Differential Diagnosis Exam 1

the RIGHT shoulder

A Visceral liver lesion to the can have a referral site to.....

Back, Inguinal Region, Genitalia

A Visceral urogenital tract lesion can have a referral site to.....

if they walk at this speed or lower, they are at a higher risk for mortality

"The Grim reaper walks at 2.0 mph". What does this statement mean?

1) bulimia 2) GI ulcer

(1) dental decay would be a sign of ________ (2) ____ _______ may also give someone bad breath

a) fruity: diabetic ketoacidosis (can present drunk) b) bad-smelling: dental decay, lung abscess, throat or sinus infections, GI disturbances, bowel obstruction, or Helicobacter pylori bacteria

1. Breath Odors May Indicate: a) fruity b) bad-smelling

COPD, constrictive pericarditis, pericardial effusion, tension pneumothorax, pericarditis with fluid, or pericardial tamponade

A Paradoxic Pulse Amplitude may indicate which diseases?

L eft Shoulder, Neck, Upper Back, TMJ

A Visceral heart lesion can have a referral site to.....

o Between ages of 48-54 o No menstrual periods for 12 months

A woman is considered menopausal when....

(a) A—Asymmetry (b) B—Border (c) C—Color — multiple colors is malignant (d) D—Diameter — it will get larger than 1/4 in. if malignant (e) E—Evolving/Elevation

ABCDEs to assess skin lesions for cancer detection

D Primary care physical therapy

Ch1 Test Bank 11. What type of physical therapy describes a philosophy of whole-person care? A Direct access B Autonomous practice C Secondary care physical therapy D Primary care physical therapy

A Medical history

Ch1 Test Bank 12. According to the Goodman Screening for Referral Model, what should be done first when screening a patient? A Medical history B Personal and family history C Risk factor assessment D Clinical presentation

D Pain

Ch1 Test Bank 13.Which of the following is a symptom? A Unusual skin color B Hematoma C Effusion D Pain

a) spoon nails b) congenital or hereditary -- hypochormic anemia -- iron deficiency -- poorly controlled diabetes > 15 years

What is Koilonychia? What is it associated with?

Confirmation bias

Define: o The tendency to look for, notice, and remember information that fits with our pre-existing expectations o No matter what, you will make the pathology "fit" what you think it is

If the HR does not go down by at least 20 bpm in three minutes, it MUST be reported.

Case Study: Patient works out very hard, reaches a max HR of 160 and then takes a seat. After sitting down for 3 minutes, his heart rate is 160. What should you do next?

b. to guide the plan of care and intervention strategies. * The primary purpose of a diagnosis is to provide information (i.e., identify as closely as possible the underlying neuromusculoskeletal [NMS] pathology) that can guide efficient treatment and effective management of the client.

Ch 1 Practice Questions 1. In the context of screening for referral, the primary purpose of a diagnosis is a. to obtain reimbursement. b. to guide the plan of care and intervention strategies. c. to practice within the scope of physical therapy. d. to meet the established standards for accreditation.

b. False * See Box 1-1.

Ch 1 Practice Questions 2. Direct access is the only reason physical therapists must screen for systemic disease. a. True b. False

b. did the physician (dentist, chiropractor) examine you?

Ch 1 Practice Questions 3. A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is a. what did the physician (dentist, chiropractor) say is the problem? b. did the physician (dentist, chiropractor) examine you? c. when do you go back to see the doctor (dentist, chiropractor)? d. how many times per week did the doctor (dentist, chiropractor) suggest you come to therapy?

c. throughout the episode of care.

Ch 1 Practice Questions 4. Screening for medical disease takes place a. only during the first interview. b. just before the client returns to the physician for his/her next appointment. c. throughout the episode of care. d. None of the above.

e. Any of the above.

Ch 1 Practice Questions 5. Medical referral for a problem outside the scope of the physical therapy practice occurs when a. no apparent movement dysfunction exists. b. no causative factors can be identified. c. findings are not consistent with neuromuscular or musculoskeletal dysfunction. d. client presents with suspicious red-flag symptoms. e. Any of the above. f. None of the above.

a. True

Ch 1 Practice Questions 6. Physical therapy evaluation and intervention may be a part of the physician's differential diagnosis. a. True b. False

A yellow flag is a 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 or tests, or to make an appropriate referral. * The presence of a single yellow or red flag is not usually a cause for immediate medical attention. Each cautionary or warning flag must be viewed in the context of the whole person, given his or her age, gender, past medical history, and current clinical presentation.

Ch 1 Practice Questions 7. What is the difference between a yellow- and a red-flag symptom?

Past medical history, risk factor assessment, clinical presentation (including pain types and pain patterns), associated signs and symptoms, review of systems. Each client can be framed by these five components. Any suspicious finding or response in any of these areas warrants a closer look.

Ch 1 Practice Questions 8. What are the major decision-making tools used in the screening process?

d. Water retention * · Look for sacral and pedal edema.

Ch 2 Practice Questions 10. You should assess clients who are receiving NSAIDs for which physiologic effect associated with increased risk of hypertension? a. Decreased heart rate b. Increased diuresis c. Slowed peristalsis d. Water retention

c. inform their primary care provider of both conditions. * Inform the primary care provider of both conditions; the therapist can also screen for potential adverse effects of NSAIDs and can monitor blood pressure.

Ch 2 Practice Questions 11. Instruct clients with a history of hypertension and arthritis to a. limit physical activity and exercise. b. avoid OTC medications. c. inform their primary care provider of both conditions. d. drink plenty of fluids to avoid edema.

b. Increases blood pressure * Nonsteroidal antiinflammatory drugs (NSAIDs) can be potent renal vasoconstrictors that cause increased blood pressure and resultant lower extremity edema as sodium and water are conserved by the body.

Ch 2 Practice Questions 1. What is the effect of NSAIDs (e.g., Naprosyn, Motrin, Anaprox, ibuprofen) on blood pressure? a. No effect b. Increases blood pressure c. Decreases blood pressure

D Accelerated joint destruction

Ch 2 Test Bank 15. Which of the following is a side effect of local injection of corticosteroids? A Liver damage B Kidney damage C Impaired cardiovascular function D Accelerated joint destruction

D Mexican Americans

Ch 2 Test Bank 16. Which population group is 60% more likely to have a stroke at age 60 to early 70s? A African Americans B Caucasians C Asian Americans D Mexican Americans

b. brief, easy to administer, and nonthreatening. * · It may not be necessary to screen every client for alcohol use. You may not conduct a full screening assessment when someone appears to have been drinking, but it may still be appropriate to ask, "I smell alcohol on your breath. How many drinks have you had?" Screening questions should be asked privately and confidentially without other family and friends listening.

