1. If a client reports that the shoulder/upper trapezius muscle pain increases with deep breathing, how can you assess whether this results from a pulmonary or musculoskeletal cause?
As always, look at past medical history, risk factors, clinical presentation, and associated signs and symptoms. Ask about a past medical history (within the last 6 to 8 weeks) of upper respiratory infection, pneumonia, pleurisy, or traumatic injury.
Evaluate whether the symptoms can be reproduced with palpation or movement. Pulmonary symptoms may be exacerbated or increased by the supine position and alleviated or decreased when the patient is lying on the involved side (autosplinting). Look for associated signs and symptoms such as fever, chills, night sweats, digital clubbing, persistent cough, or dyspnea. Examine the client for trigger points; reexamine after any trigger points have been eliminated.
2. Neurologic symptoms such as muscle weakness or muscle atrophy may be the frst indication of:
a. Cystic fbrosis
d. Deep vein thrombosis
3. 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
4. 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
5. The presence of a persistent dry cough (no sputum or phlegm produced) has no clinical signifcance to the therapist. True or false?
False. However, medical referral is usually not considered necessary when a client presents with a singular systemic sign or symptom, especially in the presence of a clear clinical presentation of a musculoskeletal pattern.
6. 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
7. What is the signifcance of autosplinting?
Autosplinting occurs when lying on the involved side quiets respiratory movement and reduces or eliminates symptoms. Most musculoskeletal problems are made worse by placing this kind of pressure on the symptomatic shoulder, neck, or thoracic spine. The therapist must also evaluate the presence of associated signs and symptoms, the effect of increased respiratory movements on symptoms, and the effect of the supine position (recumbency) on shoulder/upper trapezius pain.
8. Which symptom has greater signifcance: dyspnea at rest or exertional dyspnea?
These have equal significance when viewed as part of a continuum; dyspnea that has progressed from exertional to rest is a red flag symptom. The usual progression of dyspnea is for a client to first notice shortness of breath after a specific length of time or intensity while engaging in an activity such as walking or climbing stairs. Progression to dyspnea at rest usually occurs after the client notices shortness of breath sooner and with less intensity in the activity.
Exertional dyspnea may be the result of deconditioning alone without a specific pulmonary disease. In addition, early, mild congestive heart failure may be characterized by shortness of breath at rest that is not present with exertion. In such a case, increased stroke volume that results from increased activity may improve venous return enough to alleviate dyspnea with exertion. Over time, as the congestion progresses, dyspnea will increase with less provocation and will occur at rest as well as with exertion.
Either exertional dyspnea or dyspnea at rest that is out of proportion to the situation should be considered a red flag. Progression to dyspnea at rest usually occurs after the client notices shortness of breath that occurs sooner and with less intensity in the activity.
9. The presence of pain and anxiety in a client can often lead to hyperventilation. When a client hyperventilates, the arterial concentration of carbon dioxide will do which of the following?
c. Remain unchanged
d. Vary depending on potassium concentration
10. 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