Download Midterm 1 Differential Diagnosis: Questions and Solutions for Movement Science and more Exams Nursing in PDF only on Docsity!
Midterm 1 Differential Diagnosis
Questions With Complete Solutions
according to research, the Upper Quarter is often linked to the ______ region. (Cleland, Gonzales-Iglesias) Correct Answers Thoracic according to research, the Thoracic region is often linked to the ______ region. (mintken, Strunce, Boyles) Correct Answers Shoulder according to research, the Lumbar region is often linked to the ______ region. (Stupar, Ben-Galim) Correct Answers Hip according to research, the Hip region is often linked to the ______ region. (Powers, Souza, Bogla, Rowe) Correct Answers Knee according to research, the Knee region is often linked to the ______ region. (Molgaard) Correct Answers Ankle Can interventions have local and remote effects in linked adjacent regions? Correct Answers yes What is the concept of "Regional Interdependence" in the context of movement science? Correct Answers Regional Interdependence in movement science refers to the idea that different regions of the body are musculoskeletally linked.
Why was there a problem with the original definition of Regional Interdependence according to Wainner et al.? Correct Answers The problem with the original definition of Regional Interdependence, as implied by Wainner et al., was that it suggested that the link between regions was solely a musculoskeletal one. What is the refined concept of "Interdependence" in the context of musculoskeletal impairments and patient complaints? Correct Answers The refined concept of "Interdependence" suggests that seemingly unrelated impairments in remote anatomical regions could contribute to and be associated with a patient's primary complaint. It also indicates that a patient's primary musculoskeletal symptoms may be directly or indirectly related or influenced by impairments from various body regions and systems, regardless of their proximity to the primary symptoms. how has the initial definition of interdependence changed? The concept that seemingly unrelated impairments in remote anatomical regions could contribute to and be associated with a patient's primary complaint (Initial) Correct Answers current: The concept that a patient's primary musculoskeletal symptom(s) may be directly or indirectly related or influenced by impairments from various body regions and systems regardless of proximity to the primary symptom(s) (Sueki 2013) (J Manip Man Ther 21(2), 2013) What are the primary tasks of the body (4) Correct Answers Homeostasis
- Some physiological systems are more critical than others.
- It is plausible to suggest that physiological systems may also have a hierarchical organization -our brain is wired to work in a hierarchical manner especially at the subconscious level. what are the two types of responses to a stimulus, wether its Musculoskeletal, Biopsychosocial, Somatovisceral, or Neurophysiological? Correct Answers The stimulus causes a behavioral response, which has either a Local response or a Remote Response What somatovisceral referral: Pain on posterior and anterior neck on the left side Correct Answers Lung and Diaphragm What somatovisceral referral: Pain on Left Chest, Left neck, Left shoulder, and left Medial arm down to pinky Correct Answers heart What somatovisceral referral: Anterior middle chest into left chest Correct Answers Esophagus What somatovisceral referral: Pain on right trap, right shoulder, right scapula, and right lower back Correct Answers liver and gallbladder What somatovisceral referral: T5-T7 between the scapula, and below xiphoid process anterior Correct Answers Stomach
What somatovisceral referral: Pain below xiphoid process anterior Correct Answers Pancreas What somatovisceral referral: Pain on anterior Right side of the abdominal region Correct Answers Gallbladder What somatovisceral referral: Pain on anterior underwear area into lateral hip, and posterior belt into lateral glute Correct Answers Kidney What somatovisceral referral: pain at the belly button Correct Answers Small Intestine What somatovisceral referral: Anterior Right Hip Flexor Correct Answers Appendix What somatovisceral referral: Two dots above the bellybutton in women Correct Answers Ovary What somatovisceral referral: Pain below bellybutton Correct Answers Colon What somatovisceral referral: Anterior: genital region and below bellybutton Posterior: sacrum and below bilateral glutes Correct Answers Urinary Bladder