Ch 2 Practice Questions 12. Alcohol screening tools should be a. used with every client sometime during the episode of care. b. brief, easy to administer, and nonthreatening. c. deferred when the client has been drinking or has the smell of alcohol on their breath. d. conducted with one other family member present as a witness.

· Are there any other symptoms of any kind anywhere else in your body that we haven't discussed yet? · Is there anything else you think is important about your condition that we have not discussed yet? · Is there anything else you think I should know?

Ch 2 Practice Questions 13. With what final question should you always end your interview?

a. patient interview. * Although all details obtained from the Family/Personal History form, interview, and objective examinations provide important information, it is well documented that 80% (or more) of the information needed to determine the cause of symptoms is actually gathered during the Core Interview of the Client Interview.

Ch 2 Practice Questions 2. Most of the information needed to determine the cause of symptoms is contained in the a. patient interview. b. Family/Personal History Form. c. physical examination d. All of the above. e. A and C

b. antidepressants. * · Antidepressants are divided into three groups: tricyclics, monoamine oxidase inhibitors (MAOIs), and miscellaneous antidepressants. The tricyclics work by blocking reuptake of norepinephrine and serotonin into nerve endings and increasing the action of norepinephrine and serotonin in nerve cells. Any of the antidepressants can have gastrointestinal adverse effects, but especially, the selective serotonin uptake inhibitors (SSRIs) such as Paxil, Zoloft, Prozac, and Celexa.

Ch 2 Practice Questions 3. A risk factor for NSAID-related gastropathy is the use of a. antibiotics. b. antidepressants. c. antihypertensives. d. antihistamines.

c. a paraphrasing technique.

Ch 2 Practice Questions 4. After interviewing a new client, you summarize what she has told you by saying, "You told me you are here because of right neck and shoulder pain that began 5 years ago as a result of a car accident. You also have a 'pins and needles' sensation in your third and fourth fingers but no other symptoms at this time. You have noticed a considerable decrease in your grip strength, and you would like to be able to pick up a pot of coffee without fear of spilling it." This is an example of a. an open-ended question. b. a funnel technique. c. a paraphrasing technique. d. None of the above.

a. True

Ch 2 Practice Questions 5. Screening for alcohol use would be appropriate when the client reports a history of accidents. a. True b. False

d. All of the above.

Ch 2 Practice Questions 6. 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.

a. True *This includes any woman who has experienced a surgical menopause (e.g., oophorectomy for ovarian cancer) or any postmenopausal woman who is not taking hormone replacements.

Ch 2 Practice Questions 7. Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral. a. True b. False

e. All of the above. * All of these are red flags, along with previous history of cancer, symptoms that last longer than expected (beyond physiologic time period for healing), age, gender, comorbidities, bilateral symptoms, other constitutional symptoms, unexplained falls, substance use/abuse, unusual vital signs, and constant and intense pain; see also Appendix A-2.

Ch 2 Practice Questions 8. Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and symptoms? a. Fever, (night) sweats, dizziness b. Symptoms are out of proportion to the injury c. Insidious onset d. No position is comfortable. e. All of the above.

· The first question should always be, "Did you actually see your physician?" Then ask questions directed at assessing for the presence of constitutional symptoms. For example, after paraphrasing what the client has told you, ask, "Are you having any other symptoms of any kind in your body that you haven't mentioned?" If no, ask more specifically about the presence of associated signs and symptoms, including naming constitutional symptoms one by one. Follow up with Special Questions for Male (see Appendix B-21).

Ch 2 Practice Questions 9. A 52-year-old male with low back pain and sciatica on the left side has been referred to you by his family physician. He has had a discectomy and laminectomy on two separate occasions about 5 to 7 years ago. No imaging studies have been performed (e.g., X-ray examination or MRI) since that time. What follow-up questions should you ask to screen for medical disease?

C The client interview

Ch 2 Test Bank 1. What is the single most important tool in screening for medical disease? A Radiographic testing B Special orthopedic testing C The client interview D Systems review

A Postural orthostatic hypotension

Ch 2 Test Bank 10. The therapist begins an evaluation in a patient who is indicating he/she is taking psychotropic medications. What physical symptoms should the therapist look for during the evaluation? A Postural orthostatic hypotension B Dry skin C Hypertension D Poor memory recall

B Temperature

Ch 2 Test Bank 11. What vital sign does Dr. James Cyriax recommend all therapists take in any client with back pain of unknown origin? A Heart rate B Temperature C Blood pressure D Respiration rate

D Partner Violence Screen (PVS)

Ch 2 Test Bank 12. Which of the following is a quick three-question screening tool for domestic abuse? A Woman Abuse Screening Tool (WAST) B Composite Abuse Scale (CAS) C Index of spouse abuse D Partner Violence Screen (PVS)

C Ribs

Ch 2 Test Bank 13. In children younger than 18 months old, fractures of which bones are more likely to be associated with abuse rather than accidental trauma? A Femur B Humerus C Ribs D Metacarpals

A Excessive sweating

Ch 2 Test Bank 14. Which of the following is not a side effect of long-term use of steroids? A Excessive sweating B Increased pain thresholds C Tissue edema D Proximal muscle weakness

D Circling "yes" through all questions on a personal history form

Ch 2 Test Bank 2. There are several signs that might give a clue to the therapist that a client is functionally illiterate. Which of the following is not one of these signs? A Misspelled words B Not completing intake forms C Identifying pills by looking at the pill rather than naming the medication from the label D Circling "yes" through all questions on a personal history form

A Open-ended questions

Ch 2 Test Bank 3. What communication technique should a physical therapist use when beginning a client interview? A Open-ended questions B Closed-ended questions C Funnel sequence or technique D Paraphrasing

B Age

Ch 2 Test Bank 4. What is the most common primary risk factor for disease, illness, and comorbidities? A Gender B Age C Smoking D Diabetes

D Postmenopause

Ch 2 Test Bank 5. What is the last life cycle of a female? A Reproductive years B Perimenopause C Menopause D Postmenopause

A White females

Ch 2 Test Bank 6. Which of the following groups is most likely to exhibit osteoporosis? A White females B White males C African-American females D African-American males

B Inability to tolerate heat

Ch 2 Test Bank 7. Which of the following is not a sign or symptom of eating disorders? A Weight loss B Inability to tolerate heat C Dry skin and hair D Bradycardia

A Depressants

Ch 2 Test Bank 8. Alcohol falls under which of the following categories of abused substances? A Depressants B Stimulants C Opiates D Hallucinogens

D Dry skin

Ch 2 Test Bank 9. Which of the following is not a sign of withdrawal from excessive alcohol consumption? A Insomnia B Agitation C Loss of appetite D Dry skin

b. Do you have that pain right now?

