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USA - Differential Diagnosis - Units 9-14

Question 1 of 57

1

Referred pain patterns associated with hepatic and biliary pathologic conditions produce musculoskeletal symptoms in the:

Select one of the following:

  • Left shoulder

  • Right shoulder

  • Mid-back or upper back, scapular, and right shoulder areas

  • Thorax, scapulae, right or left shoulder

Explanation

Question 2 of 57

1

Clients with significant elevations in serum bilirubin levels caused by biliary obstruction will have which of the following associated signs?

Select one of the following:

  • a. Dark urine, clay-colored stools, jaundice

  • b. Yellow-tinged sclera

  • c. Decreased serum ammonia levels

  • d. a and b only

Explanation

Question 3 of 57

1

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?

Select one of the following:

  • Decrease in serum albumin levels

  • Elevated liver enzyme levels

  • Prolonged coagulation times

  • Elevated serum bilirubin levels

Explanation

Question 4 of 57

1

Decreased level of consciousness, impaired function of peripheral nerves, and asterixis (flapping tremor) would probably indicate an increase in the level of:

Select one of the following:

  • AST (aspartate aminotransferase)

  • Alkaline phosphatase

  • Serum bilirubin

  • Serum ammonia

Explanation

Question 5 of 57

1

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:

Select one of the following:

  • Renal failure

  • Hepatic encephalopathy

  • Diabetes

  • Gallstones obstructing the common bile duct

Explanation

Question 6 of 57

1

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 therapist to the condition of decreased albumin?

Select one of the following:

  • Increased blood pressure

  • Peripheral edema and ascites

  • Decreased level of consciousness

  • Exertional dyspnea

Explanation

Question 7 of 57

1

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

Select one of the following:

  • Signifies radiculitis

  • Signifies pseudorenal pain

  • Has no significance

  • Requires medical referral

Explanation

Question 8 of 57

1

Renal pain is aggravated by:

Select one of the following:

  • Spinal movement

  • Palpatory pressure over the costovertebral angle

  • Lying on the involved side

  • All of these

  • None of these

Explanation

Question 9 of 57

1

Important functions of the kidney include all the following EXCEPT:

Select one of the following:

  • Formation and excretion of urine

  • Acid-base and electrolyte balance

  • Stimulation of red blood cell production

  • Production of glucose

Explanation

Question 10 of 57

1

Match the Definition to the Term:
Difficult or painful sexual intercourse in women ::
Painful or difficult urination ::
Blood in the urine ::
A sudden, compelling desire to urinate ::

Drag and drop to complete the text.

    Dyspareunia
    Dysuria
    Hematuria
    Urgency

Explanation

Question 11 of 57

1

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

Select one or more of the following:

  • Proximal Muscle Weakness

  • Myalgia

  • Carpal Tunnel Syndrome

  • PeriArthritis

  • Adhesive Capsulitis

  • Hematuria

  • Pursed Lip Breathing

  • Malaise

Explanation

Question 12 of 57

1

What systemic conditions can cause carpal tunnel syndrome?

Select one or more of the following:

  • Endocrine Disorders

  • Infectious Diseases

  • Collagen Disorders

  • Cancer

  • Liver Disease

  • CHF

  • Diabetes

Explanation

Question 13 of 57

1

Disorders of the endocrine glands can be caused by:

Select one of the following:

  • a. Dysfunction of the gland

  • b. External stimulus

  • c. Excess or insufficiency of hormonal secretions

  • a and b

  • b and c

  • All the above

Explanation

Question 14 of 57

1

3 Most common symptoms of Diabetes Mellitus

Select one or more of the following:

  • Polydipsia

  • Polyuria

  • Polyphagia

  • Weight Gain

  • SOB

  • Polyketosis

Explanation

Question 15 of 57

1

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

Select one of the following:

  • True
  • False

Explanation

Question 16 of 57

1

it is safe to administer a source of sugar to a lethargic or unconscious person with diabetes.

Select one of the following:

  • True
  • False

Explanation

Question 17 of 57

1

It is NOT safe to administer a source of sugar to a lethargic or unconscious person with diabetes?

Select one of the following:

  • True
  • False

Explanation

Question 18 of 57

1

Clients with diabetes insipidus (DI) would most likely come to the therapist with which of the following clinical symptoms?

Select one of the following:

  • Severe dehydration, polydipsia

  • Headache, confusion, lethargy

  • Weight gain

  • Decreased urine output

Explanation

Question 19 of 57

1

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?

