Multi-Systems Management [Unit 1] Flashcards by Kabre Madrigal

In the context of screening for referral, the primary purpose of a diagnosis is to:
a. Obtain reimbursement
b. Guide the plan of care and intervention strategies
c. Practice within the scope of Pt
d. Meet established standards for accreditation

b. Guide the plan of care and intervention strategies

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Direct access is the only reason PTs must screen for systemic disease, true or false?

False

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

b. Did the physician examine you?

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Screening for medical disease takes place:
a. Only during the first interview
b. Just before the client returns to the physician for his/her next appointment
c. Throughout the episode of care
d. None of the above

c. Throughout the episode of care

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What is the difference between a yellow & red flag symptom?

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What is the effect of NSAIDs on blood pressure?
a. No effect
b. Increase BP
c. Decrease BP

b. Increase BP

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Most of the information needed to determine the cause of symptoms is contained in the:
a. Patient interview
b. Family/personal history form
c. Physical examination
d. All of the above
e. a and c

a. Patient interview

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A risk factor for NSAID-related gastropathy is the use of:
a. Antibiotics
b. Antidepressants
c. Antihypertensives
d. Antihistamines

b. Antidepressants

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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:
a. An open-ended question
b. A funnel technique
c. A paraphrasing technique
d. None of the above

c. A paraphrasing technique

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Screening for alcohol use would be appropriate when the client reports a history of accidents. True or false?

True

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What is the significance of 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

d. All of the above

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Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral. True or false?

True

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Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs & symptoms:
a. Fever, (night) sweats, dizziness
b. Symptoms are out of proportion to the injury
c. Insidious onset
d. No position is comfortable
e. All of the above

e. All of the above

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You should assess clients who are receiving NSAIDs for which physiological effect associated with increased risk of hypertension?
a. Decreased heart rate
b. Increased diuresis
c. Slowed peristalsis
d. Water retention

d. Water retention

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Instruct clients with a history of hypertension and arthritis to:
a. Limit physical activity and exercise
b. Avoid OTC medications
c. Inform their primary care provider of both conditions
d. Drink plenty of fluids to avoid edema

c. Inform their primary care provider of both conditions

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Alcohol screening tools should be:
a. Used with every client sometime 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 their breath
d. Conducted with one other family member present as a witness

b. Brief, easy to administer, and non-threatening

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What is the best follow-up question for someone who reports constant pain?
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 at night after you have fallen asleep?
d. Is there anything that makes the pain better or worse?

b. Do you have that pain right now?

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A 52 y/o 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 of this pain behavior?
a. Minimal distractions heighten a person’s awareness of MSK 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 MSK problem.

a. Minimal distractions heighten a person’s awareness of MSK discomfort.

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Referred pain patterns associated with impairment of the spleen can produce MSK symptoms in the:
a. Left shoulder
b. Right shoulder
c. Midback or upper back, scapula, & right shoulder
d. Thorax, scapulae, right shoulder, or left shoulder

a. Left shoulder

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Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared with MSK pain. True or false?

True

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Words used to describe neurogenic pain often include:
a. throbbing, pounding, beating
b. crushing, shooting, prickling
c. Aching, heavy, sore
d. Agonizing, piercing, unbearable

b. Crushing, shooting, prickling

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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

a. Neoplasm

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Joint pain can be a reactive, delayed, or an allergic response to:
a. Medications
b. Chemicals
c. Infections
d. Artificial sweeteners
e. All of the above

e. All of the above

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Pain of a viscerogenic nature is not relieved by a change in position. True or false?

False

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

True

A 48 y/o male presented w/ LBP of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps, and engages in repetitive motions of all kinds. The pain is intense when he has it but seems to come and go. He is not sure if eating makes pain better or worse. He has lost his appetite b/c of the pain. After conducting an exam including screening,the clinical presentation does not match the expected pattern for an MSK condition. You refer him to an MD for medical testing, finding out later that he had pancreatitis. What is the most likely explanation for this pain pattern? a. Toxic waste products from the pancreas are released into the intestines causing irritation of the retroperitoneal space b. Rupture of the pancreas causes internal bleeding and referred pain called Kehr's Sign. c. The pancreas and low back structures are formed from the same embryologic tissue in the mesoderm. d. Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm.

d. Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm.

