young adults c) thyroid d) head/neck without smoking history e) all of the above
e
Renal pain is aggravated by: a) Spinal movement b) Palpatory pressure over the costovertebral angle c) Lying on the involved side d) All of the above e) None of the above
e (pseudorenal pain would be d. all of the above but true renal pain is seldom affected by a-c)
who / what populations are at increased risk of developing cancer
elderly (older people), women with prolonged exposure to high levels of estrogen + progesterone (may be due to early menstruation, late menopause, older at 1st pregnancy/never giving birth, hormonal therapy), transplant recipients (lung, kidney, liver), exposure to HIV/AIDS, diabetes, DMARDs (Disease-modifying antirheumatic drugs = treatment of RA, lupus, psoriasis and many other autoimmune disorders), prolonged glucocorticoid use, obesity, tobacco use (any form), drinking alcohol, cancer survivors, family Hx (+ inherited gene mutation), immunosuppressed
this type of COPD is characterized by a decrease in alveolar folds which leads to a decrease in surface area and decrease in O2 getting exposure to capillary beds - impaired/destruction to the alveoli - may develop in a person after a long history of chronic bronchitis in which the alveolar walls are destroyed, leading to permanent overdistention of the air space and loss of normal elastic tension of lung tissue - S&S: SOB, dyspnea on exertion, orthopnea (only being able to breathe in upright position), chronic cough, barrel chest, weight loss, malaise, wheezing, pursed-lip breathing - Primary area affected: air spaces beyond terminal bronchioles
emphysema
___________ system involvement - Shoulder pain: lab test (serum glucose); positive correlation with shoulder capsulitis esp when it's bilateral Chest pain: Px with a positive CV history; arterial system involvement; history of hypertension Low back pain: rule out peripheral vascular disease (PVD) influence
endocrine
the following are "clues" when there is dysfunction in this body system - previous diagnosis bilateral CTS (carpal tunnel) long-term use of cortico-steroids Px taking diuretics (signs of K+ depletion) Arthralgia with signs and symptoms relating to this system
endocrine
What could be the root problem in the following patient example - a PT examines a 56 y/p male px with bilateral CTS who presents with edematous ankles
endocrine issue
the collection of glands that produce hormones that regulate metabolism, regulate water and salt balance, BP, growth and development, tissue function, sexual function, reproduction, sleep, and mood, among other things.
endocrine system
this is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus grows outside your uterus. - most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely spreads beyond pelvic organs. - Possible Causes: retrograde menstruation, transformation of peritoneal cells, immune system disorders - Sx: painful periods (or excessive bleeding), pain with sex, pain with urination/defecation, infertility
endometriosis (tissue that lines inside of uterus = endometrium)
what are the 3 regions of primary GI pain patterns
epigastric, umbilical area, lower abs
Postmenopausal women use what (2) endocrine drugs for hormone replacement therapy
estrogen, progestin
this element of patient/client management involves combining and synthesizing data from the PT exam, info from clinical lab results, and info from diagnostic imaging
eval
this element of patient/client management involves patient demographics, responses from history, scores from initial outcome questionnaires, systems review, screening, tests and measures, and special tests
exam
what are ways (4) to obtain pertinent info from patients (especially to decide if their condition is serious in nature or not)
exam, (patient) demographics, patient history (family + personal Hx, onset of condition, signs and symptoms, risk factors, medications), systems review (CV, integumentary, MSK, neuromuscular, cognition/communication)
what are the elements of patient/client management
exam, eval, diagnosis, prognosis, intervention, outcomes
Stroke Warning Signs (FAST)
face drooping, arm weakness, speech difficulty, time to call
