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دانلود کتاب Differential diagnosis for physical therapists : Screening for referral.
دانلود کتاب تشخیص افتراقی برای فیزیوتراپیست ها: غربالگری برای ارجاع
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Differential diagnosis for physical therapists : Screening for referral.
ویرایش: [6 ed.] نویسندگان: Catherine Cavallaro Goodman, Rolando T. Lazaro, John Heick سری: ISBN (شابک) : 9780323478496, 0323478492 ناشر: Saunders سال نشر: 2018 تعداد صفحات: [864] زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 56 Mb
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توجه داشته باشید کتاب تشخیص افتراقی برای فیزیوتراپیست ها: غربالگری برای ارجاع نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب تشخیص افتراقی برای فیزیوتراپیست ها: غربالگری برای ارجاع
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Differential Diagnosis for Physical Therapists
فهرست مطالب
Front Cover Differential Diagnosis for Physical Therapists Differential Diagnosis for Physical Therapists Copyright Dedication CONTRIBUTORS AUTHOR’S INTRODUCTION: A BRIEF HISTORY OF THE BOOK PREFACE ACKNOWLEDGMENTS Enhance your Learning and Practice Experience APPENDIX A: SCREENING SUMMARY APPENDIX B: SPECIAL QUESTIONS TO ASK (SCREENING FOR) APPENDIX C: SPECIAL FORMS TO USE APPENDIX D: SPECIAL TESTS TO PERFORM CONTENTS Differential Diagnosis for Physical Therapists I - Introduction to the Screening Process 1 - Introduction to Screening for Referral in Physical Therapy EVIDENCE-BASED PRACTICE STATISTICS KEY FACTORS TO CONSIDER REASONS TO SCREEN Quicker and Sicker Natural History Signed Prescription Medical Specialization Progression of Time and Disease Patient/Client Disclosure Yellow or Red Flags MEDICAL SCREENING VERSUS SCREENING FOR REFERRAL DIAGNOSIS BY THE PHYSICAL THERAPIST Further Defining Diagnosis Purpose of the Diagnosis Historical Perspective Classification System DIFFERENTIAL DIAGNOSIS VERSUS SCREENING Scope of Practice DIRECT ACCESS AND SELF-REFERRAL Primary Care Direct Access Versus Primary Care Autonomous Practice Reimbursement Trends DECISION-MAKING PROCESS Past Medical History Risk Factor Assessment Clinical Presentation Associated Signs and Symptoms of Systemic Diseases Systems Review Versus Review of Systems CASE EXAMPLES AND CASE STUDIES PHYSICIAN REFERRAL Suggested Guidelines Special Considerations Documentation and Liability Guidelines for Immediate Medical Attention Guidelines for Physician Referral General Systemic For Women Vital Signs (Report These Findings) Cardiac Cancer Pulmonary Genitourinary Gastrointestinal Musculoskeletal Precautions/Contraindications to Therapy Clues to Screening for Medical Disease RED FLAG REFERENCES 2 - Interviewing as a Screening Tool CONCEPTS IN COMMUNICATION Compassion and Caring Communication Styles Illiteracy English as a Second Language The Physical Therapist’s Role CULTURAL COMPETENCE Minority Groups Social Determinants of Health Cultural Competence in the Screening Process Resources THE SCREENING INTERVIEW Interviewing Techniques Open-Ended and Closed-Ended Questions Follow-Up Questions. The funnel sequence is aided by the use of follow-up questions, referred to as FUPs in the text. Beginning ... Paraphrasing Technique. A useful interviewing skill that can assist in synthesizing and integrating the information obtained dur... Interviewing Tools Resources. The Family/Personal History form presented in this chapter is just one example of a basic intake form. See the compan... CLIENT HISTORY AND INTERVIEW Key Components of the Client History and Interview Family/Personal History Resources Follow-Up Questions (FUPs) Age and Aging Sex and Gender Men. It may be appropriate to ask some specific screening questions just for men. A list of these questions is provided in Chap... Men and Osteoporosis. Osteoporosis has been reported to be underdiagnosed in men. Normal aging results in loss of bone mineral d... Women. The incidence of strokes is greater in middle aged and older women compared with men. In addition, these women also have ... Life Cycles. For women, it may be pertinent to find out where each woman is in the life cycle (Box 2.5) and correlate this infor... Women and Hormone Therapy (HT). Hormone therapy (HT, also known as hormone replacement therapy or HRT, or menopausal hormone the... Women and Heart Disease. When a 55-year-old woman with a significant family history of heart disease comes to the therapist with... Women and Osteoporosis. As health care specialists, therapists have a unique opportunity and responsibility to provide screening... Race and Ethnicity Resources. Definitions and descriptions for race and ethnicity are available through the Centers for Disease Control and Prevent... Past Medical and Personal History Eating Disorders and Disordered Eating. Eating disorders, such as bulimia nervosa, binge eating disorder, and anorexia nervosa, ... General Health Medications. Although the Family/Personal History form includes a question about prescription or OTC medications, specific follo... Recent Infections. Recent infections, such as mononucleosis, hepatitis, or upper respiratory infections may precede the onset of... Screening for Cancer. Any “yes” responses to early screening questions for cancer (General Health questions 5, 6, and 7) must be... Substance Abuse. Substance refers to any agent taken nonmedically that can alter mood or behavior. Addiction refers to the daily... Risk Factors. Many teens and adults are at risk for using and abusing various substances (Box 2.6). Often, they are self-medicat... Signs and Symptoms of Substance Use/Abuse. Behavioral and physiologic responses to any of these substances depend on the charact... Screening for Substance Use/Abuse. Questions designed to screen for the presence of chemical substance abuse need to become part... Resources. Several guides on substance abuse for health care professionals are available.88,89 These resources may help the ther... Alcohol. Other than tobacco, alcohol is the most dominant addictive agent in the United States. Statistics regarding alcohol abu... Effects of Alcohol Use. Excessive alcohol use can cause or contribute to many medical conditions. Alcohol is a toxic drug that i... Signs and Symptoms of Alcohol Withdrawal. The therapist must be alert to any signs or symptoms of alcohol withdrawal, a potentia... Screening for Alcohol Abuse. In the United States alcohol use/abuse is often considered a moral problem and may pose an embarras... Physical Therapist’s Role. Incorporating screening questions into conversation during the interview may help to engage individua... Recreational Drug Use. As with tobacco and alcohol use, recreational or street drug use can lead to or compound already present ... Tobacco. It is reported that one in five deaths in the United States is as a result of the use of tobacco. Persons who smoke are... Caffeine. Caffeine is a substance with specific physiologic (stimulant) effects. Caffeine ingested in toxic amounts has many eff... Sugar Substitutes. Sugar substitutes (also termed “high-intensity sweeteners” by the Food and Drug Administration [FDA]) are add... Client Checklist. Screening for medical conditions can be aided by the use of a client checklist of associated signs and symptom... Medical and Surgical History. Tests contributing information to the physical therapy assessment may include radiography (x-rays,... Surgical History. Previous surgery or surgery related to the client’s current symptoms may be indicated on the Family/Personal H... Clinical Tests. The therapist will want to examine the available test results as often as possible. Familiarity with the results... Work/Living Environment. Questions related to the client’s daily work activities and work environments are included in the Famil... When to Screen. Taking an environmental, occupational, or military history may be appropriate when a client has a history of ast... Resources. Further suggestions and tools to help health care professionals incorporate environmental history questions can be fo... History of Falls. Falls is a serious and costly health concern in the United States. In the United States, falls are the leading... Risk Factors for Falls. The ability to maintain upright balance in static and dynamic conditions is a result of a complex intera... Screening for Risk of Falls. Aging adults who have just started to fall or who fall frequently may be fearful of losing their in... Resources. As the population of older people in the United States continues to grow, the