When assessing the abdomen, what sequence of physical assessment is best? a. auscultation, inspection, palpation, percussion b. Inspection, percussion, auscultation, palpation c. Inspection, auscultation, percussion, palpation d. Auscultation, inspection, percussion, palpation

c. Inspection, auscultation, percussion, palpation

A line drawn down the middle of a lesion with two different halves suggests a: a. Malignant lesion b. Benign lesion c. Normal presentation d. Skin reaction to medication

a. Malignant lesion

Pulse strength graded as 1 means: a. Easily palpable, normal b. Present occasionally c. Pulse diminished, barely palpable d. Within normal limits

c. Pulse diminished, barely palpable

During auscultation of an adult patient with RA, the heart rate gets stronger as she breaths in and decreases as she breaths out. This sign is: a. Characteristic of lung disease b. Typical in coronary artery disease c. A normal finding d. Common in anyone with pain

c. A normal finding

Body temperature should be taken as a part of a vital sign assessment: a. only for patients who have not been seen by a physician b. For any patient who has MSK pain of unknown origin c. For any patient reporting the presence of constitutional symptoms, especially fever or sweats d. B & C e. All of the above

e. All of the above

23 y/o female presents with new onset skin rash and joint pain followed 2 weeks later by GI symptoms of abdominal pain, nausea, & diarrhea. She has a PMH of Crohn's Disease, but this condition has been stable for several years. Doesn't think her symptoms are related to previous condition. What kind of screening assessment is needed in this case? a. Vital signs only b. Vital signs and abdominal auscultation c. Vital signs, neurologic screening, and abdominal auscultation d. No further assessment needed; enough red flags present to advise patient to seek medical attention.

d. No further assessment needed; enough red flags present to advise patient to seek medical attention.

During a neurological exam, a patient presents with 3+ reflexes for their bilateral patellar and achilles reflexes. Which of the following options is the best next approach for the therapist? a. Recheck the reflexes of the upper extremities and lower extremities b. Consider it normal for this patient and document 2+ bilateral patellar reflex c. Perform the Jendrassik maneuver for this patient because there is an abnormal reflex d. Go right to superficial reflexes such as the abdominal or Beevor's sign

a. Recheck the reflexes of the upper extremities and lower extremities

During oculomotor exam, the patient presents with symptoms of double vision and exotropia during convergence testing from 15 cm away. The patient does not wear corrective lenses. What is a normal near point convergence distance? a. 10 inches b. 10 centimeters c. 5 inches d. 5 centimeters

d. 5 centimeters

A patient presents with a + Babinski Sign, clonus during rapid passive DF of the right foot, and hyperreflexia of all four extremities deep tendon reflexes. In a patient that is not known if the patient has a neurologic condition, which of the following is the MOST appropriate action? a. Document it in the medical record and forget about it b. document it in the medical record and refer the patient to a GI specialist c. Document it and refer patient to a neurologist d. Ask the patient to go to the ER immediately

C. Document it and refer patient to a neurologist

In a patient with clonus on a jaw reflex, the cranial nerve involved with this reflex is: a. CN 5; Trigeminal nerve b. CN 6: Abducens nerve c. CN 3; Oculomotor nerve d. CN 2; Optic nerve

a. CN 5; Trigeminal nerve

In a patient that presents with an inability to adduct and elevate the right eye, the cranial nerve involved with this patient is: a. Cranial nerve V or trigeminal nerve b. Cranial nerve VI or abducens nerve c. Cranial nerve III or oculomotor nerve d. Cranial nerve II or optic nerve

c. Cranial nerve III or oculomotor nerve

Pursed-lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with: a. Orthopnea b. Emphysema c. HF d. a and c

b. Emphysema

Peripheral vascular disease includes: a. Arterial & occlusive diseases b. Arterial & venous disorders c. Acute & chronic arterial diseases d. All of the above e. None of the above

d. All of the above

Which statement is the most accurate? a. Arterial disease is characterized by intermittent claudication, pain relieved by elevating the extremity, and history of smoking b. Arterial disease is characterized by loss of hair on LEs and throbbing pain in the calf muscles that goes away by using heat & elevation c. Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed d. Arterial disease is characterized by loss of hair on toes, intermittent claudication, & redness or warmth of the legs that is accompanied by a burning sensation.

