Differential Diagnosis final Exam Practice ?
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 (b) Systemic lupus erythematosus (e) HIV infection (d) Scleroderma (h) Rheumatoid arthritis (g) Allergic reaction (f) Lyme disease (c) Thrombocytopenia
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
Which one of the following is a yellow (caution) flag? a. Sacral pain occurs when the examiner performs a sacral spring test (posterior-anterior glide of the sacrum). b. Sacral pain is relieved when the client passes gas or has a bowel movement. c. Sacral pain occurs following a history of overuse. d. Sacral pain is reduced or relieved by release of trigger points.
b. Sacral pain is relieved when the client passes gas or has a bowel movement.
he most common sites of referred pain from systemic diseases are: a. Neck and back b. Shoulder and back c. Chest and back d. None of the above
b. Shoulder and back
Pain on weight bearing may be a sign of hip fracture, even whenx-rays are negative. Follow-up clinical tests may include: a. McBurney's, Blumberg's, Murphy's test b. Squat test, hop test, translational/rotational tests c. Psoas and obturator tests d. Patrick's or Faber's test
b. Squat test, hop test, translational/rotational tests
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
When is it advised to take a work or military history? a. Anyone with head and/or neck pain who uses a cell phone more than 8 hours/day b. Anyone over age 50 c. Anyone presenting with joint pain of unknown cause accompanied by multiple other signs and symptoms d. This is outside the scope of a physical therapist's practice
c. Anyone presenting with joint pain of unknown cause accompanied by multiple other signs and symptoms
Vascular diseases that may cause referred hip pain include: a. Coronary artery disease b. Intermittent claudication c. Aortic aneurysm d. All of the above
c. Aortic aneurysm
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
d. Hyperreflexia with decreased muscle strength
igns 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
d. Hypertension, slow wound healing, easy bruising
Autosplinting is the preferred mechanism of pain relief for back pain caused by kidney stones. T/F
False
Direct access is the only reason physical therapists must screen for systemic disease. T/F
False
Pain of a viscerogenic nature is not relieved by a change in position. T/F
False
The presence of a persistent dry cough (no sputum or phlegm produced) has no clinical significance to the therapist. True or false?
False
List three of the most common symptoms of diabetes mellitus.
Polydipsia - increased thirst in response to polyuria Polyuria - increased urination caused by osmotic diuresis Polyphagia - increased appetite and ingestion of food (usually only in type 1)
What are the most common musculoskeletal symptoms associated with endocrine disorders?
Proximal muscle weakness, myalgia, carpal tunnel syndrome, periarthritis, adhesive capsulitis (shoulder)
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
Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain. T/F
True
Back pain from pancreatic disease occurs when the body of the pancreas is enlarged, inflamed, obstructed, or otherwise impinging on the diaphragm. T/F
True
Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved. T/F
True
Screening for alcohol use would be appropriate when the client reports a history of accidents. T/F
True
Skin pain over T9 to T12 can occur with kidney disease as a result of multisegmental innervation. Visceral and cutaneous sensory fibers enter the spinal cord close to each other and converge on the same neurons. When visceral pain fibers are stimulated, cutaneous fibers are stimulated, too. Thus visceral pain can be perceived as skin pain. T/F
True
Twenty-five percent of the people with GI disease, such as Crohn's disease (regional enteritis), irritable bowel syndrome, or bowel obstruction, have concomitant back or joint pain. T/F
True
A 55-year-old grocery store manager reports becomingextremely weak and breathless whenever stocking groceries onoverhead shelves. What is the possible significance of thiscomplaint? a. TOS b. Myocardial ischemia c. TrP d. All of the above
b. Myocardial ischemia
A suspicious skin lesion requiring medical evaluation has: a. Round, symmetric borders b. Notched edges c. Matching halves when a line is drawn down the middle d. A single color of brown or tan
b. Notched edges
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) Neoplasm
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
A client with a past medical history of kidney transplantation (10 years ago) has been referred to you for a diagnosis of rheumatoid arthritis. His medications include tacrolimus, methotrexate, Fosamax, and Wellbutrin. During the examination, you notice a painless lump under the skin in the right upper anterior chest. There is a loss of hair over the area. What other symptoms should you look for as red flag signs and symptoms in a client with this history? a. Fever, muscle weakness, weight loss b. Change in deep tendon reflexes, bone pain c. Productive cough, pain on inspiration d. Nose bleeds or other signs of excessive bleeding
a. Fever, muscle weakness, weight loss
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
