Exam 1: Week 1 and Goodman Snyder chap 1-4

Question 1

What is AAA?

Answer 1

abdominal aortic aneurysm

An enlarged area in the lower part of the aorta. AAA often grows slowly and usually without symptoms, making them difficult to detect.

Symptoms: A pulsating feeling near the navel, deep and constant pain in your abdomen or on the side of your abdomen, Back pain

Question 2

In the context of screening for referral the primary purpose of a diagnosis is a. to obtain reimbursement b. to guide the plan of care and intervention strategies c. to practice within the scope of physical therapy d. to meet the established standards for accreditation

Answer 2

b

Question 3

A patient gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is a. What did that person say is the problem b. Did they examine you? c. When d you go back d. How many times per week did they suggest I see you??

Answer 3

b

Question 4

True or False: Physical therapy evaluation and intervention may be part of the physician’s differential diagnosis.

Answer 4

True

Question 5

What is the difference between a yellow and red flag?

Answer 5

Red – warning of something more serious

Yellow – caution – slow down and think about possible further screening/referral

You are looking for a pattern that suggests a viscerogenic or systemic origin of pain and/or symptoms

Question 6

6 red flags that suggest the need for further screening (what class said during class)

Answer 6

• Night pain
• Change in weight
• Bowel and bladder issues
• Intractable pain
• Difficulty swallowing
• No change with conservative treatment

Question 7

What are the levels of disease prevention? (4)

Answer 7

1. Primary prevention – stopping the processes that lead to disease and illness through identification, education, risk factor reduction, health promotion
2. Secondary prevention – medical screening tests (blood work, colonoscopy)
3. Tertiary prevention – limiting degree of disability, improving function
4. Health promotion and wellness – giving people greater awareness and control in making health choices

Question 8

6 guidelines for effective communication

Answer 8

1. Information giving – explain as you go. Why are you asking personal questions, or questions that seem unrelated to the CC?
2. Information seeking – your patient is there because they have a health concern
3. Partnership building – your care/advice must persist after the patient leaves you. Do they understand what they need to do to get better?
4. Never speak badly about other providers to patients
5. Being disrespectful and condescending to patients results in high malpractice rates
6. Speaking positively reassures patient of good care

Question 9

The 5 elements of patient/client management for PTs

Answer 9

1. Examination- history, systems review, tests, and measures
2. Evaluation- assessment or judgement of the data
3. Diagnosis- determined within the scope of practice
4. Prognosis- projected outcome
5. Intervention- coordination, communication, and documentation of an appropriate treatment plan for the diagnosis based on the previous 4 elements.

Question 10

When does a PT screen their patient for differential diagnosis and/or red flags?

Answer 10

It is an ongoing process throughout the patient’s course of care

Question 11

Definition of primary care

Answer 11

the coordinated, comprehensive, and personal care provided on a first-contact and continuous basis

Question 12

Guidelines for immediate medical attention (10)

Answer 12

1. Anginal pain not relieved by medication with 20 min
2. Angina with nausea, vomiting, profuse sweating
3. bowel/bladder incontinence and/or saddle anesthesia
4. anaphylactic shock
5. inadequate ventilation or CO2 retention
6. diabetic who is confused or lethargic or has changes in mentation
7. Positive McBurney’s point or rebound tenderness
8. worsening symptoms of intermittent claudication
9. Throbbing chest, back, or abdominal pain that increases with exertion accompanied by a sensation of a heartbeat when lying down and a palpable pulsating abdominal mass
10. changes in size, shape, tenderness, and consistency of lymph nodes.

Question 13

What are the major decision making tools used in the screening process? (5)

Answer 13

1. Past medical Hx
2. Risk Factor Assessment
3. Clinical Presentation (pain types and pain patterns)
4. Associated signs and symptoms
5. Review of systems

*Each client can be framed by these 5 components.

Question 14

5 F’s associated with gall stones

Answer 14

• Fat
• Fair
• Female
• Forty
• Flatulent

Question 15

What is the effect of NSAIDs on blood pressure?

a. no effect
b. increases blood pressure
c. decreases blood pressure

Answer 15

b

Question 16

With what final question should you always end your interview?

Answer 16

Options

1. Are any other symptoms of any kind anywhere else in your body that we haven’t discussed yet?
2. Is there anything else you think is important about your condition that we have not discussed yet?
3. Is there anything else you think I should know?

