USA - Differential Diagnosis - Units 1-4 and 6-8

Ben Williams
Quiz by Ben Williams, updated more than 1 year ago
Ben Williams
Created by Ben Williams over 3 years ago
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Description

All Questions and Answers taken directly from the textbook publisher's website: http://www.differentialdiagnosisforpt.com/

Resource summary

Question 1

Question
In the context of screening for referral, primary purpose of a diagnosis is:
Answer
  • To obtain reimbursement
  • To guide the plan of care and intervention strategies
  • To practice within the scope of physical therapy
  • To meet the established standards for accreditation

Question 2

Question
Direct access is the only reason physical therapists must screen for systemic disease.
Answer
  • True
  • False

Question 3

Question
A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is:
Answer
  • What did the physician (dentist, chiropractor) say is the problem?
  • Did the physician (dentist, chiropractor) examine you?
  • When do you go back to see the doctor (dentist, chiropractor)?
  • How many times per week did the doctor (dentist, chiropractor) suggest you come to therapy?

Question 4

Question
Screening for medical disease takes place:
Answer
  • Only during the first interview
  • Just before the client returns to the physician for his/her next appointment
  • Throughout the episode of care
  • None of these

Question 5

Question
Physical therapists are qualified to make a human movement system diagnosis regarding primary neuromusculoskeletal conditions, but we must do so in accordance with:
Answer
  • The Guide to Physical Therapist Practice
  • The State Practice Act
  • The screening process
  • The SOAP method

Question 6

Question
Medical referral for a problem outside the scope of the physical therapy practice occurs when:
Answer
  • No apparent movement dysfunction exists
  • No causative factors can be identified
  • Findings are not consistent with neuromuscular or musculoskeletal dysfunction
  • Client presents with suspicious red-flag symptoms
  • Any one of these
  • None of these

Question 7

Question
Physical therapy evaluation and intervention may be part of the physician’s differential diagnosis.
Answer
  • True
  • False

Question 8

Question
What is the effect of NSAIDs (e.g., Naprosyn, Motrin, Anaprox, ibuprofen) on blood pressure?
Answer
  • No effect
  • Increases blood pressure
  • Decreases blood pressure

Question 9

Question
Most of the information needed to determine the cause of symptoms is contained in the:
Answer
  • Subjective examination
  • Family/Personal History Form
  • Objective information
  • All of these
  • Subjective Examination and Objective Information

Question 10

Question
A risk factor for NSAID-related gastropathy is the use of:
Answer
  • Antibiotics
  • Antidepressants
  • Antihypertensives
  • Antihistamines

Question 11

Question
After interviewing a new client, you summarize what she has told you by saying, “You told me you are here because of right neck and shoulder pain that began 5 years ago as a result of a car accident. You also have a ‘pins and needles’ sensation in your third and fourth fingers but no other symptoms at this time. You have noticed a considerable decrease in your grip strength, and you would like to be able to pick up a pot of coffee without fear of spilling it.” This is an example of:
Answer
  • An open-ended question
  • A funnel technique
  • A paraphrasing technique
  • None of these

Question 12

Question
Screening for alcohol use would be appropriate when the client reports a history of accidents.
Answer
  • True
  • False

Question 13

Question
What is the significance of sweats?
Answer
  • A sign of systemic disease
  • Side effect of chemotherapy or other medications
  • Poor ventilation while sleeping
  • All of these
  • None of these

Question 14

Question
Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral.
Answer
  • True
  • False

Question 15

Question
Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and symptoms:
Answer
  • Fever, (night) sweats, dizziness
  • Symptoms are out of proportion to the injury
  • Insidious onset
  • No position is comfortable
  • All of these

Question 16

Question
You should assess clients who are receiving NSAIDs for which physiologic effect associated with increased risk of hypertension?
Answer
  • Decreased heart rate
  • Increased diuresis
  • Slowed peristalsis
  • Water retention

Question 17

Question
Instruct clients with a history of hypertension and arthritis to:
Answer
  • Limit physical activity and exercise
  • Avoid over-the-counter medications
  • Inform their primary care provider of both conditions
  • Drink plenty of fluids to avoid edema

Question 18

Question
Alcohol screening tools should be:
Answer
  • Used with every client sometime during the episode of care
  • Brief, easy to administer, and nonthreatening
  • Deferred when the client has been drinking or has the smell of alcohol on the breath
  • Conducted with one other family member present as a witness

Question 19

Question
What is the best follow-up question for someone who tells you that the pain is constant?
Answer
  • Can you use one finger to point to the pain location?
  • Do you have that pain right now?
  • Does the pain wake you up at night after you have fallen asleep?
  • Is there anything that makes the pain better or worse?