What is the significance of Beau's lines in a client treated with chemotherapy for leukemia? a. Impaired nail formation from death of cells b. Temporary longitudinal groove or ridge through the nail c. Increased production of the nail by the matrix as a sign of healing d. A sign of local trauma
a. Impaired nail formation from death of cells
creening for cancer may be necessary in anyone with hip pain who: a. Is younger than 20 or older than 50 b. Has a past medical history of diabetes mellitus c. Reports fever and chills d. Has a total hip arthroplasty (THA)
a. Is younger than 20 or older than 50
A client complains of throbbing pain at the base of the anterior neck that radiates into the chest and interscapular areas and increases with exertion. What should you do first? a. Monitor vital signs, and palpate pulses b. Call the physician or 911 immediately c. Continue with the exam; find out what relieves the pain d. Ask about past medical history and associated signs andSymptoms
a. Monitor vital signs, and palpate pulses
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.
a. Pain and stiffness in the morning gradually improves with gentle activity and movement during the day.
The screening model used to help identify viscerogenic or systemic origins of hip, groin, and lower extremity pain and symptoms is made up of: a. Past medical history, risk factors, clinical presentation, andassociated signs and symptoms b. Risk factors, risk reduction, and primary prevention c. Enteric disease, systemic disease, and neuromusculoskeletaldysfunction d. Physical therapy diagnosis, Review of Systems, and physicianreferral
a. Past medical history, risk factors, clinical presentation, andassociated signs and symptoms
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
b. Pathologic fractures
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 therapistto 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
A 60-year-old woman with a history of left breast cancer (10 years postmastectomy) presents with pain in her midback. The pain is described as "sharp" and radiates around her chest to the sternum. She gets some relief from her pain by lying down. Her vital signs are normal, and there are no palpable or aberrant lymph nodes. She denies any changes in breast tissue on the right or the scar and soft tissue on the left. You do not have adequate training to perform a clinical breast examination, but the client agrees to visual inspection, which reveals nothing unusual. All other findings are within normal limits; you are unable to provoke or aggravate her symptoms. Neurologic screening examination is within normal limits. The client denies any history of trauma. What plan of action would you recommend? a. Refer her to a physician before initiating treatment. b. Carry out a plan of care, and reassess after three sessions or 1 week, whichever comes first. c. Document your findings, and contact the physician by phone or by fax while initiating treatment. d. Eliminate TrPs, and then reassess symptoms.
a. Refer her to a physician before initiating treatment.
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. Severe dehydration, polydipsia
A 23-year-old woman was a walk-in to your clinic with sudden onset of left shoulder pain. She denies any history of trauma and has only a past history of a ruptured appendix three years ago. She is not having any abdominal pain or pain anywhere else in her body. How do you know if she is at risk for ectopic pregnancy? a. She is sexually active, and her period is late. b. She has a history of uterine cancer. c. She has a history of peptic ulcer. d. None of the above.
a. She is sexually active, and her period is late.
In a physical therapy practice, clients are most likely to present with signs and symptoms of metastases to: a. Skeletal system, hepatic system, pulmonary system, central nervous system b. Cardiovascular system, peripheral vascular system, enteric system c. Hematologic and lymphatic systems d. None of the above
a. Skeletal system, hepatic system, pulmonary system, central nervous system
Chest pain can be caused by trigger points of the: a. Sternocleidomastoid b. Rectus abdominis c. Upper trapezius d. Iliocostalis thoracis
a. Sternocleidomastoid
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- or upper back, scapular, and right
a. The left shoulder
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. The left shoulder
A 49-year-old man was treated by you for bilateral synovitis of the proximal interphalangeal (PIP) joints in the second, third, and fourth fingers. His symptoms went away with treatment, and he was discharged. Six weeks later, he returned with the same symptoms. There was obvious soft tissue swelling with morning stiffness worse than before. He also reports problems with his bowels but isn't able to tell you exactly what's wrong. There are no other changes in his health. He is not taking any medications or over-the-counter drugs and does not want to see a doctor. Are there enough red flags to warrant medical evaluation before resumption of physical therapy intervention? a. Yes; age, bilateral symptoms, progression of symptoms, report of GI distress b. No; treatment was effective before—it's likely that he has done something to exacerbate his symptoms and needs further education about joint protection.
