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What type of hepatitis can present as: ● Fatigue ● Anorexia ● Right shoulder pain ● Headache ● Arthralgias ● Tenderness of the right upper quadrant viral hepatitis alcoholic hepatitis

viral hepatitis

Which are NOT typical findings in a patient with spondylarthropathy? -Joint swelling and heat -Positive rheumatoid factor -Spinal stenosis -Symptoms in one or more extremity joints

-Positive rheumatoid factor

What spinal cord injury would you expect to find the following: Motor function preserved - affects only sensory tracts: position sense, discrimination, vibration ● Watch out for wide-based gait

posterior cord syndrome

What occurs with hypo-perfusion of the kidney, congestive heart failure, shock, volume-depletion, and hemorrhage?

prerenal azotemia

What type of common metastases: Increased incidence with advancing age Metastasizes to bone in 50%; lumbar vertebrae, pelvis, and proximal femurs Physical therapy: if pain due to prostate cancer is treated as a musculoskeletal condition, this may delay detection Early detection is important, prognosis is poor if metastasized

prostate

What is the most common cancer in males?

prostate cancer

Referral from the sacrum, testes and thoracolumbar could be from?

prostate gland

What structure can refer pain to the sacral area, testes, thoracolumbar? -kidney -ureter -urinary bladder -prostate gland

prostate gland

Pain of a viscerogenic nature is not relieved by a change in position. a. True b. False

What structure may be enlarged and palpable with renal cell carcinoma?

kidney

What is the DD of: Sharp stabbing pain that occurs with a deep breath in a local area.

pleurisy

Which of the following symptoms could be associated with pathology of the pulmonary system? Dyspnea Fatigue Weight loss All of the above

all of the above

What occurs with urinary outflow obstruction below the level of the kidney?

post-renal azotemia

What condition is characterized by uterine prolapse or stress incontinence?

symptomatic pelvic relaxation

What is the significance of night sweats?

systemic disease

Most of the information needed to determine the cause of symptoms is contained in the:

(Subjective examination, Family/Personal History Form, Objective Information)

What is the difference between a yellow- and a red-flag symptom?

- A yellow-flag is cautionary or warning symptom that signals "slow down" and think about the need for screening. A red-flag symptom requires immediate attention, either to pursue further screening questions and/or tests, or to make an appropriate referral.

You are seeing an 83-year-old woman for a home health evaluation after an MVA that required a long hospitalization followed by transition care in an intermediate care nursing facility and now home health care. She is ambulating short distances with a wheeled walker, but she becomes short of breath quickly and requires lengthy rest periods. At each visit the client is wearing her slippers and housecoat, so you suggest that she start dressing each day as if she intended to go out. She replies that she can no longer fit into her loosest slacks and she cannot tie her shoes. Is there any significance to this client's comments, or is this consistent with her age and obvious deconditioning? Briefly explain your answer.

- An increase in edema of the lower extremity is not consistent with the patient's presentation. The patient may be experiencing right sided heart failure consistent with the SOB and needing lengthy rest periods.

Briefly describe the difference between myocardial ischemia, angina pectoris, and myocardial infarction.

- Angina pectoris - Acute pain in the chest that results from the imbalance between cardiac workload and oxygen supply to myocardial tissue. - Myocardial infarction - The development of ischemia and necrosis of myocardial tissue. It results from a sudden decrease in coronary perfusion or an increase in myocardial oxygen demand without adequate blood supply.

A risk factor for NSAID-related gastropathy the use of:

- Antihypertensives

What is the significance of autosplinting?

- Clients usually note that the pain is alleviated by lying on the affected side, which diminishes the movement of that side of the chest called autosplinting.

Chronic GI blood loss sometimes associated with use of NSAIDs can result in which of the following problems?

- Decreased heart rate and bleeding

What is the best follow up question for someone who tells you that the pain constant?

- Do you have that pain right now?

With what final question should you always end your interview?

- Do you wish to tell me anything else about your injury, your health, or your present symptoms that we have not discussed yet?

If rapid onset of anemia occurs after major surgery, which of the following symptom patterns might develop?

- Dyspnea, Weakness and fatigue, and palpitations reflecting the lack of oxygen transport to the lungs and muscles.

What is the effect of NSAIDs (e.g. Naprosyn, motrin, anaprox, ibuprofen) on blood pressure?

- Elevate blood pressure

Pursed-lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with?

- Emphysema

When exercising a client with known anemia, what two measures can be used as guidelines for frequency, intensity, and duration of the program?

- Exercise testing and prescribed exercise(s) in clients with anemia must be instituted with extreme caution and should proceed very gradually to tolerance and/or perceived exertion levels. Exercise for any anemic client should be first approved by his or her physician.

What are the primary signs and symptoms of congestive heart failure? (4)

- Fatigue, dyspnea, edema, nocturia

Why does postural orthostatic hypotension occur upon standing for the first time in a young adult who has been supine in skeletal traction for 3 weeks?

- Gravitational effects on the circulatory system can cause a 10mmHg drop in SBP when a person changes position from supine to sitting to standing. This drop usually occurs without symptoms as the body quickly compensates to ensure there is no reduction in cardiac output. In clients on prolonged bed rest or on antihypertensive drug therapy, there may be either no reflexive increase in heart rate or a sluggish vasomotor response. These clients may experience larger drops in blood pressure and often experience lightheadedness.

A 23-year old female presents with new onset of skin rash and joint pain followed two weeks later by GI symptoms of abdominal pain, nausea, and diarrhea. She has a previous history of Crohn's disease, but this condition has been stable for several years. She does not think her current symptoms are related to her Crohn's disease. What kind of screening assessment is needed in this case?

- No further assessment is needed; there are enough red flags to advise this client to seek medical attention

You notice a new client has an unusual (strong) breath odor. How do you assess this?

- Odors may provide some significant clues to overall health status. For example, a fruity (sweet) breath odor may be symptom of diabetic ketoacidosis. Bad breath (halitosis) can be a symptom of dental decay, lung abscess, throat or sinus infection, or gastrointestinal disturbances from food intolerances, H. pylori bacteria, or bowel obstruction. Keep in mind that ethnic foods and alcohol can affect breath and body odor.

When are palpitations clinically significant?

- Palpitation lasting for hours or occurring in association with pain, shortness of breath, fainting, or severe lightheadedness requires medical evaluation. Palpitation in any person with a history of unexplained sudden death in the family requires medical referral. Palpitations may occur as a result of an overactive thyroid, secondary to caffeine sensitivity, as a side effect of some medications, and with the use of drugs such as cocaine. Palpitations can be considered physiologic when less than 6 occur per minute, this be considered WNF of the heart.

See if you can quickly name 6 to 10 red flags that suggest the need for further screening.

- Personal or family hx of cancer - Recent (last 6 weeks) infection - Recurrent colds or flu with a cyclical pattern - Recent hx of trauma such as MVA or fracture - Hx of immunosuppression - Hx of injection drug use - No known cause, unknown etiology, insidious onset - Symptoms unrelieved by physical therapy intervention - Gradual progression of symptoms

What are the 3 Ps? What is the significance of each one?

- Pleuritic pain - exacerbated by respiratory movement involving the diaphragm, such as sighing, deep breathing, coughing, sneezing, laughing, or the hiccups; this may be cardiac if pericarditis or it may be pulmonary - Pain on palpation - musculoskeletal origin - Pain with changes in position - musculoskeletal or pulmonary origin; pain that is worse when lying down and improves when sitting up or leaning forward is often pleuritic in origin

Pulse strength graded at 1+ means

- Pulse diminished, barely palpable

During observation, what could the following indicate? Pale color, diaphoretic, and cyanosis

Hemodynamic compromise

What is the significance of nadir?

- The lowest value of blood counts after chemotherapy.

What should you do if a client complains of throbbing pain at the base of the neck that radiates into the interscapular areas and increases with exertion?

- Throbbing pain at the base of the neck and/or along the back into the interscapular areas that increases with exertion requires monitoring of vital signs and palpation of peripheral pulses to screen for aneurysm. Check for a palpable abdominal heartbeat that increases in the supine position.

Bleeding under the skin, nosebleeds, bleeding gums, and black stools require medical evaluation as these may be indications of?

- Thrombocytopenia

If a client reports that the shoulder/upper trapezius muscle pain increases with deep breathing, how can you assess whether this results from a pulmonary or musculoskeletal cause?

- With pain in the shoulder/upper trapezius muscle pain in the absence of trauma or injury, check the client's personal medical history for previous or recurrent upper respiratory infection or pneumonia.

You have been treating an 18-year-old boy that was referred to you with the diagnosis "Muscle Tension Headaches." For two weeks you have not been making much progress and you are starting to suspect his pain is not of mechanical origin. Before referring the patient to his physician, you review the case and one of the things you do is develop a brief checklist for migraine. What three signs and symptoms are BEST suited to detect this condition? -1. Family history of similar headaches 2. Visual disturbances before the onset pain. 3. Headaches associated with certain types of food -1. Unilateral parietal headaches. 2. Non-dermatomal distribution. 3. Pulsating pain -1. Photophobia. 2. Pain increasing with postural change. 3. Unilateral occipital headaches -1. Unilateral mastoid/ auricular pain 2. Photophobia 3. Headaches brought on by stress

-1. Family history of similar headaches 2. Visual disturbances before the onset pain. 3. Headaches associated with certain types of food

When evaluating a patient with headaches, what signs and symptoms would prompt you perform neurological screening? -1. Headaches that increase with increased muscle tension 2. Fever 3. Nausea -1. Headaches that increase with exertion 2. Reported loss of smell 3. Intense toothache Correct -1. Fever 2. Nausea 3. Visual disturbances -1. Visual disturbances before the onset pain 2. Focal tenderness in the anterior temporal area 3. Headaches that are worse in the supine position

-1. Headaches that increase with exertion 2. Reported loss of smell 3. Intense toothache

On neurological screening you find the following: 1) your patient has numbness over the left side of the mandible, 2) cannot fully close the mouth on the left side and 3) complains of tinnitus in the left ear. These signs and symptoms indicate which nerves respectively? -1. Trigeminal (V) 2. Facial (VII) 3. Vestibulocochlear (VIII) -1. Trigeminal (V) 2. Glossopharyngeal (IX) 3. Auditory (VIII) -1. Facial (VII) 2. Glossopharyngeal (IX) 3. Auditory (VIII) -1. Facial (VII) 2. Facial (VII) 3. Vestibulocochlear (VIII)

-1. Trigeminal (V) 2. Facial (VII) 3. Vestibulocochlear (VIII)

Significant findings in the study of Boissonnault and Di Fabio included: -Aggravating movements for patients with discogenic pain are no different from aggravating movements for those with mechanical pain -Blue collar workers were more likely to have mechanical pain than discogenic pain -Patients with discogenic pain were more likely to have pain in the morning -There was a higher proportion of patients with litigation pending in the subgroup with discogenic pain

-Aggravating movements for patients with discogenic pain are no different from aggravating movements for those with mechanical pain

What would indicate to you that your patient is going into heart failure? -Ankle edema, anorexia, and increased heart rate -Decreased heart rate, hypotension, redness and heat of the distal lower extremity -Hypertension, decreased heart rate, and productive cough

-Ankle edema, anorexia, and increased heart rate

A 60-year-old lady is referred to you from a dentist with "Temporomandibular Pain." The medical history is unremarkable, other than Polymyalgia Rheumatica. Her main area of pain is in the left temporalis muscle area. On further palpation you find that the pain is really localized to small area over the posterior - inferior muscle belly, just in front of the upper part of the ear. This area is slightly warm to touch. What do you do next? -Call her physician and ask for an appointment for her the same day. -Education and advice for TMJ disorder, and ask the patient to come again in a week -Proceed with myofascial work to the right temporalis -Start treatment with ultrasound, due to the exquisite tenderness

-Call her physician and ask for an appointment for her the same day.

A 60-year-old lady is referred to you from a dentist with "Temporomandibular Pain." The medical history is unremarkable, other than Polymyalgia Rheumatica. Her main area of pain is in the left temporalis muscle area. On further palpation you find that the pain is really localized to small area over the posterior - inferior muscle belly, just in front of the upper part of the ear. This area is slightly warm to touch. What do you do next? -Call her physician and ask for an appointment for her the same day. -Education and advice for TMJ disorder, and ask the patient to -come again in a week -Proceed with myofascial work to the right temporalis -Start treatment with ultrasound, due to the exquisite tenderness

-Call her physician and ask for an appointment for her the same day.

Which of the following are accurate statements regarding depression? (2) -Depression is commonly associated with certain medications -Depression with a late onset is more likely to be bipolar disorder -Depression is less common in patients receiving physical therapy -Up to 1/4 of females can expect to have depression during their lifetime

-Depression is commonly associated with certain medications -Up to 1/4 of females can expect to have depression during their lifetime

A 23-year-old female loan officer is referred to you because of headaches. Asked about her work conditions she admits that her computer monitor is to the right side of her keyboard, and that she spends much of her working day with the telephone receiver under her left chin while entering data on the computer. Examination findings include limited and painful right cervical rotation and exquisite tenderness at the cranial insertion of the left sub-occipital muscles. Assuming that her headaches are indeed mechanical in nature, what characteristics and pain distribution would you expect based on the above information? -Dull left-sided headache with a gradual onset, located to the lower occipital area, giving rise to nausea if severe enough -Dull left-sided headaches that increases as the day goes on, located to the frontal and mastoid regions - associated with ipsilateral cervical pain. -Pain localized to the auricular-mastoid regions, alternatively on the left and the right, associated with tinnitus and lightheadedness -Pulsating left-sided pain, -precipitated by stress, sometimes associated with visual disturbances and photophobia

-Dull left-sided headaches that increases as the day goes on, located to the frontal and mastoid regions - associated with ipsilateral cervical pain.