Ch 3 Practice Questions 1. 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?

a. True * Visceral involvement can occur without preceding or prodromal symptoms, but most often, associated signs and symptoms are present. Because visceral pain can be referred to the neck, back, or shoulder, the client who experiences gastrointestinal (GI) or genitourinary (GU) symptoms does not report these additional symptoms to the therapist when providing information about the musculoskeletal condition.

Ch 3 Practice Questions 10. Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved. a. True b. False

d. Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm. * · Irritation of the retroperitoneal space begins when bleeding occurs behind the stomach, most often from a posterior duodenal ulcer. Rupture of the spleen causes Kehr's sign. The pancreas and low back structures are not formed from the same embryologic tissue. Disease of the pancreas, whether it involves the head, the body, or the tail, can put pressure on the corresponding portion of the respiratory diaphragm, resulting in shoulder or low back pain according to the location of the diaphragmatic irritation. Central diaphragmatic pressure results in referred pain to the ipsilateral shoulder; peripheral involvement of the diaphragm results in low back pain. This can occur in the right shoulder when the head of the pancreas is distended far enough, but it is more likely to affect

Ch 3 Practice Questions 11. A 48-year-old male 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 examination, 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. Minimal distractions heighten a person's awareness of musculoskeletal discomfort. * Pain that wakes a client up as soon as he or she rolls onto that side is indicative of an acute inflammatory process. Night pain associated with neoplasm is more likely to wake the client up after he or she falls asleep, when the tumor keeps normal tissue from obtaining essential blood and nutrients, thus creating tissue ischemia and subsequent pain. With chronic musculoskeletal conditions, the client can often get to sleep with just the right positioning and may even be able to sleep on that side for up to an hour or two before pressure and ischemia develop, causing pain.

Ch 3 Practice Questions 2. A 52-year-old female 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.

a. the left shoulder. * · Left shoulder pain associated with damage or injury to the spleen is called Kehr's sign.

Ch 3 Practice Questions 3. Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in a. the left shoulder. b. the right shoulder. c. the midback or upper back, scapular, and right shoulder areas. d. the thorax, scapulae, right shoulder, or left shoulder.

a. True * See Table 3-2.

Ch 3 Practice Questions 4. Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared with musculoskeletal pain. a. True b. False

C Lack of adequate history

Ch1 Test Bank 1. When a serious disorder is missed during the physical therapy screening process, what is the most likely cause of this mistake? A Lack of special tests B Lack of proper referrals C Lack of adequate history D Lack of diagnostic testing

b. crushing, shooting, pricking. * · Throbbing, pounding, and beating are more often associated with pain of a vascular nature. Aching, heavy, and sore are words used to describe musculoskeletal pain. According to the McGill Pain Questionnaire, words like agonizing, piercing, and unbearable convey more emotional content than is communicated by actual descriptors of organic disease. See Table 3-1; see also Fig. 3-11.

Ch 3 Practice Questions 5. Words used to describe neurogenic pain often include a. throbbing, pounding, beating. b. crushing, shooting, pricking. c. aching, heavy, sore. d. agonizing, piercing, unbearable.

a. neoplasm.· Neoplasm, in particular, primary bone cancer.

Ch 3 Practice Questions 6. 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.

e. All of the above. * · Artificial sweeteners have come under fire, primarily by manufacturers of artificial sweeteners. Evidence supplied by two prominent board certified neurosurgeons (see text) combined with the author's own clinical experience is sufficient to include this agent as a causative factor in joint pain.

Ch 3 Practice Questions 7. Joint pain can be a reactive, delayed, or an allergic response to a. medications. b. chemicals. c. infections. d. artificial sweeteners. e. All of the above.

a. increases with weight bearing. *· Bone pain would be accompanied by a positive heel strike test. Symptoms of angina are sometimes relieved by antacids in women. Even if bone pain were caused by metastases from the GI tract, eating would not alleviate the symptoms.

Ch 3 Practice Questions 8. 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 female. d. goes away after eating.

b. False * Some types of viscerogenic pain can be relieved by a change in position early in the disease process. For example, pain from an inflammatory or infectious process that affects the kidney may be reduced by leaning toward the involved side and applying pressure to that area. Gallbladder pain is sometimes relieved by leaning forward. Cardiac pain brought on by use of the upper extremities overhead may be relieved by bringing the arms back down to the sides.

Ch 3 Practice Questions 9. Pain of a viscerogenic nature is not relieved by a change in position. a. True b. False

c. Inspection, auscultation, percussion, palpation * Percussion and palpation can change bowel sounds. Look and listen before you palpate.

Ch 4 Practice Questions 1. 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

· After past medical history has been assessed for any of these conditions, it may be necessary for the therapist to ask directly, "I notice an unusual smell on your breath. Do you know what might be causing this?" Ask appropriate follow-up questions depending on the type of smell that you perceive. You may wish to consider screening for alcohol use at a later time, after you have established a good rapport with the client.

Ch 4 Practice Questions 10. You notice a new client has an unusual (strong) breath odor. How do you assess this?

* The patient's blood pressure (vasomotor) system is "untuned"; peripheral blood vessels do not constrict properly, so venous pooling may occur. The patient also may be receiving medication(s) that have the potential to reduce blood pressure directly or as an adverse effect of the drug or drugs in combination. Other factors may include dehydration, if the patient has not been on intravenous fluids and has not maintained adequate fluid intake.

Ch 4 Practice Questions 11. 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?

a. a malignant lesion.

Ch 4 Practice Questions 2. 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 medication.

c. pulse diminished, barely palpable.

