Multi-Systems Management [Unit 1] Flashcards
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
Direct access is the only reason PTs must screen for systemic disease, true or false?
False
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?
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
What is the difference between a yellow & red flag symptom?
What is the effect of NSAIDs on blood pressure?
a. No effect
b. Increase BP
c. Decrease BP
b. Increase BP
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
A risk factor for NSAID-related gastropathy is the use of:
a. Antibiotics
b. Antidepressants
c. Antihypertensives
d. Antihistamines
b. Antidepressants
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
Screening for alcohol use would be appropriate when the client reports a history of accidents. True or false?
True
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
Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral. True or false?
True
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
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
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
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
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?
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.
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
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
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
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
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
Pain of a viscerogenic nature is not relieved by a change in position. True or false?
False
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
