ࡱ> IKH bjbjVV A8<<********8'+4[+4*-+++++,,,z-|-|-|-|-|-|-25^|-*,,,,,|-**++-,,,,"*+*+z-,,z-,,,+Gxg*,",f--0-,5,"5,5*,,,,,,,,,|-|-,,,,-,,,,5,,,,,,,,, ): Goodman & Snyder: Differential Diagnosis for Physical Therapists, 5th Edition Chapter 13: Screening for Cancer Practice Questions 1. Name three predisposing factors to cancer that the therapist must watch for during the interview process as red flags. 2. How do you monitor exercise levels in the oncology patient without laboratory values? 3. In a physical therapy practice, clients are most likely to present with signs and symptoms of metastases to: a. Skeletal system, hepatic system, pulmonary system, central nervous system b. Cardiovascular system, peripheral vascular system, enteric system c. Hematologic and lymphatic systems d. None of the above 4. What is the significance of nerve root compression in relation to cancer? 5. Complete the following mnemonic: C A U T I O N S 6. Whenever a therapist observes, palpates, or receives a client report of a lump or nodule, what three questions must be asked? 7. How can the therapist determine whether a clients symptoms are caused by the delayed effects of radiation as opposed to being signs of recurring cancer? 8. Give a general description and explanation of the changes seen in deep tendon reflexes associated with cancer. 9. Why is weight loss a significant red flag sign in a physical therapy practice? 10. When tumors produce signs and symptoms 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 11. A client who has recently completed chemotherapy 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 12. 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 13. What is the significance of Beaus lines in a client treated with chemotherapy 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 14. A 16-year-old boy was hurt in a soccer game. He presents with exquisite right ankle pain on weight bearing but reports no pain at night. Upon further questioning, you find he is taking Ibuprofen at night before bed, which may be masking his pain. What other screening examination procedures are warranted? a. Perform a heel strike test. b. Review response to treatment. c. Assess for signs of fracture (edema, exquisite tenderness to palpation, warmth over the painful site). d. All of the above 15. When is it advised to take a work or military history? a. Anyone with head and/or neck pain who uses a cell phone more than 8 hours/day b. Anyone over age 50 c. Anyone presenting with joint pain of unknown cause accompanied by multiple other signs and symptoms d. This is outside the scope of a physical therapists practice 16. A 70-year-old man came to outpatient 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 (MCP) 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 a previous history of cancer and recent onset of skin rash. b. You cant. This requires a medical evaluation. c. Look for signs of digital clubbing, cellulitis, or proximal muscle weakness. d. Assess vital signs. 