Symptom irritability refers to: -History of repeated episodes of pain. -How easily the symptoms are provoked and then subsequently alleviated. -Peripheralization of symptoms. -Traumatic onset of symptoms.

-How easily the symptoms are provoked and then subsequently alleviated.

Which of the following signs and symptoms in a diabetic patient point out a particularly serious disease, possibly warranting a referral to a physician? (2) -Hypotension and increased heart rate -Areas of sensory deficits in the upper extremity -Intense facial pain -Weakness of distal musculature

-Hypotension and increased heart rate -Intense facial pain

A 23-year-old female loan officer is referred to you because of headaches. Asked about her work conditions she admits that her computer monitor is to the right side of her keyboard, and that she spends much of her working day with the telephone receiver under her left chin while entering data on the computer. Examination findings include limited and painful right cervical rotation and exquisite tenderness at the cranial insertion of the left sub-occipital muscles. Assuming that her headaches are indeed mechanical in nature, what characteristics and pain distribution would you expect based on the above information? -Dull left-sided headache with a gradual onset, located to the lower occipital area, giving rise to nausea if severe enough -Dull left-sided headaches that increases as the day goes on, located to the frontal and mastoid regions - associated with ipsilateral cervical pain. -Pain localized to the auricular-mastoid regions, alternatively on the left and the right, associated with tinnitus and lightheadedness -Pulsating left-sided pain, precipitated by stress, sometimes associated with visual disturbances and photophobia

-Dull left-sided headaches that increases as the day goes on, located to the frontal and mastoid regions - associated with ipsilateral cervical pain.

You have been treating a 55-year-old secretary for mid-thoracic pain. She is a heavy smoker, underweight, and physically inactive. Her pain increases in the late afternoon, but is not clearly activity related. On inspection you find a slightly increased, mid-thoracic kyphosis. There is diffuse tenderness in this area and backward bending is slightly restricted. You treat the patient with moist heat, mobilization and myofascial release. Your patient shows good improvement, but the improvement is short-lived. Three weeks later her physician calls and informs you your patient has been diagnosed with severe osteoporosis. He wants you to treat her again. What guides your choice of treatments? -Active backward bending might result in a vertebral fracture -Balance activities are not worth the risk -Continued myofascial work carries a risk of fracture -Education about nutrition and smoking should be added to the treatment -Strengthening exercises are contraindicated

-Education about nutrition and smoking should be added to the treatment

What are the 3 functions of the urogenital system?

-Filter and drain -Regulate extracellular fluid through filtration of metabolites and plasma composition -Maintain fluid and electrolyte balance

When should body temperature should be taken as part of vital sign assessment: (2)

-For any client who has musculoskeletal pain of unknown origin -presence of constitutional symptoms, especially fever or night sweats

According to the CAGE questionnaire, a positive answer to what question suggests alcoholism? -Do you abuse other substances? -Have people annoyed you by criticizing your drinking? -Have you had a hangover? -Have you been treated for alcoholism?

-Have people annoyed you by criticizing your drinking?

You are treating a 50-year-old construction worker for headaches. The headaches seem mechanical in nature; there is considerable adaptive muscle shortening in the upper trapezius and forward bending of the sub-cranial spine is quite limited. You are however not making much progress and one day the patient says something that makes you decide to terminate treatment and refer him back to his physician. You suspect Paget's disease, although you do not say so much to the physician. What did the patient say? -He has been losing weight -He has been running a fever -He has to wake up in the night to go to the bathroom -He is rapidly losing strength -His hard-hat does not fit anymore

-His hard-hat does not fit anymore

Which are NOT typical findings in a patient with spondylarthropathy? -Joint swelling and heat -Positive rheumatoid factor -Spinal stenosis -Symptoms in one or more extremity joints

-Positive rheumatoid factor

warranting a referral to a physician? (2) -Hypotension and increased heart rate -Areas of sensory deficits in the upper extremity -Intense facial pain -Weakness of distal musculature

-Hypotension and increased heart rate -Intense facial pain

Your patient comes in complaining of the following symptoms: proximal muscle weakness, constipation, and loss of appetite. You refer the patient back to the MD suspecting which of the following: -Hypothyroidism or hypoparathryordism -Hypothyroidism or hyperparathyroidism -Hyperthyroidism or hypoparathyroidism -Hyperthyroidism or hyperparathyroidism

-Hypothyroidism or hyperparathyroidism

What MSK changes can be seen during pregnancy? (4)

-Increased lumbar lordosis -Anterior tilt of the pelvis -Outflare of ilia -External rotation of the hips

Which of the following are likely to cause acute inflammation in a joint? (3) -Infections -Ankylosing spondylitis -Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) -Osteoarthritis

-Infections -Ankylosing spondylitis -Calcium pyrophosphate dihydrate crystal deposition disease (CPPD)

Which of the following are likely to cause acute inflammation in a joint? (3) -Infections -Ankylosing spondylitis -Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) -Osteoarthritis

-Infections -Ankylosing spondylitis -Calcium pyrophosphate dihydrate crystal deposition disease (CPPD)

You are examining a middle-aged woman for upper lumbar pain. Which of the following findings during interview should raise suspicion of osseous infection? -Headaches, muscle weakness -Intravenous drug use -Non-weight bearing positions relieve symptoms -Osteomyelitis in childhood, weight loss -Recent history of a closed fracture

-Intravenous drug use

Following your examination of a young woman complaining of low back pain, you feel that you have not been able to rule out pathological causes for her pain. Both you and the patient have difficulty locating the symptoms, you have not been able to provoke them, her main complaints are abdominal, and the symptoms do not behave like they are mechanical. Which of the following mainly causes you to be concerned? (2) -Location of symptoms does not match your examination findings. -Pain increases with prolonged sitting -Symptoms that do not vary with body position or rest -The patient has difficulty locating her symptoms

-Location of symptoms does not match your examination findings. -Symptoms that do not vary with body position or rest

The addition of pursed-lip breathing to the gait-training program of an 80 year-old female s/p left total hip arthroplasty who suffers from COPD allows for: -Loosening of mucosal plugs in the lungs -Maintenance of intrabronchial pressure and improves the mixing of gases in the lungs -Rest and relaxation -Retention of CO2

-Maintenance of intrabronchial pressure and improves the mixing of gases in the lungs

All of the following scenarios would cause you to contact the referring physician, EXCEPT: -Menstrual bleeding during pregnancy -Missed periods in an adolescent girl -Bleeding after menopause -Hematuria

-Missed periods in an adolescent girl

An elderly man with loss of joint space at hips, and knees but is in good health in every other respect is most likely to have: -Ankylosing spondylitis -Osteoarthritis -Rheumatoid arthritis -Reiter's syndrome

-Osteoarthritis

Which tests and findings could help you identify an inflammatory arthritis? (2) -Range of motion testing: discomfort through range of motion -End feel testing: a spongy end feel -Strength testing: localized rather than diffuse weakness -Palpation: bony thickening

-Range of motion testing: discomfort through range of motion -End feel testing: a spongy end feel

When screening for vascular disease, as a cause of leg pain, what are you looking for? -Increased temperature, indicating inadequate venous return -Muscle tone to see if muscles are adequately oxygenated -Reactive hyperemia, to see if arteries can compensate for a change in position -Superficial skin sensation

-Reactive hyperemia, to see if arteries can compensate for a change in position

Diabetic neuropathy may be hard to differentiate from neurological signs and symptoms of mechanical or musculoskeletal origin. Which of the following presentations most strongly suggests neurological deficits in the lower extremity is of musculoskeletal origin? -Diminished ankle jerk and loss of vibration sense medially and laterally on the foot -Loss of proprioception around the ankle -Paresthesia and tingling of both dorsal and plantar surfaces of the foot -Sensory deficit dorsally between the first and second toe and drop-foot

-Sensory deficit dorsally between the first and second toe and drop-foot

When should a cardiac cause of lightheadedness be suspected? (3)

-Skipped beats: Check ECG for ventricular aectopic activity (VEA), paroxysmal atrial tachycardia (PAT), bradycardia, or heart block -Hypotension: check low systolic pressure and heamodynamic compromise. A low pulse pressure can also suggest cardiac problems. -Chest pain: May be present with or without ST segment depression.

Which is a (are) correct statement(s) regarding stress?(2) -Stress and distress are synonyms -A history of abuse is known to make individuals more resistant to stress -Stressors can be infectious or chemical -Post-traumatic stress disorder is an example of failed coping

-Stressors can be infectious or chemical -Post-traumatic stress disorder is an example of failed coping

Which is a (are) correct statement(s) regarding stress? (2) -Stress and distress are synonyms -A history of abuse is known to make individuals more resistant to stress -Stressors can be infectious or chemical -Post-traumatic stress disorder is an example of failed coping

-Stressors can be infectious or chemical -Post-traumatic stress disorder is an example of failed coping

When using the exercise tolerance test to establish exercise levels with a patient with angina?

-The anginal threshold becomes the maximal heart rate -A percentage of this becomes the target heart rate -American College of Sports Medicine guidelines recommend training at 70 to 85% of anginal threshold

During your objective examination of a 25-year-old male you were unable to alter his symptoms of low back pain? What is the most likely explanation? (2) -The condition is too irritable to allow for proper testing -The patient's young age makes it more difficult to provoke musculoskeletal symptoms -The appropriate anatomical region may not have been tested -The lesion may not be of the musculoskeletal system

-The appropriate anatomical region may not have been tested -The lesion may not be of the musculoskeletal system

Your patient, an obese lady in her mid-40s, complains of pain in the right mid-thoracic area. What makes you think that the pain originates in the gastrointestinal organ system? -The onset of symptoms was sudden -The pain increases after eating fatty food -The pain is worst in the morning -The pain increases with fatigue

-The pain increases after eating fatty food

You have just finished examining a young boy complaining of left hip pain that somehow does not seem mechanical in nature. When you review your examination certain findings seem to point to an infection. Which of the following findings should raise suspicion of osteomyelitis? -The pain has remained unchanged for a couple of months -The pain is throbbing in nature -The patient recently had a fall off a bicycle and sustained a deep cut of the thigh -Pain does not increase on weight-bearing

-The pain is throbbing in nature -The patient recently had a fall off a bicycle and sustained a deep cut of the thigh

You have just finished examining a young boy complaining of left hip pain that somehow does not seem mechanical in nature. When you review your examination certain findings seem to point to an infection. Which of the following findings should raise suspicion of osteomyelitis? (2) -The pain has remained unchanged for a couple of months -The pain is throbbing in nature -The patient recently had a fall off a bicycle and sustained a deep cut of the thigh -Pain does not increase on weight-bearing

-The pain is throbbing in nature -The patient recently had a fall off a bicycle and sustained a deep cut of the thigh

Which of the following is specific to diabetic vascular disease -Atherosclerosis of both the coronary arteries and the carotid artery -Decreased capillary permeability. -Slowly developing atherosclerosis -Thickening of the capillary basement membrane

-Thickening of the capillary basement membrane

A 52-year old woman with shoulder pain tells you that she has pain at night that awakens her. After asking a series of follow up question you are able to determine that she had trouble falling asleep because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the most likely explanation for this pain behavior?

-This represents a chronic clinical presentation of a musculoskeletal problem.

Breast cancer, prostate cancer, and kidney cancer all typically metastasize to: -Proximal humerus, ribs, vertebrae -Ribs, skull, tibiae -Vertebrae, proximal tibia, ribs -Vertebrae, pelvis, proximal femurs

-Vertebrae, pelvis, proximal femurs

Which of the following would be a likely diagnosis if your patient presented with fast, irregular heartbeat, has muscle weakness and excessive perspiration. The patient with hypothyroidism may present with symptoms that present like fibromyalgia and depression. There may even be symptoms mimicking compressive neuropathy. -hypothyroidism -hyperthyroidism -hypoparathyroidism -hyperparathryoidism

-hyperthyroidism increased levels of Ca+ decreased phosphate levels

Which of the following would be a likely diagnosis if your patient presented with decreased secretion of parathyroid hormone. It may be hereditary or acquired; a solitary problem or associated with other endocrine or skin disorders. This is a fairly common condition following thyroidectomy. Symptoms are, as with other thyroid and parathyroid disorders, non-specific and may include: Depression Paresthesia Muscle cramp Psychosis Seizures (possibly life threatening)? -hypothyroidism -hyperthyroidism -hypoparathyroidism -hyperparathryoidism

-hypoparathyroidism

What are the possible areas of pain referral for the following structures? -uterus, including uterine lig (T10-L1, S2-4) (3) -ovaries (T10-L1)(2) -Testes (T10-L1)(2)

-lumbosacral junction, sacral, thoracolumbar -lower abdominal, sacral -lower abdominal sacral

What are the 6 categories of data collection?