number of falls and injuries related to... Vital Signs. Taking a client’s vital signs remains the single easiest, most economic, and fastest way to screen for many systemi... CORE INTERVIEW History of Present Illness Chief Complaint Pain and Symptom Assessment Insidious Onset Trauma Intrinsic Trauma. An example of intrinsic trauma is the unguarded movement that can occur during normal motion. For example, the... Extrinsic Trauma. Extrinsic trauma occurs when a force or load external to the body is exerted against the body. Whenever a clie... Assault. Domestic violence is a serious public health concern that often goes undetected by clinicians. Women (especially those ... Screening for Assault or Domestic Violence. The American Medical Association (AMA) and other professional groups recommend routi... Elder Abuse. Health care professionals are becoming more aware of elder abuse as a problem. Last year, more than 5 million cases... Clinical Signs and Symptoms. Physical injuries caused by battering are most likely to occur in a central pattern (i.e., head, ne... Workplace Violence. Workers in the health care profession are at risk for workplace violence in the form of physical assault and... The Physical Therapist’s Role. Providing referral to community agencies is perhaps the most important step a health care provide... Reporting Abuse. The law is clear in all U.S. states regarding abuse of a minor (under age 18 years) (Box 2.12) Documentation. Most state laws also provide for the taking of photographs of visible trauma on a child without parental consent.... Resources. Consult your local directory for information about adult and child protection services, state elder abuse hotlines, s... Medical Treatment and Medications Medical Treatment Medications Risk Factors for Adverse Drug Events. Pharmacokinetics (the processes that affect drug movement in the body) represents the bigg... Potential Drug Side Effects. Side effects are usually defined as predictable pharmacologic effects that occur within therapeutic... Nonsteroidal Antiinflammatory Drugs (NSAIDs). NSAIDs are a group of drugs that are useful in the symptomatic treatment of inflam... Side Effects of NSAIDs. In 2015, the Food and Drug Administration (FDA) strengthened its earlier warning regarding the risk of h... Screening for Risk Factors and Effects of NSAIDs. Screening for risk factors is as important as looking for clinical manifestati... Acetaminophen. Acetaminophen, the active ingredient in Tylenol and other OTC and prescription pain relievers and cold medicines,... Corticosteroids. Corticosteroids are often confused with the singular word “steroids.” There are three types or classes of stero... Opioids. Opioids, such as codeine, morphine, tramadol, hydrocodone, or oxycodone are safe when used as directed. They do not cau... Prescription Drug Abuse. The U.S. Drug Enforcement Administration has reported that more than 7 million Americans abuse prescrip... Hormonal Contraceptives. Some women use birth control pills to prevent pregnancy, whereas others take them to control their mens... Antibiotics. Skin reactions (see Fig. 4.12) and noninflammatory joint pain (see Box 3.4) are two of the most common side effects... Nutraceuticals. Nutraceuticals are natural products (usually made from plant substances) that do not require a prescription to p... The Physical Therapist’s Role. For every client the therapist is strongly encouraged to take the time to look up indications for... Resources. Many resources are available to help the therapist identify potential side effects of medications, especially in the ... Current Level of Fitness Sleep-Related History Stress (see also Chapter 3) Final Questions Special Questions for Women Special Questions for Men HOSPITAL INPATIENT INFORMATION Medical Record Nursing Assessment PHYSICIAN REFERRAL Guidelines for Physician Referral MEDICATIONS Previous Medical Treatment Activities of Daily Living (ADLS) Final Question REFERENCES 3 - Pain Types and Viscerogenic Pain Patterns MECHANISMS OF REFERRED VISCERAL PAIN Embryologic Development Multisegmental Innervation Direct Pressure and Shared Pathways ASSESSMENT OF PAIN AND SYMPTOMS Pain Assessment in the Older Adult Pain Assessment in the Young Child Characteristics of Pain Location of Pain Description of Pain Intensity of Pain Frequency and Duration of Pain Pattern of Pain Aggravating and Relieving Factors Associated Symptoms SOURCES OF PAIN Cutaneous Sources of Pain Somatic Sources of Pain Visceral Sources of Pain Neuropathic Pain Referred Pain Differentiating Sources of Pain4 TYPES OF PAIN Tension Pain Inflammatory Pain Ischemic Pain Myofascial Pain Muscle Tension Muscle Spasm Muscle Trauma Muscle Deficiency Trigger Points Joint Pain Drug-Induced Chemical Exposure Inflammatory Bowel Disease Arthritis Infectious Arthritis. Joint pain can be a local response to an infection. This is called infectious, septic, or bacterial arthri... Reactive Arthritis. Reactive arthritis is sometimes used synonymously with Reiter’s syndrome, a triad of nongonococcal urethriti... Radicular Pain Arterial, Pleural, and Tracheal Pain Gastrointestinal Pain Pain at Rest Night Pain Night Pain and Cancer Pain with Activity Diffuse Pain Chronic Pain Risk Factors Fear-Avoidance Behavior Differentiating Chronic Pain from Systemic Disease Aging and Chronic Pain COMPARISON OF SYSTEMIC VERSUS MUSCULOSKELETAL PAIN PATTERNS CHARACTERISTICS OF VISCEROGENIC PAIN Gradual, Progressive, and Cyclical Pain Patterns Constant Pain Physical Therapy Intervention “Fails” Bone Pain and Aspirin Pain Does Not Fit the Expected Pattern SCREENING FOR EMOTIONAL AND PSYCHOLOGIC OVERLAY Anxiety, Depression, and Panic Disorder Anxiety Depression Symptoms of Depression. About one third of the clinically depressed clients treated do not feel sad or blue. Instead, they repor... Drugs, Depression, Dementia, or Delirium?. The older adult often presents with such a mixed clinical presentation, it is difficu... Panic Disorder Psychoneuroimmunology SCREENING FOR SYSTEMIC VERSUS PSYCHOGENIC SYMPTOMS Screening Tools for Emotional Overlay Pain Catastrophizing Scale McGill Pain Questionnaire Illness Behavior Syndrome and Symptom Magnification Waddell’s Nonorganic Signs Conversion Symptoms Screening Questions for Psychogenic Source of Symptoms PHYSICIAN REFERRAL Guidelines for Immediate Physician Referral Guidelines for Physician Referral Required Clues to Screening for Viscerogenic Sources of Pain Show me exactly where your pain is located What does it feel like? How long do the symptoms last? Tell me about the pattern of your pain/symptoms REFERENCES 4 - Physical Assessment as a Screening Tool GENERAL SURVEY Mental Status Risk Factors for Delirium Nutritional Status Body and Breath Odors Vital Signs Pulse Rate Respirations Pulse Oximetry Blood Pressure Assessing Blood Pressure. BP should be taken in the same arm and in the same position (supine or sitting) each time it is measur... Pulse Pressure. The difference between the systolic and diastolic pressure readings (SBP − DBP) is called pulse pressure normall... Variations in Blood Pressure. There can be some normal variation in SBP from side to side (right extremity compared with left ex... Blood Pressure Changes with Exercise. As previously mentioned, the SBP increases with an increasing level of activity and exerci... Hypertension. In recent years, an unexpected increase in illness and death caused by hypertension has prompted the National Inst... Hypertension in African Americans. Nearly 40% of African Americans suffer from heart disease and 13% have diabetes. Hypertension... Hypertension in Hispanics. The Hispanic population in the United States is the largest minority group in the nation. Research on... Hypertension in Children and Adolescents.47 Up to 3.6% of children under the age of 18 years also have hypertension. Guidelines ... Hypotension. Hypotension is a systolic pressure below 90 mm Hg or a diastolic pressure below 60 mm Hg. A BP level that is border... Postural (Orthostatic) Hypotension. A common cause of low BP is postural (orthostatic) hypotension, defined as a sudden drop in ... Core Body Temperature Walking Speed: The Sixth Vital Sign TECHNIQUES OF PHYSICAL EXAMINATION Inspection Palpation Percussion Auscultation INTEGUMENTARY SCREENING EXAMINATION Skin Assessment Change in Skin Temperature Change in Skin Color Assessing Dark Skin Examining a Mass or Skin Lesion Assess Surgical Scars Common Skin Lesions Vitiligo Café-au-lait Skin Rash Hemorrhagic Rash Dermatitis Rosacea Thrombocytopenia