differential diagnosis CH 1-5

6. Body temperature should be taken as part of vital sign assessment:

. 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

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

A yellow flag is a cautionary or warning symptom that signals, 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 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.

4. A risk factor for NSAID-related gastropathy is the use of: a. antibiotics b. antidepressants c. antihypertensives d. antihistamines

Antidepressants

5. How do you plan or modify an exercise program for a client with cancer without the benefit of blood values?

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.

6. In the case of a client with hemarthrosis associated with hemophilia, what physical therapy intervention would be contraindicated?

Local heat applied to the involved joint(s)

9. What is the significance of nadir?

Nadir, or the lowest point the white blood count reaches, usually occurs 7 to 14 days after chemotherapy or radiation therapy. At that time, the client is extremely susceptible to infection; the therapist must follow all universal precautions, especially those pertaining to good handwashing.

6. Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:

Neoplasm

6. Medical referral for a problem outside the scope of the physical therapy practice occurs when:

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

9. What are the major decision-making tools used in the screening process?

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.

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?

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.

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

Thrombocytopenia

10. Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved.

True

4. Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain. true false

True

6. Screening for alcohol use would be appropriate when the client reports a history of accidents. a. true b. false

True

7. Physical therapy evaluation and intervention may be part of the physician's differential diagnosis. a. true b. false

True

8. Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral. a. true b. false

True

7. 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. A sign of systemic disease b. Side effect of chemotherapy or other medications c. Poor ventilation while sleeping

9. 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

a. Fever, (night) sweats, dizziness b. Symptoms are out of proportion to the injury c. Insidious onset d. No position is comfortable

8. Bone pain associated with neoplasm is characterized by:

a. Increases with weight bearing

7. Joint pain can be a reactive, delayed, or allergic response to:

a. Medications b. Chemicals c. Infections d. Artificial sweeteners

2. Most of the information needed to determine the cause of symptoms is contained in the: a. subjective examination b. family/personal history form c. objective information d. all of the above e. a & c

a. Subjective examination

13. 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 the breath d. Conducted with one other family member present as a witness

b. Brief, easy to administer, and nonthreatening

3. A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is:

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

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?

b. Do you have that pain right now?

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

b. Exertional dyspnea and fatigue with increased heart rate

Direct access is the only reason physical therapists must screen for systemic disease.

b. False

1. What is the effect of NSAIDs (e.g., Naprosyn, Motrin, Anaprox, ibuprofen) on blood pressure?b. Increases blood pressure

b. Increases blood pressure

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

b. Iron deficiency

5. Skin color and nail bed changes may be observed in the client with:

b. Pernicious anemia resulting from Vitamin B12 deficiency

5. Physical therapists are qualified to make a human movement system diagnosis regarding primary neuromusculoskeletal conditions, but we must do so in accordance with: a. The Guide to Physical Therapist Practice b. The State Practice Act c. The screening process d. The SOAP method

b. The State Practice Act

In the context of screening for referral, primary purpose of a diagnosis is: a. To obain reimbursement b. To guide the plan of care and intervention strategies c. To practice within the scope of physical therapy d. To meet the estabilished standards for accreditation

b. To guide the plan of care and intervention strategies

5. 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." a. an open ended question b. a funnel technique c. a paraphrasing technique d. none of the above

c. A paraphrasing technique

4. Preoperatively, clients cannot take aspirin or antiinflammatory medications because these:

c. Decrease platelets

3. Pulse strength graded as 1 means:

c. Pulse diminished, barely palpable

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 mid-back or upper back, scapular, and right shoulder areas d. The thorax, scapulae, right, or left shoulder

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

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

c. Throughout the episode of care

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

d. Water retention

3. Under what circumstances would you consider asking a client about a recent change in altitude or elevation?

When you live at an elevation of 3500 feet above sea level (or higher) and the client describes symptoms of unknown origin such as headache, dizziness, fatigue, and changes in sensation of the feet and hands (decreased feeling, burning, numbness, tingling, [polycythemia] or joint pain, swelling, and loss of motion [sickle cell disease])

5. Words used to describe neurogenic pain often include:

b. Crushing, shooting, pricking

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:

c. A normal finding

12. 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

c. Inform their primary care provider of both conditions

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

c. Inspection, auscultation, percussion, palpation

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

(1) Client tolerance; (2) Perceived exertion levels

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

(1) Trunk flexion over the hips produces severe pain in the presence of iliopsoas bleeding. Only mild pain occurs on trunk flexion over the hips for a hip hemorrhage. (2) Gently rotating the hip internally or externally causes severe pain in the presence of a hip hemorrhage but only minimal (or no) pain with iliopsoas bleeding.

9. Pain of a viscerogenic nature is not relieved by a change in position.

False

3. With what final question should you always end your interview?

Are 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?

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

Bad breath (halitosis) can be a symptom of diabetic ketoacidosis, dental decay, lung abscess, throat or sinus infection, or gastrointestinal disturbance from food intolerance, Helicobacter pylori bacteria, or bowel obstruction. Keep in mind that ethnic foods and alcohol can affect breath and body odor. 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.

7. When would you consider listening for femoral bruits?

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.

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

a. A malignant lesion