Ch 4 Practice Questions 3. Pulse strength graded as 1 means a. easily palpable, normal. b. present occasionally. c. pulse diminished, barely palpable. d. within normal limits.

c. a normal finding.

Ch 4 Practice Questions 4. 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.

e. All of the above. * We confess this is a bit of a "trick" question. Thoughts on this topic vary. Some therapists advocate taking each client's body temperature (answer "E") as one of the simplest and most inexpensive ways to screen for the presence of systemic problems. Others are more selective in the screening process and advise answer "D" (B and C) as the most appropriate response. The decision may depend, in part, on the type of practice or clinical setting in which you practice. For the new graduate, it is highly recommended that all vital signs be taken on all clients until the therapist is proficient in this skill area. With experience, each clinician will develop the decision-making skills needed to determine when additional screening, and which screening tests, should be carried out.

Ch 4 Practice Questions 5. Body temperature should be taken as a 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.

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

Ch 4 Practice Questions 6. A 23-year-old female presents with a 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 that her current symptoms are related to 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, and abdominal auscultation d. No further assessment is needed; there are enough red flags to advise this client to seek medical attention.

* Yes. The therapist must be familiar with past medical history and any factors that could put the client at risk for a medical incident of any type. Health status can change for any client within a 2-week period, but especially, the aging adult. Surgery is a major event that is traumatic to the physiologic body, despite the client's previous excellent health. Surgery can trigger the onset of new health problems or may bring to fulmination something that was present only subclinically before the operation. Some postoperative complications do not develop until 10 to 14 days later. Exercise is an additional physiologic stressor. Symptoms may not be seen when the client is at rest or sedentary and may occur only after exercise has been initiated. * Time pressure and the complexities of today's health care delivery system can also result in conditions remaining unnoticed by the examining health care professional. Systemic diseases often develop slowly and gradually over time. It is not until the disease has progressed enough that the client shows any signs and symptoms of visceral or systemic involvement. What the physician, physician's assistant, nurse, or nurse practitioner observed preoperatively may not be the clinical presentation seen by the therapist postoperatively.

Ch 4 Practice Questions 7. A 76-year-old male was referred to physical therapy after a total hip replacement (THR). The goal is to increase his functional mobility. Is a health assessment needed even though he was examined just before the surgery 2 weeks ago? The physician conducted a systems review and summarized the medical record by saying the client was in excellent health and a good candidate for THR.

* First of all, do you need to? How far out from the first medical diagnosis and final treatment is the client? Is the client still being treated? Without laboratory values, physical assessment becomes much more important. Check vital signs; observe the skin, eyes, and nail beds, and ask about the presence of associated signs and symptoms.

Ch 4 Practice Questions 8. How do you plan or modify an exercise program for a client with cancer without the benefit of blood values?

· Bruits are abnormal blowing or swishing sounds heard on auscultation of narrowed or obstructed arteries. Bruits with both systolic and diastolic components suggest the turbulent blood flow of partial arterial occlusion that is possible with aneurysm or vessel constriction. · The therapist is most likely to assess for bruits when the client or patient is older than 65 years of age and describes problems (i.e., neck, back, abdominal, or flank pain) in the presence of a history of syncopal episodes, a history of cardiovascular disease (CVD), serious risk factors for CVD, or a previous history of aortic aneurysm. Look for other signs of peripheral vascular disease that may account for the client's current symptoms. · Symptoms may be described as "throbbing" and may increase with activity and decrease with rest. In the most likely candidate, neck or back pain is not affected by physical therapy intervention. The client is an older adult, a postmenopausal woman, and/or has significant risk factors for CVD or a history of CVD.

Ch 4 Practice Questions 9. When would you consider listening for femoral bruits?

D Hip replacement

Ch 4 Test Bank 1. Onset of anesthesia-induced dementia is most likely after which of the following surgical procedures? A Liver transplant B Nephrectomy C Rotator cuff repair D Hip replacement

D Uneven edges

Ch 4 Test Bank 10. Malignant melanomas usually present with which of the following characteristics? A Smooth borders B Single color throughout the lesion C Less than ¼ inch in size D Uneven edges

A Herpes simplex virus 1

Ch 4 Test Bank 11. What type of herpesvirus usually infects areas above the waistline? A Herpes simplex virus 1 B Herpes simplex virus 2 C Herpes zoster D Herpetic whitlow

B Human immunodeficiency virus (HIV)

Ch 4 Test Bank 12. The therapist begins an evaluation of a patient with Kaposi's sarcoma. What underlying disease does this patient most likely have? A Herpes simplex B Human immunodeficiency virus (HIV) C Osteosarcoma D Diabetes

A Splinter hemorrhages

Ch 4 Test Bank 13. Which of the following nail bed conditions could be a sign of a history of myocardial infarction (MI)? A Splinter hemorrhages B Paronychia C Koilonychia D Onycholysis

D Supraclavicular, primary carcinoma of the thorax or abdomen

Ch 4 Test Bank 14. Virchow's node is usually palpated where and is indicative of what dysfunction? A Axillary, systemic infection B Axillary, primary carcinoma of the thorax or abdomen C Supraclavicular, systemic infection D Supraclavicular, primary carcinoma of the thorax or abdomen

C Temperature

Ch 4 Test Bank 15. The therapist is beginning a sensation screening for a client. If pain sensation is normal, what portion of a sensation screening can be omitted? A Light touch B Sharp/dull C Temperature D Vibration

D Hyperactive with possible spinal cord disorder

Ch 4 Test Bank 16. During chart review, a therapist notes that a patient had a 4+ reflex response at the patella tendon during the last examination. What information does this convey to the therapist? A No response or absent response B Decreased or slight muscle contraction C Normal visible muscle twitch D Hyperactive with possible spinal cord disorder

C 100

Ch 4 Test Bank 17. A pulse rate above _____ beats per minute for an adult indicates tachycardia. A 60 B 80 C 100 D 90

A likely

Ch 4 Test Bank 18.A Wells Clinical Decision Rule (CDR) Deep Vein Thrombosis score of 3 indicates that a DVT is ____________________. A likely B unlikely C more information needed D not indicated

C kidney involvement if the kidney is tender to percussion

Ch 4 Test Bank 19. Murphy's percussion test is used to indicate ____________________________ A liver involvement if the liver is tender to percussion B spleen involvement if the spleen is tender to percussion C kidney involvement if the kidney is tender to percussion D gallbladder involvement if the gall bladder is tender to percussion

C normal.