Xanthomas Rheumatologic Diseases Steroid Skin and Steroid Rosacea Erythema Chronicum Migrans Effects of Radiation Sexually Transmitted Diseases/Infections Herpes Virus. Several herpes viruses are accompanied by characteristic skin lesions. Herpes simplex virus (HSV)-1 and -2 are the... Herpetic Whitlow. Herpetic whitlow, an intense painful infection of the terminal phalanx of the fingers, is caused by HSV-1 (60%... Herpes Zoster. Varicella-zoster virus (VZV), or herpes zoster or “shingles,” is another herpes virus with skin lesions character... Cutaneous Manifestations of Abuse Mongolian Spots. Discoloration of the skin in newborn infants, called a Mongolian spot (Fig. 4.25), can be mistaken for a sign o... Cancer-Related Skin Lesions Kaposi’s Sarcoma Lymphomas NAIL BED ASSESSMENT Nail Bed Changes Onycholysis Koilonychia Beau’s lines Splinter Hemorrhages Leukonychia Paronychia Clubbing Nail Patella Syndrome LYMPH NODE PALPATION MUSCULOSKELETAL SCREENING EXAMINATION NEUROLOGIC SCREENING EXAMINATION Mental Status Cranial Nerves Motor Function Sensory Function Reflexes Neural Tension REGIONAL SCREENING EXAMINATION Head and Neck Upper and Lower Extremities Peripheral Vascular Disease Venous Thromboembolism The Chest and Back (Thorax) Chest and Back: Inspection30 Chest and Back: Palpation Chest and Back: Percussion Chest and Back: Lung Auscultation Chest and Back: Heart Auscultation Screening for Early Detection of Breast Cancer. The goal of screening is early detection of breast cancer. Breast cancers that a... Abdomen Abdomen: Inspection Abdomen: Auscultation Abdomen: Percussion and Palpation Liver. Liver percussion to determine its size and identify its edges is a skill beyond the scope of a physical therapist for the... Spleen. As with other organs, the spleen is difficult to percuss, even more so than the liver, and is not part of the physical t... Gallbladder and Pancreas. Likewise, the gallbladder tucked up under the liver (see Figs. 9.1 and 9.2) is not palpable unless gro... Kidneys. The kidneys are located deep in the retroperitoneal space in both upper quadrants of the abdomen. Each kidney extends f... Bladder. The bladder lies below the symphysis pubis and is not palpable unless it becomes distended and rises above the pubic bo... Aortic Bifurcation. It may be necessary to assess for an abdominal aneurysm, especially in the older client with back pain and/o... SYSTEMS REVIEW … OR … REVIEW OF SYSTEMS? PHYSICIAN REFERRAL Vital Signs Precautions/Contraindications to Therapy Guidelines for Immediate Physician Referral REFERENCES II - Viscerogenic Causes of Neuromusculoskeletal Pain and Dysfunction 5 - Screening for Hematologic Disease SIGNS AND SYMPTOMS OF HEMATOLOGIC DISORDERS CLASSIFICATION OF BLOOD DISORDERS Erythrocyte Disorders Anemia Clinical Signs and Symptoms. Decreased capacity of the blood to carry oxygen may result in disturbances in the function of many ... Polycythemia Clinical Signs and Symptoms. The symptoms of this disease are often insidious in onset with vague complaints. The most common fi... Sickle Cell Anemia Clinical Signs and Symptoms. A series of “crises,” or acute manifestations of symptoms, characterize sickle cell disease. The se... Leukocyte Disorders Leukocytosis Leukopenia Leukemia Platelet Disorders Thrombocytosis Thrombocytopenia Clinical Signs and Symptoms. Severe thrombocytopenia results in the appearance of multiple petechiae (small, purple, pinpoint he... Coagulation Disorders Hemophilia Clinical Signs and Symptoms. Bleeding into the joint spaces (hemarthrosis) is one of the most common clinical manifestations of ... PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening for Hematologic Disease REFERENCES 6 - Screening for Cardiovascular Disease SIGNS AND SYMPTOMS OF CARDIOVASCULAR DISEASE Chest Pain or Discomfort Palpitation Dyspnea Cardiac Syncope Fatigue Cough Cyanosis Edema Claudication Vital Signs CARDIAC PATHOPHYSIOLOGY Conditions Affecting the Heart Muscle Hyperlipidemia Screening for Side Effects of Statins. Statin associated muscle symptoms (SAMS) are the most common myotoxic events associated w... Coronary Artery Disease Atherosclerosis. Atherosclerosis is the disease process often called arteriosclerosis or hardening of the arteries. It is a prog... Thrombus. When plaque builds up on the artery walls, the blood flow is slowed and a clot (thrombus) may form on the plaque. When... Spasm. Sudden constriction of a coronary artery is called a spasm; blood flow to that part of the heart is cut off or decreased.... Risk Factors. In 1948 the United States government decided to investigate the etiology, incidence, and pathology of CAD by study... Women and Heart Disease. Many women know about the risk of breast cancer, but in truth, they are 10 times more likely to die of ... Clinical Signs and Symptoms. Atherosclerosis, by itself, does not necessarily produce symptoms. For manifestations to develop, t... Angina Types of Anginal Pain. There are a number of types of anginal pain, including chronic stable angina (also referred to as walk-th... Clinical Signs and Symptoms. The client may indicate the location of the symptoms by placing a clenched fist against the sternum... Myocardial Infarction Clinical Signs and Symptoms. There are some well-known pain patterns specific to the heart and cardiac system. Sudden death can ... Cardiac Arrest. Researchers expect the number of Americans living with angina to grow as new treatments improve survival after a... Classic Warning Signs of Myocardial Infarction. Those who do have warning signs of MI may have severe unrelenting chest pain des... Warning Signs of Myocardial Infarction in Women. For women, symptoms can be more subtle or “atypical.” Chest pain or discomfort ... Pericarditis Clinical Signs and Symptoms. At first, pericarditis may have no external signs or symptoms. The symptoms of acute pericarditis v... Congestive Heart Failure or Heart Failure Clinical Signs and Symptoms. The incidence of CHF increases with advancing age. Because of the increasing age of the U.S. popula... Left Ventricular Failure. Failure of the left ventricle causes either pulmonary congestion or a disturbance in the respiratory c... Right Ventricular Failure. Failure of the right ventricle may occur in response to left-sided CHF or as a result of pulmonary em... Diastolic Heart Failure. Diastolic heart failure describes a condition in which the left ventricle stiffens and hypertrophies. O... Aneurysm46 Thoracic and Peripheral Arterial Aneurysms. A dissecting aneurysm (most often a thoracic aneurysm) occurs when a tear develops i... Abdominal Aortic Aneurysms. An aneurysm is an abnormal dilation in a weak or diseased arterial wall causing a sac-like protrusio... Risk Factors. The therapist should look for a history of smoking,47-49 known congenital heart disease (e.g., bicuspid aortic val... Clinical Signs and Symptoms. Most AAAs are asymptomatic52; discovery occurs during physical or radiographic examination of the a... Conditions Affecting the Heart Valves Rheumatic Fever Clinical Signs and Symptoms. The most typical clinical profile of a child or young adult with acute rheumatic fever is an initia... Endocarditis Risk Factors. In addition to clients with previous valvular damage, injection drug users and postcardiac surgical clients are at... Clinical Signs and Symptoms. A significant number of clients (up to 45%) with bacterial endocarditis initially have musculoskele... Lupus Carditis Congenital Valvular Defects Mitral Valve Prolapse. Echocardiographic studies have advanced our knowledge of mitral valve prolapse (MVP) in the last two deca... Risk Factors. MVP is a benign condition in isolation; however, it can be associated with a number of other conditions, especiall... Clinical Signs and Symptoms. Two thirds of the individuals with MVP experience no symptoms. Approximately one third experience o... Conditions Affecting the Cardiac Nervous System Fibrillation Risk Factors. Persons at risk for fibrillation who require screening include those who have had a previous heart attack or a his... Clinical Signs and Symptoms. Symptoms of fibrillation vary, depending on the functional state of the heart and the location of t... Sinus Tachycardia Clinical Signs and Symptoms. The symptoms of tachycardia vary from one person to another and may range from an increased pulse t... Sinus Bradycardia Clinical Signs and Symptoms. Syncope may be preceded by sudden onset of weakness, sweating, nausea, pallor, vomiting, and distor... CARDIOVASCULAR DISORDERS Hypertension Pulse