-pt profile -location and description of symptoms -symptoms behavior - 24 hr report -symptom hx -medical hx -review of systems

What are the 2 basic theories of hypertension?

1) Increased cardiac function due to over-stimulation by the sympathetic nervous system 2) Primary retention of salt and water by the kidneys

What are the 4 stages of the menstrual cycle?

1) Menstrual phase 2) Proliferative phase - development of the ovarian follicle for ovulation. The primary hormone is estrogen 3) Secretory (luteal) phase, when the endometrium is prepared for implantation of the fertilized ovum. The primary hormone is progesterone, produced by corpus luteum 4) Menstrual phase: if no pregnancy occurs, hormonal support for the thickened endometrium ceases and menstrual flow results

Tissue assessment can help identify the rheumatic disease in question: Is the focus of discomfort in a muscle, tendon, joint, or bursa?

1) Note that pain originating in a joint is manifested by discomfort through range of motion 2) Are the changes in the joint inflammatory or degenerative in nature? -Testing end feel: inflammatory changes lead to a more spongy end feel -Degenerative joints: stiffness after resting, relieved with a few steps -Inflammatory joints: may take up to 30 minutes to relieve stiffness -Inflammation is characterized by swelling, redness, and heat Degenerative changes are characterized by bony thickening without inflammation 3) Other sources of pain Pain in tendon or bursa: discomfort in a part of range of motion (supraspinatus tendon); confirmed by finger palpation Pain due to muscle can be elicited with passive lengthening and is more notable on active contraction

A middle-aged man is not responding to treatment for low back pain. Based on prior experience you suspect prostatitis. What questions could help you screen for that condition? 1. Pain that varies with intercourse? 2. Constipation? 3. Pain on urination? 4. Fever? 6. Hematuria? 7. Joint pain? 8. Abdominal pain? 1, 3, 4, 7 2, 3, 6, 8 2, 4. 6. 8 3, 6, 7, 8

1,3,4,7

You are treating an older gentleman following a total knee replacement. The medical history is unremarkable except for chronic nephritis. Due to decreased energy levels and ankle edema you are concerned that the condition of his kidneys may be deteriorating. Which of the following could point to chronic renal failure? 1. Increased tendon reflexes, 2. Hypotension, 3. Muscle weakness, 4. Metabolic Alkalosis, 5. Hypoventilation, 6. Muscle hypertonicity, 7. Hiccups, 8. Peripheral neuropathy (Select 1)(4pts) 1, 2, 3, 4 1, 3, 5, 6 1, 3, 7, 8 2, 3, 5, 7

1,3,7,8

What are the 5 disorders that afflict the aorta?

1-Aneurysm. We speak of a true aneurysm when all three layers involved, but false aneurysm when only the intima and the media are involved. Most aneurysms are caused by atherosclerosis, but there are also traumatic and infectious causes. 2-Aortic dissection. When the intima is disrupted blood may enter between the vessel layers causing separation. Weakening of medial layer, caused for example by Marfan's syndrome or chronic hypertension, is a predisposing factor. See Figure 3-10 in your text for a summary of pain location, signs and symptoms. 3-Occlusive disease - atherosclerosis. This is characterized by plaque formation, rupture, hemorrhage, and thrombus formation 4-Aortitis. This is infectious (commonly syphilis) or noninfectious inflammation of the aorta 5-Abdominal aortal aneurysm. These are generally asymptomatic, but can cause continuous, gnawing pain in the low back. With expansion of an aneurysm, there is sudden and severe low back or lower abdominal pain. Rupture of an aortal aneurysm is associated with excruciating pain, hypotension and shock. The physical examination may reveal an enlarged, pulsatile mass. Surgical resection or use of a prosthetic graft is performed once the aneurysm reaches a certain diameter (>5.0-5.5cm).

What are 4 associated hemodyamics of acute heart failure?

1-decreased CO 2-Hypoperfusion, due to drop in output 3-elevated LEFT ventricular filling pressures 4-elevated filling pressure of the RIGHT heart manifested by systematic venous congestion

What are the 3 clinical staging of testicular cancer?

1. Stage I. Tumor confined to the testis 2. Stage II. Metastases limited to retroperitoneal nodes below the diaphragm 3. Stage III. Metastasis beyond Stage II spread

What is defined as hypertension?

140/90

You have been treating an 18-year-old boy that was referred to you with the diagnosis "Muscle Tension Headaches." For two weeks you have not been making much progress and you are starting to suspect his pain is not of mechanical origin. Before referring the patient to his physician, you review the case and one of the things you do is develop a brief checklist for migraine. What three signs and symptoms are BEST suited to detect this condition? 1. Family history of similar headaches 2. Visual disturbances before the onset pain. 3. Headaches associated with certain types of food 1. Unilateral parietal headaches. 2. Non-dermatomal distribution. 3. Pulsating pain 1. Photophobia. 2. Pain increasing with postural change. 3. Unilateral occipital headaches 1. Unilateral mastoid/ auricular pain 2. Photophobia 3. Headaches brought on by stress

1. Family history of similar headaches 2. Visual disturbances before the onset pain. 3. Headaches associated with certain types of food

On neurological screening you find the following: 1) your patient has numbness over the left side of the mandible, 2) cannot fully close the mouth on the left side and 3) complains of tinnitus in the left ear. These signs and symptoms indicate which nerves respectively? 1. Trigeminal (V) 2. Facial (VII) 3. Vestibulocochlear (VIII) 1. Trigeminal (V) 2. Glossopharyngeal (IX) 3. Auditory (VIII) 1. Facial (VII) 2. Glossopharyngeal (IX) 3. Auditory (VIII) 1. Facial (VII) 2. Facial (VII) 3. Vestibulocochlear (VIII)

1. Trigeminal (V) 2. Facial (VII) 3. Vestibulocochlear (VIII)

Describe the two tests used to distinguish an iliopsoas bleed from a joint bleed.

1. When the client flexes the trunk, severe pain is produced in the presence of iliopsoas bleeding, whereas only mild pain is found with a hip hemorrhage. 2. When the hip is gently rotated in either direction, severe pain is experienced with a hip hemorrhage, but is absent or mild with iliopsoas bleeding.

Skin color and nail bed changes may be observed in the client with: a. Thrombocytopenia resulting from chemotherapy b. Pernicious anemia resulting from Vitamin B12 deficiency c. Leukocytosis resulting from AIDS d. All of the above

You have been treating a 50-year-old woman for persistent muscle pains. What findings would make you suspect hyperthyroidism? 1. Weight gain, 2. Nervousness, 3. Muscle weakness. 4. Sluggish deep tendon reflexes 5. Indistinct borders of the sternal notch 6. Decreased sweating.

2,3,5

What finding during the interview would suggest to you that your patient has characteristics associated with maladaptive chronic pain behavior? 1. Patient tells you he has not slept so much in years, 2. He comes to the interview with his wife and two daughters, 3. His wife answers most of the questions during the interview. 4. Patient tells you that he has joined the local literary group and chess club, now that he has more time on his hands, 5. Moaning from the patient prompts his daughter to bring him an extra pillow, 6. He asks his wife to remember the date of the next appointment, 7. Patient politely tells his wife that he does not need help to sit down. 8. He tells you he is thinking about retraining for another job, now that he cannot do physical labor

2,3,5,6

Which of the following questions are of greatest help when screening for colon cancer? 1. Vomiting blood? 2. History of inflammatory bowel disease? 3. Smoking? 4. Previous cancer in another body system? 5. Muscle wasting? 6. History of repeated infections? 7. Family history of polyps? 8. Arthralgia? 9. Lumbar pain? 10. Anorexia? 2, 4, 7 2, 6, 10 3, 9, 10 6, 1, 8

2,4,7

Which type of Block -This is complete heart block between atria and ventricles -P waves occur at their own rate and rhythm and QRS complexes at a slower rate, the ventricular escape rhythm (less than 40 /min). -The rhythms have no relationship to each other -Block is usually below the AV node -There may be periods of asystole -The prognosis is poor

3rd degrees AV blocks

Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in: a. The left shoulder b. The right shoulder c. The mid-back or upper back, scapular, and right shoulder areas d. The thorax, scapulae, right shoulder, or left shoulder

A- left shoulder pain associated with damage or injury to the spleen is call Kehr's sign

When using the Riddle et al article for cluster finding for DVT what indicates a likelihood?

3 or greater will have a 75% probability of have a DVT

weeks. You review his chart and find that he was treated for lung cancer 3 years ago; successfully by his own account. This has you worried about a space-occupying lesion in the spinal canal. What findings in history and on physical examination can help you establish that his symptoms do not simply come from a nerve root entrapment? 1. Decreased tendon reflexes. 2. Dizziness. 3. Sensory disturbances. 4. Clonus. 5. Positive SLR. 6. Disturbed temperature sense. 7. Increased tendon reflexes. 8.Abdominal pain. 4 and 7 2 and 6 5 and 7 1 and 3

4 and 7

Your patient is a male college soccer-player that you are treating for strain of the adductor longus muscle. His pain started in the last game of the season when he tackled an opponent. The first six weeks of the off-season he took easy, and his groin pain only minimally bothered him. Jogging was o.k. but once he started kicking the ball, the groin was painful again and he came to you. You treat the patient for a while, but after 3 weeks of unsuccessful treatments you decide to refer the patient back to his physician to rule out hernia. What prompts you to do that? 1. Weakness in the adductor muscle group. 2. Abdominal pain on rest. 3. Symptoms >8 weeks. 4. Pain on resisted contraction of the adductor longus. 5. Sensory changes in the cutaneous distribution of the iliohypogastric nerve. 6. Pain on sit-ups. 7. Sacroiliac pain. 8. Pain while straining. 9. Positive femoral nerve tension-test. 10. Constipation (4pts) 1, 4 and 10 2, 5 and 9 3, 6 and 8 5, 6 and 7

3, 6 and 8

8. Clients with diabetes insipidus (DI) would most likely come to the therapist with which of the following clinical symptoms? a. Severe dehydration, polydipsia b. Headache, confusion, lethargy c. Weight gain d. Decreased urine output

A line drawn down the middle of a lesion with two different halves suggests: a. A malignant lesion b. A benign lesion c. A normal presentation d. A skin reaction to medications

Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain. a. True b. False

Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved. a. True b. False

12. Which glycosylated hemoglobin (A1C) value is within the recommended range? a. 6% b. 8% c. 10% d. 12%

A The American Diabetes Association recommends that people with diabetes maintain a level of 7% or below on the A1C; this reflects average blood-sugar levels over a period of 2 to 3 months.

Bone pain associated with neoplasm is characterized by: a. Increases with weight bearing b. Negative heel strike c. Relieved by Tums or other antacid in women d. Goes away after eating

A -would be accompanies by a positive heel strike test -symptoms of angina sometimes relieved with antacids in women -eating would not alleviate symptoms

Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of: a. Neoplasm b. Assault or trauma c. Drug dependence d. Fracture

A - in particularly bone cancer

A line drawn down the middle of a lesion with two different halves suggests:

A malignant lesion

Screening for alcohol use would be appropriate when the client reports a history of accidents. a. True b. False

A true

Positive answers to which of the following would lead you to suspect gastrointestinal disease? 1. Lumbar pain? 2. Anorexia? 3. Paresthesia in the abdominal area? 4. Mid-thoracic pain? 5. Jaundice? 6. Weakness? 7. Change in bowel habits? 8. Weight loss? 1 and 8 2 and 4 4 and 8 5 and 7

5 and 7

How much left ventricular volume get ejected during systole?

65%

The following would be red flags for what dislocation: Severe neck pain and spasm Lightning pain into the extremities Syncope Incontinence Instability seen on lateral stress (flexion/ extension) radiographs

A/A dislocation

A 65-year-old man that you are treating for osteoarthritis of the knees is not making satisfactory progress. You note increasing weakness and ankle edema. Because you suspect diabetes you compile a list of questions that you could use for screening. What do you include? 1. Thirst? 2. Increased urinary frequency? 3. Increased appetite? 4. Weight loss? 5. Impotence? 6. Blurred vision? 1, 3, 5 1, 5, 6 2, 3, 6 2, 4, 6 All of the above

ALL

What is among the most common pathologies of the stomach and duodenum, and includes reflex esophagitis, gastritis (irritation), gastric ulcers (perforation), duodenitis, and duodenal ulcers?

Acid peptic disorders

A 45-year-old man who has already missed a couple of appointments, arrives 15 minutes late for his first interview, but you receive him anyway since you are running late yourself. He explains his tardiness saying that his wife is such as slow driver. During the interview he appears restless, and when you him if he is uncomfortable he responds that he is not really functional before having at least three cups of coffee. Asked about his current intake of pain medications, he admits his physician has advised him to cut down, but he does not feel ready yet. What is your first impression? Alcoholism Depression Hyperparathyroidism Hyperthyroidism

Alcoholism

What vascular disease can cause the following to occur? Sudden intense headache Loss of consciousness Nuchal rigidity Neurological signs? Tend to be asymptomatic until they rupture, and this may be an incidental finding.

