Quiz 1

Question 1

Ruling out _ _ as the source of symptoms must be on the of primary objectives of the therapist’s evaluation. This responsibility is increased as the number of states _ _ _ _ increases.

Answer 1

Ruling out PATHOLOGICAL CONDITIONS . . .

This responsibility is increased as the number of states PASSING DIRECT ACCESS LEGISLATION increases

Question 2

Mechanical dsyfunction is defined as _ or _ function of _, _ and _ structure resulting from either _ or _ _.

Answer 2

Defined as IMPAIRE OR ALTERED function of SKELETAL, ARTHROIDAL, AND MYOFASCIAL structures resulting from either TRAUMA OR ABNORMAL POSTURES

Question 3

Pathological conditions may be manifested as solely _ _ _ (eg. Joint _, abnormal _ _) with the most overt sypmotoms possibly being _ or _ _.

Answer 3

May be manifested as solely MECHANICAL DSYFUNCTIONS (eg. Joint HYPOMOBILITY, abnormal MUSCLE TONE) with the most overt symptoms possibly being NECK OR BACK PAIN

Question 4

The purposes of this article are to 1) present an overview of _ _ _ and _ _ from _. 2) review general evaluation principles that may aid in the _ of _ _ _ from _ _. 3) present common symptoms and signs of _ _ _ of the _ and _ _.

Answer 4

1) present an overview of TRUE VISCERAL PAIN and REFERRED PAIN from VISCUS
2) Review general evaluation principles that may aid in the DIFFERENTIATION OF MECHANICAL DSYFUNCTION from PATHOLOGICAL LESIONS
3) Present common symptoms and signs of SPECIFIC VISCERAL DISORDERS of the GASTROINTESTINAL and UROGENITAL SYSTEMS

Question 5

Because _ _ are innervated by _ they have the potential to cause a patients pain. These _ _ _ are found in the _ _ _ _ of the viscus, including their _ and _ _.

Answer 5

Because VISCERAL ORGANS are innervated by NOCICEPTORS they have the potential to cause a patient’s pain.

These FREE NERVE ENDINGS are found in the LOOSE CONNECTIVE TISSUE WALLS of the viscus, including their EPITHELIAL AND SEROUS LININGS.

Question 6

Once receptors are activated the neural information is transmitted along _, _ _ _ _ housed with in the _ and _ nerves of the _ _ _.

Answer 6

Neural information is transmitted along SMALL, UNMYELINATED TYPE C NERVE FIBERS housed with in the SYMPATHETIC and PARASYMPATHETIC nerves of the AUTONOMIC NERVOUS SYSTEM.

Question 7

Transmission of neural information along type C nerve fibers may result in the perception of _ _ and _ to _ _.

Answer 7

Perception of DEEP ACHING and HARD TO LOCALIZE PAIN

Question 8

Chemical stimulation of nociceptors may result from a build up of _ _ _ such as _ or _ _, secondary to an _ _ of the viscus. _ _ of the smooth muscle wall of a visceral structure or _ _ of viscus may also cause _ _ to develop due to the collapse of the structure’s _ _.

Answer 8

May result from a build up of METABOLIC END PRODUCTS such as BRADYKININS OR PROTEOLYTIC ENZYMES, secondary to an ISCHEMIC STATE of the viscus.

PROLONGED SPASM of the smooth muscle wall of a visceral structure or PROLONGED DISTENTION of viscus may also cause ISCHEMIC STATE to develop due to the collapse of the structure’s MICROVASCULAR NETWORK.

Question 9

Other potentially _ _ may come in contact with _ _ resulting in stimulation of local nociceptors. An example would be _ _ _ leaking through a _ or _ _ into the _ cavity.

Answer 9

Other potentially HARMFUL SUBSTANCES may come in contact with UNPROTECTED TISSUE resulting in the stimulation of local nociceptors.

