USA - Differential Diagnosis - Units 9-14

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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End of Chapter Review Questions

Resource summary

Question 1

Question
Referred pain patterns associated with hepatic and biliary pathologic conditions produce musculoskeletal symptoms in the:
Answer
  • Left shoulder
  • Right shoulder
  • Mid-back or upper back, scapular, and right shoulder areas
  • Thorax, scapulae, right or left shoulder

Question 2

Question
Clients with significant elevations in serum bilirubin levels caused by biliary obstruction will have which of the following associated signs?
Answer
  • a. Dark urine, clay-colored stools, jaundice
  • b. Yellow-tinged sclera
  • c. Decreased serum ammonia levels
  • d. a and b only

Question 3

Question
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?
Answer
  • Decrease in serum albumin levels
  • Elevated liver enzyme levels
  • Prolonged coagulation times
  • Elevated serum bilirubin levels

Question 4

Question
Decreased level of consciousness, impaired function of peripheral nerves, and asterixis (flapping tremor) would probably indicate an increase in the level of:
Answer
  • AST (aspartate aminotransferase)
  • Alkaline phosphatase
  • Serum bilirubin
  • Serum ammonia

Question 5

Question
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:
Answer
  • Renal failure
  • Hepatic encephalopathy
  • Diabetes
  • Gallstones obstructing the common bile duct

Question 6

Question
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?
Answer
  • Increased blood pressure
  • Peripheral edema and ascites
  • Decreased level of consciousness
  • Exertional dyspnea

Question 7

Question
Percussion of the costovertebral angle that results in the reproduction of symptoms:
Answer
  • Signifies radiculitis
  • Signifies pseudorenal pain
  • Has no significance
  • Requires medical referral

Question 8

Question
Renal pain is aggravated by:
Answer
  • Spinal movement
  • Palpatory pressure over the costovertebral angle
  • Lying on the involved side
  • All of these
  • None of these

Question 9

Question
Important functions of the kidney include all the following EXCEPT:
Answer
  • Formation and excretion of urine
  • Acid-base and electrolyte balance
  • Stimulation of red blood cell production
  • Production of glucose

Question 10

Question
Match the Definition to the Term: Difficult or painful sexual intercourse in women :: [blank_start]Dyspareunia[blank_end] Painful or difficult urination :: [blank_start]Dysuria[blank_end] Blood in the urine :: [blank_start]Hematuria[blank_end] A sudden, compelling desire to urinate :: [blank_start]Urgency[blank_end]
Answer
  • Dyspareunia
  • Dysuria
  • Hematuria
  • Urgency

Question 11

Question
What are the most common musculoskeletal symptoms associated with endocrine disorders?
Answer
  • Proximal Muscle Weakness
  • Myalgia
  • Carpal Tunnel Syndrome
  • PeriArthritis
  • Adhesive Capsulitis
  • Hematuria
  • Pursed Lip Breathing
  • Malaise

Question 12

Question
What systemic conditions can cause carpal tunnel syndrome?
Answer
  • Endocrine Disorders
  • Infectious Diseases
  • Collagen Disorders
  • Cancer
  • Liver Disease
  • CHF
  • Diabetes

Question 13

Question
Disorders of the endocrine glands can be caused by:
Answer
  • a. Dysfunction of the gland
  • b. External stimulus
  • c. Excess or insufficiency of hormonal secretions
  • a and b
  • b and c
  • All the above

Question 14

Question
3 Most common symptoms of Diabetes Mellitus
Answer
  • Polydipsia
  • Polyuria
  • Polyphagia
  • Weight Gain
  • SOB
  • Polyketosis

Question 15

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

Question 16

Question
it is safe to administer a source of sugar to a lethargic or unconscious person with diabetes.
Answer
  • True
  • False

Question 17

Question
It is NOT safe to administer a source of sugar to a lethargic or unconscious person with diabetes?
Answer
  • True
  • False

Question 18

Question
Clients with diabetes insipidus (DI) would most likely come to the therapist with which of the following clinical symptoms?
Answer
  • Severe dehydration, polydipsia
  • Headache, confusion, lethargy
  • Weight gain
  • Decreased urine output

Question 19

Question
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?
Answer
  • a. Low blood pressure, hypoglycemia
  • b. Decreased bone density, muscle wasting
  • c. Slow wound healing
  • b and c

Question 20

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

Question 21

Question
Parathyroid hormone (PTH) secretion is particularly important in the metabolism of bone. The client with an oversecreting parathyroid gland would most likely have:
Answer
  • Increased blood pressure
  • Pathologic fractures
  • Decreased blood pressure
  • Increased thirst and urination

Question 22

Question
Which glycosylated hemoglobin (A1C) values are within the recommended range?
Answer
  • 4%
  • 5%
  • 6%
  • 7%
  • 8%
  • 9%
  • 10%
  • 11%
  • 12%

Question 23

Question
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?
Answer
  • Hyporeflexia but no change in strength
  • Hyporeflexia with decreased muscle strength
  • Hyperreflexia with no change in strength
  • Hyperreflexia with decreased muscle strength

Question 24

Question
All of the following are common signs or symptoms of insulin resistance except:
Answer
  • Acanthosis nigricans
  • Drowsiness after meals
  • Fatigue
  • Oliguria

Question 25

Question
Fibromyalgia syndrome is a:
Answer
  • Musculoskeletal disorder
  • Psychosomatic disorder
  • Neurosomatic disorder
  • Noninflammatory rheumatic disorder

Question 26

Question
Which of the following describes the pattern of rheumatic joint disease?
Answer
  • 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.