Question 20

Question
A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After asking a series of follow-up questions, you are able to determine that she had trouble falling asleep because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the most likely explanation for this pain behavior?
Answer
  • Minimal distractions heighten a person’s awareness of musculoskeletal discomfort.
  • This is a systemic pattern that is associated with a neoplasm.
  • It is impossible to tell.
  • This represents a chronic clinical presentation of a musculoskeletal problem.

Question 21

Question
Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in:
Answer
  • The left shoulder
  • The right shoulder
  • The mid-back or upper back, scapular, and right shoulder areas
  • The thorax, scapulae, right shoulder, or left shoulder

Question 22

Question
Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain.
Answer
  • True
  • False

Question 23

Question
Words used to describe neurogenic pain often include:
Answer
  • Throbbing, pounding, beating
  • Crushing, shooting, pricking
  • Aching, heavy, sore
  • Agonizing, piercing, unbearable

Question 24

Question
Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:
Answer
  • Neoplasm
  • Assault or trauma
  • Drug dependence
  • Fracture

Question 25

Question
Joint pain can be a reactive, delayed, or allergic response to:
Answer
  • Medications
  • Chemicals
  • Infections
  • Artificial sweeteners
  • All of these

Question 26

Question
Bone pain associated with neoplasm is characterized by:
Answer
  • Increases with weight bearing
  • Negative heel strike
  • Relieved by Tums or other antacid in women
  • Goes away after eating

Question 27

Question
Pain of a viscerogenic nature is not relieved by a change in position.
Answer
  • True
  • False

Question 28

Question
Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved.
Answer
  • True
  • False

Question 29

Question
A 48-year old man presented with low back pain of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps (accidents and falls), and engages in repetitive motions of all kinds using his arms, back, and legs. The pain is intense when he has it, but it seems to come and go. He is not sure if eating makes the pain better or worse. He has lost his appetite because of the pain. After conducting an examination including a screening exam, the clinical presentation does not match the expected pattern for a musculoskeletal or neuromuscular problem. You refer him to a physician for medical testing. You find out later he had pancreatitis. What is the most likely explanation for this pain pattern?
Answer
  • Toxic waste products from the pancreas are released into the intestines causing irritation of the retroperitoneal space.
  • Rupture of the pancreas causes internal bleeding and referred pain called Kehr’s sign.
  • The pancreas and low back structures are formed from the same embryologic tissue in the mesoderm.
  • Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm.

Question 30

Question
When assessing the abdomen, what sequence of physical assessment is best? 1.) [blank_start]Inspection[blank_end] 2.) [blank_start]Auscultation[blank_end] 3.) [blank_start]Percussion[blank_end] 4.) [blank_start]Palpation[blank_end]
Answer
  • Inspection
  • Auscultation
  • Percussion
  • Palpation

Question 31

Question
A line drawn down the middle of a lesion with two different halves suggests:
Answer
  • A malignant lesion
  • A benign lesion
  • A normal presentation
  • A skin reaction to medications

Question 32

Question
Pulse strength graded as 1 means:
Answer
  • Easily palpable, normal
  • Present occasionally
  • Pulse diminished, barely palpable
  • Within normal limits

Question 33

Question
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:
Answer
  • Characteristic of lung disease
  • Typical in coronary artery disease
  • A normal finding
  • Common in anyone with pain

Question 34

Question
Body temperature should be taken as part of vital sign assessment:
Answer
  • 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
  • B.) and C.)
  • All of the above

Question 35

Question
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?
Answer
  • Vital signs only.
  • Vital signs and abdominal auscultation.
  • Vital signs, neurologic screening examination, and abdominal auscultation.
  • No further assessment is needed; there are enough red flags to advise this client to seek medical attention.

Question 36

Question
Pursed-lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with:
Answer
  • Orthopnea
  • Emphysema
  • CHF
  • Orthopnea and CHF

Question 37

Question
Palpitations lasting for hours or occurring in association with pain, shortness of breath, fainting, or severe lightheadedness require medical evaluation.
Answer
  • True
  • False

Question 38

Question
Peripheral vascular diseases include:
Answer
  • Arterial and occlusive diseases
  • Arterial and venous disorders
  • Acute and chronic arterial diseases
  • All of these
  • None of these

Question 39

Question
Which statement is the most accurate?
Answer
  • 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 and 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.