Aneurysmal rupture

What type of arthritic disease does the follow pertain to: Age <40 Pain may be present for >3 months Pain stiffness minutes to hours after rising Insidious onset

Ankylosing spondylitis and related spondylarthropathies

The S4 sound is best heard where?

At the apex of the heart

The following are risk factors for what disease? Male Family history of coronary artery disease before age 60 Postmenopasual History of hypertension History of diabetes Dyslipoproteinemia Tobacco Obesity Physical inactivity Stress and hostility

Atherosclerosis

The following is the progression of what disease? Endothelial injury (hyperlipidemia, tobacco, hypertension) Platelet- endothelial interaction Lipid accumulation Plaque formation Vascular thickening

Atherosclerosis

11. Parathyroid hormone (PTH) secretion is particularly important in the metabolism of bone. The client with an over-secreting parathyroid gland would most likely have: a. Increased blood pressure b. Pathologic fractures c. Decreased blood pressure d. Increased thirst and urination

Bleeding under the skin, nosebleeds, bleeding gums, and black stools require medical evaluation as these may be indications of: a. Leukopenia b. Thrombocytopenia c. Polycythemia d. Sickle cell anemia

Chronic GI blood loss sometimes associated with use of NSAIDs can result in which of the following problems? a. Increased incidence of joint inflammation b. Iron deficiency c. Decreased heart rate and bleeding d. Weight loss, fever, and loss of appetite

If rapid onset of anemia occurs after major surgery, which of the following symptom patterns might develop? a. Continuous oozing of blood from the surgical site b. Exertional dyspnea and fatigue with increased heart rate c. Decreased heart rate d. No obvious symptoms would be seen

What is the best follow-up question for someone who tells you that the pain is constant? a. Can you use one finger to point to the pain location? b. Do you have that pain right now? c. Does the pain wake you up at night after you have fallen asleep? d. Is there anything that makes the pain better or worse?

Words used to describe neurogenic pain often include: a. Throbbing, pounding, beating b. Crushing, shooting, pricking c. Aching, heavy, sore d. Agonizing, piercing, unbearable

When does bone mass peak? When does it start to drop?

Bone mass peaks around 30 years of age, and tends to start dropping after 40. Changes in bone density are of importance because they are related to increased risk of fractures. Considerable costs are associated with treatment of, and disability from osteoporotic fractures.

What auscultation could be heard if a pt had AV fistula, occlusive disease?

Bruits

1. Fibromyalgia syndrome is a: a. Musculoskeletal disorder b. Psychosomatic disorder c. Neurosomatic disorder d. Noninflammatory rheumatic disorder

2. Which of the following best describes the pattern of rheumatic joint disease? a. Pain and stiffness in the morning gradually improves with gentle activity and movement during the day. b. Pain and stiffness accelerate during the day and are worse in the evening. c. Night pain is frequently associated with advanced structural damage seen on x-ray. d. Pain is brought on by activity and resolves predictably with rest.

During auscultation of an adult client with rheumatoid arthritis, the heart rate gets stronger as she breathes in and decreases as she breathes out. This sign is: a. Characteristic of lung disease b. Typical in coronary artery disease c. A normal finding d. Common in anyone with pain

Preoperatively, clients cannot take aspirin or antiinflammatory medications because these: a. Decrease leukocytes b. Increase leukocytes c. Decrease platelets d. Increase platelets e. None of the above

Pulse strength graded as 1 means: a. Easily palpable, normal b. Present occasionally c. Pulse diminished, barely palpable d. Within normal limits

When assessing the abdomen, what sequence of physical assessment is best? a. Auscultation, inspection, palpation, percussion b. Inspection, percussion, auscultation, palpation c. Inspection, auscultation, percussion, palpation d. Auscultation, inspection, percussion, palpation

C -percussion and palpation can change bowel sounds -look and listen before you palpate

Where are the following musculoskeletal referral patterns are common: Low occipital Suboccipital Auricular-mastoid

C2 interspinous space

Where are the following musculoskeletal referral patterns are common: Suboccipital Cervical Low occipital

C3 interspinous space

The following are all risk factors for what? Tobacco Hypertension Diabetes Dyslipidemia (high cholesterol) Postmenopausal status Inactivity Overweight Predisposing psychological factors

CAD and PVD

The following are part of what questionnaire: -Have you ever felt you should Cut down on your drinking? -Have people Annoyed you by criticizing your drinking? -Have you ever felt bad or Guilty about your drinking? -Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover ( Eye-opener)?

CAGE questionnaire

What could breath sound including crackling, symmetrical and bi-basilar indicate?

CHF

What 3 systems should be screened in a patient that has L/R shoulder pain?

CV Pulmonary GI

Pain in the cervical, thoracic or shoulder region accompanied by sweat should raise suspicion about?

CV disorder

If pain in typical referral areas is described as pressure-like, tight, throbbing, cramping, and aching what should be suspected?

CV pathology

What 4 systems should be screened in a patient has thoracic spine pain?

CVperipheral vascular pulmonary GI urogenital

During observation, what could the following indicate? Fingernail and toenail clubbing can be observed

Cardiac or pulmonary shunt

What percussion test is performed with the patient in supine. The examiner places their fingers over the eighth or ninth intercostal space in line with the left anterior axillary line and performs percussion during normal breathing and at full inspiration. The test is positive if dullness is noted during full inspiration.

Castell's

The following S & S apply to what type of osteogenic neoplasm: Rare benign primary neoplasm, although there are a few reports of malignancy Children and young adults, males>females Epiphyseal Pain and tenderness Limitation of function Possibly effusion Radiographic features include a large oval, lucent area with a thin sclerotic margin osteochondroma Chondroblastoma giant cell tumors

Chondroblastoma

In terms of regulating cardiac output what to chronotropic and inotropic relate to?

Chronotropic = affecting rate Inotropic = affecting strength of contraction

During observation, what could the following indicate? Acute breathlessness and cough (normally frothy pink sputum, but in chronic disease: white bubbling sputum)

Congestive heart failure, left ventricular failure

10. Signs and symptoms of Cushing's syndrome in an adult taking oral steroids may include: a. Increased thirst, decreased urination, and decreased appetite b. Low white blood cell count and reduced platelet count c. High blood pressure, tachycardia, and palpitations d. Hypertension, slow wound healing, easy bruising

13. A 38-year-old man comes to the clinic for low back pain. He has a new diagnosis of Graves' disease. When asked if there are any other symptoms of any kind, he replies "increased appetite and excessive sweating." When you perform a neurologic screening examination, what might be present that would be associated with the Graves' disease? a. Hyporeflexia but no change in strength b. Hyporeflexia with decreased muscle strength c. Hyperreflexia with no change in strength d. Hyperreflexia with decreased muscle strength

14. All of the following are common signs or symptoms of insulin resistance except: a. Acanthosis nigricans b. Drowsiness after meals c. Fatigue d. Oliguria

9. Clients who are taking corticosteroid medications should be monitored for the onset of Cushing's syndrome. You will need to monitor your client for which of the following problems? a. Low blood pressure, hypoglycemia b. Decreased bone density, muscle wasting c. Slow wound healing d. b and c

A 23-year-old female presents with new onset of skin rash and joint pain followed 2 weeks later by GI symptoms of abdominal pain, nausea, and diarrhea. She has a previous history of Crohn's disease, but this condition has been stable for several years. She does not think her current symptoms are related to her Crohn's disease. What kind of screening assessment is needed in this case? a. Vital signs only. b. Vital signs and abdominal auscultation. c. Vital signs, neurologic screening examination, and abdominal auscultation. d. No further assessment is needed; there are enough red flags to advise this client to seek medical attention.

A 48-year old man presented with low back pain of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps (accidents and falls), and engages in repetitive motions of all kinds using his arms, back, and legs. The pain is intense when he has it, but it seems to come and go. He is not sure if eating makes the pain better or worse. He has lost his appetite because of the pain. After conducting an examination including a screening exam, the clinical presentation does not match the expected pattern for a musculoskeletal or neuromuscular problem. You refer him to a physician for medical testing. You find out later he had pancreatitis. What is the most likely explanation for this pain pattern? a. Toxic waste products from the pancreas are released into the intestines causing irritation of the retroperitoneal space. b. Rupture of the pancreas causes internal bleeding and referred pain called Kehr's sign. c. The pancreas and low back structures are formed from the same embryologic tissue in the mesoderm. d. Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm.

A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After asking a series of follow-up questions, you are able to determine that she had trouble falling asleep because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the most likely explanation for this pain behavior? a. Minimal distractions heighten a person's awareness of musculoskeletal discomfort. b. This is a systemic pattern that is associated with a neoplasm. c. It is impossible to tell. d. This represents a chronic clinical presentation of a musculoskeletal problem.

Dyspnea associated with emphysema is the result of?

Destruction of the walls (septa) between the alveoli, partial airway collapse, and loss of elastic recoil

Joint pain can be a reactive, delayed, or allergic response to: a. Medications b. Chemicals c. Infections d. Artificial sweeteners E. All of the above

What is the DD of: Presents as a pain of sudden onset, often located in the patient's back, with a rapid decrease in blood pressure.

Dissecting aortic aneurysm

Body temperature should be taken as part of vital sign assessment: a. Only for clients who have not been seen by a physician b. For any client who has musculoskeletal pain of unknown origin c. For any client reporting the presence of constitutional symptoms, especially fever or sweats d. b and c e. All of the above

The following S & S apply to what type of myleogenic neoplasm: Highly malignant Children and young adults Diaphysis of femur most commonly involved Presenting signs and symptoms include pain, increasing in severity and constancy, swelling, and sometimes a palpable mass Radiographs show "onion" peel (layers of periosteal bone) and cortical thinning Plasma cell myeloma Ewing sarcoma Lipoma

Ewing sarcoma

Disorders of the endocrine glands can be caused by: a. Dysfunction of the gland b. External stimulus c. Excess or insufficiency of hormonal secretions d. a and b e. b and c f. All the above

T/F Direct access is the only reason physical therapists must screen for systemic disease

T/F The presence of a persistent dry cough (no sputum or phlegm produced) has no clinical significance to the therapist.

Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and sympstoms:

Fever, night sweats, dizziness, Symptoms are out of proportion to the injury, Insidious onset, No position is comfortable

What 3 systems should be screened in a patient has lumbo-pelvic pain?

GI urogenital peripheral vascular

An 18-year-old boy was referred to you with the diagnosis of "shin splints." His pain, of two weeks duration, is activity relate and worse on weight bearing. On palpation you find tenderness over the medial surface of the distal 1/3 of the tibia. The patient responds well to ice and medial arch support. You tell him to take the week off cross-country running and the patient is symptom-free on discharge. He comes back to you 3 weeks later, has not been running and says his pain has been getting worse day from day and is pretty much continuous. On palpation you find a tender, sharply angulated mass on the medial surface of the tibia. You decide not to treat him, but immediately refer him to his physician. What is your concern? (2) Stress fracture Giant cell tumor Enchondroma Osteosarcoma

Giant cell tumor Osteosarcoma

This is characterized by production of uric acid. Crystals may develop in many tissues and find their way into the synovium, causing an acute reaction. Any joint, though most commonly the 1st MTP Men > women, and at an earlier age Diagnosis: urate crystals in synovial fluid

Gout

What could PVD, anemia or adrenal and gonadal cancer present as?

Hair loss from distal extremity

What is the DD of: Gives rise to burning pain, limited in area over the cutaneous distribution of a nerve, and swollen local lymph This condition is often associated with recent stress or impaired immune response

Herpes Zoster

If there is positive Chovstek's sign: tapping of facial nerve causing contraction around the mouth, and Trousseau's sign: rapid development of spasm in hand when a blood pressure cuff is applied to the upper arm what pathology should be suspected?

Hypoparathyroidism

Hypothyroidism or hyperparathyroidism

When is percussion of the liver testing positive?

If the liver spans greater than 10 cm

During palpation in the supine position, where do you expect to find an empty stomach? -In the epigastric and right hypochondriac areas -In the left hypogastric and hypochondriac areas -In the umbilical and left lumbar areas -In the left upper quadrant

In the left upper quadrant

When assessing the abdomen, what sequence of physical assessment is best?

Inspection, auscultation, percussion, palpation

Which kidney can't be be palpated due to its position beneath the bowl?

L kidney

Masses associated with colon cancer or diverticulitis can be found anywhere in each of the four quadrants, although most commonly where?

L lower quadrant

What 3 areas are commonly associated with female urogenital disease?

LBP abdominal pain urogenital disease *similarly MSK structures can present as urogenital disease

What patient position are the S2 and S3 heart sounds best heard?

Left semi lateral position

The following S & S apply to what type of myleogenic neoplasm: Most common musculoskeletal tumor Asymptomatic, soft, mobile tumor Plasma cell myeloma Ewing sarcoma Lipoma

Lipoma

This is not a psychological disorder; it includes faking physical or psychological symptoms for gain. Some findings on physical examination may implicate this diagnosis: Poor effort on manual muscle testing Jerky contraction of agonist Co-contraction of antagonist Diffuse tenderness precludes physical examination Contradictory findings However the clinician should not attempt to diagnose on a psychosocial

Malingering

What special test is the percussion test is preformed to assess for costovertebral tenderness and kidney involvement. The therapist uses the ulnar border (5th metacarpal) of the fist to thump over the 12th rib at the costovertebral angle with the patient either in sitting or prone. The test is positive if pain is reproduced in the subcostal region, flank or lateral aspect of the abdomen?

