DD Exam #1: Comprehensive Study Guide and Review
Understand the reasons why a physical therapist may need to screen for medical disease - correct
answer ✔✔1. direct access: therapist has primary responsibility or first contact
2. quicker and sicker patient/client base
3. signed prescription: clients may obtain a signed prescription for PT/OT based on similar past
complaints of MSK symptoms w/o direct physician contact
4. medical specialization: medical specialists may fail to recognize underlying systemic disease
5. disease progression: early signs and sx are difficult to recognize, or sx may not be present at the time
of medical exam
6. patient/client disclosure: client discloses info previously unknown or undisclosed to physician
7. client doesn't report sx or concerns to physician b/c of forgetfulness, fear, or embarrassment
8. presence of one or more yellow (caution) or red (warning) flags
Identify yellow and red flag histories and signs and symptoms that may suggest a need for further
screening - correct answer ✔✔PMH:
-cancer
-recent (last 6 wks) infection, esp. when followed by neurologic sx 1-3 wks later, jt p!, or back p!
-recurrent colds/flu w/ cyclical pattern
-recent hx of trauma or minor trauma in older adult w/ osteopenia/osteoporosis
-hx of immunosuppression
-hx of injection drug use
Risk Factors:
-substance use/abuse
-tobacco use
-age
-gender
-BMI
-exposure to radiation
,-alcohol use/abuse
-sedentary lifestyle
-race/ethnicity
-domestic violence
-hysterectomy/oophorectomy
-occupation
Clinical Presentation:
-no known cause, unknown etiology, insidious onset
-sx not improved/relieved by PT intervention (RED FLAG)
-PT intervention doesn't change clinical picture (client may get worse)
-sx that get better after PT, but then get worse again (need to screen further) (RED FLAG)
-significant weight loss/gain w/o effort (> 10% weight in 10-21 days)
-gradual, progressive, or cyclical presentation of sx (worse/better/worse)
-unrelieved by rest or change in position; no position is comfortable
-if relieved by rest, positional change, or application of heat, in time, these relieving factors no longer
reduce sx
-sx seem out of proportion to injury
-sx persist beyond expected time for condition
-unable to alter sx during exam
-doesn't fit unexpected mechanical or neuromusculoskeletal pattern
-no discernible pattern of sx
-growing mass is a tumor until proved otherwise; a hematoma should decrease (not increase) in size w/
time
-postmenopausal vaginal bleeding
-bilateral sx: edema, numbness/tingling, skin-pigmentation changes, clubbing, nail-bed changes, skin
rash
-chance in muscle tone or ROM for individuals w/ neurologic conditions
Pain Pattern:
, -back or shoulder p!
-p! accompanied by full and painless ROM
-p! not consistent w/ emotional or psychologic overlay; screening tests for emotional overlay are
negative
-night p!
-sx consta
Recognize constitutional symptoms that may warrant further screening - correct answer ✔✔1. fever
2. diaphoresis (unexplained perspiration)
3. sweats (can occur anytime night or day)
4. nausea
5. vomiting
6. diarrhea
7. pallor
8. dizziness/syncope (fainting)
9. fatigue
10. weight loss
Understand the diagnosis process of the physical therapist - correct answer ✔✔-"diagnosis by the
physical therapist" is language used by APTA
-it is policy of APTA that PTs shall establish a dx for each pt/client
-PT qualified to make dx regarding primary NMS conditions, though we must do so in accordance w/ the
state practice act
-PT must integrate 5 elements of pt/client management in a manner designed to maximize outcomes
1. examination (hx, systems review, and tests and measures)
2. evaluation (assessment or judgment of the data)
3. diagnosis (determined within the scope of practice)
4. prognosis (projected outcome)
Understand the reasons why a physical therapist may need to screen for medical disease - correct
answer ✔✔1. direct access: therapist has primary responsibility or first contact
2. quicker and sicker patient/client base
3. signed prescription: clients may obtain a signed prescription for PT/OT based on similar past
complaints of MSK symptoms w/o direct physician contact
4. medical specialization: medical specialists may fail to recognize underlying systemic disease
5. disease progression: early signs and sx are difficult to recognize, or sx may not be present at the time
of medical exam
6. patient/client disclosure: client discloses info previously unknown or undisclosed to physician
7. client doesn't report sx or concerns to physician b/c of forgetfulness, fear, or embarrassment
8. presence of one or more yellow (caution) or red (warning) flags
Identify yellow and red flag histories and signs and symptoms that may suggest a need for further
screening - correct answer ✔✔PMH:
-cancer
-recent (last 6 wks) infection, esp. when followed by neurologic sx 1-3 wks later, jt p!, or back p!
-recurrent colds/flu w/ cyclical pattern
-recent hx of trauma or minor trauma in older adult w/ osteopenia/osteoporosis
-hx of immunosuppression
-hx of injection drug use
Risk Factors:
-substance use/abuse
-tobacco use
-age
-gender
-BMI
-exposure to radiation
,-alcohol use/abuse
-sedentary lifestyle
-race/ethnicity
-domestic violence
-hysterectomy/oophorectomy
-occupation
Clinical Presentation:
-no known cause, unknown etiology, insidious onset
-sx not improved/relieved by PT intervention (RED FLAG)
-PT intervention doesn't change clinical picture (client may get worse)
-sx that get better after PT, but then get worse again (need to screen further) (RED FLAG)
-significant weight loss/gain w/o effort (> 10% weight in 10-21 days)
-gradual, progressive, or cyclical presentation of sx (worse/better/worse)
-unrelieved by rest or change in position; no position is comfortable
-if relieved by rest, positional change, or application of heat, in time, these relieving factors no longer
reduce sx
-sx seem out of proportion to injury
-sx persist beyond expected time for condition
-unable to alter sx during exam
-doesn't fit unexpected mechanical or neuromusculoskeletal pattern
-no discernible pattern of sx
-growing mass is a tumor until proved otherwise; a hematoma should decrease (not increase) in size w/
time
-postmenopausal vaginal bleeding
-bilateral sx: edema, numbness/tingling, skin-pigmentation changes, clubbing, nail-bed changes, skin
rash
-chance in muscle tone or ROM for individuals w/ neurologic conditions
Pain Pattern:
, -back or shoulder p!
-p! accompanied by full and painless ROM
-p! not consistent w/ emotional or psychologic overlay; screening tests for emotional overlay are
negative
-night p!
-sx consta
Recognize constitutional symptoms that may warrant further screening - correct answer ✔✔1. fever
2. diaphoresis (unexplained perspiration)
3. sweats (can occur anytime night or day)
4. nausea
5. vomiting
6. diarrhea
7. pallor
8. dizziness/syncope (fainting)
9. fatigue
10. weight loss
Understand the diagnosis process of the physical therapist - correct answer ✔✔-"diagnosis by the
physical therapist" is language used by APTA
-it is policy of APTA that PTs shall establish a dx for each pt/client
-PT qualified to make dx regarding primary NMS conditions, though we must do so in accordance w/ the
state practice act
-PT must integrate 5 elements of pt/client management in a manner designed to maximize outcomes
1. examination (hx, systems review, and tests and measures)
2. evaluation (assessment or judgment of the data)
3. diagnosis (determined within the scope of practice)
4. prognosis (projected outcome)