Select one of the following:

  • a. Low blood pressure, hypoglycemia

  • b. Decreased bone density, muscle wasting

  • c. Slow wound healing

  • b and c

Explanation

Question 20 of 57

1

Signs and symptoms of Cushing’s syndrome in an adult taking oral steroids may include:

Select one of the following:

  • Increased thirst, decreased urination, and decreased appetite

  • Low white blood cell count and reduced platelet count

  • High blood pressure, tachycardia, and palpitations

  • Hypertension, slow wound healing, easy bruising

Explanation

Question 21 of 57

1

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

Select one of the following:

  • Increased blood pressure

  • Pathologic fractures

  • Decreased blood pressure

  • Increased thirst and urination

Explanation

Question 22 of 57

1

Which glycosylated hemoglobin (A1C) values are within the recommended range?

Select one or more of the following:

  • 4%

  • 5%

  • 6%

  • 7%

  • 8%

  • 9%

  • 10%

  • 11%

  • 12%

Explanation

Question 23 of 57

1

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?

Select one of the following:

  • Hyporeflexia but no change in strength

  • Hyporeflexia with decreased muscle strength

  • Hyperreflexia with no change in strength

  • Hyperreflexia with decreased muscle strength

Explanation

Question 24 of 57

1

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

Select one of the following:

  • Acanthosis nigricans

  • Drowsiness after meals

  • Fatigue

  • Oliguria

Explanation

Question 25 of 57

1

Fibromyalgia syndrome is a:

Select one of the following:

  • Musculoskeletal disorder

  • Psychosomatic disorder

  • Neurosomatic disorder

  • Noninflammatory rheumatic disorder

Explanation

Question 26 of 57

1

Which of the following describes the pattern of rheumatic joint disease?

Select one of the following:

  • Pain and stiffness in the morning gradually improves with gentle activity and movement during the day.

  • Pain and stiffness accelerate during the day and are worse in the evening.

  • Night pain is frequently associated with advanced structural damage seen on x-ray.

  • Pain is brought on by activity and resolves predictably with rest.

Explanation

Question 27 of 57

1

Which of the following symptoms are more indicative of osteoarthritis than rheumatoid arthritis?

Select one or more of the following:

  • Pain and stiffness in the morning gradually improves with gentle activity and movement during the day.

  • Pain and stiffness accelerate during the day and are worse in the evening.

  • Night pain is frequently associated with advanced structural damage seen on x-ray.

  • Pain is brought on by activity and resolves predictably with rest.

Explanation

Question 28 of 57

1

A positive Schober’s test is a sign of:

Select one or more of the following:

  • Reiter’s syndrome

  • Infectious arthritis

  • Ankylosing spondylitis

Explanation

Question 29 of 57

1

Proximal muscle weakness may be a sign of:

Select one or more of the following:

  • Paraneoplastic syndrome

  • Neurologic disorder

  • Myasthenia gravis

  • Scleroderma

Explanation

Question 30 of 57

1

Which of the following skin assessment findings in the HIV-infected client occurs with Kaposi’s sarcoma?

Select one of the following:

  • Darkening of the nail beds

  • Purple-red blotches or bumps on the trunk and head

  • Cyanosis of the lips and mucous membranes

  • Painful blistered lesions of the face and neck

Explanation

Question 31 of 57

1

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

Select one of the following:

  • Meningitis

  • Alzheimer’s disease

  • Space-occupying lesions

  • AIDS dementia complex

Explanation

Question 32 of 57

1

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

Select one of the following:

  • Hives and itching

  • Vocal hoarseness, sneezing, and chest tightness

  • Periorbital edema

  • Nausea and abdominal cramping

Explanation

Question 33 of 57

1

In a physical therapy practice, clients are most likely to present with signs and symptoms of metastases to:

Select one of the following:

  • Skeletal system, hepatic system, pulmonary system, central nervous system

  • Cardiovascular system, peripheral vascular system, enteric system

  • Hematologic and lymphatic systems

  • None of thse

Explanation

Question 34 of 57

1

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

Select one of the following:

  • True
  • False

Explanation

Question 35 of 57

1

Complete the CAUTIONS Mnemonic for Early Warning Signs for Cancer

C -
A -
U -
T - Thickening or lump in the breast or elsewhere
I -
O -
N -
S -

Drag and drop to complete the text.

    Changes in bowel or bladder habits
    A sore that does not heal within 6-weeks
    Unusual bleeding or discharge
    Indigestion or difficulty in swallowing
    Obvious change in a wart or mole
    Nagging cough or hoarsenss
    Supplemental signs and symptoms

Explanation

Question 36 of 57

1

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

Select one or more of the following:

  • 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?

  • Have you noticed this skin discoloration/mole/spot/lump?

  • When did this skin discoloration/mole/spot/lump first appear?

  • Do you have any other skin discoloration/moles/spots/lumps on your body?