17. A 49-year-old man was treated by you for bilateral synovitis of the proximal interphalangeal (PIP) 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 isnt able to tell you exactly whats 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 physical therapy intervention? a. Yes; age, bilateral symptoms, progression of symptoms, report of GI distress b. No; treatment was effective beforeits likely that he has done something to exacerbate his symptoms and needs further education about joint protection. 18. A client with a past medical history of kidney transplantation (10 years ago) has been referred to you for a diagnosis of rheumatoid arthritis. His medications include tacrolimus, methotrexate, Fosamax, and Wellbutrin. During the examination, 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 deep tendon reflexes, bone pain c. Productive cough, pain on inspiration d. Nose bleeds or other signs of excessive bleeding 19. A 55-year-old man with a left 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 history of cancer, allergies, or infections. c. Document your findings and contact the physician with your concerns. d. All of the above     13-PAGE 3 Practice Questions Copyright 2013, 2007, 2000, 1995, 1990 by Saunders, an imprint of Elsevier Inc. Copyright 2013, 2007, 2000, 1995, 1990 by Saunders, an imprint of Elsevier Inc. BCNO    \ ] _ ` a °|kXXkXkGk4$h zhK 0JDCJOJQJ^JaJ h zh\CJOJQJ^JaJ$h zh\0JCCJOJQJ^JaJ h zhK CJOJQJ^JaJhED0JCCJOJQJ^JaJ$h zhK 0JCCJOJQJ^JaJ h zh7CJOJQJ^JaJ#h zh75CJOJQJ^JaJh2h65OJQJaJh65CJOJQJaJy(h)ldh65CJOJQJaJh!h65CJOJQJaJOPqr  \ ]  ` -*$^`gdi+*$^`gdi,*$^`gdi* W*$^`Wgdi*$ Qd*$^`Qa$gdi $*$a$gd|$a$gd|   ` b                  " # $   A B D E F U ̹̹̹̹̹$h zhK CJNHOJQJ^JaJ$h zhK 0JECJOJQJ^JaJh]<CJOJQJ^JaJ$h zhK 0JCCJOJQJ^JaJh]<0JCCJOJQJ^JaJ$h zhK 0JDCJOJQJ^JaJ h zhK CJOJQJ^JaJ4          A B 1$ Qd*$^`Qa$gdi0*$^`gdi.*$^`gdi/*$^`gdi*$ Qd*$^`Qa$gdiU ` e p `aoq/1KM\^ڷږڷڃڃڃڃsڃڃڃڃsڃڃڃhK 0JCCJOJQJ^JaJ$h zhK 0JDCJOJQJ^JaJh]<CJOJQJ^JaJ$h zhK 0JCCJOJQJ^JaJh]<0JCCJOJQJ^JaJ$h zhK CJNHOJQJ^JaJ h zhK CJOJQJ^JaJ'h zhK 0JFCJOJQJ]^JaJ- o/K\G-*$^`gdi+*$^`gdi,*$^`gdi1$ Qd*$^`Qa$gdi^GI9;Z\eg{}"#),efxzCEZ[^̹̹̹̖̹hFbi0JCCJOJQJ^JaJ$h zhK CJNHOJQJ^JaJ$h zhK 0JCCJOJQJ^JaJhK 0JCCJOJQJ^JaJ$h zhK 0JDCJOJQJ^JaJ h zhK CJOJQJ^JaJ;9Ze{"#$%&'()x+*$^`gdi,*$^`gdi1$ Qd*$^`Qa$gdi-*$^`gdiCZ[VAuv7q2$ Qd*$^`Qa$gdi,*$^`gdi1$ Qd*$^`Qa$gdi-*$^`gdi+*$^`gdiVXACuvy79qs   ܹܹܞ{hyM0J_CJOJQJaJ hdhyM0J_CJOJQJaJhLGjhLGU$h zhK 0JCCJOJQJ^JaJhK 0JCCJOJQJ^JaJ$h zhK 0JDCJOJQJ^JaJ h zhK CJOJQJ^JaJ$h zhK CJNHOJQJ^JaJ-    !45-*$^`gdi^$a$gdyMZh]hgdyM Z&`#$gdyM4gd? !45gٵ h zhK CJOJQJ^JaJhyMhyMCJaJhE<hyMCJaJhLG hdhyMCJOJQJ^JaJ%htw:0J_CJOJQJaJmHnHu hdhyM0J_CJOJQJaJ)jhdhyM0J_CJOJQJUaJ? 0P1:pP&/ =!["[#$% Dp^`  666666666666666666666666666666666666666666 6666666666 666666666666 6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH j`j Normal$d1$7$8$9DH$a$%B*OJQJ^J_HmH phsH tH @DA`D 0Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List |/| 0[No Paragraph Style]d 1$7$8$9DH$!B*CJ_HaJmH phsH tH @.. 0 InfoDummydd 0 FigCaption!