CN VII *motor* and *sensory* Test = facial movement, raise eyebrows, puff cheek, smile, close eyes (taste and salivation not usually tested) *T*o *Z*anzibar *B*y *M*otor *C*ar
facial (temporal, zygomatic, buccal, mandibular, cervical)
T/F: you can tell if a lump on your body is cancerous by palpating it
false (CANNOT tell if a lump is cancerous or not just by feeling it; ~8/10 lumps found on breast palpation are benign)
T/F: there is very clear and typical presentation in patients who have brain tumors
false (NO typical presentation; can have: seizures, headache, vision changes, nausea/emesis, cognitive/behavioral/language changes, lethargy, gait changes, weakness, the list goes on)
T/F: inheriting a gene mutation means you will have cancer in your lifetime
false (increases your risk but does not necessarily mean you will develop cancer)
T/F: A patient who is seeing you from a doctor referral has been screened for cancer
false (just bc a patient saw a doctor before you does NOT mean they've been screened for cancer)
T/F: race and ethnicity are not important when it comes to risk of developing cancer and dying from cancer
false (there are definitely health disparities between races/ethnicities - worse healthcare and screening for Blacks, Hispanics, and Native Americans compared to whites)
this lobe of the brain functions in motor problem solving and speech
frontal
_____________ cause pain in the mid-upper abdomen that may radiate to the back or under the right shoulder. ________ stones cause sharp pain in the lower back or side of the body that may radiate to the lower abdomen and groin
gallstones, kidney
the functions of the ______________ system include eliminating waste from the body, regulating blood volume and blood pressure, controlling levels of electrolytes and metabolites, and regulating blood pH. - control mineral and H2O balance - filter waste products, remove excess fluids from blood - vitamin D activation and Ca2+ balance - pH balance - role in formation of RBCs - reproductive function
genitourinary
CN IX and X *motor* and *sensory* Test = patient open mouth saying "ahhhh", gag reflex for an unconscious patient
glossopharyngeal, vagus
hereditary metabolic disease that is a form of acute arthritis, characterized by excessive uric acid in the blood and around the joints especially seen in the toes
gout
____________ system involvement - Shoulder pain: Right shoulder, observe for jaundice, other red flags Chest pain: Right side, axillary line, observe for jaundice, other red flags Low back pain: dull mid-back ache, observe for jaundice, other red flags
hepatic
A _______ ________ __________ is a blood test to check how well the liver is working. This test measures the blood levels of total protein, albumin, bilirubin, and liver enzymes. High or low levels may mean that liver damage or disease is present.
hepatic function panel
this is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. - GI tract pathology - Potential causes: weakened muscle tissue allows your stomach to bulge up through your diaphragm, Age-related changes in your diaphragm. Injury to the area (trauma or certain types of surgery)
hiatal hernia
globally cancer is the 2nd leading cause of death, where is it the 1st leading cause of death?
high income countries
A ____________ monitor is a battery-operated portable device that measures and records your heart's activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used
holter
The _____________ is commonly used today in scientific disciplines such as psychology as a teaching or memory tool to describe the distorted scale model of a human drawn or sculpted to reflect the relative space human body parts occupy on the somatosensory cortex and the motor cortex. Both the motor and sensory homunculi usually appear as small men superimposed over the top of precentral or postcentral gyri for motor and sensory cortices, respectively.
homunculus
Excessive or insufficient activity of the thyroid that is possibly due to endocrine dysfunction. Both conditions show similar symptoms including: Fatigue. Frequent, heavy menstrual periods. Forgetfulness. Weight gain. Dry, coarse skin and hair. Hoarse voice. Intolerance to cold.
