Exam 1 Practice Questions

Question 1

Name 3 predisposing factors to cancer that the therapist must watch for during the interview process as red flags

Answer 1

• PMH
• Clinical presentation
• Associated s/s

Question 2

In a physical therapy practice, clients are most likely to present with s/s of metastases to:

A. skeletal system, hepatic system, pulmonary system, CNS
B. CVS, peripheral vascular sytem, enteric system
C. Hematologic and lymphatic systems
D. none of the above

Answer 2

A. skeletal system, hepatic system, pulmonary system, CNS

Question 3

What is the significance of nerve root compression in relation to cancer?

Answer 3

• may be first signs of cancer

- esp for lymphoma, multiple myeloma, cancer of the lung, breast, prostate, or kidney

Question 4

What are the supplemental s/s of CAUTIONS?

Answer 4

• rapid unintentional WL
• changes in vitals
• frequent infections
• night pain
• pathologic fx
• prox musc weakness
• change in DTRs

Question 5

Whenever a therapist observes, palpates, or receives a client report of a lump or nodule, what 3 questions must be asked?

Answer 5

1. How long have you had it?
2. Has it changed over the past 6 weeks to 6 months?
3. Has your physician examined this area?

Question 6

How can the therapist determine whether a client’s sx are caused by the delayed effects of radiation as opposed to being s/s of recurring cancer?

Answer 6

• This is a medical decision and not within the scope of PT practice
• If there is doubt, physician should be contacted

Question 7

Give a general description and explanation of the changes seen in DTRs associated with cancer

Answer 7

diminished response

Question 8

Why is WL a significant red flag sign in a physical therapy practice

Answer 8

• pain, mvt dysfunction, and disability usu result in weight gain due to inactivity
• weight loss may be a red flag for systemic origin of the problem

Question 9

When tumors produce s/s at a site distant from the tumor or its metastasized sites, these remote effects of malignancy are called:

A. bone metastases
B. Vitiligo
C. Paraneoplastic syndrome
D. Ichthyosis

Answer 9

C. Paraneoplastic syndrome

Question 10

A client who has recently completed chemo requires immediate medical referral if he has which of the following symptoms

A. Decreased appetite
B. Increased urinary output
C. Mild fatigue but moderate dyspnea with exercise
D. Fever, chills, sweating

Answer 10

D. Fever, chills, sweating

Question 11

A suspicious skin lesion requiring medical evaluation has:

A. Round, symmetric borders
B. Notched edges
C. Matching halves when a line is drawn down the middle
D. A single color of brown or tan

Answer 11

B. Notched edges

Question 12

What is the significance of Beau’s lines in a client treated with chemo for leukemia?

A. Impaired nail formation from death of cells
B. Temporary longitudinal groove or ridge through the nail
C. Increased production of the nail by the matrix as a sign of healing
D. A sign of local trauma

Answer 12

D. A sign of local trauma

Question 13

A 16-y/o boy was hurt in a soccer game. He presents with exquisite R ankle pain and WB, but reports no pain at night. Upon further questioning, you find he is taking ibuprofen at night before bed, which may be masking the pain. What other screening exam procedures are warranted?

A. perform a heel strike test
B. Review response to tx
C. Assess for signs of fx (edema, exquisite ttp, warmth over painful site
D. All of the above

Answer 13

D. All of the above

Question 14

When is it advised to take a work or military hx?

A. Anyone with head and/or neck pain who uses a cell phone more than 8 hrs/day
B. Anyone over age 50
C. Anyone presenting with joint pain of unknown cause accompanied by multiple other s/s
D. This is outside the scope of a PT’s practice

Answer 14

C. Anyone presenting with joint pain of unknown cause accompanied by multiple other s/s

Question 15

A 70 y/o man came to an OP physical therapy with a complaint of pain and weakness of his fingers and morning stiffness lasting about an hour. He presented with bilateral swelling of the metacarpophalangeal joints of the index and ring fingers.He saw his family doctor 4 weeks ago and was given diclofenac, which has not changed his symptoms. Now he wants to try physical therapy. Since he last saw his physician, he has developed additional joint pain in the left knee and right shoulder. How can you tell if this is cancer, polyarthritis, or a paraneoplastic disorder?

A. Ask about previous hx of cancer and recent onset of skin rash
B. You can’t. This requires a medical evaluation
C. Look for signs of digital clubbing, cellulitis, or proximal muscle weakness
D. assess vital signs

Answer 15

B. You can’t. This requires a medical evaluation

Question 16

A 49 y/o man was treated by you for bilateral synovitis of the proximal interphalangeal joints in the second, third and fourth fingers. His symptoms went away with treatment, and he was discharged. Six weeks later, he returned with the same symptoms. There was obvious soft tissue swelling with morning stiffness worse than before. He also reports problems with his bowels but isn’t able to tell you exactly what’s wrong. There are no other changes in his health. He is not taking any medications or over the counter drugs and does not want to see a doctor. Are there enough red flags to warrant medical evaluation before resumption of PT intervention?

A. Yes; age, bilateral sx, progression of sx, report of GI distress
B. No, tx was effective before - it’s likely that he has done something to exacerbate his sx and needs further education about joint protection

Answer 16

A. Yes; age, bilateral sx, progression of sx, report of GI distress

Question 17

A client with a PMH of kidney transplant (10 yrs ago) has been referred to you for dx of RA. His meds include tacrolimus, methotrexate, fosamax,and wellbutrin. During the exam, you notice a painless lump under the skin in the right upper anterior chest. There is a loss of hair over the area. What other symptoms should you look for as red flag signs and symptoms in a client with this history?

A. Fever, muscle weakness, weight loss
B. Change in DTR’s, bone pain
C. Productive cough, pain on inspiration
D. Nosebleeds or other signs of excessive bleeding

Answer 17

A. Fever, muscle weakness, weight loss

Question 18

A 55 y/o man with a L shoulder impingement also has palpable axillary lymph nodes on both sides. They are firm but movable, about the size of an almond. What steps should you take?

A. Examine other areas where lymph nodes can be palpated
B. Ask about hx of cancer, allergies, or infections
C. Document your findings and contact the physician with your concerns
D. All of the above

Answer 18

D. All of the above

Question 19

CAUTIONS mnemonic:

C

Answer 19

Changes in bowel/bladder

Question 20

CAUTIONS mnemonic:

A

Answer 20

A sore that doesn’t heal in 6 weeks

Question 21

CAUTIONS mnemonic:

U

Answer 21

Unusual bleeding or d/c

Question 22

CAUTIONS mnemonic:

T

Answer 22

Thickening or lump in breast or elsewhere

Question 23

CAUTIONS mnemonic:

I

Answer 23

Indigestion or difficulty swallowing

Question 24

CAUTIONS mnemonic:

O

Answer 24

Obvious change in wart or mole

Question 25

CAUTIONS mnemonic:

N

Answer 25

Nagging cough or hoarseness

Question 26

CAUTIONS mnemonic:

S

Answer 26

Supplemental s/s