<d$d`Nգ``<CJOJQJ^JaJh"h 0 ChapterLabel d*$*5;@PB*CJ(OJQJ\^JaJ(ph`2` 0 ChapterTitledh*$5CJ.OJQJ\^JaJ.6B6 0 FirstSectParaJRJ 0BulletListPara1^`BQbB 0BulletListPara2 ^FarF 0BulletListParaIndent1ZqZ 0BulletListParaIndent1_FirstlineXqX 0BulletListParaIndent1_Lastline<< 0 NextSectPara `pp 0 Sec1Title$$hx&d *$P a$ ;B* CJOJQJ^JaJphtt 0 Sec2Title$$hx&d*$Pa$#5B*CJOJQJ\^JaJphAdNQN 0BulletListPara1_FirstlineLQL 0BulletListPara1_Lastline^^ 0 Sec3Title$<*$a$B* CJOJ QJ ^J aJph[mRR 0Sec4Title_FirstSectPara `zz 0 alt2_Title,!$ hx&d *$P a$ ;B* CJOJ QJ ^J aJph[mT"T 0alt2_FirstSectPara"CJOJ QJ ^J aJT!2T 0alt2_BulletListPara1#L^`LX1BX 0alt2_BulletListPara1_Firstline$l1Rl 0alt2_BulletListPara1_Lastline%&dPRbR 0Sec5Title_FirstSectPara &`RrR 0 Ttype2_TB'$d^`a$CJaJ8q8 0Ttype2(x] 0exam_questions_SectionTitle3)$dh$d`&d*$NS(m`PŹa$*5;@ B*CJ OJQJ\^JaJ phO 0 exam-questions_NumberListPara1_2 * Jd^J`CJaJvOv 0exam-questions_LetterListPara2+)!d^)`!CJaJlOl 0(exam-questions_LetterListPara2_Firstline,jOj 0'exam-questions_LetterListPara2_Lastline-XOX 0exam-questions_NormalListPara2.lOl 0(exam-questions_NormalListPara2_Firstline/jOj 0'exam-questions_NormalListPara2_Lastline0~O~ 0exam-questions_NumberListPara1 1 Jd^J`CJaJjO"j 0'exam-questions_NumberListPara1_Lastline2v2v 0 RefMainTitle$3$hx&d *$P a$ ;B* CJOJQJ^JaJph[mTOBT 0 ReferencePara4Jd^J`CJaJ`R` 0 auformtitle5$dh*$a$5CJ OJ QJ \^J aJ D/aD 0 ChapterLabel1@B*CJ\phD/qD 0BulletListLabelIndent1(/( 0crossref4/4 0 crossref_supH*"/" 0SupH*(/( 0Italic68/8 0BulletListLabel1"/" 0dummy6/6 0 Sec4Title CJOJ QJ / 0UL>*(/( 0InterrefB/B 0alt2_BulletListLabel1:/!: 0 Sec5Title6CJOJQJVo1V 0exam-questions_NumberListLabel1VoAV 0exam-questions_LetterListLabel2>oQ> 0exam_questions_BoldFoaF 0exam_questions_Italic64/q4 0ReferenceLabel,/, 0 RefSurname0/0 0 RefGivenname / 0etal2/2 0 DocumentTitle4/4 0 JournalTitle6(/( 0VolumeNo./. 0 FirstPageNo,/, 0 LastPageNo&/& 0PubDate./. 0 BibInterref0/!0 0 PublisherLoc2/12 0 PublisherName:/A: 0EditedBookTitle6&/Q& 0IssueNo8/a8 0RefEditorSurname</q< 0RefEditorGivenname2/2 0 SymbolNewOJQJ6/6 0 Ttype2_TB_SUPH*4@4 [P&0Header Z 9r T/T ZyM0 Header Char%B*OJQJ^J_HmH phsH tH @4 4 ]P&0Footer \ 9r X/X \0 Footer Char)B*CJOJQJ^JaJmHphsHtH @VoV yM0Default ^7$8$H$!B*CJ_HaJmH phsH tH 2)@2 yM0 Page Number^JPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  8 .. U ^ !8@0(  B S  ?   K d6P&2N:tw:E<EDLGyMP%b)ldFbiqt z4|?!]<7inK\ @X@Unknowng* Times New RomanTimes New Roman5Symbol3. * ArialEMinion-RegularOHelveticaNeue-RomanAUnivers-Bold?Minion-BoldWHelveticaNeue-HeavyCondUHelveticaNeue-BoldCondYHelveticaNeue-MediumCondAMinion-BlackWHelveticaNeue-LightCond]M Times-BoldTimes New RomanQHelveticaNeue-MediumQHelveticaNeue-Italic;SymbolNewA BCambria Math"h&G&Go )o )!!),.:;?]}   0 ([{  [dx3?nK2!xx Reed Elsevier Reed ElsevierOh+'0|  8 D P\dltReed Elsevier Normal.dotmReed Elsevier2Microsoft Office Word@@f@fo՜.+,0 hp|  )   Title  !"#$%&'()*+,-./012345679:;<=>?ABCDEFGJRoot Entry FsgL1Table5WordDocumentA8SummaryInformation(8DocumentSummaryInformation8@CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q