hyper-thyroidism (increase in hormone production), hypo-thyroidism (decrease in hormone production)
this type of movement disorder involves an increase in movement and uses an indirect pathway - Examples include: Huntington's disease
hyperkinetic (movement disorder)
CN XII *motor* test = check tongue muscle side to side and stick out tongue
hypoglossal
this type of movement disorder involved a decrease in movement and uses a direct pathway - Examples include Parkinson's disease
hypokinetic (movement disorder)
Red flags of the PNS
hyporeflexia, weakness (decreased tone), numbness, tingling, pain, mono-filament testing
If a patient presents to you the following what should you do as a therapist? - Px with diabetes being confused, lethargic, sweating at rest, hypoglycemic
immediate referral (to physician)
If a patient presents to you the following, what should you do as a therapist? - signs of K+ depletion (muscle weakness and cramping, arrhythmia, nausea) signs of "thyroid storm" (fever, tachycardia, hypertension, neurological, GI abnormalities)
immediate referral (to physician)
cancer is an overgrowth of cells AND a failure of what system
immune
____________ system involvement - Shoulder pain: positive cardinal signs for inflammation Chest pain: Px histroy, pericarditis (esp in Px with SLE) Low back pain: dull ache, mid-back (myalgia)
immunologic
During cold and flu season, decongestants (increase/decrease) BP and (increase/decrease) cardiac workload
increase, increase
____________ system involvement - Shoulder pain: observe for trophic changes Chest pain: observe for trophic changes Low back pain: observe for trophic changes; rule out peripheral vascular disease (PVD) with LE symptoms; wound care issues
integumentary
this element of a systems review involves skin integrity and stage of healing, skin color change, presence of scar formation, hair growth pattern, skin turgor (pinching checking for rebound to assess for dehydration), nail trophic changes, and skin/body temperature
integumentary (system review)
this element of patient/client management is evidence-based, matched with patient's goals, regularly measured, and focuses on successful discharge what the therapist actually does
intervention
this is a common sign of liver dysfunction that may be due to cirrhosis (liver scarring), hepatitis, drug-related toxicity, or cancer
jaundice (buildup of bilirubin, a waste material, in the blood. An inflamed liver or obstructed bile duct can lead to jaundice, as well as other underlying conditions. Symptoms include a yellow tinge to the skin and whites of the eyes, dark urine, and itchiness) (Other S&S of hepatic dysfunction: light stools, tea-colored urine, itching, spider angiomas - superficial swollen blood vessels resembling a spider, palmar erythema - red palms, plantar erythema - redness on soles of feet, whiter than expected nails esp. with darker rims)
What is the first most common sign associated with liver disease?
jaundice (first noted as a yellowing of the sclerae of the eyes. The skin may take on a yellow hue as well, but this is not as easily observed as the change in the eye. This change in eye and skin color can also occur with pernicious anemia, a condition that may be accompanied by peripheral neuropathy as well.)
what structures make up the Genitourinary system (upper and lower)
kidneys (upper), ureters (upper), bladder (lower), urethra (lower), reproductive organs (lower)
How can we as PTs prevent cancer (3)
know current cancer screening guidelines (patient edu), know preventable risk factors (encourage healthy lifestyle), restore ability to participate in activities
this is the largest visceral organ in the body that functions in bile production and detoxification - more than 500 functions - secretes bilirubin, albumin, bile - produces clotting factors - stores vitamins - filters the gut from toxins
liver
In (chronic/local) pain, the patient can ID where the pain is, the pain is mediated through "typical" pathways, and if the pain generator is removed the pain also dissipates
local
what are the three most common / primary metastatic (spread of cancer cells to new areas of the body) targets in the body?
lungs, lymph, bone (most common place for bone mets = T spine; bone mets increase risk for Fx, cord compression, and hypercalcemia; bones mets NOT detected by x-ray is < 30% involved)
this type of tumor invades and metastasizes (develops secondary growths at a distance from the primary site of cancer) - irregular, diffuse border, goes into normal tissue (invasive) - mitotically active; grows faster
malignant
what are all the potential sources of restrictive lung dysfunction
maturational (abnormal fetal development), pulmonary (fibrotic changes over time), CV (pulmonary edema), neuromuscular (motor control, SCI), MSK (scoliosis), CT (with RA, SI, etc), immunological (lupus), metabolic (diabetes, obesity), trauma (crash injury, flail chest)
Why is it important to screen for neurologic conditions as a PT
may be the first to ID a neuromuscular problem (onset may occur over time while in PT; may be seen for diff issue than neuromuscular, helps in prognosis, goal setting, and duration of Tx; it's good Pt care)
Under the _________ health sub-scale on the SF-36 outcome measure, the following areas of interest are considered: Vitality (from "pep" to "tired") Social functioning (extend and time) Emotional role Mental health (self perception; from "distress" to "positive")
mental
the following are characteristics with ____________ problems - fluid imbalances edema K+ depletion
metabolic
A syndrome marked by the presence of usually three or more of a group of factors (high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, insulin resistance, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.
