Home Blog Page 24

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 18 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 18 (Answer Key)

1. A 66-year-old woman has been referred to you by her physiatrist for preprosthetic training after an above-knee amputation. Her past medical history is signifcant for chronic diabetes mellitus (insulin dependent), coronary artery disease with recent angioplasty and stent placement, and peripheral vascular disease. During the physical therapy evaluation, the client experienced anterior neck pain radiating down the left arm. Name (and/or describe) three tests you can do to differentiate a musculoskeletal cause from a cardiac cause of shoulder pain.

  • Orthopedic evaluation: Palpate structures of the shoulder, including trigger point assessment; perform special orthopedic tests such as Yergason’s, apprehension test, relocation test, and Speed’s test; perform neurologic screening examination, including reflex testing, coordination, manual muscle testing, and sensory testing; screen for mechanical dysfunction above and below (temporomandibular joint, cervical spine, elbow).
  • Systemic evaluation: Assess the effects of stair climbing or stationary bicycle riding (using only the lower extremities) on shoulder pain; assess for associated signs and symptoms (e.g., dyspnea, fatigue, palpitations, diaphoresis, cough, dizziness), and perform a systems review; measure vital signs on both sides.


2. 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

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

4. Referred 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

5. The most common sites of referred pain from systemic diseases are:


a. Neck and hip
b. Shoulder and back
c. Chest and back
d. None of the above

6. 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

7. A client reports shoulder and upper trapezius pain on the right that increases with deep breathing. How can you tell if this results from a pulmonary or a musculoskeletal cause?


a. Symptoms get worse when lying supine but better when right sidelying when it is pulmonary
b. Symptoms get worse when lying supine but better when right sidelying when it is musculoskeletal

8. Organ systems that can cause simultaneous bilateral shoulder pain include:


a. Spleen
b. Heart
c. Gallbladder
d. None of the above

9. 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.

10. The most signifcant 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

ANSWER KEY

02D03A04C
05B06S07A
08B09A10D

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 17 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 17 (Answer Key)

1. Chest pain can be caused by trigger points of the:


a. Sternocleidomastoid
b. Rectus abdominis
c. Upper trapezius
d. Iliocostalis thoracis

2. During examination of a 42-year-old woman’s right axilla, you palpate a lump. Which characteristics most suggest the lump may be malignant?


a. Soft, mobile, tender
b. Hard, immovable, nontender

3. 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 frst?


a. Monitor vital signs, and palpate pulses
b. Call the physician or 911 immediately
c. Continue with the exam; fnd out what relieves the pain
d. Ask about past medical history and associated signs and symptoms

4. A 55-year-old grocery store manager reports becoming extremely weak and breathless whenever stocking groceries on overhead shelves. What is the possible signifcance of this complaint?


a. TOS
b. Myocardial ischemia
c. TrP
d. All of the above

5. 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

6. 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 signifcant 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

7. 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 signifcant 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 frst.
c. Document your fndings, and contact the physician by phone or by fax while initiating treatment.
d. Eliminate trigger points, and then reassess symptoms.

8. 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 fndings 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 frst.
c. Document your fndings, and contact the physician by phone or by fax while initiating treatment.
d. Eliminate TrPs, and then reassess symptoms.

9. You 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

10. 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

ANSWER KEY

01A02B03A
04B05C06D
07C08A09D
10D    

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 16 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 16 (Answer Key)

1. 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, and associated signs and symptoms
b. Risk factors, risk reduction, and primary prevention
c. Enteric disease, systemic disease, and neuromusculoskeletal dysfunction
d. Physical therapy diagnosis, Review of Systems, and physician referral

2. When would you use the iliopsoas, obturator, or Blumberg’s test?

  • Any time you suspect an infectious or inflammatory cause of hip, groin, or pelvic symptoms. Abdominal or intraperitoneal inflammation leads to irritation and/or abscess formation of the psoas muscle, causing musculoskeletal pain. These tests are especially appropriate for the client who has a history of Crohn’s disease, diverticulitis, pelvic inflammatory disease, or
  • Chlamydia with a new onset of hip and/or groin pain.
  • Combined with findings of Blumberg’s rebound test and McBurney’s point, the information gained can help the clinician to identify signs and symptoms of possible appendicitis.