An example would be ACIDIC GASTRIC JUICES leaking through a GASTRIC or DUODENAL ULCER into the peritoneal cavity.

Question 10

There is more _ than _ when considering the _ clinical phenomenon of _ _.

Answer 10

There is more MYSTERY than FACT when considering the CONFUSING clinical phenomenon of REFERRED PAIN.

Question 11

Referred pain is defined as pain experienced in tissues that are _ _ _ of _ _ and whose _ or _ _ are _ _ in the physiological process of _ _.

Answer 11

Experienced in tissues that are NOT THE SITE of TISSUE DAMAGE and whose AFFERENT OR EFFERENT NEURONS are NOT INVOLVED in the physiological process of PAIN PERCEPTION

Question 12

With referred pain _ _ of _ _ results in perception of pain at a distance from the _ of the _. Referred pain may lie within the _ of those _ _ the receive sensory information from the _ _.

Answer 12

With referred pain CORTICAL MISINTERPRETATION of SENSORY INFORMATION results in perception of pain at a distance from the SITE OF THE LESION.

Referred pain may lie with the DERMATOME of those SPINAL SEGMENTS that receive sensory information from the VISCERAL ORGAN.

Question 13

Therapists should be aware of the _ _ _ of the various _ _.

Answer 13

Should be aware of the COMMON REFERRAL PATTERNS of the various VISCERAL STRUCTURES.

Question 14

Few principles exist that _ _ _ the presence of either _ _ _ or _ _. Specific findings or patterns of findings revealed during the exam should _ the _ that _ _ may be _ or _ _ for the patients trunk or neck symptoms.

Answer 14

Few principles exists that DEFINITIVELY RULE OUT the presence of either MECHANICAL MUSCULOSKELETAL DYSFUNCTION or PATHOLOGICAL CONDITIONS.

Specific findings or patterns of finding revealed during the exam should RAISE the SUSPICION that PATHOLOGICAL LESION may be PARTIALLY OR COMPLETELY RESPONSIBLE for the patients trunk or neck symptoms

Question 15

A _ _ will aid the clinical in detecting potential pathological conditions. Accurate descriptions of the _ of _ experienced and the _ of _ are helpful in making a differential diagnosis.

Answer 15

A GOOD HISTORY will aid the clinician in detecting potential pathological conditions.

Accurate descriptions of the TYPE OF PAIN experienced and the BEHAVIOR OF SYMPTOMS are helpful . . .

Question 16

Visceral pain has been described as being _ _, _, _ and _ in character. Pain can be _, but may _ _ to a _ and then _.

Answer 16

Has been described as POORLY LOCALIZED, DIFFUSE, DULL and VAGUE in character. Pain can be CONSTANT, but may RHYTHMICALLY BUILD to a PEAK and then RECEDE.

Question 17

Sensations of _ _ have been attributed to spasm of the muscle wall of hollow viscus. The _ of the _ sensation _ as the smooth muscle wall _ and _. Cycle may last up to a _ _.

Answer 17

Sensations of CRAMPING PAIN have been attributed to the spasm of the muscle wall of hollow viscus.

The INTENSITY of the CRAMPING sensation VARIES as the smooth muscle wall CONTRACTS AND RELAXES.

Cycle may last up to a FEW MINUTES

Question 18

Gastroenteritis, constipation, menstruation, gall bladder disease, and urethral obstruction all have been attributed to causing a _ _ of _, which may be experienced in the _ or referred to the _.

Answer 18

All been attributed to causing a CRAMPING TYPE OF PAIN which may be experienced in the ABDOMEN or referred to the BACK.

Question 19

_ _ cramping pain, _ of the _, _, and _ and _ sensation associated with activity and relieved promptly with rest may suggest a _ _ _. The complaint of _ _ at rest can also indicate the presence of a _ _.

Answer 19

LOWER LEG cramping pain, HEAVINESS of the LEGS, and PINS AND NEEDLES sensation associated with activity and relieved promptly with rest may suggest a PERIPHERAL VASCULAR DISORDER.