a. Yes; age, bilateral symptoms, progression of symptoms, report of GI distress
5. 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
b. Pernicious anemia resulting from Vitamin B12 deficiency
Which of the following skin assessment findings in the HIV infected client occurs with Kaposi's sarcoma? a. Darkening of the nail beds b. Purple-red blotches or bumps on the trunk and head c. Cyanosis of the lips and mucous membranes d. Painful blistered lesions of the face and neck
b. Purple-red blotches or bumps on the trunk and head
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 of time 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
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
5. 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
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
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 or dentist, chiropractor say is the problem? b. Did the physician or dentist, chiropractor examine you? c. When do you go back to see the doctor or dentist, chiropractor? d. How many times per week did the doctor or dentist, chiropractor suggest you come to therapy?
b. Did the physician or 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?
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
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
b. Exertional dyspnea and fatigue with increased heart rate
True hip pain is characterized by: a. Testicular (male) or labial (female) pain b. Groin or deep buttock pain with active or passive range of motion c. Positive McBurney's test d. All of the above
b. Groin or deep buttock pain with active or passive range of motion
Organ systems that can cause simultaneous bilateral shoulder pain include: a. Spleen b. Heart c. Gallbladder d. None of the above
b. Heart
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
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
b. Increases blood pressure
2. 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
b. Iron deficiency
67-year-old man was seen by a physical therapist for low back pain rated 7 out of 10 on the visual analogue scale. He was evaluated, and a diagnosis was made by the physical therapist.The client attained immediate relief of symptoms, but after 3 weeks of therapy, the symptoms returned. What is the next step from a screening perspective? a. The client can be discharged. Maximum benefit from physical therapy has been achieved. b. The client should be screened for systemic disease even if you have already included screening during the initial evaluation. c. The client should be sent back to the physician for further medical follow-up. d. The client should receive an additional modality to help break the pain-spasm cycle.
b. The client should be screened for systemic disease even if you have already included screening during the initial evaluation.
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
b. Thrombocytopenia
In the context of screening for referral, 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. To guide the plan of care and intervention strategies
A 70-year-old man came to outpatient physical therapy with a complaint of pain and weakness of his fingers and morning stiffness lasting about an hour. He presented with bilateral swelling of the metacarpophalangeal (MCP) joints of the index and ring fingers. He saw his family doctor 4 weeks ago and was given diclofenac, which has not changed his symptoms. Now he wants to try physical therapy. Since he last saw his physician, he has developed additional joint pain in the left knee and right shoulder. How can you tell if this is cancer, polyarthritis, or a paraneoplastic disorder? a. Ask about a previous history of cancer and recent onset of skin rash. b. You can't. This requires a medical evaluation. c. Look for signs of digital clubbing, cellulitis, or proximal muscle weakness. d. Assess vital signs.
b. You can't. This requires a medical evaluation.
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.