metabolic syndrome
Oswestry Disability Index - 0-20%: 20-40%: 40-60%: 60-80%: 80-100%:
minimal (disability), moderate (disability), severe (disability), crippled, bed bound (or exaggerating symptoms)
what are the red flags of *cerebrum* involvement
mood changes (labile/quick changes/emotionally unstable), vision changes (double vision/loss of vision/tunnel vision), speech changes, motor control changes (SPASTICITY), sensation changes (numbness/tingling), dizziness, nausea, vomiting
this is a cancer that forms in a type of white blood cell called a plasma cell (this type of WBC is not usually found in the blood). Plasma cells help you fight infections by making antibodies that recognize and attack germs - causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells - Sx: *fatigue*, *pain*, infection - osteoclast proliferation --> bone resorption --> Fx, spinal cord compression, hypercalcemia (high blood Ca2+ levels) - treatment generally NOT curative - 5 yr survival rate: ~50%
multiple myeloma
what are the two most common primary cancers of the musculoskeletal system
multiple myeloma (common after age 50, common sites: pelvis, spine, cranium), osteosarcoma (common in younger people, can spike again when older; common sites: around knee - proximal tibia / distal femur)
what side effects may be present on a patient taking statins (for lowering their cholesterol)
myalgia, fever, nausea, dark urine, bilateral CTS, nail bed changes
Red flags for concussion/TBI
neck pain, weakness, doube vision, vomiting, seizures, LOC (loss of consciousness), HA (headache), agitation, dizziness
For the HINTs test (dizziness screening), the head impulse test (HIT) is *positive* when... Skew = (positive/negative) Nystagmus = (present/absent) Hearing loss = (positive/negative)
negative, present (with head movement), negative
this type of pain is indicated by words like "sharp, crushing, burning, stinging, numbness, tingling" could be caused by compression from a tumor, spinal nerve root irritation, peripheral nerve entrapment, or neuritis PT should test dermatomes, myotomes, DTRs, selective tissue testing (Cyriax), dural testing (Butler), and/or repeated test movements (MDT)
neurogenic
____________ system involvement - Shoulder pain: rule out upper motor neuron vs lower motor neuron symptoms and signs; rule out hand-shoulder syndrome Chest pain: rule out ANS involvement; vital signs and response to activity Low back pain: rule out complex regional pain syndrome (CRPS); sort out radicular pattern vs stocking and glove pattern of involvement (peripheral neuropathy); rule out stenosis (relief with repeated knees to chest in supine, positive bike test)
neurologic
this element of a systems review involves general gross coordinated movement, balance, locomotion, transfers, and transitions
neuromuscular (system review)
when is an *immediate referral* warranted in a patient relating to hepatic dysfunction / liver disease
new onset of myopathy WITH a Hx of statin use (reduces blood cholesterol), obvious signs of hepatic disease presented with a previous Hx of hepatic disease or cancer
(cancerous/non-cancerous) tumors are usually more superficial while (cancerous/non-cancerous) ones are generally deeper
non-cancerous (benign), cancerous (malignant)
Is the following description of a palpable node *normal or suspicious* - - Consistency: Soft/rubbery, mobile - Temperature: Normal - Sx with palpation: non-tender - Size: small (< 1 cm)
normal
this lobe of the brain is the primary visual area
occipital
CN III, IV, and VI often tested together *motor nerves* test = VOMs concussion testing (smooth pursuits, saccades, convergence, and light pupil reflex)
oculomotor, trochlear, abducens (in MS opposite reactions occur during the light pupil reflex; light in eye causes dilation)
a condition in which the bones become fragile and break easily (density and quality of bone is reduced) characterized by pain and palpable tenderness over site of possible Fx aggravating factors: prolonged sitting, standing, bending, with Valsalva Alleviating factors: side-lying with hips and knees flexed loss of height rib/spinal deformity
osteoporosis
What could be the root problem in the following patient example - an 85 y/o male presents with severe pain in the ribs and mid-back following extended coughing. Radiographs show a decrease in Ca2+ in the rib body and thoracic vertebral bodies