The complaint of RESTLESS LEGS at rest can also indicate the presence of a VASCULAR DISORDER.

Question 20

Classically aggravation or alleviation of symptoms from a mechanical musculoskeletal dsyfunction can be related to a _ in _ or _ _ or to _ _.

Answer 20

Can be related to a CHANGE IN BODY OR LIMB POSITION or to SPECIFIC MOVEMENTS

Question 21

If sypmtoms do not vary, regardless of body position and movement, or are present at rest, the therapist should suspect a _ _. This is especially important if the patient complains of their _ _ _, _ them _ _ _.

Answer 21

Therapist should suspect PATHOLOGICAL DISORDER

This is especially important if the patient complains of their MOST SEVERE PAIN, WAKING them UP AT NIGHT.

Question 22

If the patient reports and incident, accident, or trauma that precipitated the onset of sypmtoms, a _ _ _ is probably the source of the complaint.

Answer 22

A MECHANICAL MUSCULOSKELETAL DSYFUNCTION is probably the source of the complaint.

Question 23

If the onset of the original symptoms is _ _ or if unexplained symptoms develop _ during the _ of _, the therapist should be wary of a pathological lesion.

Answer 23

If the onset of the original symptoms is TRULY INSIDIOUS, or if unexplained symptoms develop INSIDIOUSLY during the COURSE OF TREATMENT the therapist . . .

Question 24

If the patient complains of insidious onset of symptoms in multiple joints the therapist should be wary of? (Ex. -2)

Answer 24

Should be wary of the PRESENCE OF INFLAMMATORY DISORDERS

Examples: RA, Lupus

Question 25

Presence of symptoms such as _, _, _, etc for more than - _ duration suggest the possible presence of an occult infection or a neoplasm.

Answer 25

Presence of symptoms such as FEVER, CHILLS, NAUSEA, etc. for more than 1-2 WEEK duration suggest . . .

Question 26

Unexplained weight loss, anorexia, malaise, change in bowel habits, or rectal or vaginal bleeding are also early signs of the presence of?

Answer 26

Early signs of the presence of NEOPLASTIC DISORDER

Question 27

If the patient has a history of _, especially in organs which commonly _ to the _, and the patient has not seen a physician prior, the therapist should make the appropriate referral _.

Answer 27

If the patient has a history of CANCER, especially in organs which commonly METASTASIZE TO THE SPINE, and the patient has not seen a physician prior the therapist should make the appropriate referral IMMEDIATELY.

Question 28

Investigating which _ the patient _ _ _ along with corresponding _ _ may provide explanations for the presence of certain complaints such as dizziness, fatigue, light headedness, constipation, etc.

Answer 28

Investigating which MEDICATION the patient MAY BE TAKING along with corresponding SIDE EFFECTS may provide explanation . . .

Question 29

The therapist should also inquire about significant _ _, because certain _ have _ tendencies.

Answer 29

Inquire about significant FAMILY HISTORY because certain DISEASES have FAMILIAL tendencies.

Question 30

Therapist should not assume the patient will _ _ regarding the presence of abdominal pain or their symptoms being related to visceral function. what should be routine? (2)

Answer 30

Should not assume patient will VOLUNTEER INFORMATION . . .

Questions FOCUSING ON CERTAIN VISCERAL STUCTURES/ FUNCTION and questions ON GENERAL HEALTH

Question 31

Even if questions regarding visceral symptoms and function and general health do not reveal pertinent clinical information during the initial exam they should be?

Answer 31

Should be REPEATED EVERY FEW WEEKS, in order to RULE OUT THE DEVELOPMENT OF AN ILLNESS that may be affecting a patients progress.

Question 32

The most important factor in the physical exam relates to the _ of _. If the therapist _ _, _ or _ _ by palpation, active or passive movements, resisted tests or special tests the therapist should be _ of a _ _.