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

What are the primary signs and symptoms of HF? a. Fatigue, dyspnea, edema, nocturia b. Fatigue, dyspnea, varicose veins c. Fatigue, dyspnea, tinnitus, nocturne d. Fatigue, dyspnea, headache, night sweats

a. Fatigue, dyspnea, edema, nocturia

When would you advise a client in PT to take his/her nitroglycerin? a. 45 minutes before exercise b. When symptoms of chest pain do not subside w/ 10-15 min of rest c. As soon as chest pain begins d. None of the above e. All of the above

d. None of the above

Neurological symptoms such as muscle weakness or muscle atrophy may be the first indication of: a. Cystic fibrosis b. Bronchiectasis c. Neoplasm d. Deep vein thrombosis

c. Neoplasm

Back pain with radiating numbness and tingling down the leg past the knee does not occur as a result of: a. Post-op thrombus b. Bronchogenic carcinoma c. Pott's disease d. Trigger points

b. Bronchogenic carcinoma

Pain associated with pleuropulmonary disorders can radiate to the: a. Anterior neck b. Upper trap c. Ipsilateral shoulder d. Thoracic spine e. a & c f. All of the above

f. All of the above

The presence of a persistent dry cough (no sputum or phlegm produced) has no clinical significance to the therapist. True or false?

False

Dyspnea associated with emphysema is the result of: a. Destruction of the alveoli b. Reduced elasticity of the lungs c. Increased effort to exhale trapped air d. a & b e. All of the above

e. All of the above

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? a. Increase b. Decrease c. Remain unchanged d. Vary depending on potassium concentration

Decrease

Common symptoms of respiratory acidosis would be most closely represented by which of the following descriptions? a. Presence of numbness and tingling in face, hands, and feet b. Presence of dizziness and light-headedness c. Hyperventilation with change in LOC d. Onset of sleepiness, confusion, and decreased ventilation

d. Onset of sleepiness, confusion, and decreased ventilation

Bleeding in the GI tract can be manifested as: a. Dysphagia b. Melena c. Psoas abscess d. Tenderness over McBurney's point

b. Melena

What is the significance of Kehr's sign? a. Gas, air, or blood in the abdominal cavity b. Infection of the peritoneum (peritonitis, appendicitis) c. Esophageal cancer d. Thoracic disk herniation masquerading as chest or anterior neck pain

a. Gas, air, or blood in the abdominal cavity

What areas of the body can GI disorders refer pain to? a. Sternum, shoulder, scapula b. Anterior neck, midback, low back c. Hip, pelvis, sacrum d. All of the above

d. All of the above

A 56 y/o client is referred to PT for pelvic floor rehab. His primary symptoms are obstructed defection and puborectalis muscle spasm. He was nightly w/ left flank pain. The pattern is low thoracic, laterally, but superior to iliac crest. Sometimes he has buttock pain on the same side. He does not have any daytime pain bt 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 femurs. Change in symptoms with gas or defecation is possible with: a. Thoracic disk disease b. Obturator nerve compression c. Small intestine disease d. Large intestine and colon dysfunction

d. Large intestine and colon dysfunction

Name two of the most common medications taken by clients seen in PT practice likely to induce GI bleeding. a. Corticosteroids b. Antibiotics and antiinflammatories c. Statins d. None of the above

b. Antibiotics and antiinflammatories

Which of the following are clues to the possible involvement of the GI system? a. Abdominal pain alternating with TMJ pain within a 2-week period b. Abdominal pain at the same level as back pain, occurring either simultaneously or alternatively c. Shoulder pain alleviated by a bowel movement d. All of the above

b. Abdominal pain at the same level as back pain, occurring either simultaneously or alternatively