osteoporosis (exacerbated by valsalva; due to his age and likely poor diet/inactive lifestyle)
this outcome measure is specifically for those with low back pain (LBP); self-reported on perceived disability; commonly used in PT and ortho spine clinics; very responsive to change in Px's status areas considered with this outcome measure: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, employment Each area scored from 0-5; bottom potential score = 50; score is doubled for a total percentage score
oswestry disability index
this element of patient/client management is the result of the intervention based on data from questionnaires and tools (e.g. DASH) can be expressed as changes in impairments (ROM, distanced walk, vital sign responses, etc)
outcomes
this is a noxious sensation/stimulus that is generally subjective info usually shorter duration if peripheral (remove source and it should dissipate) usually chronic if centrally derived if neurogenic, described with words like "burning, shooting, numb, tingling" classified on numeric scale 0-10 (NPS), visual analog scale (VAS), or with drawings
pain
this is a complex phenomenon that is multifactorial, subjective, and individualized
pain (nocioception)
this is a syndrome that is the consequence of cancer in the body specifically due to the production of chemical signalling molecules (such as hormones or cytokines) by tumor cells or by an immune response against the tumor. = indirect effects occurring *distant to any tumor/met site*
paraneoplastic (syndrome)
this lobe of the brain functions in sensory, body awareness, and visuospatial info/tasks
parietal
Under the ________ health sub-scale on the SF-36 outcome measure the following areas of interest are considered: physical functioning (vigorous activities, descending order..., bathing and dressing) Physical role Bodily pain General health
physical
this lung condition is an *infection* in one or both lungs. Bacteria, viruses, and fungi cause it. The infection causes inflammation in the alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. - this condition can be prevented in post-op patients with early mobilization
pneumonia
For the HINTs test (dizziness screening), the head impulse test (HIT) is *negative* when... Skew = (positive/negative) Nystagmus = (direction changing/no change) Hearing loss = (positive/negative)
positive, direction changing, positive
what are ~*the big 4*~ when it comes to common cancers (most common we will see and need to be aware of)
prostate (symptoms of urinary obstruction; hip/spine/rib/pelvic bone pain = v concerning), breast (starting at 45 women should begin yearly mammograms; at 55 transition to every other year), lung (risks = smoking, environmental exposures, prior lung disease, genetic factors; most commonly Dx by routine chest films or Pt being anemic), colorectal (colon & rectal; starting at age 50 you should get a colonoscopy every 10 yrs if you're at average risk)
this disease is common in men in their 50's - three most common forms of this disease are inflammation of the gland, non-cancerous enlargement of the gland (benign) and cancer. - pain and subsequent problems can refer to the low back (source: Dionne)
prostate disease
this type of pain is indicated by words like "tiring, miserable, cruel, agonizing" PT could do an assortment of tests including: Waddell's non-organic signs, Somatic amplification rating scale (SARS), SF-36 (general health status), Oswestry perceived disability for LBP, and/or neck disability index (NDI) these tests are not Dx in isolation but with other indicators may guide the therapist to D/C and refer to a psychologist or other med professional
psychogenic
___________ system involvement - Shoulder pain: lung abscess (ulcer/cyst) or tumor; pneumonia; prefers to sleep on that side Chest pain: breast cancer, pneumonia, pulmonary function test (PFTs), vitals Low back pain: more upper back - pneumonia
pulmonary
this condition occurs most often in babies under six months. In this condition, the pylorus muscles block food from entering the small intestine - A condition in which the opening between the stomach and small intestine thickens - can lead to forceful vomiting, dehydration, and weight loss. Babies with this condition may seem to always be hungry. - fixed with surgery.