Answer 32

Most important factor of the physical exam relates to the PROVOCATION OF SYMPTOMS.

If the therapist CANNOT REPRODUCE, INCREASE OR DECREASE SYMPTOMS by palpation, active or passive movements, resisted tests or specials tests the therapist should be SUSPICIOUS OF A PATHOLOGICAL LESION.

Question 33

What are two examples of pathological lesions that could increase symptoms or pain with specific movements or changes in posture?

Answer 33

Infection in the IV disc

Pathological fracture of a vertebral body secondary to a metastatic lesion

Question 34

Palpable _ _ may suggest infection or neoplasm. Areas to be palpated should include the _ _, the _, the _ region, and the _ and _ _ areas.

Answer 34

Palpable LYMPH NODES may suggest infection or neoplasm.

Areas to be palpated should include the FEMORAL TRIANGLE, the AXILLA, the SUPRACLAVICULAR region, and the ANTERIOR and POSTERIOR CERVICAL areas.

Question 35

_ _ _ on palpation and complaints of _ _ _ may suggest underlying visceral pathological disorders.

Answer 35

ABDOMINAL MUSCLE RIGIDITY on palpation and complaints of SIGNIFICANT LOCAL TENDERNESS may suggest underlying visceral pathological disorders.

Question 36

_ may also reveal vascular disorders. An _ or _ _ suggests vascular obstruction. Lower extremity _ to be assessed include the _ _ in the _ _, the _ _ in the _ _ (with the knee _), _ _ _ near the _ and _ _ _ of the foot and the _ _ _, _ to the medial malleolus.

Answer 36

PALPATION may also reveal vascular disorders. An ABNORMAL OR DIMINISHED PULSE suggests vascular obstruction.

Lower extremity PULSES to be assessed include the FEMORAL ARTERY in the FEMORAL TRIANGLE, the POPLITEAL ARTERY in the POPLITEAL FOSSA (with the knee FLEXED), DORSALIS PEDIS ARTERY near the 1st and 2nd METATARSAL BASES, and the POSTERIOR TIBIAL ARTERY, POSTERIOR to the medial malleolus.

Question 37

Pulses that should be checked in the upper extremity include: _ _ in the _ _ and the _ _ at the _. The _ in the abdomen should also be palpated for the presence of an _.

Answer 37

Pulses in the UE include: BRACIAL ARTERY in the CUBITAL FOSSA and the RADIAL ARTERY at the WRIST

The AORTA in the abdomen should also be palpated for the presence of an ANEURISM

Question 38

Palpating the _ _, _ _, _ and taking a patients _ _ should be routine in a therapist’s evaluation scheme.

Answer 38

Palpating the BLOOD VESSELS, LYMPH NODES, ABDOMEN, and taking a patient’s BLOOD PRESSURE should be routine . . .

Question 39

The most important component of the physical exam for ruling out pathologies is the _, _ _ of active and passive testing, resistive testing, special tests, and palpation to _ _ the _ of the musculoskeletal system for _ of _.

Answer 39

Most important component of the physical exam for ruling out pathologies is the CAREFUL, PRECISE IMPLEMENTATION of active and passive testing, resistive testing, special tests, and palpation to SELECTIVELY STRESS THE STRUCTURES of the musculoskeletal system for PROVOCATION OF SYMPTOMS.

Question 40

There is _ _ _or _ that allows the clinician to reach a concrete conclusion.

Answer 40

There is NO SINGLE SIGN or SYMPTOM that allows . . .

Question 41

Many diseases of visceral organs may cause _ and _ pain as an _ symptom.

Answer 41

May cause TORSO AND NECK pain as an EARLY symptom.

Question 42

Men over 60 years of age with low back pain should have a _ and _ _ by a physician to rule out _.

Answer 42

Men over 60 with LBP should have a PROSTATE AND RECTAL EXAM by a physician to rule out CANCER

Question 43

Women with _ _ should have a complete examination by a physician including an _ _ _ if they have not had one recently.