Ch 4 Test Bank 2. On chart review, the therapist finds that a patient's pulse strength was documented as 2+ at a previous physical therapy appointment. With this information, the therapist knows that, at that time, the pulse strength was: A absent. B diminished. C normal. D bounding.

B Nebraska

Ch1 Test Bank 10. What state was the first to pass a scope of practice law that allowed direct access to physical therapists? A California B Nebraska C New York D Ohio

Lub is referred to as S1 sound that occurs when the AV valve closes. Dub is referred to as S2 sound that occurs when the aortic and pulmonic valves close. Any additional sounds are referred to as abnormal sounds and are termed by the appropriate number. In this instance ah is referred to as an S3 sound. Any additional sounds after that are labeled consecutively.

Ch 4 Test Bank 20. Upon auscultating a patient, a therapist hears the following heart sounds: lub-dub-ah. Describe these sounds.

D 90%.

Ch 4 Test Bank 3. Referral for medical evaluation is advised when resting oxygen saturation falls below A 97%. B 95%. C 92%. D 90%.

C 1 minute

Ch 4 Test Bank 4. A physical therapist wishes to reassess blood pressure in the client's upper extremity. How long should the therapist wait before repeating the measurement? A There is no need to wait. B 30 seconds C 1 minute D 3 minutes

D Oral contraceptive use and increased blood pressure

Ch 4 Test Bank 5. A female with which of the following histories should be advised to see her physician for close monitoring? A Low heart rate and elevated blood pressure B Oral contraceptive use and increased heart rate C High heart rate and low blood pressure D Oral contraceptive use and increased blood pressure

A Decrease in systolic blood pressure of 20 mm Hg or decrease in diastolic blood pressure of 10 mm Hg and a 10% to 20% increase in pulse rate

Ch 4 Test Bank 6. What of the following is the most accurate definition of postural orthostatic hypotension? A Decrease in systolic blood pressure of 20 mm Hg or decrease in diastolic blood pressure of 10 mm Hg and a 10% to 20% increase in pulse rate B Increase in systolic blood pressure of 20 mm Hg or increase in diastolic blood pressure of 10 mm Hg and 10% to 20% decrease in pulse rate C Decrease in systolic blood pressure of 20 mm Hg or increase in systolic blood pressure of 10 mm Hg and 10% to 20% increase in pulse rate D Decrease in systolic blood pressure of 20 mm Hg or decrease in systolic blood pressure of 10 mm Hg and 10% to 20% decrease in heart rate

C Thorazine

Ch 4 Test Bank 7. A patient taking which of the following medications will have a lower normal body temperature? A Coumadin B Lortab C Thorazine D Haldol

C) Inspection, auscultation, percussion, palpation

Ch 4 Test Bank 8. What is the correct order of examination of the abdomen? A) Inspection, palpation, percussion, auscultation B) Auscultation, inspection, palpation, percussion C) Inspection, auscultation, percussion, palpation D) Inspection, percussion, auscultation, palpation

A Hepatic system

Ch 4 Test Bank 9. What visceral system is most likely to cause pruritus? A Hepatic system B Cardiopulmonary system C Gastrointestinal system D Genitourinary system

D There is usually muscle spasm associated with the pain.

Ch. 3 Test Bank 7. Which of the following is a false statement regarding neuropathic pain? A It is usually described as sharp or shooting pain. B Acute nerve root irritation tends to be severe. C It is not alleviated by narcotics. D There is usually muscle spasm associated with the pain.

D Ipsilateral kidney

Ch. 3 Test Bank 1. When a child is born with an abnormal ear, what part of the body should be examined first for similar dysfunction? A Contralateral lung B Ipsilateral lung C Contralateral kidney D Ipsilateral kidney

A Active trigger points

Ch. 3 Test Bank 10. What type of trigger points cause pain at rest? A Active trigger points B Latent trigger points C Key trigger points D Satellite trigger points

B Skin lesions of the joint

Ch. 3 Test Bank 11. Joint pain accompanied by what other condition could be a sign of sexually transmitted diseases? A Excessive sweating B Skin lesions of the joint C Muscle weakness D Hair loss

D Numbness

Ch. 3 Test Bank 12. What is the primary symptom of radiculopathy? A Dull aching pain B Sharp stabbing pain C Loss of range of motion D Numbness

A Cancer

Ch. 3 Test Bank 13. Bone pain at night is a red flag symptom of what disorder/disease? A Cancer B Diabetes C Osteoporosis D Paget's disease

C) Vascular origin

Ch. 3 Test Bank 14. Painful symptoms that start 3 to 5 minutes after initiating activity and then go away when the client stops suggest pain from what structures? A) Muscles B) Nerves C) Vascular origin D) Bone

D 3

Ch. 3 Test Bank 15. What is the minimum Waddell score to place a client in the category of "nonmovement pain dysfunction"? A 0 B 1 C 2 D 3

C neuromatrix

Ch. 3 Test Bank 16. Life experiences related to pain and coping with pain shape neural patterns. Each person has a unique response to pain referred to as ___________________. A pain behavior B pain reaction C neuromatrix D sensory overload

C C3-T4

Ch. 3 Test Bank 2. Cardiac pain can occur in any structure innervated by ______________ spinal segments. Fill in the blank. A C1-C6 B C2-T8 C C3-T4 D C5-T8

D Child Facial Coding System (CFCS)

Ch. 3 Test Bank 3. Which of the following should be used to rate pain in an infant? A Visual analog scale (VAS) B FACES Pain Scale (FPS) C Verbal descriptor scale (VDS) D Child Facial Coding System (CFCS)

B Peptic ulcer

Ch. 3 Test Bank 4. The patient who has an increase in pain after taking nonsteroidal antiinflammatory drugs (NSAIDs) should be screened for which medical disorder? A Myocardial infarction B Peptic ulcer C COPD D Diabetes

D Tendon sheaths

Ch. 3 Test Bank 5. Superficial somatic referred pain would involve which of the following structures? A Bone B Nerve C Muscles D Tendon sheaths

C T10

Ch. 3 Test Bank 6. Sensory fibers to the appendix enter at what spinal cord level? A T8 B T9 C T10 D T11

