Ben Williams
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All Questions and Answers taken directly from the textbook publisher's website: http://www.differentialdiagnosisforpt.com/

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USA - Differential Diagnosis - Units 1-4 and 6-8

Question 1 of 56

1

In the context of screening for referral, primary purpose of a diagnosis is:

Select one of the following:

  • To obtain reimbursement

  • To guide the plan of care and intervention strategies

  • To practice within the scope of physical therapy

  • To meet the established standards for accreditation

Explanation

Question 2 of 56

1

Direct access is the only reason physical therapists must screen for systemic disease.

Select one of the following:

  • True
  • False

Explanation

Question 3 of 56

1

A patient/client gives you a written prescription from a physician, chiropractor, or dentist. The first screening question to ask is:

Select one of the following:

  • What did the physician (dentist, chiropractor) say is the problem?

  • Did the physician (dentist, chiropractor) examine you?

  • When do you go back to see the doctor (dentist, chiropractor)?

  • How many times per week did the doctor (dentist, chiropractor) suggest you come to therapy?

Explanation

Question 4 of 56

1

Screening for medical disease takes place:

Select one of the following:

  • Only during the first interview

  • Just before the client returns to the physician for his/her next appointment

  • Throughout the episode of care

  • None of these

Explanation

Question 5 of 56

1

Physical therapists are qualified to make a human movement system diagnosis regarding primary neuromusculoskeletal conditions, but we must do so in accordance with:

Select one of the following:

  • The Guide to Physical Therapist Practice

  • The State Practice Act

  • The screening process

  • The SOAP method

Explanation

Question 6 of 56

1

Medical referral for a problem outside the scope of the physical therapy practice occurs when:

Select one of the following:

  • No apparent movement dysfunction exists

  • No causative factors can be identified

  • Findings are not consistent with neuromuscular or musculoskeletal dysfunction

  • Client presents with suspicious red-flag symptoms

  • Any one of these

  • None of these

Explanation

Question 7 of 56

1

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

Select one of the following:

  • True
  • False

Explanation

Question 8 of 56

1

What is the effect of NSAIDs (e.g., Naprosyn, Motrin, Anaprox, ibuprofen) on blood pressure?

Select one of the following:

  • No effect

  • Increases blood pressure

  • Decreases blood pressure

Explanation

Question 9 of 56

1

Most of the information needed to determine the cause of symptoms is contained in the:

Select one of the following:

  • Subjective examination

  • Family/Personal History Form

  • Objective information

  • All of these

  • Subjective Examination and Objective Information

Explanation

Question 10 of 56

1

A risk factor for NSAID-related gastropathy is the use of:

Select one of the following:

  • Antibiotics

  • Antidepressants

  • Antihypertensives

  • Antihistamines

Explanation

Question 11 of 56

1

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:

Select one of the following:

  • An open-ended question

  • A funnel technique

  • A paraphrasing technique

  • None of these

Explanation

Question 12 of 56

1

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

Select one of the following:

  • True
  • False

Explanation

Question 13 of 56

1

What is the significance of sweats?

Select one of the following:

  • A sign of systemic disease

  • Side effect of chemotherapy or other medications

  • Poor ventilation while sleeping

  • All of these

  • None of these

Explanation

Question 14 of 56

1

Spontaneous uterine bleeding after 12 consecutive months without menstrual bleeding requires medical referral.

Select one of the following:

  • True
  • False

Explanation

Question 15 of 56

1

Which of the following are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal signs and symptoms:

Select one of the following:

  • Fever, (night) sweats, dizziness

  • Symptoms are out of proportion to the injury

  • Insidious onset

  • No position is comfortable

  • All of these

Explanation

Question 16 of 56

1

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

Select one of the following:

  • Decreased heart rate

  • Increased diuresis

  • Slowed peristalsis

  • Water retention

Explanation

Question 17 of 56

1

Instruct clients with a history of hypertension and arthritis to:

Select one of the following:

  • Limit physical activity and exercise

  • Avoid over-the-counter medications

  • Inform their primary care provider of both conditions

  • Drink plenty of fluids to avoid edema

Explanation

Question 18 of 56

1

Alcohol screening tools should be:

Select one of the following:

  • Used with every client sometime during the episode of care

  • Brief, easy to administer, and nonthreatening

  • Deferred when the client has been drinking or has the smell of alcohol on the breath

  • Conducted with one other family member present as a witness

Explanation

Question 19 of 56

1

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

Select one of the following:

  • Can you use one finger to point to the pain location?

  • Do you have that pain right now?

  • Does the pain wake you up at night after you have fallen asleep?

  • Is there anything that makes the pain better or worse?

Explanation

Question 20 of 56

1

A 52-year-old 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 for this pain behavior?

Select one of the following:

  • Minimal distractions heighten a person’s awareness of musculoskeletal discomfort.

  • This is a systemic pattern that is associated with a neoplasm.

  • It is impossible to tell.

  • This represents a chronic clinical presentation of a musculoskeletal problem.

