Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 10 (Answer Key)

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 10 (Answer Key)


1. Percussion of the costovertebral angle that results in the reproduction of symptoms:

a. Signifes radiculitis
b. Signifes pseudorenal pain
c. Has no signifcance
d. Requires medical referral

2. Renal pain is aggravated by:

a. Spinal movement
b. Palpatory pressure over the costovertebral angle
c. Lying on the involved side
d. All of the above
e. None of the above

3. 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

4. Who should be screened for possible renal/urologic involvement?

Anyone with back pain or shoulder pain of unknown origin, especially when accompanied by changes in urination, blood in the urine, or constitutional symptoms.

5. What do the following terms mean?

• Dyspareunia
• Dysuria
• Hematuria
• Urgency

Dyspareunia—Difficult or painful sexual intercourse in women Dysuria—Painful or difficult urination Hematuria—Blood in the urine

Urgency—A sudden, compelling desire to urinate

6. What is the difference between urge incontinence and stress\ incontinence?

Urge incontinence—Inability to hold back urination when one is feeling the urge to void (putting the key in the door or passing by a bathroom may trigger urine to leak)

Stress incontinence—Involuntary escape of urine due to strain on the bladder (e.g., cough, sneeze, standing up, lifting, exercising)

7. What is the signifcance of “skin pain” over the T9/T10 dermatomes?

“Skin pain” may be a sign of referred pain from the upper urinary tract because visceral sensory fibers via the autonomic nervous system and cutaneous sensory fibers via the peripheral nervous system (dermatomes) enter the spinal cord in close proximity and even converge on some of the same neurons. When visceral pain fibers are stimulated, concurrent stimulation of cutaneous fibers also occurs that is then perceived as “skin pain.”

8. How do you screen for possible prostate involvement in a man with pelvic/low-back pain of unknown cause?

A physical therapist who is screening for prostate involvement must ask direct questions. A medical evaluation is necessary to identify actual prostate disease. Questions may include the following (see also Appendix B-27):

  • Are you experiencing any other symptoms of any kind? (If no, you may have to prompt with specifics: Have you had any fever or chills? Muscle or joint aches?)
    • Have you ever had any problems with your prostate in the past?
  • When you urinate, do you have trouble starting or continuing the flow of urine?
  • (Alternate questions): Has your urine stream changed in size? Do you urinate in a steady stream, or does the flow of urine start and stop?
  • Are you getting up to urinate at night? (If the answer is “yes,” make sure this is something new or unusual for the client.)
  • Have you noticed any blood in your urine (or change in the color of your urine)?

9. Explain why renal/urologic pain can be felt in such a wide range of dermatomes (i.e., from the T9 to L1 dermatomes).

Visceral pain is not well differentiated because innervation of the viscera is multisegmental with few nerve endings (see Fig. 3-3). As was previously discussed inquestion (7), renal/urologic pain enters the spinal cord at the same level and in close proximity to cutaneous nerves in these multiple segments (from T10 to L1). Stimulation of these renal/urologic fibers can lead to stimulation of cutaneous fibers. As a result, renal and urethral visceral pain may be felt as skin pain throughout the T10-L1 dermatomes.

10. What is the mechanism of referral for urologic pain to the shoulder?

If the diaphragm becomes irritated as the result of pressure from a distended kidney (caused by tumor, cyst, inflammation), pain can be referred via interconnections between the phrenic nerve (innervating the diaphragm) and the cervical plexus (innervating the shoulder).


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