Pressure Blood Pressure Classification Risk Factors Clinical Signs and Symptoms Transient Ischemic Attack Orthostatic Hypotension (See also discussion on Hypotension in Chapter 4) Peripheral Vascular Disorders Arterial (Occlusive) Disease Risk Factors. Diabetes mellitus increases the susceptibility to CHD. People with diabetes have abnormalities that affect a numbe... Clinical Signs and Symptoms. The first sign of vascular occlusive disease may be the loss of hair on the toes. The most importan... Raynaud’s Phenomenon and Disease Clinical Signs and Symptoms. The typical progression of Raynaud’s phenomenon is pallor in the digits, followed by cyanosis accom... Venous Disorders Acute Venous Disorders. Acute venous disorders are caused by the formation of thrombi (clots), which obstruct venous flow. Block... Risk Factors. Deep venous thrombosis (DVT) defined as blood clots in the pelvis, leg, or major upper extremity veins is a common... Clinical Signs and Symptoms. Superficial thrombophlebitis appears as a local, raised, red, slightly indurated (hard), warm, tend... Chronic Venous Disorders. Chronic venous insufficiency, also known as postphlebitic syndrome, is identified by chronic swollen l... Lymphedema LABORATORY VALUES Serum Electrolytes Potassium Sodium Calcium Magnesium SCREENING FOR THE EFFECTS OF CARDIOVASCULAR MEDICATIONS Diuretics Beta-Blockers Alpha-1 Blockers ACE Inhibitors Calcium Channel Blockers Nitrates PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening for Cardiovascular Signs and Symptoms NONCARDIAC CHEST PAIN PATTERNS REFERENCES 7 - Screening for Pulmonary Disease SIGNS AND SYMPTOMS OF PULMONARY DISORDERS Cough Dyspnea Cyanosis Clubbing (see Chapter 4) Altered Breathing Patterns Pulmonary Pain Patterns Tracheobronchial Pain Pleural Pain Diaphragmatic Pleural Pain Pulmonary Physiology Acid-Base Regulation Pulmonary Pathophysiology Respiratory Acidosis Respiratory Alkalosis Chronic Obstructive Pulmonary Disease Acute. Acute bronchitis is an inflammation of the trachea and bronchi (tracheobronchial tree) that is self-limiting and of short... Chronic. Chronic bronchitis is a condition associated with prolonged exposure to nonspecific bronchial irritants and is accompan... Bronchiectasis. Bronchiectasis is a form of obstructive lung disease that is actually a type of bronchitis. It is a progressive ... Emphysema. Emphysema may develop in a person after a long history of chronic bronchitis in which the alveolar walls are destroye... Types of Emphysema. There are three types of emphysema. Centrilobular emphysema (Fig. 7.4), the most common type, destroys the b... Clinical Signs and Symptoms. The irreversible destruction reduces elasticity of the lung and increases the effort to exhale trap... INFLAMMATORY/INFECTIOUS DISEASE Asthma Immune Sensitization and Inflammation Clinical Signs and Symptoms Complications. Status asthmaticus is a severe, life-threatening complication of asthma. With severe bronchospasm the workload of... Pneumonia Risk Factors Clinical Signs and Symptoms Tuberculosis Risk Factors Clinical Signs and Symptoms Systemic Sclerosis Lung Disease Clinical Signs and Symptoms Neoplastic Disease Lung Cancer (Bronchogenic Carcinoma) Risk Factors. Smoking is the major risk factor for lung cancer, accounting for 82% of deaths caused by lung cancer.22 Other risk... Metastases. Metastatic spread of pulmonary tumors is usually to the long bones, vertebral column (especially the thoracic verteb... Clinical Signs and Symptoms. Clinical signs and symptoms of lung cancer often remain silent until the disease process is at an a... GENETIC DISEASE OF THE LUNG Cystic Fibrosis Clinical Signs and Symptoms OCCUPATIONAL LUNG DISEASES Home Remodeling Clinical Signs and Symptoms PLEUROPULMONARY DISORDERS Pulmonary Embolism and Deep Venous Thrombosis Risk Factors Prevention Deep Venous Thrombosis (see also Chapter 6) Pulmonary Embolism Cor Pulmonale Pulmonary Arterial Hypertension Clinical Signs and Symptoms Pleurisy Clinical Signs and Symptoms Pneumothorax Clinical Signs and Symptoms PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening for Pulmonary Disease Environmental and Work History REFERENCES 8 - Screening for Gastrointestinal Disease SIGNS AND SYMPTOMS OF GASTROINTESTINAL DISORDERS Abdominal Pain Primary Gastrointestinal Visceral Pain Patterns. Visceral pain (internal organs) occurs in the midline because the digestive org... Referred Gastrointestinal Pain Patterns. Sometimes visceral pain from a digestive organ is felt in a location remote from the us... Dysphagia Odynophagia Gastrointestinal Bleeding Epigastric Pain with Radiation Symptoms Affected by Food Early Satiety Constipation Diarrhea Fecal Incontinence Arthralgia Shoulder Pain Obturator or Psoas Abscess Neuropathy GASTROINTESTINAL DISORDERS Gastroesophageal Reflux Disease Clinical Signs and Symptoms Peptic Ulcer Clinical Signs and Symptoms Gastrointestinal Complications of Nonsteroidal Antiinflammatory Drugs Diverticular Disease Appendicitis Clinical Signs and Symptoms McBurney’s Point Pancreatitis Clinical Signs and Symptoms Pancreatic Carcinoma Clinical Signs and Symptoms Inflammatory Bowel Disease Crohn’s Disease Clinical Signs and Symptoms Ulcerative Colitis Clinical Signs and Symptoms Irritable Bowel Syndrome Clinical Signs and Symptoms Colorectal Cancer Clinical Signs and Symptoms Acute Colonic Pseudo-obstruction PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening for Gastrointestinal Disease REFERENCES 9 - Screening for Hepatic and Biliary Disease HEPATIC AND BILIARY SIGNS AND SYMPTOMS Skin and Nail Bed Changes Musculoskeletal Pain Neurologic Symptoms Gastrointestinal System HEPATIC AND BILIARY PATHOPHYSIOLOGY Liver Diseases Hepatitis Viral Hepatitis. Viral hepatitis is an acute infectious inflammation of the liver caused by one of the following identified viru... Chronic Hepatitis. Chronic hepatitis is the term used to describe an illness associated with prolonged inflammation of the liver... Metabolic Disease. The most common metabolic diseases that can cause chronic hepatitis and are of interest to a physical therapi... Nonviral Hepatitis. Nonviral hepatitis is considered to be a toxic or drug-induced form of liver inflammation. This type of hepa... Cirrhosis Progression of Cirrhosis. As cirrhosis progresses and hepatic insufficiency develops, a series of conditions emerges, including ... Hepatic Encephalopathy (Hepatic Coma) Clinical Signs and Symptoms. Clinical manifestations of hepatic encephalopathy vary, depending on the severity of neurologic inv... Newborn Jaundice Liver Abscess Liver Cancer GALLBLADDER AND DUCT DISEASES Cholelithiasis Biliary Colic Cholecystitis Cholangitis Clinical Signs and Symptoms Primary Biliary Cirrhosis Gallbladder Cancer PHYSICIAN REFERRAL Guidelines to Immediate Physician Referral Guidelines to Physician Referral Clues to Screening for Hepatic Disease Special Questions to Ask REFERENCES 10 - Screening for Urogenital Disease SIGNS AND SYMPTOMS OF RENAL AND UROLOGIC DISORDERS THE URINARY TRACT RENAL AND UROLOGIC PAIN Upper Urinary Tract (Renal/Ureteral) Pseudorenal Pain Lower Urinary Tract (Bladder/Urethra) RENAL AND URINARY TRACT PROBLEMS Inflammatory/Infectious Disorders Inflammatory/Infectious Disorders of the Upper Urinary Tract Inflammatory/Infectious Disorders of the Lower Urinary Tract Cystitis Obstructive Disorders Obstructive Disorders of the Upper Urinary Tract Obstructive Disorders of the Lower Urinary Tract Prostatitis. Prostatitis is a relatively common inflammation of the prostate causing prostate enlargement. This condition accoun... Benign Prostatic Hyperplasia. BPH (enlarged prostate) is the most common prostate problem in men 50 years or older. Like all cel... Prostate Cancer. Prostate cancer is a slow growing form of malignancy causing microscopic changes in the prostate and is one of ... Incontinence Chronic Kidney Disease Clinical Signs and Symptoms Cancers of the Urinary Tract Bladder Cancer Renal Cancer Testicular Cancer81 Clinical Signs and Symptoms PHYSICIAN REFERRAL Diagnostic Testing Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues Suggesting Pain of Renal/Urologic Origin 11 - Screening for Endocrine and Metabolic Disease ENDOCRINE-ASSOCIATED NEUROMUSCULAR AND MUSCULOSKELETAL SIGNS AND SYMPTOMS Muscle Weakness, Myalgia, Cramps, and Fatigue Bilateral Carpal Tunnel Syndrome Periarthritis and Calcific Tendinitis Chondrocalcinosis Spondyloarthropathy and Osteoarthritis Hand Stiffness and Hand Pain ENDOCRINE PATHOPHYSIOLOGY Pituitary Gland Diabetes Insipidus