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Flashcards in Case Scenarios Deck (29):
1

-Joanne is a 57-year-old female referred to you for shoulder pain. During your examination, you notice a lesion on her involved shoulder.
-The lesion is a uniform darker brown, compared to her normal skin tone; about 9 mm in diameter, with irregular borders that fade into the surrounding skin.
-On questioning, Joanne tells you that the lesion has been there “since my kids were little”, but she cannot recall if it’s grown or changed since she first noticed it.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

2

-John is being followed by you for post-operative rehab of his knee. He had a minor (soft tissue only) infection following his surgery which was treated with a short course of antibiotics. His last dose was this morning.
-During his rehab session, John complains of itching “all over”, which started a day or two ago. As you observe his skin (he’s in shorts and a t-shirt for the session), you notice a widespread mild erythema with faint distinct elevations with irregular borders and shapes. This effect is noted over all exposed skin on his extremities.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

3

-James is a 46-year-old male referred to you for bilateral knee pain. He works as a carpenter and lives in a multi-level house with his wife and three kids.
-During your examination, you notice a silvery plaque covering his elbows and lower legs. On questioning, James says the lesions “come and go” but are worse in the winter and if he gets ill.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

4

-Jeanette is a 60-year-old female with diabetes mellitus followed by you for wound care of a slow-healing wound on her right foot.
-On arrival at the clinic today, she is exhibiting an antalgic gait on her left lower extremity; when you ask her about it, she says she “scraped the leg” against a bush when she was out gardening two days ago.
-On observation, you notice definite erythema with multiple open, weeping lesions over her tibial crest; there is moderate erythema of the lower leg and tenderness to light touch over the entire area.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

5

-Jerry is a 4-year-old male followed by you for mild developmental delay. When his mother brings him in for treatment, she mentions some lesions on his face that “just popped up” yesterday.
-On observation, you notice vesicles surrounding his nose and mouth that are draining a straw-colored fluid; some are crusted over and have the appearance of dried honey.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

6

Doreen is a 75-year old female referred to you for an exercise program. She complains of incidental abdominal pain that is episodic in nature. She enjoys reading and listening to music. She denies fatigue, malaise, fever, weight changes, nausea, dizziness, numbness and cognitive changes. Her favorite foods are cheese and crackers.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

7

David is a 45-year old male followed by you in an inpatient setting for reconditioning; he has undergone repeated paracentesis for advanced liver disease. As you are ambulating with him in the clinic, he suddenly starts vomiting bright red fluid and starts to sag to the floor. You support him by his gait belt and safely transfer him to a sidelying position on the treatment mat.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

8

Dennis is a 48-year-old African-American male with a history of GERD, referred to you for new onset of cervical pain. On his MSF, he notes regular use of tobacco and EtOH. His other complaints listed on the form are difficulty swallowing and pain just below his sternum when he lies down.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

9

Dottie is a 66-year-old female referred to you for exercise prescription for advanced DJD in B knees. She incidentally c/o severe epigastric pain which comes and goes throughout the day, as well as darker-colored stool. She denies fever and weight loss.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

10

Deidre is a 70-year old female immigrant from Norway referred to you for chronic LBP. On her MSF, she notes fatigue with normal ADLs and numbness/tingling in her feet and fingers. On observation, Deidre is thin with sallow skin tone and a darker color to her tongue.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

11

Donna is a 59-year-old female with history of CAD resulting in 4-vessel CABG in 2013, and complicated by a DVT post-operatively. She has been followed in your clinic for endurance training over the past month but while she is exercising today she c/o pain at the thoracolumbar junction that “feels like a muscle cramp”. On further questioning, her last bowel movement was yesterday morning.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

12

Edwina is a 23-year-old Peace Corps worker who is home on vacation from her assignment in Myanmar. She presents to your clinic with a complaint of right shoulder pain of gradual onset over the past 3 weeks. It doesn’t seem to be related to any specific activity or time of day.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

13

Edward is a 45-year old male followed by you in an inpatient setting for reconditioning; he has undergone repeated paracentesis for advanced liver disease. As you are ambulating with him in the clinic, he suddenly starts vomiting bright red fluid and starts to sag to the floor. You support him by his gait belt and safely transfer him to a sidelying position on the treatment mat.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

14

Eric is a 42-year-old male undergoing initial evaluation for an exercise prescription. On his MSF, he complains of fatigue and “itching all over”; he has a surgical history of ORIF of the right femur following a fall from standing height. On observation, you note moderate distention of his abdomen and moderate edema in BLE. He has several areas of light ecchymosis which he attributes to “bumping into things”.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

15

Edgar is a 56-year-old male who presents with back pain of sudden onset, approximately three days ago. He describes it as “steady and penetrating”. On his MSF, he complains of nausea and vomiting which started yesterday. On your exam, his heart rate is 110 bpm and regular, and the upper quadrants of his abdomen are rigid and tender to palpation.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

16

Eduardo is a 35-year-old male who presents with right shoulder pain of gradual onset approximately 4 weeks ago. On his MSF, he denies alcohol, tobacco, and drugs but does note a “poor diet” and “not much” exercise. He says his doctor is currently worried about his cholesterol level. On examination, you find tenderness just inferior to the right costal margin at its midpoint.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

17

Evangeline is a 66-year-old retired RN who presents with right periscapular and upper back pain. She has a history of Hepatitis B incurred through accidental finger-stick which has resulted in cirrhosis of her liver. On her MSF, she complains of fatigue and malaise, and notes a loss of 15 pounds over the past month.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

18

-Samuel is a 72-year-old male with hypertension (controlled by diuretics) and a 50-pack-year history of tobacco use.
-He presents to your clinic with a complaint of LBP that radiates around to his left flank.
-On his medical screening form, he has checked “yes” for changes in bowel and bladder (“bloody pee for 1 week”) and weight gain/loss (“lost 20 pounds over past month”).