B To the back

Ch. 3 Test Bank 8. Visceral diseases of the abdomen and pelvis are likely to refer pain where? A To the shoulders B To the back C To the arms D To the legs

A potassium

Ch. 3 Test Bank 9. Muscle pain from trauma occurs as broken fibers leak _______________ into the interstitial fluid. Fill in the blank. A potassium B sodium C calcium D iron

C Recognize clusters of associated signs and symptoms

Ch1 Test Bank 14.What is the purpose of the review of symptoms during the screening process? A Guide the physical therapist to the appropriate intervention B Help diagnose the patient's specific dysfunction C Recognize clusters of associated signs and symptoms D Speed the evaluation process

B Resting heart rate 100 beats/min

Ch1 Test Bank 15. Which of the following would not be a red flag for a physician referral during a physical therapy screening? A Resting systolic rate 200 mm Hg B Resting heart rate 100 beats/min C Unusual fatigue D Blood in urine

B Unexplained syncope without a significant past medical history of cardiac disorder

Ch1 Test Bank 16. Which of the following is a red flag for a physician referral during a physical therapy screening? A Angina following light activity that is relieved with rest B Unexplained syncope without a significant past medical history of cardiac disorder C Rise of blood pressure following mild exercise for 20 minutes D Pulse oximeter reading of 94% (SaO2) before starting a physical therapy session

D Side effects of medication

Ch1 Test Bank 2. Neuromuscular signs and symptoms are sometimes observed in clients receiving physical therapy because of an adverse reaction. What is the most likely source of this adverse reaction? A Visceral pain mechanisms B Comorbidities C Lack of progress with physical therapy interventions D Side effects of medication

A Early detection and referral

Ch1 Test Bank 3. What is the key to prevention of further significant comorbidities or complications of a medical problem? A Early detection and referral B Proper special testing C Correct imaging studies D Direct access by a physical therapist

C Slow down and think about the need for further screening.

Ch1 Test Bank 5.A physical therapist finds a yellow flag symptom during the screening process of a new patient. What is the appropriate action by the physical therapist? A Make an appropriate referral. B Send the patient to the emergency department immediately. C Slow down and think about the need for further screening. D Aggressive further screening is required.

B red flags.

Ch1 Test Bank 6. Symptoms that present bilaterally are always A yellow flags. B red flags. C originated in the peripheral nervous system. D originated in the central nervous system.

A Primary prevention

Ch1 Test Bank 7.Risk factor assessment and risk reduction fall under which type of disease prevention? A Primary prevention B Secondary prevention C Tertiary prevention D Health promotion and wellness

C Medical differential diagnosis

Ch1 Test Bank 8.Which of the following is defined as a comparison of symptoms of similar diseases and laboratory/procedure results? A Physical therapy and differential diagnosis B Evaluation C Medical differential diagnosis D Examination

C Visceral

Ch1 Test Bank 9. Which of the following is not one of the four categories of preferred practice patterns in the Guide to Physical Therapist Practice? A Musculoskeletal B Integumentary C Visceral D Neuromuscular

B Evaluation

Ch1 Test Bank 4.Which element of the patient management model, according to the Guide to Physical Therapist Practice, consists of assessment or judgment of the patient's data/condition? A Examination B Evaluation C Prognosis D Diagnosis

telescoping.

Clients may forget, underreport, or combine separate health events into a single memory, a process called...

160 degrees or less

Clubbing is defined as when the curve of the bail becomes....

COPD, congenital heart defects, cor pulmonale (R Heart failure)

Clubbing of the nails is associated w/ which diseases?

oxygen deprivation in the tissue beds

Clubbing results from....

Direct Pressure and Shared Pathways

Define the mechanism of referred visceral pain: ex: the diaphragm — when organs become inflamed and they push on the diaphragm, with that pressure, it will send signals to the nervous system that there is something wrong there because all of the information synapses at the one spot within the spinal cord

Multisegmental Innervation

Define the mechanism of referred visceral pain: if one viscera of the overlapping segments is treated, pain is significantly decreased in all segments

Embryologic Development

Define the mechanism of referred visceral pain: · Pain is referred to the site where the organ was located in fetal development

Deductive Reasoning o More advanced clinicians, start to create ideas of what specific pathologies look like

Define: o Based on assumptions about reality (your knowledge) that consider it objective, measurable, predictive and generalizable

Secondary Prevention

Define the type of PT prevention: Early detection of disease, illness, and other pathologic health conditions through regular screening; this does NOT prevent the condition but may decrease the duration and/or severity of disease and thereby improve the outcome, including improved QOL.

Tertiary Prevention

Define the type of PT prevention: Providing ways to limit the degree of disability while improving function in patients/clients with chronic and/or irreversible diseases.

a) loosening of the nail plate (1) Graves' Disease (2) psoriasis (3) reactive arthritis (4) OCD (nail pickers)

What is Onycholysis? What is it associated with?

Primary Prevention

Define the type of PT prevention: Stopping the process that leads the the development of the disease, illness, and other pathologic health conditions through education, risk factor reduction, and general health promotion

Inductive Reasoning o Most common/used amongst new clinicians

Define: o Taking information/data directly and not applying it to "norms" to validate the hypothesis

Outcome Bias

Define: o Tendency for overreliance on outcome information to indicate the accuracy or quality of the clinical reasoning that went into determining the choice of intervention o Could do everything wrong and patient got better, so you think you did everything right

a) vascular/cardiovascular b) muscula c) nerve d) joint, tendon, nerve, bone e) visceral ** localized, sharp pain, posterior to patella — chondromalacia

Define the description of sensation: a) throbbing: b) dull ache: c) burning: d) sharp: e) knife-like/boring (deep)

1. cigarette burns 2. thermal burns from water 3. squeezing or shaking

Cutaneous Manifestations of Abuse: 1. punched out ulceration with dry, purple crusts indicate.... 2. splash marks or scald lines indicate... 3. bruising

Evaluation

Define the element of patient/client management: Assessment or judgement of data collected

Examination

Define the element of patient/client management: History, systems review, and tests & measures are completed

Embryologic Development

Define the mechanism of referred visceral pain: Ex: If someone has an ear deformity, most likely the kidneys have to be checked because those two areas were developed at the same time

Embryologic Development

Define the mechanism of referred visceral pain: Ex: the cardiovascular system and the GI system were also developed at the same time — when you are very nervous, you will feel a pit in your stomach/have to go to the bathroom. These two systems are connected!!