Explanation

Question 21 of 56

1

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

Select one of the following:

  • The left shoulder

  • The right shoulder

  • The mid-back or upper back, scapular, and right shoulder areas

  • The thorax, scapulae, right shoulder, or left shoulder

Explanation

Question 22 of 56

1

Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain.

Select one of the following:

  • True
  • False

Explanation

Question 23 of 56

1

Words used to describe neurogenic pain often include:

Select one of the following:

  • Throbbing, pounding, beating

  • Crushing, shooting, pricking

  • Aching, heavy, sore

  • Agonizing, piercing, unbearable

Explanation

Question 24 of 56

1

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

Select one of the following:

  • Neoplasm

  • Assault or trauma

  • Drug dependence

  • Fracture

Explanation

Question 25 of 56

1

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

Select one of the following:

  • Medications

  • Chemicals

  • Infections

  • Artificial sweeteners

  • All of these

Explanation

Question 26 of 56

1

Bone pain associated with neoplasm is characterized by:

Select one of the following:

  • Increases with weight bearing

  • Negative heel strike

  • Relieved by Tums or other antacid in women

  • Goes away after eating

Explanation

Question 27 of 56

1

Pain of a viscerogenic nature is not relieved by a change in position.

Select one of the following:

  • True
  • False

Explanation

Question 28 of 56

1

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

Select one of the following:

  • True
  • False

Explanation

Question 29 of 56

1

A 48-year old man presented with low back pain of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps (accidents and falls), and engages in repetitive motions of all kinds using his arms, back, and legs. The pain is intense when he has it, but it seems to come and go. He is not sure if eating makes the pain better or worse. He has lost his appetite because of the pain. After conducting an examination including a screening exam, the clinical presentation does not match the expected pattern for a musculoskeletal or neuromuscular problem. You refer him to a physician for medical testing. You find out later he had pancreatitis.

What is the most likely explanation for this pain pattern?

Select one of the following:

  • Toxic waste products from the pancreas are released into the intestines causing irritation of the retroperitoneal space.

  • Rupture of the pancreas causes internal bleeding and referred pain called Kehr’s sign.

  • The pancreas and low back structures are formed from the same embryologic tissue in the mesoderm.

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

Explanation

Question 30 of 56

1

When assessing the abdomen, what sequence of physical assessment is best?

1.)
2.)
3.)
4.)

Drag and drop to complete the text.

    Inspection
    Auscultation
    Percussion
    Palpation

Explanation

Question 31 of 56

1

A line drawn down the middle of a lesion with two different halves suggests:

Select one of the following:

  • A malignant lesion

  • A benign lesion

  • A normal presentation

  • A skin reaction to medications

Explanation

Question 32 of 56

1

Pulse strength graded as 1 means:

Select one of the following:

  • Easily palpable, normal

  • Present occasionally

  • Pulse diminished, barely palpable

  • Within normal limits

Explanation

Question 33 of 56

1

During auscultation of an adult client with rheumatoid arthritis, the heart rate gets stronger as she breathes in and decreases as she breathes out.

This sign is:

Select one of the following:

  • Characteristic of lung disease

  • Typical in coronary artery disease

  • A normal finding

  • Common in anyone with pain

Explanation

Question 34 of 56

1

Body temperature should be taken as part of vital sign assessment:

Select one of the following:

  • A.) Only for clients who have not been seen by a physician

  • B.) For any client who has musculoskeletal pain of unknown origin

  • C.) For any client reporting the presence of constitutional symptoms, especially fever or sweats

  • B.) and C.)

  • All of the above

Explanation

Question 35 of 56

1

A 23-year-old female presents with new onset of skin rash and joint pain followed 2 weeks later by GI symptoms of abdominal pain, nausea, and diarrhea. She has a previous history of Crohn’s disease, but this condition has been stable for several years.
She does not think her current symptoms are related to her Crohn’s disease.

What kind of screening assessment is needed in this case?

Select one of the following:

  • Vital signs only.

  • Vital signs and abdominal auscultation.

  • Vital signs, neurologic screening examination, and abdominal auscultation.

  • No further assessment is needed; there are enough red flags to advise this client to seek medical attention.

Explanation

Question 36 of 56

1

Pursed-lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with:

Select one of the following:

  • Orthopnea

  • Emphysema

  • CHF

  • Orthopnea and CHF

Explanation

Question 37 of 56

1

Palpitations lasting for hours or occurring in association with pain, shortness of breath, fainting, or severe lightheadedness require medical evaluation.

Select one of the following:

  • True
  • False

Explanation

Question 38 of 56

1

Peripheral vascular diseases include:

Select one of the following:

  • Arterial and occlusive diseases

  • Arterial and venous disorders

  • Acute and chronic arterial diseases

  • All of these

  • None of these

Explanation

Question 39 of 56

1

Which statement is the most accurate?

Select one of the following:

  • Arterial disease is characterized by intermittent claudication, pain relieved by elevating the extremity, and history of smoking.

  • Arterial disease is characterized by loss of hair on the lower extremities and throbbing pain in the calf muscles that goes away by using heat and elevation.