Syndrome of Inappropriate Secretion of Antidiuretic Hormone Risk Factors. Risk factors for the development of SIADH include pituitary damage caused by infection, trauma, or neoplasm; secre... Clinical Presentation. Symptoms of SIADH are the clinical opposite of symptoms of DI. They are the result of water retention and... Acromegaly Clinical Presentation. Degenerative arthropathy may be seen in the peripheral joints of a client with acromegaly, most frequentl... Adrenal Glands Adrenal Insufficiency Primary Adrenal Insufficiency Secondary Adrenal Insufficiency. Secondary adrenal insufficiency refers to a dysfunction of the gland because of insufficient st... Cushing’s Syndrome Effects of Cortisol on Connective Tissue. Overproduction of cortisol or closely related glucocorticoids by abnormal adrenocortic... Thyroid Gland Goiter Thyroiditis Hyperthyroidism Clinical Presentation. Excessive thyroid hormone creates a generalized elevation in body metabolism. The effects of thyrotoxicos... Thyroid Storm. Life-threatening complications with hyperthyroidism are rare but still important for the therapist to recognize. ... Hypothyroidism Risk Factors. Women are 10 times more likely than men to have hypothyroidism. More than 10% of women over age 65 years and 15% o... Clinical Presentation. As with all disorders affecting the thyroid and parathyroid glands, clinical signs and symptoms affect ma... Myxedema. A characteristic sign of hypothyroidism and more rarely associated with hyperthyroidism (Graves’ disease) is myxedema ... Neuromuscular Symptoms. Neuromuscular symptoms are among the most common manifestations of hypothyroidism. Flexor tenosynovitis ... Neoplasms Parathyroid Glands Hyperparathyroidism Clinical Presentation. Many systems of the body are affected by hyperparathyroidism (Table 11.6). Proximal muscle weakness and f... Hypoparathyroidism Clinical Presentation. Hypocalcemia occurs when the parathyroid glands become inactive. The resultant deficiency of calcium in t... Pancreas Diabetes Mellitus Clinical Presentation. Specific physiologic changes occur when insulin is lacking or ineffective. Normally, the blood glucose le... Diagnosis. To be diagnosed with DM, a person must have fasting plasma glucose (FPG) readings of 126 mg/dL or higher on 2 differe... Physical Complications. At presentation, the client with DM may have a variety of serious physical problems. Infection and ather... Physical Complications of Diabetes Mellitus Depression. Depression is common in individuals with type 2 DM (see Box 3.10) and is linked with a 1.5-fold increase in mortalit... Diabetic Neuropathy. Neuropathy is the most common chronic complication of long-term DM. Neuropathy in the client with DM is tho... Risk Factors. Other than glycemic control, there is no curative intervention for diabetic neuropathy. Identifying potentially mo... Clinical Presentation. Neuropathy may affect the central nervous system, peripheral nervous system, or autonomic nervous system.... Periarthritis. Musculoskeletal disorders of the hand and shoulder, including periarthritis of the shoulder, is five times as com... Hand Stiffness. Diabetic stiff hand, LJM syndrome, cheirarthritis (inflammation of the hand and finger joints), and diabetic con... Intervention Exercise-Related Complications. Any exercise can improve the body’s ability to use insulin. Exercise causes a decrease in the am... Insulin Pump During Exercise. People with type 1 DM (and some individuals with insulin-requiring type 2 DM) may be using an insu... Severe Hyperglycemic States Hypoglycemia Hypoglycemia Associated With Diabetes Mellitus Clinical Presentation. The severity and number of signs and symptoms depend on the individual client and the rapidity of the dro... Intervention. Hypoglycemia can be treated in the conscious client by immediate administration of sugar. It is always safer to gi... Other Hypoglycemic States Clinical Presentation. Clinical signs and symptoms of non–DM-related hypoglycemic states are the same as those described earlier... INTRODUCTION TO METABOLISM Fluid Imbalances Fluid Deficit/Dehydration Fluid Excess Water Intoxication. Water intoxication (resulting in hyponatremia) is an excess of extracellular water in relationship to solute... Edema. An excess of solutes and water is called isotonic volume excess. The excess fluid is retained in the extracellular compar... Metabolic Disorders Metabolic Syndrome Risk Factors and Red Flags. Serious health complications can be reduced by identifying risk factors early through screening. The... Metabolic Alkalosis Metabolic Acidosis Gout Risk Factors. Increased serum uric acid levels are associated with middle age, menopause, obesity, white race, stress (including... Clinical Presentation. Uric acid is usually dissolved in the blood until it is passed through the kidneys into the urine and the... Pseudogout. Pseudogout is an arthritic condition caused by calcium pyrophosphate dihydrate (CPPD) crystals. It occurs about one-... Hemochromatosis Clinical Presentation. For many years, hemochromatosis was identified by a classic clinical triad of enlarged liver, skin hyperp... Metabolic Bone Disease Osteoporosis. Osteoporosis, meaning “porous bone,” is defined as a decreased mass per unit volume of normally mineralized bone c... Risk Factors. Box 11.2 lists the risk factors for osteoporosis Clinical Presentation. Osteoporosis is a silent disease with no visible signs or symptoms until bone loss is sufficient to resul... Osteomalacia. Osteomalacia is a softening of the bones caused by a vitamin D deficiency in adults, resulting from impaired miner... Paget’s Disease. Paget’s disease (osteitis deformans), named after Sir James Paget from the mid-1880s, is a focal inflammatory c... Risk Factors. Paget’s disease is the most common skeletal disorder after osteoporosis, affecting men more often than women by a ... Clinical Presentation. The severity of involvement and associated clinical characteristics vary greatly. Although some people ar... PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Symptoms of Endocrine or Metabolic Origin Past Medical History Clinical Presentation Associated Signs and Symptoms Clues to Recognizing Osteoporosis 12 - Screening for Immunologic Disease USING THE SCREENING MODEL Past Medical History Risk Factor Assessment Clinical Presentation Associated Signs and Symptoms Review of Systems IMMUNE SYSTEM PATHOPHYSIOLOGY Immunodeficiency Disorders Acquired Immunodeficiency Syndrome Risk Factors. Population groups at greatest risk include commercial sex workers (prostitutes) and their clients, men having sex ... Transmission. Transmission occurs through either horizontal (from either sexual contact or parenteral exposure to blood and bloo... Blood and Blood Products. Parenteral transmission occurs when there is direct blood-to-blood contact with a client infected with... Clinical Signs and Symptoms. Many individuals with HIV infection remain asymptomatic for years, with a mean time of approximatel... Side Effects of Medication. The therapist should review the potential side effects from medication used in the treatment of AIDS... AIDS and Other Diseases Kaposi’s Sarcoma. Classic Kaposi’s sarcoma (KS) was first recognized as a malignant tumor of the inner walls of the heart, veins... Non-Hodgkin’s Lymphoma. Approximately 3% of AIDS diagnoses in all risk groups and in all areas originate through discovery of no... Tuberculosis. Tuberculosis (TB) was considered a stable, endemic health problem, but now, in association with the HIV/AIDS pande... Clinical Signs and Symptoms. Pulmonary TB is the most common manifestation of TB disease in HIV-positive clients. When TB preced... HIV Neurologic Disease. HIV neurologic disease may be the presenting symptom of HIV infection and can involve the central and pe... Central Nervous System. Central nervous system (CNS) disease in HIV-infected clients can be divided into intracerebral space–occ... Peripheral Nervous System. Peripheral nerve disease is a common complication of the HIV infection. Peripheral nervous system syn... Hypersensitivity Disorders Type I Anaphylactic Hypersensitivity (“Allergies”) Allergy and Atopy. Allergy refers to the abnormal hypersensitivity that takes place when a foreign substance (allergen) is intro... Clinical Signs and Symptoms. Clinical signs and symptoms vary from one client to another according to the allergies present. Wit... Anaphylaxis. Anaphylaxis, the most dramatic and devastating form of type I hypersensitivity, is the systemic manifestation of