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

19

-Sarah is a 70-year-old female s/p L MCA stroke (6 weeks ago). You are seeing her for home health PT following her return home from acute rehab.
-During your screening, Sarah complains of difficulty holding her urine; she tells you, with some chagrin, that “the need to pee is sudden” and she often feels like she can’t make it to the toilet in time. She says that she knows it’s not the primary reason you’re seeing her, but could you please give her some recommendations?

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

20

-Susan is a 42-year-old female referred to you for exercise prescription.
-Her PMH includes DM, CAD, HTN (treated with diuretics), and OA (treated with NSAIDs). -Her BMI is 36. She is a clerical assistant at the headquarters of a major supermarket chain.
-You have access to her lab values, and notice that her BUN is 37 (high) but her calcium is 10 mg/dL (WNL) and her pH is 7.4.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

21

-Scott is a 42-year-old male who comes to your direct-access clinic with complaint of sudden onset of lancinating pain over his right lumbar area that started yesterday without any known cause. He is a construction worker and has had some long shifts up on the girders of a new high-rise downtown.
-The pain is so severe that this morning he threw up, and is still feeling quite nauseous. He also complains of “not feeling quite right” and experiencing chills.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

22

-Shahara is a 22-year-old foreign-aid worker who just returned from sub-Saharan Africa. She presents to your direct-access clinic with sharp, “crampy” pain over her left flank which has been present since her last week there.
-She denies fever, chills, and malaise but does state the pain has been intense enough recently to make her throw up.
-She cannot recall any change in her routine prior to the onset of the pain, but does note that she enjoyed the local coffee, which she drank in lieu of water as the aid workers were cautioned against drinking unsafe tap water.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

23

-Sherman is a 72-year-old male with benign prostatic hyperplasia (BPH). He presents to your clinic with a referral to evaluate and treat his low back pain.
-Sherman states the pain began about a week ago; it’s been increasing over the past three days. On your screening form, he’s checked “yes” to bowel/bladder function (“I’ve been peeing more lately, and it sort of hurts”) and change in cognition (“I feel like my thoughts are sort of fuzzy; I can’t seem to concentrate”).

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

24

-Beth is a 32-year-old female who is referred to you for chronic LBP. She cannot recall any initial event or injury and states it’s been going on “for years”. It does vary in intensity over the course of a month.
-On her medical screening form, she has marked fatigue (“it comes and goes”) but denies any other symptoms on the General Health Checklist. Her family history is non-contributory; her mother has some degenerative arthritis and her aunts and sisters are in excellent health.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

25

-Brody is a 72-year-old black male who presents to your clinic with a referral to evaluate and treat his low back pain.
-Brody states his pain began about a week ago; it’s been increasing over the past three days. On your screening form, he’s checked “yes” to bowel/bladder function (“I’ve been peeing more lately, and it sort of hurts”) and change in cognition (“I feel like my thoughts are sort of fuzzy; I can’t seem to concentrate”). He also admits to tobacco use but denies use of alcohol.
-On further questioning, he notes difficulty in starting urine flow that’s been going on for about a year, but “I thought that was just part of getting old.”
-On your exam, you find palpable, tender nodules in the area of his inguinal lymph nodes.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

26

-Brigham is a 56-year-old male referred to you for an exercise prescription for weight reduction. His BMI is 36 and he has additional PMH of diabetes mellitus and tobacco and alcohol use.
-As you are going over his medical screening form, he starts talking to you about difficulties with his wife: “You know, in the—the bedroom.” He wonders if by losing weight his marriage might improve and asks your guidance.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

27

-Brendon is a 27-year-old white male who presents to your direct-access clinic with low back pain of gradual onset about 1 week ago.
-On your medical screening form, he has checked fatigue and weight loss (10 pounds over the past month). He has a family history of heart disease and prostate cancer.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

28

-Betty is a 59-year-old female referred to you for an exercise prescription to address her hypertension and diabetes mellitus.
-She is the secretary for the CEO of a major local corporation and spends approximately 60 hours a week in the office.
-On your medical screening form, she has marked “fatigue” and “weakness” which she attributes to a recent recurrence of menses (“I thought I finished menopause about two years ago, but last month I started my period again!”); she’s had two episodes in the past 30 days.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.

29

-Belinda is a 52-year-old female referred to you for left shoulder pain.
-On your medical screening form, she has marked “fatigue” and “weight loss” (“20 pounds in one month! Isn’t that great?!”). She has a family history of coronary artery disease; her mother died after a myocardial infarction, and her sister died from the effects of breast cancer.
-During your exam, you find multiple discrete, painless nodules in the axillary region.

-What’s going on with the patient?

-What findings support your hypothesis (assessment)? What other findings (tests, measures, and procedures) might you like to have available?

-If your hypothesis/assessment is true, provide at least one intervention for the patient.

-Write at least one physical therapy goal for this patient.