McBurney's point for appendicitis is located: a. Approximately one-third the distance from the ASIS toward the umbilicus, usually on the left side b. Approximately one-half the distance from the ASIS toward the umbilicus, usually on the left side c. Approximately one-third the distance from the ASIS toward the umbilicus, usually on the right side d. Approximately one-half the distance from the ASIS toward the umbilicus, usually on the right side e. Impossible to tell because the appendix can be located anywhere in the abdomen
d. Approximately one-half the distance from the ASIS toward the umbilicus, usually on the right side
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
c. A normal finding
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
c. A paraphrasing technique
A positive Schober's test is a sign of: a. Reiter's syndrome b. Infectious arthritis c. Ankylosing spondylitis d. a or b e. a or c
c. Ankylosing spondylitis
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, 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
4. Preoperatively, clients cannot take aspirin or anti inflammatory medications because these: a. Decrease leukocytes b. Increase leukocytes c. Decrease platelets d. Increase platelets e. None of the above
c. Decrease platelets
You are evaluating a 30-year-old woman with left chest pain that starts just below the clavicle and extends down to the nipple line. The majority of test results point to thoracic outlet syndrome. Her blood pressure is 120/78 mm Hg on the right (sitting) and 125/100 on the left (sitting). She is in apparent good health with no history of surgeries or significant health problems. What plan of action would you recommend? a. Refer her to a physician before initiating treatment. b. Carry out a plan of care, and reassess after three sessions or 1 week, whichever comes first. c. Document your findings, and contact the physician by phone or by fax while initiating treatment. d. Eliminate trigger points, and then reassess symptoms.
c. Document your findings, and contact the physician by phone or by fax while initiating treatment.
Chest pain of a pleuritic nature can be distinguished by: a. Increases with autosplinting (lying on the involved side) b. Reproduced with palpation c. Exacerbated by deep breathing d. All of the above
c. Exacerbated by deep breathing
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
Fibromyalgia syndrome is a: a. Musculoskeletal disorder b. Psychosomatic disorder c. Neurosomatic disorder d. Noninflammatory rheumatic disorder
c. Neurosomatic disorder
When tumors produce signs and symptoms at a site distant from the tumor or its metastasized sites, these "remote effects" of malignancy are called: a. Bone metastases b. Vitiligo c. Paraneoplastic syndrome d. Ichthyosis
c. Paraneoplastic syndrome
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
c. Pott's disease
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
Pain that is relieved by placing a pillow or support under the hips and buttocks describes: a. Constitutional symptom b. Infectious process c. Response to vascular congestion d. Trigger point pattern
c. Response to vascular congestion
eferred pain patterns associated with hepatic and biliary pathology can produce musculoskeletal symptoms in: a. The left shoulder b. The right shoulder c. The mid or upper back, scapular, and right shoulder areas d. The thorax, scapulae, right or left shoulder
c. The mid or upper back, scapular, and right shoulder areas
A 28-year-old mechanic reports bilateral shoulder pain (right more than left) whenever he has to work on a car on a lift overhead. It goes away as soon as he puts his arms down. Sometimes, he has numbness and tingling in his right elbow going down the inside of his forearm to his thumb. The most likely explanation for this pattern of symptoms is: a. Angina b. Myocardial ischemia c. Thoracic outlet syndrome d. Peptic ulcer
c. Thoracic outlet syndrome
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
A 75-year-old woman with a known history of osteoporosis has pain over the sacrum radiating to the right PSIS and right buttock. How do you rule out an insufficiency fracture? a. Perform Blumberg's test. b. Conduct a sacral spring test (posterior-anterior overpressure of the sacrum). c. Perform Murphy's percussion test. d. Diagnostic imaging is the only way to know for sure.
d. Diagnostic imaging is the only way to know for sure.
client who has recently completed chemotherapy requires immediate medical referral if he has which of the following symptoms? a. Decreased appetite b. Increased urinary output c. Mild fatigue but moderate dyspnea with exercise d. Fever, chills, sweating
d. Fever, chills, sweating
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
d) Water retention.