Murphy's

What are the 2 main diagnostic test for hypertension?

Measurement of blood pressure Blood and urine analysis to determine severity of cardiovascular disease, as well as the causes of hypertension, and cardiovascular risk

Joint pain can be a reactive, delayed, or allergic response to? (4)

Medications, Chemicals, Infections, Artificial sweeteners

What test has the patient in right side lying. The examiner percusses the posterior axillary line from the distal end of the lung to the middle anterior costal margin. This test is positive when dullness extends over 8 cm above the costal margin with normal being 6 to 8 cm.

Nixon's for splenomegaly

During auscultation of an adult client with rheumatoid arthritis, the heart rate gets stronger as she breathes in and decreases as she breathes out. This sign is:

Normally, the pulse increases slightly with inspiration and decreases with expiration.

What type of angina is characterized by severe, longer duration pain, not precipitated by cardiac work Pain is almost always present at rest, even at night

Prinzmetal angina

The following refers to what cranial N: use familiar odor such a coffee. Failure to recognize could indicate: ● Upper respiratory infection ● Normal decline of olfactory capacity with aging ● Frontal lobe damage

Olfactory: CN I

An elderly man with loss of joint space at hips, and knees but is in good health in every other respect is most likely to have: Ankylosing spondylitis Osteoarthritis Rheumatoid arthritis Reiter's syndrome

Osteoarthritis

A 14-year-old boy complains of lower thoracic pain of five months duration. The pain is unrelated to activity, worst during the night, but relieved by Aspirin. Scheuermann's disease was suspected, but ruled out on radiographic examination. The patient still brings the radiographs. During your physical examination you are not able to provoke his symptoms on movement but there is tenderness over the T9 spinous process. Percussion on the spinous process gives rise to pain that lasts a few minutes. You take a look at the radiographs and on the lateral view you see a small, but clearly defined radiolucency in the center of the spinous process. You decide refer the patient back to his physician. Why? What do you suspect? Ewing's sarcoma Giant cell tumor Metastasis Multiple myeloma Osteoid osteoma Paget's disease

Osteoid osteoma

What do osteoporosis and multiple myeloma have in common? Anemia Both affect the skull Osteopenia Weight loss

Osteopenia

What does the P wave, the QRS wave and the ST segment represent?

P wave: atrial depolarization QRS wave: ventricular depolarization ST segment and T wave: atrial repolarization

What do PQRST stand for?

P-pain provocation or palliation Q-quality of pain R-region or radiation S-severity T-timing

Regarding the patient interview, PQRST stands for what?

Pain provocation quality region severity timing

During the clinical examination the following should be considered specific findings indicating a musculoskeletal neoplasm: (2) Pain on movement Palpable mass Swelling

Palpable mass Swelling

During the clinical examination the following should be considered specific findings indicating a musculoskeletal neoplasm: (2) Pain on movement Palpable mass Swelling

Palpable mass Swelling

What type of tumor can lead to pain in the shoulder, neck and upper extremity as it can invade a portion of the brachial plexus?

Pancoast

The following S & S apply to what type of myleogenic neoplasm: Most common primary bone tumor >40 years of age, especially after 60 Spine, pelvis, and skull Clinical presentation include bone tenderness, weight loss, anemia, and pathological fractures Pain is deep, increasing with activity, frequently located in spine There is frequently neurological involvement Radiographs show osteopenia and "punched out" osteolytic lesions Plasma cell myeloma Ewing sarcoma Lipoma

Plasma cell myeloma

5. List three of the most common symptoms of diabetes mellitus.

Polydipsia, polyuria, polyphagia

What are the Prochaska and DiClemente devised the Stages of Change model in order to promote heath through behavioral change?

Precontemplation: no intention to change. May be unaware of the problem Contemplation: patient is aware that a problem exists. Seriously thinking about changing. No commitment yet. Preparation: intention to change in the next month. Action: modification of behavior, or environment in order to overcome the problem. This is characterized by behavioral changes and requires time and energy. Maintenance: working to maintain gains and prevent relapse

Pain from the gallbladder is most likely to be referred to the ____________ region: (R) scapular area (L) scapular area (R) lower abdominal region (L) lower abdominal region

R scapular area

What heart sound is due to altered compliance of ventricles; CHF, HTN, atrial stenosis, pulmonary HTN, previous MI?

S4 - atrial gallop

A major psychiatric disturbance Disordered behavior Bizarre delusions Hallucinations Disturbed affect

Schizophrenia

What type of arthritic disease does the follow pertain to: Asymmetric oligoarthritis Typically involve spine Inflammation at the site of insertion of tendons and ligaments (enthesitis) Sacroilitis Absent rheumatoid factor Presence of HLAB-27 antigen (but note the high incidence of this antigen in asymptomatic individuals)

Spondylarthropathies

What is the most serious complication of a hernia?

Strangulation, where blood supply to the prolapsed abdominal contents is cut off, leading to bowel necrosis. This can happen with both indirect inguinal and femoral hernias. The associated symptoms are ischemic pain, a tender abdominal mass, and nausea.

T/F . Physical therapy evaluation and intervention may be part of the physician's differential diagnosis.

T/F Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain

T/F Pain of viscerogenic nature is not relieved by change in position.

T/F Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral.

A 25-year-old man with an unremarkable medical history is being treated for low back pain, but is not responding to treatment. On re-examination you find abdominal tenderness, gynecomastia, and enlarged supraclavicular lymph nodes. What do you suspect? Colon cancer Prostate cancer Rheumatoid arthritis Testicular cancer

Testicular cancer

What type of vascular disease is manifested by a throbbing headache of sudden onset, can have the serious complications of sudden blindness when the optic A. becomes involved?

temporal arteritis

Which of the following is specific to diabetic vascular disease: -Atherosclerosis of both the coronary arteries and the carotid artery -Decreased capillary permeability. -Slowly developing atherosclerosis -Thickening of the capillary basement membrane

Thickening of the capillary basement membrane

-Angina is typically described as pressure, not necessarily as a pain -Angina can be mistaken for: indigestion, nausea, epigastric distress, and belching -Sensations of numbness or tingling in the left hand can be associated with angina. -Note that true angina rarely lasts longer than 5 minutes if the patient rests

Things to note :)

What is the difference between psoriatic arthritis and rheumatoid arthritis?

This is differentiated from rheumatoid arthritis on the basis of different involvement of the hands

Which type of Block -Block occurs at the AV node -Often due to increased parasympathetic tone or to drug effect -Usually transient

Type I block

Which type of Block -Block occurs below the level of the AV node, in the bundle of His -Generally results from an organic lesion, so it can deteriorate to a third-degree block -PR interval does not lengthen before a dropped beat -May be intermittent, or the conduction ratio may vary

Type II block

Referral from the sacral apex, suprapubic, thoracolumbar could be from what?

Urinary bladder

Body temperature should be taken as part of vital sign assessment: a. For every client evaluated b. For any client who has musculoskeletal pain of unknown origin c. For any client reporting the presence of constitutional symptoms, especially fever or night sweats d. b and c

d. b and c

During observation, what could the following indicate? extensive brown or purple discolorations with roughened skin texture

Venous problems

During observation, what could the following indicate? Painless edema of both ankles - tan or brown color changes

Venous stasis

Vertebrae, pelvis, proximal femurs

What is the PT relevance for knowing diverticulitis?

We need to be aware of the possibility of splenic rupture in these patients when doing soft tissue work in left upper quadrant pain

3. Match the following skin lesions with the associated underlying disorder: a. Raised, scaly patches b. Flat or slightly raised malar on the face c. Petechiae d. Tightening of the skin e. Kaposi's sarcoma f. Erythema migrans g. Hives h. Subcutaneous nodules ______ Psoriatic arthritis ______ Systemic lupus erythematosus ______ HIV infection ______ Scleroderma ______ Rheumatoid arthritis ______ Allergic reaction ______ Lyme disease ______ Thrombocytopenia

___A___ Psoriatic arthritis ___H___ Systemic lupus erythematosus __C____ HIV infection ___B___ Scleroderma ___D___ Rheumatoid arthritis __G____ Allergic reaction ___F___ Lyme disease ___E___ Thrombocytopenia

Your patient, a 56-year-old truck driver, complains of occasional difficulty breathing. While you recognize that this is not an uncommon complaint, you want to make sure you rule out cardiovascular causes. Which of the following would indicate a cardiovascular cause? -Low VO2 max -"Flat" blood pressure response to exercise -High respiratory rate -Frequent paroxysmal nocturnal dyspnea -all of the above

all of the above

What are the primary signs and symptoms of CHF? a. Fatigue, dyspnea, edema, nocturia b. Fatigue, dyspnea, varicose veins c. Fatigue, dyspnea, tinnitus, nocturia d. Fatigue, dyspnea, headache, night sweats

a. Fatigue, dyspnea, edema, nocturia

What is the significance of Kehr's sign? a. Gas, air, or blood in the abdominal cavity b. Infection of the peritoneum (peritonitis, appendicitis) c. Esophageal cancer d. Thoracic disk herniation masquerading as chest or anterior neck pain

a. Gas, air, or blood in the abdominal cavity

The presence of pain and anxiety in a client can often lead to hyperventilation. When a client hyperventilate, the arterial concentration of carbon dioxide will increase or decrease?

decrease

You should assess clients who are receiving NSAIDs for which physiologic effect associated with increased risk of hypertension?

decreased HR

The following refers to what cranial N: Motor supply of upper trapezius and sternomastoid

accessory: CN XI

What diagnosis could have the following presentation: Pain in the epigastric or right upper quadrant, may radiate to back ● Black, tarry stool ● Pallor ● Fatigue ● Vomiting blood (more serious)

acid peptic disorders aggravating factors include: -pain is worse at night or on empty stomach

What disease has the following clinical presentation: 1) Skeletal changes Tallness Hypertrophy of mandible, leading to prognathism Hypertrophy of most facial bones, phalanges, metacarpals, and metatarsals Barrel-shaped chest Kyphosis Prominent joints 2) Failure of multiple body systems Hypertension Congestive heart failure Hypertrophy of viscera Diabetes Kidney stones

acromegaly - abnormal production of growth hormone after adolescence

An elderly lady that you have been treating for craniofacial pain, presumably due hyperactivity of the muscles of mastication, does not respond well local treatment of the muscles and splint therapy. The patient has severely increased cervical lordosis and judging by her CT scan, considerable facet osteoarthritis at C2/3 and 3/4, as well as thickening of the ligamentum flavum. You are aware that encroachment in this area could affect both the trigeminal and hypoglossal nerves. What functions would you test? -Ability to look left and right -Active protrusion of the tongue -Balance -Swallowing

active protrusion of the tongue

What type of hepatitis can present as: ● Jaundice ● Muscle wasting ● Gynecomastia ● Abdominal bloating viral hepatitis alcoholic hepatitis

alcoholic hepatitis

A 45-year-old man who has already missed a couple of appointments, arrives 15 minutes late for his first interview, but you receive him anyway since you are running late yourself. He explains his tardiness saying that his wife is such as slow driver. During the interview he appears restless, and when you ask him if he is uncomfortable he responds that he is not really functional before having at least three cups of coffee. Asked about his current intake of pain medications, he admits his physician has advised him to cut down, but he does not feel ready yet. What is your first impression? Alcoholism Depression Hyperparathyroidism Hyperthyroidism

alcoholism

Which of the following findings should alert you to the possibility of prostate cancer in an older man with low back pain? -Tenderness over lower ribs -Voiding difficulties -Pelvic pain -Supraclavicular lymph node enlargemnt -All of the above

all

Jarvin and Deyo have the following reservations against routine use of imaging modalities for low back pain: -Standard radiographs do not provide much clinically useful information -Most men over the age of forty have degenerative changes of the intervertebral discs -While it is highly likely that metastases can be picked up on MRI, it is unlikely that this will save lives -Most patients will get better in 6 weeks any way

all are true

A 17 year-old male soccer player is receiving physical therapy s/p right ACL reconstruction. He reports during the interview that he has exercise-induced asthma and he uses an inhaler to help keep his breathing under control. The physical therapist can take which of the following steps to avoid an asthma attack in the clinic: -Ask patient to bring his inhaler to each treatment session -Provide an adequate warm-up -Recommend two puffs of the inhaler 10 minutes before exercise -If symptoms develop during exercise, advise patient to slow down and take two more puffs -If the patient is having a difficulty breathing, avoid strenuous activity -All of the above

all of the above

Patients with pleurisy may complain of: -Chest wall pain. -Pain of sudden onset. -Pain increased with deep -breathing. -All of the above.

all of the above

According to the study by Boissonnault (1999) on comorbidities in the physical therapy outpatient population, the following diseases are common in the population seeking physical therapy: headache, osteoarthritis, depression, asthma and anemia. Which is the most correct statement? -Asthma and anemia are more common among females than males, osteoarthritis and depression are more common among males than females -All of the diseases are more common in females -Four out of six diseases are more common in males than in females. -The diseases are equally common in the sexes

all of the disease are more common in females

What is a summation gallop (S1,S2,S3,S4) an indicator of? (3)

anemia, hyperthyroidism, CHF

What spinal cord injury would you expect to find the following: Loss of motor function below lesion - note corticospinal tracts ● Also loss of pain and temperature sense - note spinothalamic tracts

anterior cord syndrome

Where can pain associated with pleuropulmonary disorders can radiate? (4)

anterior neck, upper trapezius muscle, ipsilateral shoulder, thoracic spine

The GI tract can cause pain where?