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

  • Arterial disease is characterized by loss of hair on the toes, intermittent claudication, and redness or warmth of the legs that is accompanied by a burning sensation.

Explanation

Question 40 of 56

1

What are the primary signs and symptoms of CHF?

Select one or more of the following:

  • Fatigue

  • Dyspnea

  • Edema

  • Nocturia

  • Varicose Veins

  • Tinnitus

  • Headache

  • Night Sweats

Explanation

Question 41 of 56

1

When would you advise a client in physical therapy to take his/her nitroglycerin?

Select one of the following:

  • 45 minutes before exercise

  • When symptoms of chest pain do not subside with 10 to 15 minutes of rest

  • As soon as chest pain begins

  • None of the above

  • Any of the above

Explanation

Question 42 of 56

1

Neurologic symptoms such as muscle weakness or muscle atrophy may be the first indication of:

Select one of the following:

  • Cystic fibrosis

  • Bronchiectasis

  • Neoplasm

  • Deep vein thrombosis

Explanation

Question 43 of 56

1

Back pain with radiating numbness and tingling down the leg past the knee does not occur as a result of:

Select one of the following:

  • Postoperative thrombus

  • Bronchogenic carcinoma

  • Pott’s disease

  • Trigger points

Explanation

Question 44 of 56

1

Pain associated with pleuropulmonary disorders can radiate to the:

Select one or more of the following:

  • Anterior Neck

  • Upper Trapezius Muscle

  • Ipsilateral Shoulder

  • Thoracic Spine

Explanation

Question 45 of 56

1

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

Select one of the following:

  • True
  • False

Explanation

Question 46 of 56

1

Dyspnea associated with emphysema is the result of:

Select one of the following:

  • A.) Destruction of the alveoli

  • B.) Reduced elasticity of the lungs

  • C.) Increased effort to exhale trapped air

  • A.) and B.)

  • All of the above

Explanation

Question 47 of 56

1

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?

Select one of the following:

  • Increase

  • Decrease

  • Remain unchanged

  • Vary depending on potassium concentration

Explanation

Question 48 of 56

1

Common symptoms of RESPIRATORY ACIDOSIS would be most closely represented by which of the following descriptions?

Select one of the following:

  • Presence of numbness and tingling in face, hands, and feet

  • Presence of dizziness and lightheadedness

  • Hyperventilation with changes in level of consciousness

  • Onset of sleepiness, confusion, and decreased ventilation

Explanation

Question 49 of 56

1

Bleeding in the gastrointestinal (GI) tract can be manifested as:

Select one of the following:

  • Dysphagia

  • Melena

  • Psoas abscess

  • Tenderness over McBurney’s point

Explanation

Question 50 of 56

1

What is the significance of Kehr’s sign?

Select one of the following:

  • Gas, air, or blood in the abdominal cavity

  • Infection of the peritoneum (peritonitis, appendicitis)

  • Esophageal cancer

  • Thoracic disk herniation masquerading as chest or anterior neck pain

Explanation

Question 51 of 56

1

What areas of the body can GI disorders refer pain to?

Select one or more of the following:

  • Sternum

  • Shoulder

  • Scapula

  • Anterior Neck

  • Mid-Back

  • Lower Back

  • Hip

  • Pelvis

  • Sacrum

Explanation

Question 52 of 56

1

A 56-year-old client was referred to PT for pelvic floor rehab. His primary symptoms are obstructed defecation and puborectalis muscle spasm. He wakes nightly with left flank pain. The pattern is low thoracic, laterally, but superior to iliac crest. Sometimes he has buttock pain on the same side. He doesn’t have any daytime pain but 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 femoris.

Change in symptoms with gas or defecation is possible with:

Select one of the following:

  • Thoracic disk disease

  • Obturator nerve compression

  • Small intestine disease

  • Large intestine and colon dysfunction

Explanation

Question 53 of 56

1

Which of the following are common medications, taken by clients seen in a physical therapy practice, that are likely to induce GI bleeding.

Select one of the following:

  • Corticosteroids

  • Antibiotics and antiinflammatories

  • Statins

  • None of these

Explanation

Question 54 of 56

1

Which of the following are clues to the possible involvement of the GI system?

Select one of the following:

  • Abdominal pain alternating with TMJ pain within a 2-week period

  • Abdominal pain at the same level as back pain, occurring either simultaneously or alternately

  • Shoulder pain alleviated by a bowel movement

  • All of these

Explanation

Question 55 of 56

1

A 65-year-old client is taking OxyContin for a “sore shoulder.” She also reports aching pain of the sacrum that radiates.

The sacral pain can be caused by:

Select one of the following:

  • Psoas abscess caused by vertebral osteomyelitis

  • GI bleeding causing hemorrhoids and rectal fissures

  • Crohn’s disease manifested as sacroiliitis

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

Explanation

Question 56 of 56

1

Body temperature should be taken as part of vital sign assessment:

Select one of the following:

  • a. For every client evaluated

  • b. For any client who has musculoskeletal pain of unknown origin

  • c. For any client reporting the presence of constitutional symptoms, especially fever or night sweats

  • d. b and c

Explanation

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