pyloric stenosis
___________ system involvement - Shoulder pain: Right shoulder, bladder dysfunction Low back pain: positive Murphy's test; rule out with Mechanical diagnosis and therapy (MDT) (McKenzie) evaluation
renal
this is a fancy term for "kidney stone" - these form when your urine contains more crystal-forming substances — such as *Ca2+*, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form. - pain from this can construed initially as low back pain (according to Dionne)
renal calculi
the function of this system is moving air in and our of the lungs via pressure gradient (ventilation), and gas exchange (supply O2 to blood and tissues, remove CO2)
respiratory (system)
this movement disorder is characterized by resistance to passive movement - associated with the *basal ganglia* - seen in disorders of bradykinesia or dystonia - resistance is the same in both directions - not weak - not velocity dependent - sub types: cog wheel, lead pipe should refer out if you see this in a patient
rigidity
Martin Roland developed this outcome measure that is designed as a health status measure; self-reported by patients with LBP originally designed for use in research but now found useful in primary care clinics derived from sickness impact profile Scoring: Px puts a mark next to each appropriate statement, total # of marked statements are summed
roland-morris disability questionnaire
what are signs and symptoms of acute spinal cord compression (potentially from a tumor extending from the vertebral body putting pressure on the cord)
severe back pain (in spinal nerve root distribution, worse with WB and coughing), weakness (distal and/or myotomal; atrophy), sensory loss (distal and/or dermatomal), autonomic changes (late; sluggish bowel, urinary incontinence)
'Textbook' metastatic (spread of cancer cells to new areas of the body) bone pain - - Quality: _________ - Intensity: ________ - Temporal variation: _________ - Progression: ____________
sharp, severe, worse at night, initially transient --> later constant (MANY cases don't necessarily follow these characteristics)
Refer patients with respiratory problems to the physician when...
shoulder pain aggravated by respiratory movements, shoulder pain aggravated by supine positioning (pain that is worse when lying down and improves when sitting up or leaning forward is often pleuritic in origin), shoulder or chest pain that subsides with auto splinting (lying on painful side), weak and rapid pulse accompanied by fall in BP (pneumothorax) (in patients with asthma: signs of asthma or bronchial activity during exercise)
this term refers to what you as a therapist measure/observe about a patient's condition; more objective
signs
Have patient look at your nose with their eyes and then cover one eye. Then rapidly uncover the eye and quickly look to see if the eye moves to re-align. Repeat with on each eye. _________ deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome.
skew
this movement disorder is the inability to produce and control bodily movements, that presents as increased tone or stiffness of the muscles. - lesions of the cortical spinal tracts, upper motor neuron (UMN) lesions resulting in hyperreflexia, stroke, SCI, MS, CP - positive clonus test
spasticity
Is the following more likely to be a vascular or spinal stenosis - leg pain with walking, relief with sitting, unilateral or symmetrical leg pain claudication (pain caused by too little blood flow to your legs or arms), normal pulses; worse with trunk extension, better with flexion
spinal
Acquired conditions of the _______ _______ include - SCI (elderly people with spinal stenosis can develop/acquire SCI) MS ALS
spinal cord
this type of pain is indicated by words like "aching, dull, deep" indicate pathologies involving bone infections, neoplasms, and/or metabolic disorders Px presentation: severe & unrelenting pain, fever, bone tenderness, unexplained weight loss, night sweats, unexplained generalized weakness
spondylogenic
what are the three causes of cancer
sporadic (chance; generally caused by multiple accumulated mutations; most common cause!!), familial (genetic + environmental, no clear inheritance pattern), hereditary (gene mutation passed from parent to child; not super common)
this instrument is used during auscultation (the action of listening to sounds from the heart, lungs, or other organs) for pulse, heart, and respiratory sounds
stethoscope
what are some diagnostic tests used with hepatic/GI pathologies?