A 65 y/o client is taking oxycontin for a "sore shoulder". She also reports aching pain of the sacrum that radiators. The sacral pain can be caused by: a. Psoas abscess caused by vertebral osteomyelitis b. GI bleeding causing hemorrhoids and rectal fissures c. Crohn's disease manifested as sacroiliitis d. Pressure on sacral nerves from stored fecal content in the constipated client taking narcotics

d. Pressure on sacral nerves from stored fecal content in the constipated client taking narcotics

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

d. b and c

Referred pain patterns associated with hepatic and biliary pathologic conditions produce MSK symptoms in the: a. Left shoulder b. Right shoulder c. Midback or upper back, scapular, and right shoulder areas d. Thorax, scapulae, right or left shoulder

c. Midback or upper back, scapular, and right shoulder areas

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

d. a and b only

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? a. Decrease in serum albumin levels b. Elevated liver enzyme levels c. Prolonged coagulation time d. Elevated serum bilirubin levels

c. Prolonged coagulation time

Decreased level of consciousness, impaired function of peripheral nerves, and asterixis (flapping tremor) would probably indicate an increase in the level of: a. Aspartate aminotransferase (AST) b. Alkaline phosphatase c. Serum bilirubin d. Serum ammonia

d. Serum ammonia

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: a. Renal failure b. Hepatic encephalopathy c. Diabetes d. Gallstones obstructing the common bile duct

b. Hepatic encephalopathy

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 result sin some easily identifiable signs. Which of the following signs might alert the therapist to the condition of decreased albumin? a. Increased blood pressure b. Peripheral edema & ascites c. Decreased level of consciousness d. Exertional dyspnea

b. Peripheral edema & ascites

Percussion of the costovertebral angle that results in the reproduction of symptoms: a. Signifies radiculitis b. Signifies pseudo renal pain c. Has no significance d. Requires medical referral

d. Requires medical referral

Renal pain is aggravated by: a. Spinal movement b. Palpatory pressure over the costovertebral angle c. Lying on the involved side d. All of the above e. None of the above

e. None of the above

Important functions of the kidney include all the following except: a. Formation and excretion of urine b. Acid-base and electrolyte balance c. Stimulation of red blood cell production d. Production of glucose

d. Production of glucose

What do the following terms mean: a. Dysparunia b. Dysuria c. Hematuria d. Urgency

a. Dysparunia: Difficult, painful intercourse in women b. Dysuria: difficult or painful urination c. Hematuria: blood in the urine d. Urgency: the sudden, compelling urge to urinate

Differentiate a PT diagnosis versus a medical diagnosis

PT diagnosis: looks specifically at changes to the movement system; aims to direct our patient management; purpose is to improve functional ability medical diagnosis: Based on the medical model; directions patient management; purpose is to cure disease/pathology

Delineate a screening examination from the diagnostic process

A screening exam is simply looking comprehensively at each body system to ensure that the person is appropriate for your care; you are NOT making a diagnosis, but simply determining if the patient requires further care outside of your scope of practice

Discuss reasons why a PT needs to conduct screening examinations. (4)

1. Direct access care; patients have direct access, making us the first providers that some patients will see. We must make sure they are appropriate for PT 2. Physician referral; pts may be referred via phone or the physician may not have the background to catch specific pathology or progression 3. "Quicker": Shorter lengths of stay meaning that patients are discharged sooner, making them more likely to have problems that a PT would be in the position to catch 4. "Sicker": Larger # of people have an extensive list of comorbidities

Approximately 80% of the information needed to distinguish between a systemic and neuromusculoskeletal issue is provided during which portion of the PT examination?

Subjective Exam/Patient Interview

What important change in vocabulary should be used when discussing a patient's symptoms?

Use symptoms versus pain, as symptoms is broader and may trigger the patient to mention potentially pertinent symptoms; only asking about pain boxes the patient in to only talking about that part of their condition

List common associated signs/symptoms (constitutional symptoms) that may be associated with systemic disease processes (10)

1. Fever 2. Diaphoresis 3. Night sweats 4. Vomiting 5. Diarrhea 6. Pallor 7. Dizziness/syncope 8. Fatigue 9. Unexplained weight loss 10. Bilateral symptoms

What patient presentation factors would indicate the need for the PT to screen for systemic disease?