3. Hip and groin pain can be referred from:


a. Low back
b. Abdomen
c. Retroperitoneum
d. All of the above

4. Screening 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)

5. Pain on weight bearing may be a sign of hip fracture, even when x-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

6. Abscess of the hip flexor muscles from intraabdominal infection or inflammation can cause hip and/or groin pain. Clinical tests to differentiate the cause of hip pain resulting from psoas
abscess include:


a. McBurney’s, Blumberg’s, or Murphy’s test
b. Squat test, hop test, translational/rotational tests
c. Iliopsoas and obturator tests
d. Patrick’s or Faber’s test

7. 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

8. Vascular diseases that may cause referred hip pain include:


a. Coronary artery disease
b. Intermittent claudication
c. Aortic aneurysm
d. All of the above

9. 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

10. 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

ANSWER KEY

01A03D04A
05B06C07D
08C09B10D

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 15 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 15 (Answer Key)

1. 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

2. 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

3. A positive Blumberg’s sign indicates:


a. Pelvic infection
b. Ovarian varicosities
c. Arthritis associated with IBD
d. Sacral neoplasm

4. A 33-year-old pharmaceutical sales representative reports pain over the mid-sacrum radiating to the right PSIS. Overpressure on the sacrum does not reproduce symptoms. This signifes:


a. Neoplasm is present
b. Red flag sign of sacral insuffciency fracture
c. A lack of objective fndings
d. Coccygodynia

5. A 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 beneft 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.

6. 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

7. 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.

8. 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

9. Reproduced or increased abdominal or pelvic pain when the iliopsoas muscle test is performed suggests:


a. Iliopsoas trigger point
b. Inflammation or abscess of the muscle from an inflamed appendix or peritoneum
c. Abdominal aortic aneurysm
d. Neoplasm

10. 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 insuffciency 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.


11. What is the importance of the pelvic floor musculature in relation to the abdominal and pelvic viscera?

See Figs. 15-2 and 15-3.

ANSWER KEY

01D02C03A
04C05B06D
07B08E09B
10D    

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 14 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 14 (Answer Key)

1. The 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

2. To 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 ask about associated signs and symptoms
c. Perform a Review of Systems
d. All of the above

3. What are two ways of classifying back pain (as presented in the text)?

Back pain can be examined and classified in many ways. We have presented Sources of Back Pain (e.g., visceral, neurogenic, vasculogenic, spondylogenic, psychogenic, neoplasm; see Table 3-3) and Location of Back Pain (e.g., cervical spine, scapula, thoracic spine, lumbar spine, sacrum, sacroiliac; see Table 14-1).

4. 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.

5. 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

6. 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

7. Percussion of the costovertebral angle resulting in the reproduction of symptoms signifes:


a. Radiculitis
b. Pseudorenal pain
c. Has no signifcance
d. Medical referral is advised

8. 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”

9. Twenty-fve 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.


a. True
b. False

10. Skin pain over T9 to T12 can occur with kidney disease as a result of multisegmental innervation. Visceral and cutaneous sensory fbers enter the spinal cord close to each other and
converge on the same neurons. When visceral pain fbers are stimulated, cutaneous fbers are stimulated, too. Thus visceral pain can be perceived as skin pain.


a. True
b. False

11. Autosplinting is the preferred mechanism of pain relief for back pain caused by kidney stones.


a. True
b. False

12. Back pain from pancreatic disease occurs when the body of the pancreas is enlarged, inflamed, obstructed, or otherwise impinging on the diaphragm.


a. True
b. False

13. A 53-year-old postmenopausal woman with a history of breast cancer 5 years ago with mastectomy presents with a report of sharp pain in her mid-back. The pain started after she lifted her 2-year-old granddaughter 3 days ago. Tylenol seems to help, but the pain is keeping her awake at night. Once she wakes up, she cannot fnd a comfortable position to go back to sleep. What are the red flags? What will you do to screen for a medical cause of her symptoms?

  • Red flags include age (over 50), previous history of cancer, and lack of pain relief with recumbency. Screening should follow the decision-making model presented in Chapter 1.
  • Conduct a careful history of symptoms, and ask about symptoms anywhere else in the body.
  • Find out when the last medical follow-up was done by the oncologist and when the patient had her last clinical breast examination and mammogram. Clinical assessment should include vital signs, lymph node palpation, skin inspection that includes the mastectomy site, and a neurologic screening examination. Palpate the painful area, and perform a percussive Tap test

ANSWER KEY

01B02D04C
05E06B07D
08D09A10A
11B12A  

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 13 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 13 (Answer Key)

1. Name three predisposing factors to cancer that the therapist must watch for during the interview process as red flags.