and discomfort associated with inflammation in the internal organs. Can Somatovisceral structures produce musculoskeletal responses? Correct Answers yes According to the Smith 2009, what are some somatovisceral structures or conditions that have been associated with the development of low back pain, particularly in women? Correct Answers In women, conditions such as menstrual cramping, incontinence, gastrointestinal symptoms, and respiratory problems have been associated with the development of low back pain. According to the study by Anderson et al. 2013, what was the significant finding regarding passive hip extension range of motion in women during menstruation compared to mid-cycle, and was pelvic pain found to be a significant factor in this context? Correct Answers According to the study by Anderson et al. 2013, the significant finding was that average hip extension passive range of motion (PROM) during menstruation was significantly decreased by approximately 6 degrees compared to during mid-cycle. -Pelvic pain was not identified as a significant factor influencing this decrease. In the study conducted by Leonti and Wolfe in 2014, what did they find regarding the effect of menstruation on hip extension, and were pain or differences between the left and right sides found to be significant factors in this context? Correct Answers In the study by Leonti and Wolfe in 2014, they
continued to find a significant decrease in hip extension during menstruation. -Pain was not identified as a significant factor, and there were differences observed between the left and right sides. -The study suggests that other factors, such as hormones and the side of menstruation, may be the primary causes of this effect. According to the study by Soli and Pabin in 2014, how did pain influence hip flexion strength during menses, and what was the primary assessment method used to measure hip flexion strength in the study? Correct Answers In the study by Soli and Pabin in 2014, pain was identified as a significant factor that decreased hip flexion strength during menses. The primary assessment method used to measure hip flexion strength in the study was a hand-held dynamometer. In the study by Hobday (2001) that used functional MRI to investigate the cortical processing of ano-rectal sensation, what were the key findings regarding the activation of the somatosensory cortex and the anterior cingulate cortex, and what do these findings suggest about the representation of viscera and somatic structures in the cortex? Correct Answers Both rectal and ano-rectal stimulation activated the somatosensory cortex. However, the anterior cingulate cortex was specifically activated by rectal stimulation, suggesting that the viscera have a greater representation on the limbic cortex than somatic structures. According to the study by Bernstein et al. in 2002, what were the key findings regarding cortical mapping of visceral pain in patients with GI disorders, specifically those with IBS (Irritable
- using traditional assessment methods to identify and treat the source of the patient's symptoms, particularly addressing local tissue symptoms.
- In the second step, the goal is to identify other regions and/or systems that could be influencing or causing the local system impairments. -However, the primary goal is not to propose the diagnosis or treatment of visceral tissue but to suggest that visceral structures and systems may be contributory factors in musculoskeletal pain. what is the hepatic system made up of? (3) Correct Answers liver gallbladder bile duct where is the hepatic system situated? Correct Answers anterior to lower lobes of lungs what are the orthopedic mechanical implications for hepatic issues? (7) Correct Answers -pain in R shoulder/UT -hypertonic secondary respiratory muscles, especially on R -R wide rib angle or flare, stiffness in R ribcage -Poor diaphragmatic expansion -may be sitting high-can fit your fingers up under ribs >2-3cm -There is often also secondary poor core stability/kinetic chain engagement and potential for LBP -digestive issues: LBP, bloat, protective slump
what is the function of bile? Correct Answers 1) transports toxins and other hepatic waste OUT of body into GI tract for excretion via stool (excretory function
- Digests fat
- sterilizes small intestine to prevent SIBO and maintains appropriate pH for optimal digestion/absorption
- necessary for absorption of vitamin A, D, E, K what are the functions of the liver Correct Answers -filters 1.4L of blood per minute -breaks down carbs into glucose for energy -Removes toxins -filters blood to remove toxins -produce bile -holds onto fat -stocks iron -creates blood -regenerates -doesn't hurt main 3 pathways for excretion from the body Correct Answers -breathing -bowel and bladder -skin when we stand up straight, what happens to the bile duct? Correct Answers bile duct stretches when we stand up straight, and goes on slack. What are some common Hepatic Pathologies? Correct Answers -Infections
- In sidelying, compress anteriorly and posteriorly, assess liver in 3 planes What causes infections in liver disease? Correct Answers parasites and viruses that cause inflammation that leads to reduced liver function other than parasites and viruses, what are some other causes of liver disease/infection? Correct Answers - Excessive alcohol consumption
- NAFL-D
- Toxins in the blood (mold, environmental toxins/pollutants
- Reaction to certain medicines
- Poor circulation
- Pregnancy
- Autoimmune and hereditary conditions what are the types of hepatitis? Correct Answers A B C what is hepatitis? Correct Answers inflammation of the liver what is the etiology of hepatitis? Correct Answers Caused by viral infections, chemical or drug reactions, or alcohol abuse patient comes in with these symptoms. What is the Dx? fever flu-like symptoms abrupt onset of fatigue anorexia