im... Type II Hypersensitivity (Cytolytic or Cytotoxic) Type III Hypersensitivity (Immune Complex) Type IV Hypersensitivity (Cell-Mediated or Delayed) Fibromyalgia Syndrome Risk Factors. Numerous studies have implicated a genetic predisposition related to brain and/or body chemistry, but it has also ... Clinical Signs and Symptoms. The core features of FMS include widespread pain lasting more than 3 months and widespread local te... Rheumatoid Arthritis Risk Factors. The etiologic factor or trigger for this process is as yet unknown. Support for a genetic predisposition comes fro... Clinical Signs and Symptoms. Clinical features of RA vary not only from person to person but also in an individual over the dise... Shoulder. Chronic synovitis of the elbows, shoulders, hips, knees, and/or ankles creates special secondary disorders. When the s... Elbow. Destruction of the elbow articulations can lead to flexion contracture, loss of supination and pronation, and subluxation... Wrists. The joints of the wrist are frequently affected in RA, with variable tenosynovitis of the dorsa of the wrists and, ultim... Hands and Feet. Forefoot pain may be the only small-joint complaint and is often the first one. Subluxation of the heads of the ... Cervical Spine. Involvement of the cervical spine by RA tends to occur late in more advanced disease. Clinical manifestations of... Extraarticular. Extraarticular features, such as rheumatoid nodules, atherosclerosis, arteritis, anemia, neuropathy, scleritis, ... Age-Related Differences. One-third of persons with RA acquire the disease after the age of 60 years. There are differences in pr... Juvenile Idiopathic Arthritis. Juvenile idiopathic arthritis (JIA) replaces the term juvenile rheumatoid arthritis (JRA). JIA is... Diagnosis. The clinical diagnosis of RA is based on careful consideration of three factors: the clinical presentation of the cli... Treatment. Early treatment provided to decrease the inflammatory process has been proven to decrease long-term joint destruction... Polymyalgia Rheumatica Risk Factors. PMR occurs almost exclusively in people over 55 years of age, with the mean age of onset being 73 years and predom... Clinical Presentation. PMR is characterized by severe aching and stiffness primarily in the muscles, as opposed to the joints. S... Systemic Lupus Erythematosus Risk Factors. The exact cause of SLE is unknown, although it appears to result from an immunoregulatory disturbance brought abou... Clinical Signs and Symptoms. There is no single characteristic clinical pattern of symptoms. Clients may differ dramatically in ... Integumentary Changes. The classic butterfly rash associated with SLE often appears on the cheeks, bridge of the nose, forehead,... Musculoskeletal Changes. Arthralgia and arthritis are the most common presenting manifestations of SLE. Acute migratory or persi... Peripheral Neuropathy. Peripheral neuropathy may be motor, sensory (stocking-glove distribution), or mixed motor and sensory pol... Neuropsychiatric Manifestations. Individuals with SLE are at increased risk of several neuropsychiatric manifestations sometimes... Scleroderma (Progressive Systemic Sclerosis) Risk Factors. Although the cause of scleroderma is unknown, researchers suspect a complex interaction of genetic and environment... Musculoskeletal. Articular complaints are very common in progressive systemic sclerosis (PSS) and may begin at any time during t... Viscera. Skin changes, Raynaud’s phenomenon, and involvement of the GI tract are the most common manifestation of SSc. Esophagea... Spondyloarthropathy Ankylosing Spondylitis. Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disorder of undetermined cause. It is... Clinical Signs and Symptoms. The classic presentation of AS is insidious onset of middle and low back pain and stiffness for mor... Extraarticular features. Uveitis, conjunctivitis, colitis, psoriasis, enthesitis, or iritis occurs in nearly 25% of clients and ... Complications. The very stiff osteoporotic spine of clients with AS is prone to fracture from even minor trauma. It has been est... Risk Factors. The prevalence of AS is 31.9 people per 10,000 in North America.95 Although 90% of patients with AS are HLA-B27 po... Reactive Arthritis. Reactive arthritis (ReA) was formerly known as Reiter’s syndrome. Reiter first described a triad of arthriti... Risk Factors. ReA occurs in response to infection and typically begins acutely 2 to 4 weeks after venereal infections or bouts o... Clinical Signs and Symptoms. ReA often occurs precipitously and frequently affects the knees and ankles, lasting weeks to months... Psoriatic Arthritis. Psoriatic arthritis (PsA) is a chronic, recurrent, erosive, and inflammatory arthritis associated with the ... Risk Factors. The cause of psoriasis and any risk factors for PsA are unknown. PsA is a complex, multifactorial disease; multipl... Clinical Signs and Symptoms. Skin lesions that characterize psoriasis are readily recognized as piles of well-defined, dry, eryt... Lyme Disease Clinical Signs and Symptoms. Seventy to 80% of individuals with Lyme disease will first develop a red rash, known as erythema mi... Autoimmune-Mediated Neurologic Disorders Multiple Sclerosis Risk Factors. Women are two to three times more affected than men. Epidemiologic values are reported to just be estimates becaus... Clinical Signs and Symptoms. Clinically, MS is characterized by multiple and varying signs and symptoms and by unpredictable and... Motor Symptoms. Many persons with MS experience weakness in the extremities, leading to difficulty with ambulation, coordination... Sensory Symptoms. Unilateral visual impairment (e.g., double vision, visual loss, red-green color blindness) that comes and goes... Other symptoms. Sleep and seizure disorders can have severe effects on a person’s life and have been shown to have higher incide... Guillain-Barré Syndrome (Acute Idiopathic Polyneuritis) Risk Factors. The exact cause of the disease is unknown, but it frequently occurs after an infectious illness. Upper respiratory... Clinical Signs and Symptoms. The onset of acute idiopathic polyneuritis is generally characterized by a rapidly progressive weak... Treatment. There is no immediate cure for this disease, but medical support is vital during the progression of symptoms, particu... Myasthenia Gravis Clinical Signs and Symptoms. Clinically, the disease is characterized by muscle weakness and fatigability, most commonly in the ... Immunoproliferative Disorders PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Immune System Dysfunction 13 - Screening for Cancer CANCER STATISTICS Cancer Cure and Recurrence Childhood Cancers RISK FACTOR ASSESSMENT Known Risk Factors for Cancer Age Ethnicity Family History and Genetics Environment and Lifestyle Factors Sexually Transmitted Infections. Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) have been positi... Tobacco Use. Tobacco and tobacco products are known carcinogens, not just for lung cancer but also for leukemia and cancers of t... Occupation and Local Environment. Well-defined problems occur in people engaging in specific occupations, especially involving e... Ionizing Radiation. Exposure to ionizing radiation is potentially harmful. Ionizing radiation is the result of electromagnetic w... Military Workers. Survivors of recent wars who have been exposed to chemical agents may be at risk for the development of soft t... Risk Factors for Cancer Recurrence CANCER PREVENTION Genomics and Cancer Prevention MAJOR TYPES OF CANCER RESOURCES METASTASES Mechanisms and Modes of Metastasis Benign Mechanical Transport CLINICAL MANIFESTATIONS OF MALIGNANCY Early Warning Signs Lumps, Lesions, and Lymph Nodes Proximal Muscle Weakness Pain Change in One or More Deep Tendon Reflexes Integumentary Manifestations Skin Cancers Risk Factor Assessment. All adults, regardless of skin tone and hair color, are at risk for skin cancer; however, some people ar... Basal Cell Carcinoma. Basal cell carcinoma involves the bottom layer of the epidermis and occurs mainly on any hair-bearing area... Squamous Cell Carcinoma. Squamous cell carcinoma arises from the top of the epidermis and is found on areas often exposed to the... Malignant Melanoma. Malignant melanoma (MM) is the most serious form of skin cancer. It arises from pigmented cells in the skin ... Resources. The Skin Cancer Foundation (www. skincancer.org) has many public education materials available to help the therapist ... Pulmonary Manifestations Neurologic Manifestations Clinical