Previous personal history of cancer; age in correlation with a personal or family history of cancer; age and gender in correlation with incidence of certain cancers; exposure to environmental and occupational toxins; geographic location; lifestyle (e.g., consumption of alcohol, smoking cigarettes, poor diet)

2. How do you monitor exercise levels in the oncology patient without laboratory values?

In any patient or client who is undergoing cancer treatment (especially chemotherapy), laboratory values offer a guide for determining appropriate frequency, intensity, and duration of exercise. In an outpatient setting, laboratory values may be unavailable or outdated. Without the benefit of laboratory values (and even when laboratory values are available), the therapist can and should monitor vital signs and rate of perceived exertion (RPE), and should look for associated signs and symptoms (e.g., pallor, dyspnea, unexplained or excessive diaphoresis, heart palpitations, visual changes, dizziness). Anything out of the ordinary should be considered a yellow (cautionary) flag that requires careful observation, further evaluation, and possibly medical referral.


3. 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

4. What is the signifcance of nerve root compression in relation to cancer?

In any individual, any neurologic sign may be the presentation of a silent lung tumor.


5. Complete the following mnemonic:
C A U T I O N S

  • Changes in bowel or bladder habits
  • A sore that does not heal within 6 weeks
  • Unusual bleeding or discharge
  • Thickening or lump in the breast or elsewhere
  • Indigestion or difficulty in swallowing
  • Obvious change in a wart or mol
  • Nagging cough or hoarseness
  • Supplemental signs and symptoms (rapid unintentional weight loss, changes in vitalsigns, frequent infections, night pain, pathologic fracture, proximal muscle weakness, change in deep tendon reflexes)


6. Whenever a therapist observes, palpates, or receives a client report of a lump or nodule, what three questions must be asked?

  • How long have you had this area of skin discoloration/mole/spot/lump?
  • Has it changed over the past 6 weeks to 6 months?
  • Has your physician examined this area? (Alternate question: Has your physician seen this?)


7. How can the therapist determine whether a client’s symptoms are caused by the delayed effects of radiation as opposed to being signs of recurring cancer?

This is a medical decision and is not within the scope of physical therapist practice. If the clinician has any doubt, the physician should be contacted. The therapist can certainly take vital signs, ask about the presence of constitutional symptoms such as fever, weight loss, nausea, vomiting, and look for and document associated signs and symptoms. All of these findings can be submitted to the physician for consideration.


8. Give a general description and explanation of the changes seen in deep tendon reflexes associated with cancer.

Space-occupying lesions (whether discogenic, bony spurs in the foraminal spaces, or tumor cells invading and occupying the spaces next to nerve roots) may cause an increase in deep tendon reflexes when compression irritates the nerve but does not obstruct the reflex arc. When any anatomic obstruction is large enough to compress the nerve and interfere with the reflex arc, the deep tendon reflex is diminished or absent.


9. Why is weight loss a signifcant red flag sign in a physical therapy practice?

Pain, movement dysfunction, and disability usually result in weight gain due to inactivity. When someone is experiencing back pain, for example, and reports a significant weight loss, this may be a red flag for systemic origin of the problem.

10. 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

11. A 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

12. 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

13. What is the signifcance 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

14. 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 fnd 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

15. 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

16. A 70-year-old man came to outpatient physical therapy with a complaint of pain and weakness of his fngers and morning stiffness lasting about an hour. He presented with bilateral
swelling of the metacarpophalangeal (MCP) joints of the index and ring fngers. 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.

17. A 49-year-old man was treated by you for bilateral synovitis of the proximal interphalangeal (PIP) joints in the second, third, and fourth fngers. 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

18. 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

19. A 55-year-old man with a left shoulder impingement also has palpable axillary lymph nodes on both sides. They are frm 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 fndings and contact the physician with your concerns.
d. All of the above

ANSWER KEY

03A10C11D
12B13A14D
15C16B17A
18A19D  

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 12 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 12 (Answer Key)

1. Fibromyalgia syndrome is a:


a. Musculoskeletal disorder
b. Psychosomatic disorder
c. Neurosomatic disorder
d. Noninflammatory rheumatic disorder

2. 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.

3. 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 (subcutaneous nodules may also occur with SLE)

(e) HIV infection

(d) Scleroderma

(H) Rheumatoid arthritis

(G) Allergic reaction (see Table 12-1)

(F) Lyme disease

(c )Thrombocytopenia

 4. A new client has come to you with a primary report of new onset of knee pain and swelling. Name three clues that this client might give from his medical history that should alert youto the possibility of immunologic disease.