stool samples (blood in stool), colonoscopy, x-rays (for Dx problems in esophagus, stomach, duodenum, and large intestine)
With the Fear Avoidance Beliefs Quiestionnaire (FABQ), in patients with *chronic* back pain, this outcome measure can predict who may need to be _______ more than those that confront their pain
supervised
Is the following description of a palpable node *normal or suspicious* - - Consistency: soft/rubbery, mobile - Temperature: sometimes warm - Sx with palpation: tender - Size: enlarged
suspicious (potentially cancer) (MOST palpable nodes are benign)
this term refers to what patient describes about their condition; more subjective
symptoms
Characteristics of _____________ pain include: awaken at night deep aching, throbbing reduced by pressure constant or waves/spasms history of infection recent medications associated signs and symptoms (jaundice, migratory joint pain, fatigue, weight loss, weakness, etc)
systemic
this is a rare condition that occurs in the medulla of the brainstem; can occur unilaterally; the person will have cranial nerve loss, plus SCI-like symptoms of the facial region only
wallenberg stroke
Sacral / Sacroiliac pain could be due to various sources, usually a physical event (in which the therapist does a cluster of provocative tests once LBP has been ruled out). Name what non-musculoskeletal condition goes with each of the following descriptions - ___________: endocarditis, prostate cancer; Ankylosing spondylitis (AS - arthritis primarily effecting the spine); Paget's disease (body's normal recycling process, in which new bone tissue gradually replaces old bone tissue is abnormal causing bone's to become fragile over time) _________: Chron's disease (IBD), IBS, colon cancer
systemic, GI
this lobe of the brain functions in understanding speech, learning, and memory
temporal
this structure in the brain performs several functions such as relaying of sensory signals (including motor signals to the cerebral cortex), regulation of consciousness, sleep, and alertness
thalamus
what *musculoskeletal* pain is associated with hepatic dysfunction
thoracic pain between scapulae, R shoulder (R upper trap, R subscap), osteoporosis
this movement disorder associated with the basal ganglia has rhythmic or semi-rhythmic oscillations; 3 types - - Resting (occurs when limb relaxed; Parkinson's) - Postural (occurs when limb is held in a position and disappears at rest; e.g. Essential) - Intention/Ataxic (occurs when Pt attempts to move limb)
tremor
CN V *motor* and *sensory* Tests = light touch and pinprick on face check all three areas, clench jaw, corneal reflex
trigeminal
T/F: clues for a PT to suspect *liver disease* include - Pt Hx, pain report (R shoulder/upper mid back), GI symptoms, neurologic symptoms (bilateral CTS/tarsal tunnel), skin symptoms (jaundice, palmar erythemia), and/or post-op drug induced hepatitis
true
T/F: weight gain can be a sign of cancer
true
T/F: in the earliest stages of many cancers there may be *no* signs/symptoms
true (also, most cancers cannot be detected at an early stage due to lack of appropriate tools and biomarkers)
this type of diabetes is characterized by: usually younger than 30 y/o abrupt onset requires insulin injections possible vector/autoimmune response Beta cell destruction leading to absolute insulin insufficiency normal/thin BWT managed-diet, exercise, insulin
type I
this type of diabetes is characterized by: usually older than 35 y/o gradual onset progressive insulin secretory defect, background of insulin resistance can still produce some insulin much higher incidence (90% of cases) managed with diet, exercise, meds
type II
Is the following more likely to be a vascular or spinal stenosis - symmetrical leg pain claudication (pain caused by too little blood flow to your legs or arms); brought on by exercise, promptly diminished with rest; diminished pulses
vascular
this type of pain is indicated by words like "throbbing, pounding, pulsing, beating" worsened by activity (check pulses, ankle brachial index - ABI, trophic changes - nails, skin, hair) SOB in recumbent postures vitals should be taken at rest, during activity, and at the end after a period of recovery rapid weight gain
vasculogenic
the QRS complex on an ECG represents
ventricular depolarization
the T wave on an ECG represents
ventricular repolarization
CN VIII *sensory* Test = check hearing loss by rubbing fingers together, tuning fork (Rinne and Weber test) for conductive and sensorineural loss; HINTs test (head impact test), don't usually check for nystagmus
vestibulocochlear
Generally speaking, a _________ source of symptoms should *always* be suspected if the symptoms are *not* altered with movement or position changes
visceral (systemic, not musculoskeletal)
this type of pain is produced by chemical change, ischemia, or spasms originating from the viscera (body organs) poorly localized accompanied by ANS symptoms
viscerogenic
when doing a systems review, what components should be looked at in relation to reviewing the CV system
vitals (HR, BP, RR, Palpation of distal pulses), family Hx, medications, gender, age, activity level, risk factor assessment, Borg RPE (particularly w/ Pts on beta blockers; taken before, during, and after exercise)
What action(s) should be taken by the therapist in the following patient example - a PT is initiating the Px interview when she notes the Px is profusely perspiring and lethargic in movement
vitals, (potentially) immediate referral (prep for emergency situation / Px going down)