anywhere in the torso

A pulsating mass in the midline should raise suspicion of what?

aortic aneurism

A pulsating mass in the midline should raise suspicion of what?

aortic aneurysm

All of the following apply to what palpation? -Most often found caudal to the renal arteries -Evidenced by a prominent pulsation within a confined area -If the palpable pulse is wider than 2-3 inches, be concerned -Auscultation: bruit

aortic aneurysm

What is the DD of: Hot throbbing sensation that increases with physical activity

aortic aneurysm

Pancoast syndrome is marked by a tumor in which part of the lung? Apex of lung Lower lobe (superior segment) Middle lobe All of the above

apex of the lung

The patient you have been successfully treating for right shoulder bursitis, comes in today and tells you she has started running a fever. She has also noticed right lower quadrant pain that comes in waves and occasionally radiates to her right thigh. Based on what she tells you, you suspect: Appendicitis Gallstones Kidney infection Pancreatitis

appendicitis

An adolescent boy presents with right-sided thoracolumbar pain that radiates across the iliac crest towards the abdominal midline, just above the pubis. You are not able to reproduce his pain, and on the following day he further defines his pain as being colicky in nature. The patient is running a fever. Based on the distribution of pain, what organ do you suspect is responsible for the symptoms? Appendix Ascending colon Gallbladder Liver

appendix

During observation, what could the following indicate? blue to black skin lesions in regions of smooth, hairless skin.

arterial problems

What mechanical event begins shortly after the P wave?

atrial contraction

What is referred to as elevation of blood urea nitrogen (BUN) and creatinine due to decreased in glomerular filtration rate (GFR)

azotemia

This is associated with diffuse myalgias and synovitis. Signs and symptoms: Fever Heart murmus

infective endocarditis

A female patient complains of sacral and thoracolumbar pain. What organs are most likely to be involved: Internal genital organs Large intestine Kidneys Ureter

internal genital organs

Which of the following are clues to the possible involvement of the GI system? a. Abdominal pain alternating with TMJ pain within a 2-week period b. Abdominal pain at the same level as back pain, occurring either simultaneously or alternately c. Shoulder pain alleviated by a bowel movement d. All of the above

b. Abdominal pain at the same level as back pain, occurring either simultaneously or alternately

Name two of the most common medications taken by clients seen in a physical therapy practice likely to induce GI bleeding. a. Corticosteroids b. Antibiotics and antiinflammatories c. Statins d. None of the above

b. Antibiotics and antiinflammatories

A risk factor for NSAID-related gastropathy is the use of: a. Antibiotics b. Antidepressants c. Antihypertensives d. Antihistamines

b. Antidepressants

Back pain with radiating numbness and tingling down the leg past the knee does not occur as a result of: a. Postoperative thrombus b. Bronchogenic carcinoma c. Pott's disease d. Trigger points

b. Bronchogenic carcinoma

The presence of pain and anxiety in a client can often lead to hyperventilation. When a client hyperventilates, the arterial concentration of carbon dioxide will do which of the following? a. Increase b. Decrease c. Remain unchanged d. Vary depending on potassium concentration

b. Decrease

Pursed-lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with: a. Orthopnea b. Emphysema c. CHF d. a and c

b. Emphysema

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. Hepatic encephalopathy

Bleeding in the gastrointestinal (GI) tract can be manifested as: a. Dysphagia b. Melena c. Psoas abscess d. Tenderness over McBurney's point

b. Melena

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. Peripheral edema and ascites

Where are the following musculoskeletal referral patterns are common: Frontal Suboccipital Auricular-mastoid

basi occput

When is it important to add Ca+ in a person who has osteoporosis?

before 1st symptom develops

The following clinical presentation would most likely be what diagnosis: A. Epidemiology 1. Increased incidence with age: 20% of males age 40 70% by age 60 90% by age 80 2. Black population affected 10 years earlier than white 3. US and Western Europeans 4. Only 5-10% will require surgery C. Clinical Presentation 1. Obstructive voiding symptoms, usually starts in the central part of the gland 2. Acute urinary retention 3. Urinary tract infection 4. No association between BPH and cancer 5. 25% need surgery

benign prostatic hyperplasia

ormerly called manic-depressive illness, is characterized by alternating depression and mania, typically starting with depression. A third of the patients demonstrate progressive worsening of symptoms. Symptoms may include: Increased productivity and creativity, initially Euphoria Irritable mood Grandiosity Distractibility Note that behavior associated with certain drugs may have similar effects, and needs to be ruled out.

bipolar disease

Your patient is a 45 male smoker you are treating for left shoulder pain. Your treatment consists of ultrasound and high-repetition/ low load exercises for the rotator cuff muscles. After 2 weeks of successful treatment the patient starts complaining of epigastric pain that is worse at night, and weakness. You suspect acid peptic disorder, but are wondering if the situation is serious enough to warrant a physician referral, or if simple advice will do the trick. What questions would you want to ask the patient? Bloody vomit? Tarry stools? Nausea? Pain over trachea? Fever? Anorexia? Heavy alcohol use? Low back pain?

bloody vomit? Tarry stools?

What type of common metastases: Third most common cancer (after lung and skin cancer) Most common metastases to bone involve the pelvis, ribs, vertebrae, and proximal femur is leading cause of cancer death in 40-60 old females Important to teach patient self-examination; to look for lumps, discharge, and local skin changes High rate of reoccurrence Success of treatment depends on early detection

breast cancer

What spinal cord injury would you expect to find the following: Loss of voluntary motor function, with normal motor function contralaterally ● Below the lesion ipsilateral loss of position sense and contralateral loss of pain/ temperature sense

brown-sequard syndrome

How can you palpate for a hernia?

by pushing your finger into the inguinal canal and have the patient perform the Valsalva maneuver or cough.

Which statement is the most accurate? a. Arterial disease is characterized by intermittent claudication, pain relieved by elevating the extremity, and history of smoking. b. Arterial disease is characterized by loss of hair on the lower extremities and throbbing pain in the calf muscles that goes away by using heat and elevation. c. Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed. d. Arterial disease is characterized by loss of hair on the toes, intermittent claudication, and redness or warmth of the legs that is accompanied by a burning sensation.

c. Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed.

When would you advise a client in physical therapy to take his/ her nitroglycerin? a. 45 minutes before exercise b. When symptoms of chest pain do not subside with 10 to 15 minutes of rest c. As soon as chest pain begins d. None of the above e. All of the above

c. As soon as chest pain begins

Referred pain patterns associated with hepatic and biliary pathologic conditions produce musculoskeletal symptoms in the: a. Left shoulder b. Right shoulder c. Mid-back or upper back, scapular, and right shoulder areas d. Thorax, scapulae, right or left shoulder

c. Mid-back or upper back, scapular, and right shoulder areas

Neurologic symptoms such as muscle weakness or muscle atrophy may be the first indication of: a. Cystic fibrosis b. Bronchiectasis c. Neoplasm d. Deep vein thrombosis

c. Neoplasm

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 levels c. Prolonged coagulation times d. Elevated serum bilirubin levels

c. Prolonged coagulation times

If there is onset of angina that does not subside with 3 nitroglycerin's what should you do?

call 911

If the patient presents with the following what should be done? a) unknown arrhythmia, or new onset of arrhythmia b) when an irregular pulse becomes more irregular with exercise c) slow heart rate that is associated with symptoms d) tachycardia that does not resolve with rest. Here you might ask the patient is he/ she is on medications

call PCP

An elderly lady with a history of mid-thoracic compression fractures and thoracic pain seeks your help. Because of her increased kyphosis her cervical posture leaves a lot to be desired, and her cervical lordosis is sharply increased. You obtain her mid-cervical CT scans, and see a narrowing of the spinal canal due to buckling of the ligamentum flavum. There are however no osteophytes on the vertebral borders and her facet joints look quite good. Still you are wondering if her spinal stenosis could have neurological consequences. What question best reveals that? -Can you feel the temperature of the bath water on your legs? -Can you identify an object you are holding in your hand? -Do you have weakness in your arms? -Do you feel like your knee is buckling when you go downstairs?

can you identify an object you are holding in your hand

What spinal cord injury would you expect to find the following: More motor dysfunction in the upper extremities, proximal more than distal - note the position of the motor tracts on a cross section of the spinal cord

central cord syndrome

Here is a major health problem that can impact on physical therapy treatment. Some issues include: Patient may not be able to cooperate fully Increased pain intensity and decreased capacity to cope with pain stress Psychophysiologic pain syndromes Substances may slow healing It is highly important that we recognize chemical dependency and appropriately refer.

chemical dependency

What does Murphy's sign test for?

cholecystitis

The following S&S are associated with what kidney pathology: -Inability to concentrate -Increased deep tendon reflexes -Proximal muscle weakness -Paresthesias Note that these changes will neither follow normal dermatomal or myotomal patterns, nor peripheral nerve distribution

chronic renal failure

What type of vascular disorder has a classic symptom of pain in the buttocks, thighs and calves?

claudication pain

When exercising a client with known anemia, what two measures can be used as guidelines for frequency, intensity, and duration of the program?

client tolerance perceived exertion levels

What causes the S1 heart sound?

closure of mitral and tricuspid valves as a result of increased ventricular pressure at the beginning of systole

What type of headache does the following describe: There is excruciating pain behind one eye that typically begins a.m. and lasts <2 hrs. Pain may recur daily for weeks or months Redness and lacrimation Horner's syndrome Male smokers

cluster headaches

This is the second most frequently diagnosed cancer in the USA, after skin cancer. It primarily seen in individuals >50 years of age, more common in males than females, blacks than white.

colon cancer

What time of cancer has the following symptoms: ● Progressive constipation ● Bleeding ● Nonspecific complaints: weakness, malaise, weight loss * metastasizes to ribs and thoracic spine

colon cancer

What GI organ can refer pain to the upper abdominals and middle thoracic spine?

common bile duct

During observation, what could the following indicate? Signs may be painless edema of both ankles (no discoloration), rapid weight gain (4-5 pounds/ 2-3 days), jugular venous distention, and ascites

congestive heart failure, with right ventricular failure

According to the Diagnostic and Statistical manual of Mental disorders 4th ed. this denotes pain-free loss of physical function, suggesting a physical disorder. These symptoms, which the patient does not consciously produce, do not have an identified physical explanation. The demonstration of psychological stress or conflict is a prerequisite for the diagnosis. Symptoms mediated by the autonomic nervous system are excluded.

conversion disorder

What is the significance of "skin pain" over the T9/T10 dermatomes?

could be referral pain from upper urinary tract

9. Peripheral vascular diseases include: a. Arterial and occlusive diseases b. Arterial and venous disorders c. Acute and chronic arterial diseases d. All of the above e. None of the above

d. All of the above

What areas of the body can GI disorders refer pain to? a. Sternum, shoulder, scapula b. Anterior neck, mid-back, lower back c. Hip, pelvis, sacrum d. All of the above

d. All of the above

What is the significance of sweats? a. A sign of systemic disease b. Side effect of chemotherapy or other medications c. Poor ventilation while sleeping d. All of the above e. None of the above

d. All of the above

A 56-year-old client was referred to PT for pelvic floor rehab. His primary symptoms are obstructed defecation and puborectalis muscle spasm. He wakes nightly with left flank pain. The pattern is low thoracic, laterally, but superior to iliac crest. Sometimes he has buttock pain on the same side. He doesn't have any daytime pain but is up for several hours at night. Advil and light activity do not help much. The pain is relieved or decreased with passing gas. He has very tight hamstrings and rectus femoris. Change in symptoms with gas or defecation is possible with: a. Thoracic disk disease b. Obturator nerve compression c. Small intestine disease d. Large intestine and colon dysfunction

d. Large intestine and colon dysfunction

Common symptoms of respiratory acidosis would be most closely represented by which of the following descriptions? a. Presence of numbness and tingling in face, hands, and feet b. Presence of dizziness and lightheadedness c. Hyperventilation with changes in level of consciousness d. Onset of sleepiness, confusion, and decreased ventilation

d. Onset of sleepiness, confusion, and decreased ventilation

A 65-year-old client is taking OxyContin for a "sore shoulder." She also reports aching pain of the sacrum that radiates. The sacral pain can be caused by: a. Psoas abscess caused by vertebral osteomyelitis b. GI bleeding causing hemorrhoids and rectal fissures c. Crohn's disease manifested as sacroiliitis d. Pressure on sacral nerves from stored fecal content in the constipated client taking narcotics

d. Pressure on sacral nerves from stored fecal content in the constipated client taking narcotics

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. Production of glucose

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. Requires medical referral

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. Serum ammonia

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. a and b only

What could depression of the ST segment indicate? Elevate it?