Many red flag clues must be considered. The therapist may observe or hear reports of any one or combination of the following:

• Previous history of allergies, especially if the client has received medications over the past 6 weeks (even if the client is no longer taking the medications)

•  Recent history or presence of burning or urinary frequency (urethritis)

• Recent history or presence of conjunctivitis or eye crusting, redness, burning, or tearing that lasts only a few days

• Recent report or presence of skin rash, especially combined with a report of exposure to ticks

•  Positive family history for arthritis, spondyloarthropathy, psoriasis

•  Recent report of dry mouth or sore throat

•  Recent history of operative procedure

• Other extra-articular signs or symptoms, such as diarrhea, constitutional symptoms, or other symptoms already mentioned

•  Enlarged lymph nodes

5. 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

6. What is Lhermitte’s sign, and what does it signify?

An electric shock sensation down the spine and radiating to the extremities when the neck is flexed; this is a fairly common sign in multiple sclerosis but may also accompany disc protrusion against the spinal cord.


7. 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

8. Which of the following skin assessment fndings in the HIVinfected 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

9. The most common cause of change in mental status of the HIV-infected client is related to:


a. Meningitis
b. Alzheimer’s disease
c. Space-occupying lesions
d. AIDS dementia complex

10. Symptoms of anaphylaxis that would necessitate immediate medical treatment or referral are:


a. Hives and itching
b. Vocal hoarseness, sneezing, and chest tightness
c. Periorbital edema
d. Nausea and abdominal cramping

ANSWER KEY

01C02D05C
07F08B09D
10B    

Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 11 (Answer Key)

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 11 (Answer Key)

1. What are the most common musculoskeletal symptoms associated with endocrine disorders?

Proximal muscle weakness, myalgia, carpal tunnel syndrome, periarthritis, adhesive capsulitis (shoulder) (see Table 11-1)


2. What systemic conditions can cause carpal tunnel syndrome?

Endocrine disorders, infectious diseases, collagen disorders, cancer, liver disease (see Table 11-2).


3. What are the mechanisms by which carpal tunnel syndrome
occurs?

Depends on the underlying disease process. For example, thickening of the transverse carpal ligament is associated with acromegaly and myxedema. Increased volume of the contents of the carpal tunnel occurs with pregnancy, neoplasm, gouty tophi deposits, and lipids in diabetes mellitus. Hormonal changes (e.g., menopause, pregnancy) can also result in carpal tunnel syndrome (CTS). See also liver-related causes in Chapter 9).

4. Disorders of the endocrine glands can be caused by:


a. Dysfunction of the gland
b. External stimulus
c. Excess or insuffciency of hormonal secretions
d. a and b
e. b and c
f. All the above

5. List three of the most common symptoms of diabetes mellitus.
Polydipsia, polyuria, polyphagia


6. What is the primary difference between the two hyperglycemic states: diabetic ketoacidosis (DKA) and hyperglycemic, hyperosmolar, nonketotic coma (HHNC)?

The major differentiating factor between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) is the absence of ketosis in HHS.


7. Is it safe to administer a source of sugar to a lethargic or unconscious person with diabetes?

Yes. If their glucose levels are high, you will not endanger them any further with a small amount of sugar, and you may help someone who is experiencing hypoglycemia associated with diabetes mellitus

8. 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

 9. 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

10. Signs 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

11. Parathyroid hormone (PTH) secretion is particularly important in the metabolism of bone. The client with an oversecreting parathyroid gland would most likely have:


a. Increased blood pressure
b. Pathologic fractures
c. Decreased blood pressure
d. Increased thirst and urination

12. Which glycosylated hemoglobin (A1C) value is within the recommended range?


a. 6%
b. 8%
c. 10%
d. 12%

13. 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

14. All of the following are common signs or symptoms of insulin resistance except:

a. Acanthosis nigricans
b. Drowsiness after meals
c. Fatigue
d. Oliguria

ANSWER KEY

04F08A09D
10D11B12A
12D14D  

Position Vacant at The University of Faisalabad (TUF)|| Jobs 2020

0
Position Vacant at The University of Faisalabad|| Jobs 2020

Applications are invited against the vacancies of

  • professors
  • associate professors
  • assistant professors

POSITIONS:

Disciplines
Rehabilitation Sciences
Optometry
Management studies
Arabic
Islamic Studies
Statistics
Computtaional Sciences
Electrical Engineering
Civil Engineering
Chemical Engineering

NOTE:

Salary package will commensurate with qualification and experience

Apply:

Apply Online

Last Date:

January 31, 2020

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

0
Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 10 (Answer Key)

MCQ

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).

ANSWER KEY

01D
02E
03D