- Age > 40 - Hx of cancer - Insidious onset/unknown cause - Progressive/cyclical symptoms - No relief from pain (e.g. position or rest) - Tx does not improve symptoms - Symptom level ≠ injury - Can't reproduce symptoms - Night pain - Constant, intense pain - Pain described as: knifelike, boring, deep, deep-aching, colicky - Proximal muscle weakness w/ DTR change

What is the appropriate course of action for a patient presenting with: Angina > 20 min

Refer immediately

What is the appropriate course of action for a patient presenting with: Angina w/ nausea, vomiting, &/or sweating

Refer immediately

What is the appropriate course of action for a patient presenting with: Bowel &/or bladder incontinence/insensate "saddle" disruption

Refer immediately

What is the appropriate course of action for a patient presenting with: Anaphylactic shock

Refer immediately

What is the appropriate course of action for a patient presenting with: Inadequate ventilation/CO2 retention

Refer immediately

What is the appropriate course of action for a patient presenting with: Diabetic patient who appears confused & lethargic

Refer immediately

What is the appropriate course of action for a patient presenting with: Rebound abdominal tenderness

Refer immediately

What is the appropriate course of action for a patient presenting with: Increased intermittent claudication

Refer immediately

What is the appropriate course of action for a patient presenting with: Throbbing pain that increases with exertion in chest/back/abdomen

Refer immediately

What is the appropriate course of action for a patient presenting with: Changes in lymph nodes or irregular mass in breast/axilla

Refer immediately

The following would all be considered signs to take what course of action? - Unknown source of problem - No objective NMS findings - Constitutional symptoms - PMH told to PT but not MD - Flu (etc.) > 7-10 days - Jaundice unknown to MD - Lymph node changes

Recommend referral

What are some specific signs present in female patients that would indicate the potential need for a referral? (5)

- No known cause + constitutional symptoms - Symptoms occur during period - Increased BP in women using birth control - Reported bleeding after menopause - During pregnancy: vaginal bleeding, increased BP, exercise-increased BH contractions

What vital sign changes would indicate the potential need for a referral? (5)

- Increase/decrease in BP that doesn't recover - Increased BP in women using BC - Increased pulse amplitude w/ expiration & decrease w/ inspiration - sBP-dBP > 40 mmHg - Fever w/out systemic symptoms

What cardiac signs would indicate the potential need for a referral? (6)

- Angina (@ rest, > 3 nitroglycerin, changes in pattern, etc.) - Palpitations - SOB (climbing 1 flight of stairs, in supine) - Increased dyspnea - Fainting - Patient/client concerned about condition

Discuss signs that would indicate a potential referral with concerns about cancer

CAUTION: Changes in bowel/bladder habits A sore that doesn't heal in 6 weeks Unusual bleeding/discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious changes in wart or mole Nagging cough or hoarseness Proximal muscle weakness w/ DTR change Lumps that increase in size Bone pain w/ weight bearing > 1 wk Men w/ hx of prostate cancer Women w/ insidious chest/breast/axilla/shoulder pain

What pulmonary signs would indicate the potential need for a referral?

- Shoulder pain that increases w/ respiration, moving into supine - Autosplinting that decreases pain in shoulder/chest - Weak, rapid pulse w/ low BP - Persistent cough - Dyspnea - Asthma

What genitourinary signs would indicate the potential need for a referral?

Changes in urine color, amount, odor, or flow Blood in urine Urinary incontinence w/ C-spine pain

What GI signs would indicate the need for a potential referral?

- Abdominal pain reported at same level as back pain - Unknown cause of pain in person w/ PMH of cancer - Back/shoulder pain in person taking NSAIDs - Back pain that increases w/ meals, lessens w/ BM

What MSK signs would indicate the need for a potential referral?