Explanation

Question 37 of 57

1

When tumors produce signs and symptoms at a site distant from the tumor or its metastasized sites, these “remote effects” of malignancy are called:

Select one of the following:

  • Bone metastases

  • Vitiligo

  • Paraneoplastic syndrome

  • Ichthyosis

Explanation

Question 38 of 57

1

A client who has recently completed chemotherapy requires immediate medical referral if he has which of the following symptoms?

Select one of the following:

  • Decreased appetite

  • Increased urinary output

  • Mild fatigue but moderate dyspnea with exercise

  • Fever, chills, sweating

Explanation

Question 39 of 57

1

A suspicious skin lesion requiring medical evaluation has:

Select one of the following:

  • Round, symmetric borders

  • Notched edges

  • Matching halves when a line is drawn down the middle

  • A single color of brown or tan

Explanation

Question 40 of 57

1

What is the significance of Beau’s lines in a client treated with chemotherapy for leukemia?

Select one of the following:

  • Impaired nail formation from death of cells

  • Temporary longitudinal groove or ridge through the nail

  • Increased production of the nail by the matrix as a sign of healing

  • A sign of local trauma

Explanation

Question 41 of 57

1

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?

Select one or more of the following:

  • Perform a heel strike test.

  • Review response to treatment.

  • Assess for signs of fracture (edema, exquisite tenderness to palpation, warmth over the painful site).

Explanation

Question 42 of 57

1

When is it advised to take a work or military history?

Select one of the following:

  • Anyone with head and/or neck pain who uses a cell phone more than 8 hours/day

  • Anyone over age 50

  • Anyone presenting with joint pain of unknown cause accompanied by multiple other signs and symptoms

  • This is outside the scope of a physical therapist’s practice

Explanation

Question 43 of 57

1

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?

Select one of the following:

  • Ask about a previous history of cancer and recent onset of skin rash.

  • You can’t. This requires a medical evaluation.

  • Look for signs of digital clubbing, cellulitis, or proximal muscle weakness.

  • Assess vital signs.

Explanation

Question 44 of 57

1

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?

Select one of the following:

  • Yes; age, bilateral symptoms, progression of symptoms, report of GI distress

  • No; treatment was effective before—it’s likely that he has done something to exacerbate his symptoms and needs further education about joint protection.

Explanation

Question 45 of 57

1

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?

Select one of the following:

  • Fever, muscle weakness, weight loss

  • Change in deep tendon reflexes, bone pain

  • Productive cough, pain on inspiration

  • Nose bleeds or other signs of excessive bleeding

Explanation

Question 46 of 57

1

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?

Select one of the following:

  • Examine other areas where lymph nodes can be palpated.

  • Ask about history of cancer, allergies, or infections.

  • Document your findings and contact the physician with your concerns.

  • All of these

Explanation

Question 47 of 57

1

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

Select one of the following:

  • Neck and back

  • Shoulder and back

  • Chest and back

  • None of these

Explanation

Question 48 of 57

1

To screen for back pain caused by systemic disease:

Select one of the following:

  • Perform special tests (e.g., Murphy’s percussion, Bicycle test)

  • Correlate client history with clinical presentation and ask about associated signs and symptoms

  • Perform a Review of Systems

  • All of the above

Explanation

Question 49 of 57

1

Which statement is the most accurate?

Select one of the following:

  • Arterial disease is characterized by intermittent claudication, pain relieved by elevating the extremity, and history of smoking.

  • 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.

  • Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed.

  • 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.

Explanation

Question 50 of 57

1

Pain associated with pleuropulmonary disorders can radiate to:

Select one of the following:

  • a. Anterior neck

  • b. Upper trapezius muscle

  • c. Ipsilateral shoulder

  • d. Thoracic spine

  • A. and C.

  • B. and C.

  • B., C., and D.

  • A., B., C., and D.

Explanation

Question 51 of 57

1

Which of the following are clues to the possible involvement of the GI system?

Select one of the following:

  • Abdominal pain alternating with TMJ pain within a 2-week period of time

  • Abdominal pain at the same level as back pain occurring either simultaneously or alternately

  • Shoulder pain alleviated by a bowel movement

  • All of these

Explanation

Question 52 of 57

1

Percussion of the costovertebral angle resulting in the reproduction of symptoms signifies:

Select one of the following:

  • Radiculitis

  • Pseudorenal pain

  • Has no significance

  • Medical referral is advised

Explanation

Question 53 of 57

1

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:

Select one of the following:

  • Sore, hurting

  • Hot or burning

  • Shooting or stabbing

  • Throbbing, “tired”

Explanation

Question 54 of 57

1

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.

Select one of the following:

  • True
  • False

Explanation

Question 55 of 57

1

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.

Select one of the following:

  • True
  • False

Explanation

Question 56 of 57

1

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

Select one of the following:

  • True
  • False

Explanation

Question 57 of 57

1

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

Select one of the following:

  • True
  • False

Explanation

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