Answer 43

Women with PELVIC SYMPTOMS should have a complete examination by a physician including an INTERNAL PELVIC EXAM if they have not had one recently

Question 44

Patients with unexplained weight loss, change in bowel or bladder pattern, prolonged cough, chills, unexplained fever, or a change in skin lesion should be seen by a _, regardless of the _ _ _ that they _.

Answer 44

. . . .should be seen by a PHYSICIAN regardless of the MECHANICAL MUSCULOSKELETAL DYSFUNCTIONS that they EXHIBIT

Question 45

Diseases of the uterus and ovaries are common causes of _ and _ _ and _ pain.

Answer 45

Common causes of ABDOMINAL and CENTRAL LUMBAR and SACRAL PAIN

Question 46

General symptoms of pelvic disease in women include _ or _ _, painful _, painful _, and _.

Answer 46

Include HEAVY OR IRREGULAR BLEEDING, painful MENSES, painful INTERCOURSE, and INFERTILITY.

Question 47

_ of the _ is often Asymptomatic except for intermittent vaginal bleeding and spotting. _ of the _ and _ is indicated by heavy irregular bleeding or post menopausal bleeding.

Answer 47

CANCER OF THE CERVIX is often Asymptomatic . . .

CANCER OF THE UTERUS AND OVARIES in indicated by heavy irregular bleeding . . .

Question 48

Both cancer of the cervix, uterus or ovaries may be associated with _, _ _ and _ localized to the _, _ and _ areas.

Answer 48

May be associated with DULL, DIFFUSE DISCOMFORT and PAIN localized to the ABDOMEN, LUMBAR, AND SACRAL areas.

Question 49

Both benign and malignant tumors of the uterus may be indicated by a _ _ or _ in the _ or _ _ region.

Answer 49

May be indicated by a PALPABLE MASS or FULLNESS in the LOWER OR MIDDLE ABDOMINAL region

Question 50

_ _ _ is another common condition which may cause abdominal and back pain in women during an active infection of the Fallopian tubes or after the infection has been treated.

Answer 50

PELVIC INFLAMMATORY DISEASE . . .

Question 51

_ is another common cause of recurrent lumbar and sacral pain in women. Pain is worse during the _, and is common in women between the ages of _ and _.

Answer 51

ENDOMETRIOSIS is another common cause of recurrent lumbar and sacral pain in women.

Pain is worse during the MENSES, and is common in women between the ages of 30 AND 40.

Question 52

The kidneys, unitary tract and prostate gland are located in the _, an area located in the _ _ of the abdomen and separated from the _ _ by the _ _.

Answer 52

Are located in the RETROPERITONEUM, an area located in the POSTERIOR PART of the abdomen and separated from the GI ORGANS by the PERITONEAL MEMBRANE.

Question 53

Retroperitoneal organs can refer pain anywhere from the _ _ to the _ and _ _, as well as referred pain around the _ to the _ _ region, the _, and the _ and _ _. Most common diseases of this organ system are indicated by _ symptoms that make _ _ apparent.

Answer 53

Can refer pain anywhere from the LOWER THORACIC to the LUMBAR AND PELVIC areas, as well as referred pain around the FLANKS to the LOWER ABDOMINAL region, the GENITALIA, and the ANTERIOR AND MEDIAL THIGHS.

Most common diseases of this organ system are indicated by STRIKING symptoms that make MEDICAL DIAGNOSIS APPARENT.

Question 54

_ _ _ ( _ _) is often associated with a variety of distinct skeletal abnormalities including inadequate calcium deposition in bones resulting in a structural weakness. Has _ _ for the practicing clinician.

Answer 54

CHRONIC KIDNEY DISEASE (KIDNEY FAILURE) is often associated . . . .

Has SIGNIFICANT IMPLICATIONS for the practicing clinician.