Question 40

Question
What are the primary signs and symptoms of CHF?
Answer
  • Fatigue
  • Dyspnea
  • Edema
  • Nocturia
  • Varicose Veins
  • Tinnitus
  • Headache
  • Night Sweats

Question 41

Question
When would you advise a client in physical therapy to take his/her nitroglycerin?
Answer
  • 45 minutes before exercise
  • When symptoms of chest pain do not subside with 10 to 15 minutes of rest
  • As soon as chest pain begins
  • None of the above
  • Any of the above

Question 42

Question
Neurologic symptoms such as muscle weakness or muscle atrophy may be the first indication of:
Answer
  • Cystic fibrosis
  • Bronchiectasis
  • Neoplasm
  • Deep vein thrombosis

Question 43

Question
Back pain with radiating numbness and tingling down the leg past the knee does not occur as a result of:
Answer
  • Postoperative thrombus
  • Bronchogenic carcinoma
  • Pott’s disease
  • Trigger points

Question 44

Question
Pain associated with pleuropulmonary disorders can radiate to the:
Answer
  • Anterior Neck
  • Upper Trapezius Muscle
  • Ipsilateral Shoulder
  • Thoracic Spine

Question 45

Question
The presence of a persistent dry cough (no sputum or phlegm produced) has no clinical significance to the therapist.
Answer
  • True
  • False

Question 46

Question
Dyspnea associated with emphysema is the result of:
Answer
  • A.) Destruction of the alveoli
  • B.) Reduced elasticity of the lungs
  • C.) Increased effort to exhale trapped air
  • A.) and B.)
  • All of the above

Question 47

Question
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?
Answer
  • Increase
  • Decrease
  • Remain unchanged
  • Vary depending on potassium concentration

Question 48

Question
Common symptoms of RESPIRATORY ACIDOSIS would be most closely represented by which of the following descriptions?
Answer
  • Presence of numbness and tingling in face, hands, and feet
  • Presence of dizziness and lightheadedness
  • Hyperventilation with changes in level of consciousness
  • Onset of sleepiness, confusion, and decreased ventilation

Question 49

Question
Bleeding in the gastrointestinal (GI) tract can be manifested as:
Answer
  • Dysphagia
  • Melena
  • Psoas abscess
  • Tenderness over McBurney’s point

Question 50

Question
What is the significance of Kehr’s sign?
Answer
  • Gas, air, or blood in the abdominal cavity
  • Infection of the peritoneum (peritonitis, appendicitis)
  • Esophageal cancer
  • Thoracic disk herniation masquerading as chest or anterior neck pain

Question 51

Question
What areas of the body can GI disorders refer pain to?
Answer
  • Sternum
  • Shoulder
  • Scapula
  • Anterior Neck
  • Mid-Back
  • Lower Back
  • Hip
  • Pelvis
  • Sacrum

Question 52

Question
A 56-year-old client was referred to PT for pelvic floor rehab. His primary symptoms are obstructed defecation and puborectalis muscle spasm. He wakes nightly with left flank pain. The pattern is low thoracic, laterally, but superior to iliac crest. Sometimes he has buttock pain on the same side. He doesn’t have any daytime pain but is up for several hours at night. Advil and light activity do not help much. The pain is relieved or decreased with passing gas. He has very tight hamstrings and rectus femoris. Change in symptoms with gas or defecation is possible with:
Answer
  • Thoracic disk disease
  • Obturator nerve compression
  • Small intestine disease
  • Large intestine and colon dysfunction

Question 53

Question
Which of the following are common medications, taken by clients seen in a physical therapy practice, that are likely to induce GI bleeding.
Answer
  • Corticosteroids
  • Antibiotics and antiinflammatories
  • Statins
  • None of these

Question 54

Question
Which of the following are clues to the possible involvement of the GI system?
Answer
  • Abdominal pain alternating with TMJ pain within a 2-week period
  • Abdominal pain at the same level as back pain, occurring either simultaneously or alternately
  • Shoulder pain alleviated by a bowel movement
  • All of these

Question 55

Question
A 65-year-old client is taking OxyContin for a “sore shoulder.” She also reports aching pain of the sacrum that radiates. The sacral pain can be caused by:
Answer
  • Psoas abscess caused by vertebral osteomyelitis
  • GI bleeding causing hemorrhoids and rectal fissures
  • Crohn’s disease manifested as sacroiliitis
  • Pressure on sacral nerves from stored fecal content in the constipated client taking narcotics

Question 56

Question
Body temperature should be taken as part of vital sign assessment:
Answer
  • a. For every client evaluated
  • b. For any client who has musculoskeletal pain of unknown origin
  • c. For any client reporting the presence of constitutional symptoms, especially fever or night sweats
  • d. b and c
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