A 16-year-old boy was hurt in a soccer game. He presents with exquisite right ankle pain on weight bearing but reports no pain at night. Upon further questioning, you find he is taking Ibuprofen at night before bed, which may be masking his pain. What other screening examination procedures are warranted? a. Perform a heel strike test. b. Review response to treatment. c. Assess for signs of fracture (edema, exquisite tenderness to palpation, warmth over the painful site). d. All of the above
d. All of the above
A 55-year-old man with a left shoulder impingement also has palpable axillary lymph nodes on both sides. They are firm but movable, about the size of an almond. What steps should you take? a. Examine other areas where lymph nodes can be palpated. b. Ask about history of cancer, allergies, or infections. c. Document your findings and contact the physician with your concerns. d. All of the above
d. All of the above
A 66-year-old woman has come to you with a report of anterior neck pain radiating down the left arm. Her past medical history is significant for chronic diabetes mellitus (insulin dependent), coronary artery disease, and peripheral vascular disease. About 6 weeks ago, she had an angioplasty with stent placement. Which test will help you differentiate a musculoskeletal cause from a cardiac cause of neck and arm pain? a. Stair climbing or stationary bike test b. Using arms overhead for 3 to 5 minutes c. TrP assessment d. All of the above
d. All of the above
Anyone with hip pain of unknown cause must be asked about: a. Previous history of cancer or Crohn's disease b. Recent infection c. Presence of skin rash d. All of the above
d. All of the above
Hip and groin pain can be referred from: a. Low back b. Abdomen c. Retroperitoneum d. All of the above
d. All of the above
Hip pain associated with primary or metastasized cancer is characterized by: a. Bone pain on weight bearing; may not be able to stand on that leg b. Night pain that is relieved by aspirin c. Positive heel strike test with palpable local tenderness d. All of the above
d. All of the above
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 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
Which of the following would be useful information when evaluating a 57-year-old woman with shoulder pain? a. Influence of antacids on symptoms b. History of chronic NSAID use c. Effect of food on symptoms d. All of the above
d. All of the above
o screen for back pain caused by systemic disease: a. Perform special tests (e.g., Murphy's percussion, Bicycle test) b. Correlate client history with clinical presentation and askabout associated signs and symptoms c. Perform a Review of Systems d. All of the above
d. All of the above
ou are working with a client in his home who had a total hip replacement 2 weeks ago. He describes chest pain with increased activity. Knowing what could cause this symptom will help guide you in asking appropriate screening questions. Can this be a symptom of: a. Asthma b. Angina c. Pleuritis or pleurisy d. All of the above
d. All of the above
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
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 doesnot 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.
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.
d. Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm.
All of the following are common signs or symptoms of insulin resistance except: a. Acanthosis nigricans b. Drowsiness after meals c. Fatigue d. Oliguria
d. Oliguria
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
The most significant red flag for shoulder pain secondary to cancer is: a. Previous history of coronary artery disease b. Subscapularis trigger point alleviated with trigger point therapy c. Negative neurologic screening exam d. Previous history of breast or lung cancer
d. Previous history of breast or lung cancer
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
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
A 53-year-old woman comes to physical therapy with a report of leg pain that begins in her buttocks and goes all the way down to her toes. If this pain is of a vascular origin she will most likely describe it as: a. Sore, hurting b. Hot or burning c. Shooting or stabbing d. Throbbing, "tired"
d. Throbbing, "tired"
Cardiac pain in women does not always follow classic patterns. Watch for this group of symptoms in women at risk: a. Indigestion, food poisoning, jaw pain b. Nausea, tinnitus, night sweats c. Confusion, left biceps pain, dyspnea d. Unusual fatigue, shortness of breath, weakness, or sleep disturbance
d. Unusual fatigue, shortness of breath, weakness, or sleep disturbance
Pelvic pain that is made worse after 5 to 10 minutes of physical activity or exertion but goes away with rest or cessation of the activity describes: a. Constitutional symptom b. Infectious process c. Symptom of osteoporosis d. Vascular pattern of ischemia
d. Vascular pattern of ischemia
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
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
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
d. b and c
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
e. All of the above
Cancer as a cause of sacral or pelvic pain is usually characterized by: a. A previous history of reproductive cancer b. Constant pain c. Blood in the urine or stools d. Constitutional symptoms e. All of the above
e. All of the above
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
Pain associated with pleuropulmonary disorders can radiate to: a. Anterior neck b. Upper trapezius muscle c. Ipsilateral shoulder d. Thoracic spine e. All of the above
e. All of the above
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
e. All of the above
6. 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
e. Any of the above
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
e. a and c
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
Proximal muscle weakness may be a sign of: a. Paraneoplastic syndrome b. Neurologic disorder c. Myasthenia gravis d. Scleroderma e. b, c, and d f. All of the above
f. All of the above
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
f. All the above
Physical therapy evaluation and intervention may be part of the physician's differential diagnosis. T/F
true
Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral. T/F
true