headache jaundice darkened urine lightened stool enlarged spleen/liver intermittent pruritus (itchiness) Correct Answers Hepatitis What type of Hepatitis:
- Transmission: Fecal-oral route (contaminated food or water),
- Typically does not progress to chronic disease, virus is self- limiting. Recovery usually 6-10 weeks Correct Answers Hepatitis A What type of Hepatitis:
- Transmission: sexually transmissible, sharing of needles, exposure to infected blood/semen, maternal-fetal exposure
- Prevented and mitigated with vaccine
- Medical interventions available Correct Answers Hepatitis B What type of Hepatitis:
- Transmission: sexually transmissible, sharing of needles, exposure to infected blood/semen, maternal-fetal exposure
- Newly treatable with 12 week course of daily oral medication
- Previously about 50% of infections lead to chronic hepatitis-
eventual need for liver transplant Correct Answers Hepatitis C what are the implications for Healthcare workers for Hepatitis? Correct Answers • Up to date on vaccines/boosters
- If exposed to bodily fluids or blood of infected person, report to receive immunoglobulin therapy within 24 hours
- Heart failure
- Liver failure
- Bronze or gray skin color
- Memory fog Correct Answers genetic liver disease what are the types of cancer liver disease? (2) Correct Answers Liver cancer/liver adenoma bile duct cancer What is Cirrhosis? Correct Answers scarring of the liver what are the implications of Cirrhosis? Correct Answers stops normal blood flow through the organ, ruins its function -cannot be reversed, and tx for this situation consists of stopping or delaying progression what causes Cirrhosis? Correct Answers - Mostly due to prolonged alcoholism
- Fatty liver disease
- Hepatitis C
- Tobacco smoking
- Certain drugs
- Anything that causes long term or severe inflammation in the liver. patient comes in with these s/s. What is the suspected dx?
- Encephalopathy
- Spider angioma
- Sparse body hair
- Muscle wasting
- Dilated stomach vessels
- Red Palms
- Jaundice
- Ascites: water accumulation in abdomen secondary to decreased albumin production
- Peripheral edema
- Itchiness Correct Answers Cirrhosis what do you want to avoid with Cirrhosis? (2) Correct Answers valsalva maneuvers fatigue fatty liver disease occurs when the liver stores more than ___% Correct Answers 10 Most liver diseases are interlinked. Chronic Hepatitis typically leads to ______. Hepatocellular carcinoma can be caused by hepatitis ___ or ___ or by chronic ______ Correct Answers Cirrhosis B, C Cirrhosis What is Non Alcoholic Fatty Liver Disease? Correct Answers Downstream effect of insulin resistance -muscles are full of glycogen, if it cant store anymore, then it sends excess glucose to the liver. -once the liver is full, it spreads it around to other visceral organs -Liver can also become insulin resistant in which case it won't stop putting more glucose into circulation. This is now full blown DMII need for meds.
perforated gallbladder Correct Answers occurs when your gallstones over time wear a hole in the walls of your organs gallbladder inflammation (cholecystitis) Correct Answers occurs if bile builds up in your gallbladder what are the 2 main types of gallstones? Correct Answers - Cholesterol stones. Yellow-green in color and the most common kind, accounting for 80% of gallstones.
- Pigment stones. Smaller and darker and made up of bilirubin, which comes from bile, a fluid your liver makes and your gallbladder stores. what causes gallstones? Correct Answers - Hypomobility of gallbladder (all organs have "tone" and contraction)
- Supersaturation of bile with cholesterol or bilirubin salts
- Blood sugar
- Imbalanced high Estrogen
- Food allergies
- Stress
- Low fiber intake
- Low stomach acid (compensatory hyper secretion of bile)
- Obesity
- Rapid weight loss
- Low fat diets
- Cholesterol meds
- Leaky gut patient comes in with these s/s. What is the suggested dx?
- Pain in their right upper quadrant- upper belly and upper back that can last for several hours
- Pain may radiate into interscapular region
- Fever/Nausea/Vomiting
- bloating, indigestion and heartburn, and gas Correct Answers gallstones tubes do not like to be (compressed/stretched), structures do not like to be (compressed/stretched) Correct Answers stretched, compressed what is acute cholecystitis? Correct Answers inflammation of the gallbladder -gallstones can cause obstruction of the bile flow and painful dissention of the gall bladder are gallstones painful in the bile duct? Correct Answers In the structure, no, but once in the tubes yes what is the treatment for acute cholecystitis Correct Answers low(er) fat diet, lithotripsy (US shock waves), laparoscopic cholecystectomy when will acute cholecystitis resolve itself? Correct Answers usually within a week with analgesics, abx, possible IV feedings. what does post surgical PT look like for Acute Cholecystitis? Correct Answers scar tissue mobilization, liver support, visceral support along liver, bile duct, small intestine, diaphragmatic restoration, patient education