ischemia injury

You have been treating a young woman for non-specified low back pain. There is a cyclical character to her pain, and she volunteers the information that it is related to her menstrual cycle. What modifications might you have to make to her treatment program? -Cancel traction therapy -Decrease strength training in the first half of the menstrual cycle -Decrease stretching in the second half of the menstrual cycle -Not apply electrotherapy the first 5 days following her period -Stop stabilization exercises all together

decreased stretching in the 2nd half of the menstrual cycle

Non-bizarre delusions (fixed, but unrealistic ideas) Grandiose Jealous Persecutory

delusional disorders

. Clinical Presentation: 1. Most depression will resolve in a few weeks or months but some patients will go on to have a chronic problem 2. There is a 25% relapse rate in 12 weeks 3. 15% of patients depressed for longer than 1 month will commit suicide G. Diagnosis 1. Depressed mood daily for the last 2 weeks

depression

. Etiology: 1. There is a strong genetic link to depression 2. Diseases with a high association with depression are: a. central nervous system (CNS): i. Parkinson's disease ii. CVA, especially frontal and left sided iii. post-concussion injury iv. MS v. cerebral arteriosclerosis vi. Alzheimer's disease b. endocrine/metabolic: i. hyperthyroidism ii. hypothyrodism iii. hypoglycemia iv. hyperglycemia v. hyperparathroidism c. viral: i. AIDS ii. pneumonia iii. influenza iv. hepatitis d. nutritional: i. folic acid deficiency ii. vitamin B6 deficiency iii. vitamin B12 deficiency e. cancer: i. pancreatic ii. bronchogenic iii. renal iv. ovarian f. miscellaneous: i. SLE ii. sarcoidosis iii. pancreatitis

depression

A primary disorder of mood (the internal emotional state of the patient). Note that affect is the external manifestation of mood.

depression

Epidemiology 1. The most common adult psychiatric disorder 2. Prevalence: a. 2% in males, 4% in females b. Over six months = 2.5 million men and 5 million women c. 1 in 8 adults 3. Life time risk: a. 8-12% in males and 20-25% in females b. 11% prevalence in an outpatient PT practice 4. A prevalence of 10% in a rural population (Barrett, et al., 1988). 5. Mean age of onset is 40 years-of-age 6. The earlier the age of onset the more likely that a re-occurrence will occur 7. Bipolar depressive disorders are more prevalent among artistic/creative people 8. It is hard to differentiate depression from dementia in the elderly

depression

What CV structure can refer pain to the cervical spine?

diaphragm (central portion)

What are the 2 major mechanism underlying arrhythmia?

disturbances in the inherent generation of the heartbeat disturbed conductivity

This is an inflammation of pouches in the colon, containing trapped feces, most frequently in the descending or sigmoid colons.

diverticulitis

Which GI disorder has the following clinical presentation, risk factors and presentation: Clinical presentation: ● Left lower quadrant pain ● Change in stool pattern ● May be associated low back, pelvis, or left leg pain Enlargement of spleen (splenomegaly) Pathology/ risk factors: ● Infectious mononucleosis ● Cancer (leukemia and lymphoma) ● Mainly young people Presentation: ● Flank pain ● Left upper quadrant pain ● Mid-back

diverticulitis

You have finished examining a patient complaining of low back pain and you suspect that the abdominal viscera as causing the symptoms. What symptom description would best identify the abdominal viscera? Aching and tiring Burning and electrical Dull and poorly localized Sharp and shooting

dull and poorly localized

What anatomy lies in the upper R quadrant on top of the psoas and crosses the vertebral column at the L3 level?

duodenum

Which of the following would you normally expect to be associated with the last trimester of pregnancy? (2) Decreased glucose levels Dyspnea Hypertension Increased lumbar lordosis

dyspnea and increased lumbar lordosis

Which symptom has greater significance: dyspnea at rest or exertional dyspnea?

dyspnea at rest

Dyspnea associated with emphysema is the result of: a. Destruction of the alveoli b. Reduced elasticity of the lungs c. Increased effort to exhale trapped air d. a and b e. All of the above

e. All of the above

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. None of the above

What can relieve referred pain caused by ulcers?

eating, which returns a few hrs later

If the pulse pressure (difference between systolic and diastolic blood pressure) falls with exercise?

it is a sign of cardiac failure

What is the first most common sign associated with liver disease?

jaundice

What structure can refer pain to the lumbar spine (ipsilateral), lower and upper abdominals? -kidney -ureter -urinary bladder -prostate gland

kidney

What diagnosis has the following clinical presentation: 1. 40% will present with life threatening, acute rupture 2. 60% will present with chronic tubal rupture 3. woman may or may not have suspected pregnancy 4. menstrual periods frequently replaced with variably, delayed, slight vaginal bleeding 5. 80% of patients will have some vaginal bleeding 6. symptoms frequently vague and inconclusive 7. classically: -sudden onset of sharp stabbing pain -pain may be of gradual onset 8.pain location: -lower back -one or the other hip -shoulder strap pain, especially with inspiration 9. symptoms of early pregnancy: -morning nausea -breast tenderness -fatigue -urinary frequency

ectopic pregnancy

Distention of air spaces distal to the terminal bronchioles with destruction of the alveolar septa is a description of: Chronic bronchitis. Emphysema. Lung cancer. Pleurisy.

emphysema

The follow classic triad applies to what pathology: -Dysmenorrhea: occurs in 1/3 of the patients (not correlated with severity) -Dyspareunia, that will not change with a change in position -Infertility

endometriosis

What female urogenital disease could have the following locations of pain: -Low back and pelvic pain common -Lower thoracic pain -Thigh/sciatic pain -Shoulder strap pain, bilateral or unilateral

endometriosis

What GI organ can refer pain to the suprasternal and upper abdominal area?

esophagus

How often does the The American Cancer Society recommends includes annual fecal occult blood (stool blood) tests, together with a flexible sigmoidoscopy and digital rectal exam be performed?

every 5 years

Pain associated with pleuropulmonary disorders can radiate to the: a. Anterior neck b. Upper trapezius muscle c. Ipsilateral shoulder d. Thoracic spine e. a and c f. All of the above

f. All of the above

The following refers to what cranial N: Facial expressions, relating both to upper and lower parts of the face

facial: CN VII

What is an abnormal S3 indicative of?

failing left ventricle

The presence of a persistent dry cough (no sputum or phlegm produced) has no clinical significance to the therapist. True or false

false

What test is performed with patient in supine and the examiner places his/her hands on the right upper abdominal quadrant at the inferior costal margin. The patient inspires and the examiner palpates deeply in the subcostal region with the fingertips. The test is considered positive if pain is perceived during inspiration or the patient's stops inspiration due to discomfort.

gall bladder

What GI organ can refer pain to the right upper abdominal, right middle and lower thoracic spine including the caudal angle of scapula?

gallbladder

What GI disorder can present as the following: o pain in the right upper quadrant, radiating to back o pain in the scapula and right shoulder o pain in the neck o nausea and vomiting o fever o tenderness, or mass in the right upper quadrant

gallstones

When DD vascular insufficiency, what is typically described as very intense, constant localized pain associated with blackened lesions?

gangrenous lesions

Hans Selye observed that all human illness is accompanied by certain common changes. What did he called these changes?

general adaptation syndrome

The symptoms of this disorder are: Motor tension Autonomic hyperactivity Apprehension Vigilance Rehabilitation may be affected, due to difficulty in relaxing.

generalized anxiety disorders

The following S & S apply to what type of chondrogenic neoplasm: Fairly common primary neoplasm Classified as benign, but is locally aggressive, has high recurrence and 15% become malignant [i] Young individuals, females>males Epiphysis of long bones, with a tendency to involve subchondral bone Pain is the most common presenting symptom Impaired function Radiographs show large osteolytic lesion that may expand the cortex of the bone osteochondroma Chondroblastoma giant cell tumors

giant cell tumors

The following refers to what cranial N: (2) These work together in swallowing and the gag reflex. If you limit your testing to swallowing, that is more acceptable to the patient! ● taste buds on the posterior 1/3 of tongue

glossopharyngeal: CN IX vagus: Cn X

What CV structure can refer pain to the anterior cervical, upper thorax and left upper extremity? It can also cause pain in the chest, jaw and epigastrium.

heart

During observation, what could the following indicate? pale, even ashen color, diaphoresis, and cyanosis

hemodynamic compromise

What type of hernia will allow a part of the stomach to protrude through the respiratory diaphragm and may give rise to symptoms similar to those of esophageal spasm?

hiatal hernia *these individuals will not tolerate lumbar stab corsets well

Unrealistic, chronic fear of serious disease based on physical sensations and frequently associated with depression.

hypochondriasis

The following refers to what cranial N: Motor supply of the tongue ● Unilateral weakness results in deviation of tongue, on protrusion

hypoglossal: CN XII

The diagnostic criteria for major depression, according to DSM III-R?

include five of the following symptoms, for two weeks or longer: Continuous depressed mood Diminished interest Significant weight loss/gain Sleep disturbances Psychomotor agitation/retardation Fatigue Feeling of worthlessness Diminished ability to think Recurrent thoughts of death

What type of common metastases: Renal cell carcinoma: 50-60 years age group Clinical presentation includes pain, hematuria, fever, and weight loss Examination includes percussion for tenderness (strike at the costovertebral angles) Metastases most commonly involve the vertebrae, pelvis, and proximal femur

kidney

A 45-year-old male you have been treating for thoracolumbar pain starts showing signs of anemia. On re-examination you find hypertension. What is your concern? -Colon cancer -Coronary artery disease -Kidney problems -Metastases from the prostate

kidney problems

What organ produces angiotensin II, prostaglandins and kinins?

kidneys

Malfunction of what organ can result in hypertension or anemia? Why?

kidneys they play a role in the synthesis of RBC

When examining the urogenital system, what structures can you palpate externally? Fimbria Kidneys and bladder Prostate Ureters Uterus

kidneys and bladder

In what quadrant are masses associated with colon cancer or diverticulitis most commonly found?

left lower quadrant

What GI organ can refer pain to the lower abdominals and middle lumbar spine?

lg intestine

This is transmitted by a tick bite, this disease is characterized by: Rash (chronicum migrans) Later: neuropathic and cardiac findings Later still: arthritis. Note that patients often are not seen until in this stage Suspect in patients with new inflammatory arthritis Management: antibiotic therapy

lime disease

What GI organ can refer pain to the right middle and lower thoracic spine, right cervical spine?

liver

What is being palpated when the examiner uses tips of the fingers with two hands inferior to the ribs in the mid-clavicular line? What are they palpating for?

liver to descend with inspiration

What is the typical pain referral pattens for the ovaries? (2)

lower abdominal, sacral

What is the typical pain referral pattens for the testes? (1)

lower abdominal, sacral

What are the possible areas of pain referral for the following structures? -kidney (T10-L1)

lumbar spine (ipsilateral)

What is the typical pain referral pattens for the uterus including uterine ligaments?

lumbosacral junction sacral thoracolumbar

What type of common metastases: Leading cause of death in women Symptoms tend not to present until the disease is advanced Metastasizes early in disease

lung cancer

What CV structure can refer pain to the ipsilateral thoracic spine and cervical spine?

lungs and bronchi

Which of the following require physician referral due to suspected GI pathology? Abdominal pain Hemorrhoids Mid Thoracic pain Melena

melena

What auscultation could be heard if a pt had valvular disorders, atrial aneurysm, throtoxicosis?

murmurs

Chest pain due to exertion, cold air or draft, or chest pain after a meal raises suspicion for?

myocardial ischemia

What is the DD of: This does not necessarily cause chest pain, but chest tightness and breathlessness. These conditions may be accompanied by low-grade fever, malaise, and arthralgias

myocarditis and endocarditis

Neurologic symptoms such as muscle weakness or muscle atrophy may be the first indication of?

neoplasm

What could suspicious lymph nodes indicate?

neoplasm or infection

Which of the following s/s is (are) usually associated with musculoskeletal joint pain? Jaundice Low grade fever Skin rash Sweating None of the above

none

Which of the following findings from your interview specifically indicate or are specific to asthma? -Smoking -Wheezing when breathing out -Exposure to industrial pollutants -Difficulty with full expiration -All of the above -None of the above

none of these

What type of problem is often referred to as cramping or colicky pain?

obstruction or distention of viscera

Increased residual lung volume and obstruction of airflow during both inspiration and expiration is the definition of: -Obstructive pulmonary disease. -Pulmonary vascular disease. -Restrictive pulmonary disease. -Ventilating regulation disease.