dementia (a) for each 10-point drop in pressure, the risk of dementia increases by 20%

Decreased BP may be an early warning sign of ________

older age, slower metabolism, and polypharmacy

Delirium is attributed to...

a) cyclical (better, worse, better) b) constant c) unchanging, regardless of position *** three exceptions ! if you say visceral pathologies are NEVER impacted by position — false d) does not fit typical patterns ` e) unaffected by PT intervention f) pain description (colicky, knifelike, boring, deep aching) *** "I cannot touch where that pain is coming from" — common complaint

Describe visceral pain patterns

the impairment classification

During medical screening, it is the PT's responsibility to identify what NMS pathology is present. We call this....

o post-menopause: remaining years where there are no menstrual cycles o Any spontaneous uterine bleeding after this time is abnormal and is considered a red flag. There should NEVER be any bleeding with post-menopause

What would be considered a red-flag during post-menopause?

(1) decrease in SBP of at least 20 mmHg or decrease in diastolic pressure of at least 10 mmHg AND a 10-20% increase in pulse rate *** the reason the pulse rate increases is because the blood pressure is decreasing *** to compensate for the decrease in BP, your heart has to pump harder

What is Orthostatic Hypotension (max's definition)?

1) gallbladder: affected by a heavy or fatty meal 2) peptic ulcers: pain gets worse with ingestion of food; NSAIDs use can cause them (3) duodenal ulcers: pain gets better with food

GI Pain: (1) gall bladder (2) peptic ulcers (3) duodenal ulcers

inflammation of nerve-endings; fluid-filled nerve root cysts found most commonly at the sacral level of the spine *** Can use T-2 weighted imaging to see fluid

What is a Tarloff cyst?

1) heart rate (pulse) 2) blood pressure

Guide to Physical Therapist Practice recommends that __1__ ___1___ and __2__ ___2___ are vitals that should be measured at new patient examinations

Approximately 10% of body weight lost/gained over the course of five weeks

What is a red flag with weight loss?

- systolic < 90 mmHg - diastolic < 60 mmHg

HYPOtension normal values: - systolic - diastolic

increased intracranial pressure

High pulse pressure along with bradycardia is a sign of ____ ____ ___ and requires immediate medical evaluation — call primary care provider

significant loss of fluid (blood, sweat, tears) — no treatment = death

What is hypovolemic shock?

SBP — DBP ** Normal is around 40mmHg

What is pulse pressure?

the RIGHT shoulder

if the GALLBLADDER (cholecystitis) is affected, pain is referred to....

Bone pain!!! Perform a heel strike test (a) lay them down and tap them on the heel to see if it reproduces symptoms (b) if it does, maybe they have a tumor or fracture because of osteoporosis (c) whether if its a fracture or cancer, it does not matter — you still need to refer

If a patient describes deep pain, or pain on weight bearing, what test should you do?

C7, T1-T5

If a patient feels pain near the Interscapular/ Posterior Shoulder, where could the lesion be?

Interscapular, Posterior Shoulder

If a patient has a somatic lesion of C7, T1-T5, where is the referred pain?

SI Joint and Hip

If a patient has a somatic lesion of L1-L2, where is the referred pain?

Head, Neck, Heart ** chest pain

If a patient has a somatic lesion of the TMJ, where is the referred pain?

SI Joint and Knee

If a patient has a somatic lesion of the hip joint, where is the referred pain?

ipsilateral ear

If a patient has a somatic lesion of the pharynx, where is the referred pain?

- Associated s/s (bleesing, pruritus, fever, joint pain) - When did the lesion first appear? - Is it changing over time? How? - Were there any known suspected triggers? - A military history may be important

If a skin lesion or mass is present, what should a PT ask about?

paradoxic, and should be reported to a physician

If pulse strength fades with inspiration and strengthens with expiration, its ____________

the LEFT shoulder

if the SPLEEN becomes inflamed and hits the diaphragm, it will refer to....

client interview/subjective

It is generally agreed that 80% of the information needed to identify the cause of a client's symptoms is obtained during the....

Pulse rate changes are minimal in patients taking beta blockers & CCB ****** use RPE instead

Medications such as beta blockers and CCB may affect which vital sign?

(1) 60-100 bpm (2) < 60 bradycardia (3) > 100 tachycardia

Normal pulse rate? Tachycardia? Bradycardia?

o Past medical history o Personal and family history o Risk factor assessment o Clinical presentation -- Pain types/pain patterns o Associated signs and symptoms of systemic diseases o Review of systems

What is the Goodman Screening for Referral Model?

MI chest pain is MORE severe and intense

What is the difference in intensity when a patient has angina compared to MI?

o 30 days of direct access until referral is needed o DO NOT say prescription lol

What is the direct access component of the Practice Act of Florida for PTs?

o Moving from open ended to closed ended

What is the funnel technique used during the client interview?

1) premenses 2) reproductive years 3) perimenopausal 4) menopausal 5) post-menopausal

What is the life cycle for women?

Guillan Barre has GI symptoms, CVA does not

What is the main differentiator in symptoms between Guillan Barre and CVA?

Cancer ** night pain occurs due to metastasis, usually

Pain at night is a classic symptom of

Age o Especially Cancer - Age greater than 50

What is the most common primary risk factor for disease?

o Using information previously given to lead into another question

What is the paraphrasing technique used during the client interview?

a) trunk flexion b) ipsilateral trunk flexion (SB) c) sitting upright or leaning forward

Positional Relief? Three Exceptions to the Visceral Pain Rule: a) gall bladder relieved with..... b) kidney relieved with.... c) pancreas relieved with....

- Theory of affected mental status. - similar to fight or flight (a) fight: middle of poly-vagal theory (b) shock: late — so much trauma that their brain shuts down i) vagus: largest nerve in body, latin for wandering

What is the polyvagal theory?

1) increases 2) decreases

Pulse strength normally ___1___ slightly with inspiration and ___2___ with expiration

0: absent, not palpable 1+: pulse diminished, barely palpable 2+: normal, easily palpable 3+: full pulse, increased strength 4+: bounding, too strong to obliterate

Pulse strength scale?