Question 27

Question
Which of the following symptoms are more indicative of osteoarthritis than rheumatoid arthritis?
Answer
  • 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.

Question 28

Question
A positive Schober’s test is a sign of:
Answer
  • Reiter’s syndrome
  • Infectious arthritis
  • Ankylosing spondylitis

Question 29

Question
Proximal muscle weakness may be a sign of:
Answer
  • Paraneoplastic syndrome
  • Neurologic disorder
  • Myasthenia gravis
  • Scleroderma

Question 30

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

Question 31

Question
The most common cause of change in mental status of the HIV-infected client is related to:
Answer
  • Meningitis
  • Alzheimer’s disease
  • Space-occupying lesions
  • AIDS dementia complex

Question 32

Question
Symptoms of anaphylaxis that would necessitate immediate medical treatment or referral are:
Answer
  • Hives and itching
  • Vocal hoarseness, sneezing, and chest tightness
  • Periorbital edema
  • Nausea and abdominal cramping

Question 33

Question
In a physical therapy practice, clients are most likely to present with signs and symptoms of metastases to:
Answer
  • Skeletal system, hepatic system, pulmonary system, central nervous system
  • Cardiovascular system, peripheral vascular system, enteric system
  • Hematologic and lymphatic systems
  • None of thse

Question 34

Question
In any individual, any neurologic sign may be the presentation of a silent lung tumor.
Answer
  • True
  • False

Question 35

Question
Complete the CAUTIONS Mnemonic for Early Warning Signs for Cancer C - [blank_start]Changes in bowel or bladder habits[blank_end] A - [blank_start]A sore that does not heal within 6-weeks[blank_end] U - [blank_start]Unusual bleeding or discharge[blank_end] T - Thickening or lump in the breast or elsewhere I - [blank_start]Indigestion or difficulty in swallowing[blank_end] O - [blank_start]Obvious change in a wart or mole[blank_end] N - [blank_start]Nagging cough or hoarsenss[blank_end] S - [blank_start]Supplemental signs and symptoms[blank_end]
Answer
  • 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

Question 36

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

Question 37

Question
When tumors produce signs and symptoms at a site distant from the tumor or its metastasized sites, these “remote effects” of malignancy are called:
Answer
  • Bone metastases
  • Vitiligo
  • Paraneoplastic syndrome
  • Ichthyosis

Question 38

Question
A client who has recently completed chemotherapy requires immediate medical referral if he has which of the following symptoms?
Answer
  • Decreased appetite
  • Increased urinary output
  • Mild fatigue but moderate dyspnea with exercise
  • Fever, chills, sweating

Question 39

Question
A suspicious skin lesion requiring medical evaluation has:
Answer
  • Round, symmetric borders
  • Notched edges
  • Matching halves when a line is drawn down the middle
  • A single color of brown or tan

Question 40

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

Question 41

Question
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?
Answer
  • Perform a heel strike test.
  • Review response to treatment.
  • Assess for signs of fracture (edema, exquisite tenderness to palpation, warmth over the painful site).

Question 42

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

Question 43

Question
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?
Answer
  • 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.

Question 44

Question
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?
Answer
  • 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.

Question 45

Question
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?
Answer
  • 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

Question 46

Question
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?
Answer
  • 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

Question 47

Question
The most common sites of referred pain from systemic diseases are:
Answer
  • Neck and back
  • Shoulder and back
  • Chest and back
  • None of these

Question 48

Question
To screen for back pain caused by systemic disease:
Answer
  • 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

Question 49

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, 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 50

Question
Pain associated with pleuropulmonary disorders can radiate to:
Answer
  • 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.

Question 51

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 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

Question 52

Question
Percussion of the costovertebral angle resulting in the reproduction of symptoms signifies:
Answer
  • Radiculitis
  • Pseudorenal pain
  • Has no significance
  • Medical referral is advised

Question 53

Question
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:
Answer
  • Sore, hurting
  • Hot or burning
  • Shooting or stabbing
  • Throbbing, “tired”

Question 54

Question
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.
Answer
  • True
  • False

Question 55

Question
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.
Answer
  • True
  • False

Question 56

Question
Autosplinting is the preferred mechanism of pain relief for back pain caused by kidney stones.
Answer
  • True
  • False

Question 57

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