obstructive pulmonary disease

Your patient is an obese 46-year-old male. His complaints include fatigue, shortness of breath, and interrupted sleep. On inspection you note slight cyanosis and rapid respiration. Palpation, and percussion are negative. On pulmonary function tests FEV 1 and FVC is normal. Auscultation is within normal limits, except there are periods of no airflow, in spite of continued respiratory movements. Which of the following is most likely: COPD Lung tumor Obstructive sleep apnea Pneumonia Restrictive lung disease

obstructive sleep apnea

Where are the following musculoskeletal referral patterns are common: Suboccipital Low occipital Parietotemporal

occipitoatlantic region

What could the presence of the following be? fever/chills/sweats

occult infection cancer

The following refers to what cranial N: (3) Movements of the eyes; tested by moving a pen in front of the patient. Observe for symmetry and speed of motion ● Pupillary reaction to light; both pupils should constrict when light is directed at one eye

oculomotor: CN III trochlear: CN IV abducens: CN VI

The following refers to what cranial N: Central visual acuity: read signs across the room ● Peripheral vision: movements outside the focus of the patient's visual field

optic: CN II

The following S & S apply to what type of osteogenic neoplasm: A benign lesion, although an aggressive variant has been described Clinical presentation may be similar to osteoid osteoma, though less painful and more difficult to localize Young individuals; primarily males 1/3 of lesions in the spine, usually in posterior elements, and half of those cause neurological symptoms Radiography: less of a sclerotic margin than seen in osteoid osteoma Significance for physical therapy: In the spine, the area of the lesion may appear enlarged to palpation

osteoblastoma

The following S & S apply to what type of chondrogenic neoplasm: Most common benign lesion Spongy bone osseous outgrowth, capped by cartilage, into surrounding soft tissue Metaphyses of long bones: knee and elbow Localized inflammatory response A firm nontender mass Radiographic: exotosis that is smaller than might be expected from palpation Surgical treatment if lesion interferes with function osteochondroma Chondroblastoma giant cell tumors

osteochondroma

The following S & S apply to what type of osteogenic neoplasm: Boys and young males Pain, which is worse at night and relieved with Aspirin Loss of function Late radiographic presentation (months or years after onset of symptoms) - a well demarcated area of translucency (nidus) inside the bone, sometimes with a central calcified dot Significance for physical therapy: patient may have long-standing symptoms with few objective finding. osteoid osteoma osteoblastoma osteosarcoma osteochondroma

osteoid osteoma

Which type of infection does the follow refer to: Rapidly progressing infection of the medullary cavity of bone Metaphyses of long bones Stapylococcus aureus in >90% Via scratches on skin or because of upper respiratory infection If untreated: septicemia May cause septic arthritis

osteomyelitis

What do osteoporosis and multiple myeloma have in common? Anemia Both affect the skull Osteopenia Weight loss

osteopenia

The following S & S apply to what type of osteogenic neoplasm: 20% of primary malignant bone tumors. Primarily children and young adults, predominantly males, although it is also seen in the older population as sarcomatous degeneration (Paget's disease) Rapidly growing lesions Often in metaphyses of long bones Early metastases to lungs Pain is the consistent finding, progressive, severe, and continuous osteoid osteoma osteoblastoma osteosarcoma osteochondroma

osteosarcoma

What disease do the following characteristics refer to: Males >50 years of age Several phases to the disease; first osteolysis, then weakening of bones (filled with fibrous tissue), and lastly enlargement of bones Tibia , femur, vertebral bodies, pelvis, and skull Signs and symptoms are mild and may include dull ache, enlargement of bones, jaw, skull, extremities, bowing of lower extremity bones, and increased kyphosis Disease often an incidental finding Diagnosis: radiographic, biochemical Complications include secondary osteosarcoma ( occurs in less than 1% of patients ) and pathological fracture (common) Treatment: alleviate disability resulting from fracture

pagets

Which disease would have the following clinical presentation: 1. Vaginal discharge 2. Frequently associated with dysuria/frequency 3. Pain, anorectal, midline abdominal, bilateral, lower abdominal pain 4. Referred pain to the shoulder area 5. Usually low grade fever

pelvic inflammatory disease

What disease is most often associated with gonococcus or chlamydia infections, viral, fungal, and parasitic infections?

pelvic inflammatory disorder

What organs refer pain to the lower abdominal, sacral, lumbar and thoracolumbar regions?

pelvic organs

If there is a S1 or S2 heart sound during a pause in the peripheral pulse, there is no?

perfusion with the beat

What is the DD of: Thoracic pain that worsens with inspiration, is sharp and improves with change in position

pericarditis

What painful cardiac condition can present as sharp burning pain in chest or left shoulder? It is aggravated by coughing or positional changes and relieved with sitting in a forward flexed posture

pericarditis

What system should be screened in a patient has R/L knee pain?

peripheral vascular

Tenderness, when quickly releasing the palpating pressure, (rebound tenderness) should result in immediate physician referral. It could indicate what?

peritoneal irritation due to serious pathology

The following clinical presentation would most likely be what diagnosis: 1. Generalized symptoms: -malaise -fever -chills -arthralgia 2. Perineal pain 3. Irritative voiding symptoms 4. Obstructive voiding symptoms 5. Low back pain -very low location, mid sacral area -central location -frequent missed diagnosis in patients with "mechanical LBP"

prostatitis

What diagnosis can often presents as dull perineal pain that may vary with intercourse, urination, or defecation. Hemorrhoids can give rise to similar symptoms, but the physician's examination should quickly differentiate between these two.

prostatitis

What is the #1 missed diagnosis in individuals complaining of LBP?

prostatitis

What 4 systems should be screened in a patient has inconsistent symptomatic patterns?

psychologic endocrine neurologic rheumatic

Finding(s) on abdominal palpation that raise suspicion of gastrointestinal system disease include: -Increased abdominal tone -Pulsating midline-mass -Rebound tenderness -Tenderness of the abdominal wall that increases with resistance

rebound tenderness

What hormone is sig to PT in that there could be decreased tolerance to stretching in women?

relaxin

What cancer diagnosis has the following clinical presentation? 1. Classic triad Pain Gross hematuria Abdominal mass 2. Pain is located in the flank or abdominal areas 3. Weight loss 4. Anemia 5. Fever 6. Metastasis occur in approximately 10% of the patients Lungs (60%) Local nodes (35%) Liver (30%) Bone (30%) Adrenal (20%)

renal cell carcinoma

What is the most common renal cancer?

renal cell carcinoma

The following symptoms would indicate which respiratory state? - Onset of sleepiness, confusion, and decreased ventilation

respiratory acidosis

This is an immunoreactive process following streptococcal laryngitis. There are cardiac and neurological features, but also inflammatory arthritis.

rheumatic fever

What type of arthritic disease does the follow pertain to: Most common inflammatory joint disorder Any age, peaking at 30-50 Female:male ratio 3:1 All cardinal signs and symptoms of inflammation A duration of > 6 weeks excludes infectious origin Prolonged morning stiffness Symmetric distribution, not influenced by mechanical stress Disease can involve any joint, typically MCP, wrists, elbows, and cervical spine . Half of the patients have symptoms in the temporomandibular joints

rheumatoid arthritis

This disorder characterized by seasonal depression for at least 2 months, usually presents during the wintertime. The etiology, clinical presentations, criteria, and assessment are discussed on the Psychiatry Online Homepage.

seasonal affective disorder

What GI organ can refer pain to the upper sacral, suprapubic, left lower quadrant or abdomen?

sigmoid colon

What causes the S2 heart sound?

slightly louder, heard when the pulmonic and aortic valves close, following systole. Sometimes it is possible to discern between the sounds made by these two valves (split S2 sound). Then the sounds can be referred to as A2 (aortic) and P2 (pulmonic)

What GI organ can refer pain to the middle lumbar spine?

sm intestine

What are the 2 leading predisposing factors for bladder cancer?

smoking and chemical exposure

This is another disorder without organic findings, characterized by a history of multiple somatic complaints, beginning before the age of 30. Complaints typically involve most organs The clinical presentation tends to be dramatic There is a detailed history of hospitalizations and over-treatment A high incidence of concurrent psychiatric disorders.

somatization disorder

Conversion disorder, somatoform pain disorder, somatization disorder, and hypochondriasis are all types of what disorder?

somatoform

This disorder is characterized by: Presence of pain >6 months, in absence of pathophysiology that can account for changes in pain or for the severity of pain. This includes most cases of chronic pain and frequently depression is involved Explanations include self-punishment, loss of effective modulation of afferent signals, and psychological distress Note that somatic expression (pain) of these disorders is socially acceptable and gets social and professional attention and postpones tackling the underlying psychological problem.

somatoform pain disorder

What does Nixon's and Castell's percussion test test for?

splenomegaly

Physical therapists are qualified to make a diagnosis regarding primary neuromusculoskeletal conditions, but we must do so in accordance with:

state practice act

What GI organ can refer pain to the upper abdominal, middle and lower thoracic spine?

stomach

What type of disorder Very rare Patients <60 years of age Associated with polymyalgia rheumatica There may be exquisite tenderness and warmth over the temporal artery Diagnosis by ESR and biopsy of artery Note that missed/ delayed diagnosis may result in blindness and/ or cerebral ischemia

temporal arteritis immediately contact physician

What cancer diagnosis has the following clinical presentation? 1. Asymptomatic testicular masses 2. Significant delay in diagnosis is common 3. Masses may or may not be painful 4. Other presenting signs/symptoms: ● Back/abdominal pain secondary to retroperitoneal adenopathy ● Weight loss ● Dyspnea (lung metastases) ● Gynecomastia ● Supraclavicular lymphadenopathy

testicular cancer

Where is the best place to hear the S4 heart sound?

the apex of the heart

What is the significance of nadir?

the lowest point the white blood count reaches, usually occurs 7-14 days after chemotherapy or radiation therapy. pt is susceptible to infection and therapist should use universal precautions

When DD vascular insufficiency, what is typically described as localized pain, a red, hot area and swelling. There is often a history of prolonged immobilization?

thrombophlebitis

The following clinical presentation is often found in what diagnosis common in pregnant women: -Pain in the inguinal area or around greater trochanter, possibly radiating to the anterior thigh -Limited hip range of motion -Limited functional weight bearing -Condition is self-limiting in 2-12 months

transient osteoporosis

On auscultation you hear a snapping sound over the sternum at its junction with fifth rib. What structure do you think gives rise to that sound? Tricuspid valve Pulmonary valve Aortic valve

tricuspid

The following refers to what cranial N: Sensory: light touch to the side of face, in the three regions of the branches ● Motor: palpation for contraction of the muscles of mastication

trigeminal: CN V

Dyspnea, accompanied by a high respiratory rate (>40/min), is a symptom, not a condition. T/F

true

T/F Many cervical dysfunctions lead to vasospasms

true

Describe the two tests used to distinguish an iliopsoas bleed from a joint bleed.

trunk flexion over hip produces severe pain in the presence of iliopsoas bleeding but only mild pain with hip flexion for a hip hemorrhage

What pathological disease is most mistaken for pain due to mechanical dysfunction?

tumors

The follow S&S could be a result of what? -GI disorder -DM -Hyperthyroidism -Adrenal insufficiency -Infections -Depression

unexplained weight change, >5% in 4 wks

What N fibers carry pain which typically give rise to deep aching pain that is hard to localize?

unmyelinated C fibers

You are treating a 65-year-old gentleman post total hip replacement. There is history of coronary heart disease that has been well controlled for the last few years. Normally one nitroglycerine decreases symptoms. One day following an exercise session, the patient complains of chest pain, radiating into the left arm. The patient confirms that this is similar to pains he has experienced before, but the pain extends further into the arm. After ten minutes of rest and two nitroglycerines the patient still is not fully recovered. This presentation is typical for: Stable, atypical angina Stable, typical angina Unstable atypical angina Unstable, typical angina

unstable, typical angina

What is referred to as azotemia plus clinical signs and symptoms associated with renal failure?

uremia

Referral to the groin, upper abdominal, suprapubic, medial/proximal thigh, thoracolumbar could be from what?

ureter

What structure can refer pain to the groin, upper abdominals, suprapubic, medial/posterior thigh. thoracolumbar? -kidney -ureter -urinary bladder -prostate gland

ureter

What structure can refer pain to the sacral apex, suprapubic, medial/proximal thigh and thoracolumbar? -kidney -ureter -urinary bladder -prostate gland

urinary bladder

Your 45-year-old female patient reports the following during the interview: Cloudy urine, pain with urination, bloody urine, frequency, low back pain. What do you suspect? Urinary infection Dyspareunia Pelvic inflammatory disease

urinary infection

Where is the problem if the following premature beats are appearing too close together: normal with a P wave before the QRS complex?

usually atrial

When evaluating a patient with headaches, what signs and symptoms would prompt you perform neurological screening? 1. Headaches that increase with increased muscle tension 2. Fever 3. Nausea 1. Headaches that increase with exertion 2. Reported loss of smell 3. Intense toothache 1. Fever 2. Nausea 3. Visual disturbances 1. Visual disturbances before the onset pain 2. Focal tenderness in the anterior temporal area 3. Headaches that are worse in the supine position

What type of syncope is most frequently seen in a high anxiety, pain, or hunger. Premonitory signs or symptoms are: Pallor Yawning Sighing Hyperventilation Epigastric discomfort Nausea Blurred vision.

vasovagal syncope

When DD vascular insufficiency, what is typically described as constant pain, brownish discolored skin, and local edema?

venous stasis ulcers

Where is the problem if the following premature beats are appearing too close together: if different from the normal beat, with no P wave before the QRS?

ventricular

What mechanical event begins near the end of the R wave and ends after the T wave?

ventricular contraction

The following refers to what cranial N: patients may complain of: ● Dizziness, nausea, balance problems (vestibular portion) ● Tinnitus or hearing deficit (cochlear portion); hearing tests address both air-transmitted sound and sound conducted in bone (Weber's test)

vestibulocochlear: CN VIII

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