1) yellow 2) atrial fibrillation

RESTING pulse pressure consistently greater than 60-80 mmHg is a ___1___ flag and is a risk factor for new onset ___2___ ____2_____

Refer to a constellation of signs and symptoms present whenever the patient is experiencing a systemic/visceral illness. * No matter what system is involved, thees core s/s are often present.

What are constitutional symptoms?

· Have you had any fractures or dislocations to your bones or joints? · Have you been injured in a road traffic accident? · Have you injured your head? · Have you been in a fight or assault?

What are som FUP's for substance abuse?

a) muscle wasting b) alopecia (hair loss) c) dermatitis d) chapped lips !! dehydration e) brittle nails f) abdominal distention g) fatigue/lethargy h) peripheral edema i) bruising

S/S of malnutrition

Fever Diarrhea Diaphoresis Pallor Sweats Dizziness/Syncope Nausea Fatigue Vomiting Weight loss *** Anytime this is reported, it is a VISCERAL pathology

What are some examples of constitutional symptoms?

systolic: 140-159 diastolic: 90-99

Stage 1 hypertension values - systolic - diastolic

- systolic: >160 - diastolic: >100

Stage 2 hypertension values - systolic - diastolic

- very dry mouth - cracked lips - sunken eyes - sunken fontanel (infants) - poor skin turgor - postural hypotension - headache

What are some signs of MODERATE dehydration?

- rapid, weak pulse (more than 100 bpm at rest) - rapid breathing - confusion - lethargy - irritability - cold hands and feet - unable to cry or urinate

What are some signs of SEVERE dehydration?

a) surgery or hospitalization within the last 24 hours (anesthesia) b) Age > 65 c) Hip fx, TKA, THA d) medication e) urinary retention, decal impaction, diarrhea f) decreased physical function

What are the risk-factors for iatrogenic/post-op delirium?

· Fatigue/Malaise · Depression, mood swings · Difficulty Concentrating "brain fog" · Headache · Altered sleep pattern (insomnia/sleep disturbance) · Hot flashes · Irregular menses, cessation of menses · Vaginal Dryness/Pain during intercourse · Atrophy of breasts and vaginal tissue · Pelvic floor relaxation (cystocele/retrocele) *** Will lead to incontinence which will be reported in subjective · Urge incontinence *** Once they have to go, they go

What are the s/s of menopause?

evaluate if managing the causative pathology is within the scope of physical therapy practice. "are they eligible for PT?"

The first goal of PT is to....

the client interview/subjective

The first step in screening for medical disease is...

a) (right side) — right shoulder b) (left side) — left shoulder

The head and the tail of the pancreas refer to different shoulders: a) head of the pancreas refers to... b) tail of the pancreas refers to....

o Statins = muscle breakdown, rhabdomyolysis, generalized myalgia o Steroids = bone degradation *** Establish a timeline for these symptoms!! Connect symptoms with amount of time they've been taking meds

What are the side effects of statins and steroids medications?

o To see if MSK symptoms are being mimicked by visceral pathology. o Systemic diseases can mimic neuromusculoskeletal (NMS) dysfunction o This step requires us to screen for the possibility of systemic disease

What is the purpose of medical screening?

Walking Speed

What is the sixth vital sign?

When diastolic >100, there is a contraindication to exercise

What should you do if your pt reports to therapy with a diastolic > 100

-- increased risk with hip fractures, THA, TKA

There is an increased risk of Delirium with which surgeries?

1) Side effects of medications 2) Comorbidities ** ie Diabetes, obesity, cardiovascular, high cholesterol etc 3) Visceral pain mechanisms

What three key factors need to be taken into account during medical screening?

FALSEEEE. · One red flag is NOT enough, must have cluster of red flags to refer out o Ie numbness bilaterally is a red flag, but imaging is not needed o Ie recent unexplained weight loss or gain = red flag, but not enough for referral o Ie personal history of cancer combined with weight loss/gain can be a cluster and big red flag

True or False: One red flag is enough to refer out to another clinician/physician.

FALSEEEEE according to max

True or false: Pain is the 5th vital.

1) Physical therapy is NOT indicated ** Ie cardiac pathology, no functional deficits. We don't treat PAIN, we treat FUNCTION 2) Physical therapy is NOT indicated AND a consultation to another health care provider is required ** Ie Gallbladder/Cardiovascular/Pulmonary condition is being reported for the first time and needs proper examination 3) Physical therapy can proceed independent of additional consultation. ** Ie MSK pathology

What are the three possible outcomes when a patient comes out of an eval for PT?

shoulder, low back

Visceral diaphragmatic irritation referral site is to.....

o Removal of uterus and cervix, even without removal of the ovaries brings on early menopause o Removal of the ovaries (oophorectomy) brings on menopause immediately ***** Doubles the risk of osteoporosis (if done before age 30)

What can cause early-onset menopause?

a) burn or trauma patients — lose ability to regulate temperature b) allergies (anaphylactic shock) c) diabetes (ketoacidosis) d) severe blood loss

Which populations are at risk for hypvolemic shock?

radial, dorsalis pedis

Which two pulse sites are checks on people with diabetes and older adults?

liver disease

White Nail Zytery indicates...

1) all of these areas synapse in the same place in the dorsal horn of your spinal cord 2) the brain does not differentiate where exactly the pain is — the brain gets the signal because they all synapse at the one area in the dorsal horn and now the pain is everywhere in that area

Why do patients have left shoulder and ulnar distribution pain when they have an MI?

because the ligament is not vascularized and the bone is

Why is it better to have a fracture than a tear of a ligament?

1) temperature 2) blood pressure

_____1______ and ___2___ _____2___ have the greatest utility as early screening tools for systemic illness or disease

Confusion

________ is not a normal change and should be documented a) often associated with visceral conditions or systemic conditions

Confusion

___________ can signal infection, electrolyte imbalance, or delirium (1) in an outpatient setting — if the patient gets confused and they come out of it, you need to call their primary care provider and their session is done for the day (2) if the confusion continues and they do not come out of it, call 911

a) musculoskeletal b) visceral

a) small, localized pain is usually a _____________ problem b) diffuse and referred pain is usually a _______ problem

a) 40-50 b) 10

a) systolic blood pressure changes up to ____-____ mmHg with intense exercise b) diastolic blood pressure does not change more than ______ mmHg in either direction

1) pulse 2) blood pressure 3) Oxygen Saturation level

these three vital signs offer valuable information about the cardiovascular/pulmonary systems