Differential Diagnosis (DD) Answer Key || Chapter 04

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Differential Diagnosis (DD) Answer Key || Chapter 04

MCQ

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

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 medications

3. Pulse strength graded as 1 means:


a. Easily palpable, normal
b. Present occasionally
c. Pulse diminished, barely palpable
d. Within normal limits

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 fnding
d. Common in anyone with pain

5. How do you plan or modify an exercise program for a client with cancer without the beneft 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 nailbeds, and ask about the presence of associated signs and symptoms.


6. 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

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.

The therapist is most likely to assess for bruits when the client or patient is older than 65years 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.


8. A 23-year-old female presents with new onset of skin rash and joint pain followed 2 weeks later by GI symptoms of abdominal pain, nausea, and diarrhea. She has a previous history of Crohn’s disease, but this condition has been stable for several years. She does not think her current symptoms are related to her Crohn’s disease. What kind of screening assessment is needed in this case?


a. Vital signs only.
b. Vital signs and abdominal auscultation.
c. Vital signs, neurologic screening examination, and abdominal auscultation.
d. No further assessment is needed; there are enough red flags
to advise this client to seek medical attention.

9. A 76-year-old man was referred to physical therapy after a total hip replacement (THR). The goal is to increase his functional mobility. Is a health assessment needed since 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.

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.


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 andalcohol 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.


11. Why does postural orthostatic hypotension occur upon standing for the frst 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.

ANSWER KEY

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