- Symptoms out of proportion w/ injury - Progressive, severe back pain - New joint pain/inflammation post-surgery

Discuss precautions/contraindications to PT (11)

1. Uncontrolled CHF or pulmonary edema 2. Acute myocarditis 3. Resting HR > 120-130 4. Resting sBP > 180 mmHg 5. Resting dBP > 105-1110 mmHg 6. Moderate dizziness 7. Marked dyspnea 8. Unusual fatigue 9. Unsteadiness 10. Post-op calf pain 11. Diabetic w/ unstable BG (caution w/ <100 mg/dL or > 250 mg/dL

Visceral pain can be influenced by

Embryological development Multi-segmental innervation Direct pressure/shared pathways

Localized pain tends to indicate a more ____ cause, while distributed pain is more associated with a ______ cause

Somatic; visceral

The following presentation would indicate the PT should take what course of action? - Unknown cause of symptoms - Sxs persist past normal healing times - Sxs unrelieved by rest or position change - Pattern inconsistent w/ NMS source - Cannot be provoked or relieved - Pt intervention does not change s/s - Poorly localized - Associated s/s related to visceral organs - Constant intense pain - Aspirin fully relieves bony pain - Throbbing or activity induced after 3-5 min - Night pain that awakens from sleep - Joint pain w/ associated skin rash before or with

Screen for viscerogenic sources of pain

Discuss the potential next steps for a patient presenting with neurological symptoms

a. If neuro condition is known and the symptoms fit, proceed to treat impairments b. If no known neuro condition, conduct full PT neuro exam (not just a screen) and treat/refer accordingly

Differentiate the following types of GI pain: visceral vs. parietal

Visceral: typically midline, poorly localized, cramping, burning, gnawing, dull, constant Parietal: can be unilateral, more localized, knifelike, cutting, stabbing, intense, constant, increases with coughing & respiratory movements

Epigastric pain sources

Esophagus, stomach, duodenum

Epigastric pain is typically reported in

Ribs, chest, T-spine T3-T7

Periumbilical pain sources

Pancreas, intestine, appendix

Periumbilical pain is typically reported in

Low back L3-L4

Hypogastric pain sources

Large intestine, colon

Hypograstric pain is typically reported in

Sacrum

The liver, diaphragm, and pericardium often refer to

the shoulder

The esophagus often refers to

Mid back

The gallbladder, stomach, pancreas, & small intestine are most likely to refer to

Mid back/scapula

The sigmoid colon, rectum, ureters, and testes are most likely to refer to

pelvis, flank, low back, & sacrum

A patient presenting with dysphagia should always warrant a referral. True or false.

True

A patient presenting with odynophagia should be what?

Referred

Melena is an important GI symptom that warrants a referral

True

Cullen sign indicates what?

Bluish skin around the umbilicus; indicates pancreatitis

A (+) heel tap test may indicate

Peritoneal inflammation

A (+) hop on one leg test may indicate

Peritoneal inflammation

a (+) Iliopsoas muscle test may indicate

Inflamed iliopsoas d/t appendicitis (RLQ) or perforated bowel (LLQ)

A (+) obturator test may indicate

Appendicitis, peritoneal infection

When should you screen for GI source?

Age > 45 Chronic NSAID use Symptoms altered by food Cycliclal presentation of GI/MS/SK sxs Concurrent back/ab symptoms Shoulder, back, pelvic, or sacral pain of unknown origin L shoulder pain post-trauma Kehr's sign Joint pain after rash w/ hisotry of Crohn's disease

Discuss risk factors for urogenic disease

Discuss Murphy's percussion test & its interpretation

Renal pain tends to refer to

- Ipsilateral shoulder - Posterior subcostal & costovertebral region - Across low back - Lower abdominal quadrant and testicular region

The liver typically refers to

Midback Scapula Right shoulder

The liver/gallbladder/common bile duct is most likely to refer where

Upper right quadrant of the abdomen Right shoulder upper mid-back Right scapular region

Discuss cardiovascular signs/symptoms for each of the following systems: General Integumentary Central nervous system Pulmonary Genitourinary MSK Gastrointestinal

Table 7.1

Pulmonary symptoms that would indicate the need for a referral include: (4)

- Abrupt onset of dyspnea + weak pulse & falling BP - Chest, rib, or shoudler pain reported after scuba diving - Symptoms of CO2 retention or inadequate ventilatino - Shoulder or chest pain that: - Is aggravated by respirtaory movements - Worse in supine than sitting - Better when lying on affected side (auto splinting) - Better in sitting if leaning forward