Signs and Symptoms Nerve and Cord Compression Signs and Symptoms of Cord Compression. Spinal cord compression with resultant quadriplegia, paraplegia, and possible death is t... Cauda Equina Syndrome. Cauda equina syndrome is defined as a constellation of symptoms that result from damage to the cauda equi... Peripheral Neuropathy. Peripheral neuropathy with loss of vibratory sense, proprioception, and DTRs is most often chemotherapy-r... Paraneoplastic Syndromes Clinical Signs and Symptoms of Paraneoplastic Syndromes. Clinical findings of paraneoplastic syndromes may resemble those of pri... Rheumatologic Manifestations. Cancer can be associated with arthritis and can present as a paraneoplastic syndrome called carcin... Digital Clubbing. Digital clubbing is another possible sign of paraneoplastic syndrome, especially when associated with pulmonar... Skeletal Manifestations Bone Pain Fracture Back Pain Hypercalcemia from Skeletal Metastases Hepatic Manifestations Carpal Tunnel Syndrome ONCOLOGIC PAIN Signs and Symptoms Associated with Levels of Pain Biologic Mechanisms Bone Destruction Visceral Obstruction Nerve Compression Skin or Tissue Distention Tissue Inflammation, Infection, and Necrosis SIDE EFFECTS OF CANCER TREATMENT Common Physical Effects Monitoring Laboratory Values Late and Long-Term Physical Effects CANCERS OF THE MUSCULOSKELETAL SYSTEM Sarcoma Soft Tissue Tumors Risk Factors. Soft tissue sarcomas occur more frequently in persons who have one of the following conditions Metastases. In children, tumors of the extremities tend to behave relatively aggressively, with a high incidence of nodal spread... Clinical Signs and Symptoms. Soft tissue sarcomas most often appear as asymptomatic soft tissue masses. Because these lesions ar... Bone Tumors Osteosarcoma. Osteosarcoma (also known as osteogenic sarcoma) is the most common type of bone cancer, occurring between the ages... Risk Factors. There appears to be an association between rapid bone growth and risk of tumor formation. Young people previously ... Metastases. Bone tumors, unlike carcinomas, disseminate almost exclusively through the blood; bones lack a lymphatic system. Met... Clinical Signs and Symptoms. Osteosarcoma usually appears with pain in a lesioned area, usually around the knee in clients with ... Ewing Sarcoma. Four percent of all childhood tumors are in the Ewing family of tumors (EFT). In the United States approximately ... Risk Factors. Ewing sarcoma is most common between the ages of 5 and 16 years, with a slightly greater incidence in boys than in... Metastases. Metastases are predominantly hematogenous (to lungs and bone), although lymph node involvement may occur. Metastases... Clinical Signs and Symptoms. Ewing sarcoma is a rapidly growing tumor that often outgrows its blood supply and quickly erodes th... Chondrosarcoma. Chondrosarcoma, the most common malignant cartilage tumor (and second most common sarcoma of bone after osteosar... Risk Factors. See information related to soft tissue sarcomas Metastases. Although slow growing, chondrosarcoma has a high tendency for thrombus formation in the tumor blood vessels, with an... Clinical Signs and Symptoms. Clinical presentation of chondrosarcoma varies. Peripheral chondrosarcomas (arising from bone surfa... Osteoid Osteoma. Osteoid osteoma is a noncancerous osteoblastic tumor that accounts for approximately 10% of benign bone tumors.... Clinical Signs and Symptoms. The clinical presentation typically consists of pain, which is often worse at night, increased skin... PRIMARY CENTRAL NERVOUS SYSTEM TUMORS Risk Factors Brain Tumors Primary Malignant Brain Tumors Metastatic Brain Tumors Spinal Cord Tumors Metastases CANCERS OF THE BLOOD AND LYMPH SYSTEM Leukemia Risk Factors Clinical Signs and Symptoms Multiple Myeloma Risk Factors Clinical Signs and Symptoms Bone Destruction. Bone pain is the most common symptom of myeloma. It is caused by infiltration of the plasma cells into the mar... Hypercalcemia. Bone fractures are a result of osteoclast activity and bone destruction. This process results in calcium release ... Renal Effects. Drainage of calcium and phosphorus from damaged bones eventually leads to the development of renal stones, partic... Neurologic Complications. Approximately 10% of persons with myeloma have amyloidosis, deposits of insoluble fragments of a monoc... Hodgkin’s Disease Risk Factors Metastases Clinical Signs and Symptoms Non-Hodgkin’s Lymphoma Risk Factors Clinical Signs and Symptoms Acquired Immunodeficiency Syndrome–Non-Hodgkin’s Lymphoma Risk Factors Clinical Signs and Symptoms PHYSICIAN REFERRAL Guidelines for Immediate Physician Referral Clues to Screening for Cancer III: Systemic Origins of Neuromusculoskeletal Pain and Dysfunction 14 - Screening the Head, Neck, and Back USING THE SCREENING MODEL TO EVALUATE THE HEAD, NECK, OR BACK Past Medical History Risk Factor Assessment Clinical Presentation Effect of Position Night Pain Associated Signs and Symptoms Review of Systems Yellow Flag Findings Work. In particular, belief that pain is harmful resulting in fear-avoidance behavior and belief that all pain must be gone befo... Beliefs. People with chronic LBP who demonstrate yellow flag beliefs also have an increased risk for poor prognosis. This catego... Behaviors. Beliefs extend into behaviors such as passive attitude toward rehabilitation, use of extended rest, reduced activity,... Affective. Depressed mood, irritability, and heightened awareness of bodily sensations along with anxiety represent affective ps... Red-Flag Signs and Symptoms LOCATION OF PAIN AND SYMPTOMS Head Causes of Headaches Cancer. The greatest concern is always whether or not there is a brain tumor causing the headaches. Only a minority of individua... Migraines. Migraine headaches are often accompanied by nausea, vomiting, and visual disturbances, but the pain pattern is also o... Cervical Spine Thoracic Spine Scapula Lumbar Spine Sacrum/Sacroiliac SOURCES OF PAIN AND SYMPTOMS Viscerogenic Neurogenic Vasculogenic Spondylogenic Psychogenic SCREENING FOR ONCOLOGIC CAUSES OF BACK PAIN Past Medical History Red Flags and Risk Factors Clinical Presentation Associated Signs and Symptoms SCREENING FOR CARDIAC CAUSES OF NECK AND BACK PAIN Angina Myocardial Ischemia Abdominal Aortic Aneurysm Risk Factors Clinical Presentation SCREENING FOR PERIPHERAL VASCULAR CAUSES OF BACK PAIN Back Pain: Vascular or Neurogenic? The Bicycle Test SCREENING FOR PULMONARY CAUSES OF NECK AND BACK PAIN Past Medical History Clinical Presentation Associated Signs and Symptoms SCREENING FOR RENAL AND UROLOGIC CAUSES OF BACK PAIN Origin of Pain Patterns Past Medical History Clinical Presentation Screening Questions: Renal and Urologic System Pseudorenal Pain History Risk Factors Clinical Presentation Associated Signs and Symptoms SCREENING FOR GASTROINTESTINAL CAUSES OF BACK PAIN Past Medical History and Risk Factors Signs and Symptoms of Gastrointestinal Dysfunction Esophagus Stomach and Duodenum Small Intestine SCREENING FOR LIVER AND BILIARY CAUSES OF BACK PAIN The Pancreas SCREENING FOR GYNECOLOGIC CAUSES OF BACK PAIN Past Medical History Risk Factors Multiple Pregnancies and Births Endometriosis Ovarian Cysts and Uterine Fibroids Ectopic Pregnancy Intrauterine Contraceptive Device Clinical Presentation Associated Signs and Symptoms SCREENING FOR MALE REPRODUCTIVE CAUSES OF BACK PAIN Risk Factors Clinical Presentation Associated Signs and Symptoms SCREENING FOR INFECTIOUS CAUSES OF BACK PAIN Vertebral Osteomyelitis Disk Space Infection Bacterial Endocarditis PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening Head, Neck, or Back Pain General Past Medical History Oncologic Cardiovascular Pulmonary Renal/Urologic Gastrointestinal Gynecologic Nonorganic (Psychogenic) (see discussion in Chapter 3) Infectious Pediatrics 15 - Screening the Sacrum, Sacroiliac, and Pelvis THE SACRUM AND SACROILIAC JOINT Using the Screening Model to Evaluate Sacral/Sacroiliac Symptoms Clinical Presentation Sacroiliac Joint Pain Pattern. Whether from a mechanical or a systemic origin, the patient usually experiences pain over the pos... Screening for Infectious/Inflammatory Causes of Sacroiliac Pain Rheumatic Diseases as a Cause of Sacral or Sacroiliac Pain Screening for Spondylogenic Causes of Sacral/Sacroiliac Pain Metabolic Bone Disease Osteoporosis. Osteoporosis can cause insufficiency fractures of the sacrum. The therapist must assess for risk factors (see Boxe... Paget’s Disease. Paget’s disease as a cause of lumbar, sacral, SI, or