Question 17

What is the significance of night sweats?

a. a sign of systemic disease
b. side effect of chemotherapy or other medications
c. poor ventilation while sleeping
d. all of the above
e. none of the above

Answer 17

d

Question 18

6 components of patient centered interview

Answer 18

1. Explore patient’s disease/diagnosis and its effect on his or her life
2. Understanding the whole person (patient’s goals)
3. Finding common ground for intervention and/or management
4. advocate prevention and health promotion (patient’s perception)
5. Enhancing patient- provider relationship (improves outcomes)
6. Providing realistic expectations

Question 19

Common interview deficiencies

Answer 19

• Low therapeutic content
• Inattention to primary data (symptoms)
• High control style by provider
• Incomplete database usually omitting patient centered problems

Question 20

True or False: Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral.

Answer 20

True

Question 21

Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and symptoms: a. fever, night sweats, dizziness

b. symptoms are out of proportion to the injury
c. insidious outset
d. no position is comfortable
e. all of the above

Answer 21

e

Question 22

You should assess patients who are receiving NSAIDS for which physiologic effect associated with increased risk of hypertension?

a. decreased heart rate
b. increased diuresis (peeing too much)
c. slowed peristalsis (the contraction/relaxation of intestines)
d. water retention

Answer 22

d Water retention. look for sacral and pedal edema

Question 23

Instruct patients with a history of hypertension and arthritis to:

a. limit physical activity and exercise
b. avoid OTC meds
c. Inform PCP provider of both conditions
d. drink plenty of fluids to avoid edema

Answer 23

c

Question 24

Alcohol screening tools should be:

a. used with every client some time during the episode of care
b. brief, easy to administer, and non-threatening
c. deferred when the client has been drinking or has the smell of alcohol on his breath
d. conducted with one other family member present as a witness

Answer 24

b

Question 25

What is the best follow up question for someone who tells you their pain is constant?

a. Can you use one finger to point to the pain location?
b. Do you have that pain right now?
c. Does the pain wake you up at night after you have fallen asleep?
d. Is there anything that makes the pain better or worse?

Answer 25

b

Question 26

52-year old woman has difficulty falling asleep due to pain and wakes as soon as she rolls to the painful side. What is the most likely explanation for this pain behavior?

a. minimal distractions heighten a person’s awareness of musculoskeletal discomfort.
b. This is a systemic pattern that is associated with a neoplasm
c. It is impossible to tell
d. This represents a chronic clinical presentation of a musculoskeletal problem

Answer 26

a

Pain with neoplasm will most likely wake a patient up after having fallen asleep Chronic musculoskeletal conditions will often allow patient to fall asleep if properly positioned for up to an hour or two before pressure and ischemia to the tissue develop and cause pain.

Question 27

Referred pain patterns associated with impairment of the spleen can produce musculoskeletal in:

a. left shoulder
b. right shoulder
c. mid or upper back, scapular, and right shoulder areas
d. thorax, scapulae, right, or left shoulder areas

Answer 27

a

Kehr’s sign with pain referred to left shoulder

Question 28

True or False: Associated signs and symptoms are a major red flag fr pain of a systemic or visceral origin compared to musculoskeletal pain.

Answer 28

True

Question 29

Words used to describe neurogenic pain often include:

a. throbbing, pounding, beating
b. crushing, shooting, pricking
c. aching, heavy, sore
d. agonizing, heavy, sore

Answer 29

b

Question 30

Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:

a. neoplasm
b. assault or trauma
c. drug dependence
d. fracture

Answer 30

a

in particular bone cancer

Question 31

Joint pain can be reactive, delayed, or allergic response to:

a. medications
b. chemicals
c. infections
d. artificial sweeteners
e. all of the above

Answer 31

e

Question 32

Bone pain associated with neoplasm is characterized by:

a. increases with weight bearin
b. negative heel strike
c. relieved by Tume or other antacid in women
d. goes away after eating

Answer 32

a

• bone pain would be accompanied by a positive heel strike test
• symptoms of angina are sometimes relieved by antacids in women

Question 33

True or False: Pain of a viscerogenic nature is not relieved by a change in position.

Answer 33

False

Question 34

True or False: Referred pain from the viscera can occur alone, but is usually preceded by visceral pain when an organ is involved.

Answer 34

True