Exam 1: Case Studies/Misc

Question 1

Why might a pt have a mechanical pattern of LBP associated with an infection?

Answer 1

pus pocket or something else that might be causing pressure in the spine or nerve roots during movement

Question 2

What is the significance of a pt having had a partial hysterectomy?

Answer 2

Only takes out uterus, so hormones are still there

Question 3

c/c LBP with B leg pain (R more than L) suggests…

Answer 3

possible central stenosis

Question 4

If you suspect a pt has a dx of central stenosis, but they haven’t had a medical dx, what should you do?

Answer 4

We can treat this dx, but it would be a good idea to refer her for a formal medical dx

Question 5

What is Synthroid commonly used for?

Answer 5

• HYPOTHYROIDISM
• enlarged glands
• thyroid cancer

Question 6

What should you find out with a diabetic pt?

Answer 6

• controlled by meds or diet?
• blood sugar levels?
• regularly monitored by doc?

Question 7

What should you find out with a cancer pt?

Answer 7

• What type

- How long ago?

Question 8

When might cancer present with a mechanical pattern of agg/ease factors?

Answer 8

• Pain may be intermittent if early in the process

- Size of mass could potentially allow the pt to take pressure off of a tumor by changing position

Question 9

SINSS

Answer 9

Severity
Irritability
Nature
Stage
Stability

Question 10

SINSS:

Severity

Answer 10

pain rating: mild, mod, severe

Question 11

SINSS:

Irritability

Answer 11

Think T1, T2, T3

How long it lingers

Question 12

SINSS:

Nature - courses of action

Answer 12

• Refer for nonmusculoskeletal
• treat for neuromusculoskeletal
• treat and refer for something MSK, but there’s something else going on that another provider should know about

Question 13

SINSS:

Stage (what are they?)

Answer 13

• Acute
• Subacute
• Chronic
• Acute on chronic

Question 14

SINSS:

Stability

Answer 14

overall, is their problem better, worse, or the same?

Question 15

What are the screening questions for depression?

Answer 15

1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?
2. During the past month, have you often been bothered by little interest or pleasure in doing things?

Question 16

Your pt is a long distance truck driver. Name at least 2 risk factors associated with this occupation.

Answer 16

1. Constant low frequency whole-body vibration (e.g. driving)
2. Heavy or frequent lifting
3. Prolonged or frequent bending or lifting
4. Postural stresses (high spinal loads or awkward postures)

Question 17

Which areas should be cleared bilaterally with a pt with one-sided LBP?

Answer 17

• low thoracic
• lumbar
• abdomen
• anterior thigh
• groin
• calves
• feet

*ask about pain ratings and any N/T in any of the screened areas

Question 18

You pt had 6/10 pain on admission and now two weeks later he reports 4/10. Has he improved?

Answer 18

Yes, MCID is 2 points for NPRS

Question 19

A homemaker can’t think of any reason for her recent onset of LBP. How can you question her further about activities that might have led to the development of LBP (write a question or two)?

Answer 19

1. Any changes in activity?

2. What is your typical day like?

Question 20

A pt reports her pain worsens in standing and prone. What is the likely mechanical analysis/implication of these agg factors?

Answer 20

• Extension worsens symptoms

- Possible stenosis or flexion directional preference

Question 21

Why does a PT care about a patient’s self-assessment of his or her overall health status?

Answer 21

• Helps determine prognosis

- poor perception = poor prognosis