Question 55

Diseases of the prostate gland often have _ symptoms unless the disease is _ or _ _. Usually symptoms are _ with _ or _ _ dominating the clinical picture.

Answer 55

Often have MINIMAL symptoms unless the disease is SEVERE OR WELL ADVANCED.

Usually symptoms are SUBTLE with CENTRAL LUMBAR or SACRAL PAIN dominating the clinical picture.

Question 56

Prostate illnesses are _ in _ regardless of _, and should always be considered when lumbar and sacral pain is _ _ _.

Answer 56

Illnesses are COMMON IN MEN regardless of AGE, and should always be considered when lumbar and sacral pain is NOT CLEARLY MECHANICAL.

Question 57

Tumors in _ of the _ _ _ may be indicated primarily by pain with few other _ _ being present.

Answer 57

Tumors in ANY of the RENAL UROLOGIC ORGANS may be primarily indicated by pain with few other UROLOGIC SYMPTOMS being present.

Question 58

With cancer of the prostate symptoms include _ , _ at _ (), difficulty _ the _ _, or _ _ _. These symptoms are also common in _ _, due to?

Answer 58

Symptoms include: FREQUENT URINATION, URINATION AT NIGHT (NOCTURIA), difficulty STARTING THE URINE STREAM, or WEAKENED URINE STREAM

These symptoms are also common in ELDERLY MEN, due to normal prostate enlargement with age.

Question 59

The GI tract can cause pain anywhere in the _ from the _ to the _, serious disease rarely causes _ without _ _.

Answer 59

Can cause pain anywhere in the TORSO from the THROAT to the RECTUM, serious diseases rarely cause PAIN WITHOUT DIGESTIVE SYMPTOMS.

Question 60

_ _ and _ can cause pain of the upper and middle abdomen, mid back, anterior chest and neck. Pain may be relieved by _ or _ following _.

Answer 60

PEPTIC ULCER and ESOPHAGITIS can cause pain . . . .

Pain may be relieved by EATING OR WORSENED following a MEAL.

Question 61

Cancer of the stomach, liver, pancreas and gall bladder occurs in _ and _ over _ _ of _ and may be indicated by deep, gnawing, poorly localized pain in the _ _ or _ before _ _ become prominent.

Answer 61

Occurs in MEN AND WOMEN OVER THE AGE 50 and may be indicated by deep, gnawing, poorly localized pain in the UPPER ABDOMEN or BACK before GI SYMPTOMS become prominent.

Question 62

Therapist should be alert for the presence of an _ _ _ or _ and _ _ during the physical exam. (Could indicate cancer of the stomach, liver, pancreas, or gall bladder)

Answer 62

Presence of an UPPER ABDOMINAL MASS or TENDERNESS and MILD JAUNDICE during the physical exam.

Question 63

Diseases of the liver, esophagus, stomach, and pancreas may cause irritation to the _ with referral of symptoms to the _ and _ regions.

Answer 63

May cause irritation to the DIAPHRAGM with referral of symptoms to the CERVICAL AND SHOULDER REGIONS.

Question 64

Gall bladder diseases, especially _ () and _ () may be indicated by recurrent _ thoracic pain at the level of the lower ribs, with possible referral to the _ scapular region.

Answer 64

Especially INFLAMMATION (CHOLECYSTITIS) and STONES (CHOLELITHIASIS), may be indicated by recurrent RIGHT thoracic pain at the level of the lower ribs, with possible referral to the RIGHT scapular region.

Question 65

A patient with gall bladder disease may experience _ _ _ after _, _ or _ foods worsen symptoms. _ _ over _ are the most likely candidates for gall bladder disease.

Answer 65

Patient with gall bladder disease may experience RIGHT UPPER ABDOMINAL PAIN after MEALS, FATTY OR GREASY foods worsen symptoms.

OBESE WOMEN OVER 40 are the most likely candidates for gall bladder disease.