pelvic pain occurs most commonly in men over 70 years of a... Fracture Screening for Gynecologic Causes of Sacral Pain Screening for Gastrointestinal Causes of Sacral/Sacroiliac Pain Screening for Tumors as a Cause of Sacral/Sacroiliac Pain THE COCCYX Coccygodynia THE PELVIS Using the Screening Model to Evaluate the Pelvis History Associated With Pelvic Pain Clinical Presentation Associated Signs and Symptoms Anterior Pelvic Pain Posterior Pelvic Pain Screening for Gynecologic Causes of Pelvic Pain Ectopic Pregnancy Prolapsed Conditions Uterine Prolapse. Uterine prolapse occurs most often after childbirth (Fig. 15.7). Secondary prolapse may occur with prolonged p... Cystocele and Rectocele. Cystocele is the protrusion of the anterior vaginal wall against the wall of the vagina. Rectocele is a... Endometriosis Chronic Pelvic Pain Screening for Infectious Causes of Pelvic Girdle Pain Pelvic Inflammatory Disease Screening for Vascular Causes of Pelvic Girdle Pain Peripheral Vascular Disease Pelvic Congestion Syndrome Screening for Cancer as a Cause of Pelvic Pain Using the Screening Model for Cancer Gynecologic Cancers Endometrial (Uterine) Cancer. Cancer of the uterine endometrium, or lining of the uterus, is the most common gynecologic cancer,... Clinical Signs and Symptoms. Seventy-five percent of all cases of endometrial cancer occur in postmenopausal women. The most com... Ovarian Cancer. Ovarian cancer is the second most common reproductive cancer in women and the leading cause of death from gyneco... Risk Factors. Risk increases with advancing age, and the incidence of ovarian cancer peaks between the ages of 40 and 70 years. ... Extraovarian Primary Peritoneal Carcinoma. Extraovarian primary peritoneal carcinoma (EOPPC) is an abdominal cancer (peritoneal ... Cervical Cancer. Cancer of the cervix is the third most common gynecologic malignancy in the United States. It is the most commo... Risk Factors. Risk factors associated with the development of cervical cancer are many, and varied, and include the following Clinical Signs and Symptoms. Early cervical cancer has no symptoms. Clinical symptoms related to advanced disease include painfu... Screening for Gastrointestinal Causes of Pelvic Pain Screening for Urogenital Causes of Pelvic Pain Screening for Other Conditions as a Cause of Pelvic Girdle Pain PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening the Sacrum/Sacroiliac Past Medical History Clinical Presentation Associated Signs and Symptoms Clues to Screening the Pelvis Past Medical History/Risk Factors Clinical Presentation Associated Signs and Symptoms Gynecologic Vascular 16 - Screening the Lower Quadrant: Buttock, Hip, Groin, Thigh, and Leg USING THE SCREENING MODEL TO EVALUATE THE LOWER QUADRANT Past Medical History Risk Factors Clinical Presentation Hip and Buttock Pain Pattern. True hip pain, whether from a neuromusculoskeletal or systemic cause (Table 16.2), is usually felt posteriorly dee... Neuromusculoskeletal Presentation. Identifying the hip as the source of a client’s symptoms may be difficult because pain origin... Systemic Presentation. A noncapsular pattern of restricted hip motion (e.g., limited hip extension, adduction, lateral rotation)... Groin Neuromusculoskeletal Presentation. Neuromuscular or musculoskeletal causes of groin pain should also be considered (Case Example... Systemic Presentation. The clinical presentation of groin pain from a systemic source does not vary from musculoskeletally induc... Thigh Neuromusculoskeletal Presentation. The lower lumbar vertebrae and sacrum can refer pain to the gluteal and hip region, with pain... Systemic Presentation. The pain pattern for anterior thigh pain produced by systemic causes is often the same as that presented ... Knee and Lower Leg Neuromusculoskeletal Presentation. In addition to screening for medical problems, the therapist must remember to clear the joint... Systemic Presentation. Systemic or pathologic conditions presenting as generalized knee pain can include fractures, Baker’s cyst... TRAUMA AS A CAUSE OF HIP, GROIN, OR LOWER QUADRANT PAIN Birth Trauma Stress Reaction or Fracture Assault SCREENING FOR SYSTEMIC CAUSES OF SCIATICA Risk Factors SCREENING FOR ONCOLOGIC CAUSES OF LOWER QUADRANT PAIN Cancer Recurrence Hodgkin’s Disease Spinal Cord Tumors Bone Tumors SCREENING FOR UROLOGIC CAUSES OF BUTTOCK, HIP, GROIN, OR THIGH PAIN SCREENING FOR MALE REPRODUCTIVE CAUSES OF GROIN PAIN SCREENING FOR INFECTIOUS AND INFLAMMATORY CAUSES OF LOWER QUADRANT PAIN Clinical Presentation Psoas Abscess SCREENING FOR GASTROINTESTINAL CAUSES OF LOWER QUADRANT PAIN Crohn’s Disease Reactive Arthritis SCREENING FOR VASCULAR CAUSES OF LOWER QUADRANT PAIN Peripheral Vascular Disease Abdominal Aortic Aneurysm Avascular Osteonecrosis SCREENING FOR OTHER CAUSES OF LOWER QUADRANT PAIN Osteoporosis Extrapulmonary Tuberculosis Sickle Cell Anemia and Hemophilia Liver (Hepatic) Disease PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening Lower Quadrant Pain Past Medical History Clinical Presentation Associated Signs and Symptoms REFERENCES 17 - Screening the Chest, Breasts, and Ribs USING THE SCREENING MODEL TO EVALUATE THE CHEST, BREASTS, OR RIBS Past Medical History Risk Factors Clinical Presentation Chest Pain Patterns Associated Signs and Symptoms SCREENING FOR ONCOLOGIC CAUSES OF CHEST OR RIB PAIN Clinical Presentation Skin Changes Palpable Mass SCREENING FOR CARDIOVASCULAR CAUSES OF CHEST, BREAST, OR RIB PAIN Risk Factors Clinical Presentation Cardiac Pain Patterns Chest Pain Associated with Angina SCREENING FOR PLEUROPULMONARY CAUSES OF CHEST, BREAST, OR RIB PAIN Past Medical History Clinical Presentation SCREENING FOR GASTROINTESTINAL CAUSES OF CHEST, BREAST, OR RIB PAIN Past Medical History Clinical Presentation Esophagus Epigastric Pain Hepatic and Pancreatic Systems SCREENING FOR BREAST CONDITIONS THAT CAUSE CHEST OR BREAST PAIN Past Medical History Clinical Presentation Causes of Breast Pain Mastodynia Mastitis Benign Tumors and Cysts Paget’s Disease Breast Cancer Risk Factors. Despite the discovery of a breast cancer gene (BRCA-1 and BRCA-2), researchers estimate that only 5% to 10% of bre... Clinical Presentation. Breast cancer may be asymptomatic in the early stages. The discovery of a breast lump with or without pai... Clinical Breast Examination. Breast cancer mortality is reduced when women are screened by both clinical breast examination (CBE... Lymph Node Assessment. Palpation of the underlying soft tissues (chest wall, axilla) and lymph nodes in the supraclavicular and ... Metastases. Metastases have been known to occur up to 25 years after the initial diagnosis of breast cancer. On the other hand, ... SCREENING FOR OTHER CONDITIONS AS A CAUSE OF CHEST, BREAST, OR RIB PAIN Breast Implants Anxiety Risk Factors Clinical Presentation Cocaine Anabolic-Androgenic Steroids Clinical Presentation SCREENING FOR MUSCULOSKELETAL CAUSES OF CHEST, BREAST, OR RIB PAIN Costochondritis Tietze’s Syndrome Hypersensitive Xiphoid Slipping Rib Syndrome Trigger Points Past Medical History Clinical Presentation Myalgia Rib Fractures Cervical Spine Disorders Intercostal Neuritis Risk Factors Clinical Presentation Dorsal Nerve Root Irritation Thoracic Outlet Syndrome Past Medical History Risk Factors Clinical Presentation Postoperative Pain PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Guidelines for Physician Referral Clues to Screening Chest, Breast, or Rib Pain Past Medical History Risk Factors (see also Table 6.3) Clinical Presentation Cardiovascular Pleuropulmonary (see also Clues to Screening in Chapter 7) Gastrointestinal (Upper GI/Epigastric; see also Clues to Screening in Chapter 8) Breast (alone or in combination with chest, neck, or shoulder symptoms) Anxiety (see Table 3.9) Neuromusculoskeletal SPECIAL QUESTIONS TO ASK: CHEST/THORAX Musculoskeletal Neurologic Pulmonary Cardiac Epigastric SPECIAL QUESTIONS TO ASK: BREAST SPECIAL QUESTIONS TO ASK: LYMPH NODES SPECIAL QUESTIONS TO ASK: SOFT TISSUE LUMPS OR SKIN LESIONS 18 - Screening the Shoulder and Upper Extremity USING THE SCREENING MODEL TO EVALUATE SHOULDER AND UPPER EXTREMITY Past Medical History Clinical Presentation The Shoulder Is Unique Shoulder Pain Patterns Multisegmental Innervations. Because the shoulder is innervated by the same spinal nerves that innervate the diaphragm (C3 to C5... Diaphragmatic Irritation. Irritation of the peritoneal (outside) or pleural (inside) surface of the central diaphragm refers sha... Associated Signs and Symptoms Review of Systems SCREENING FOR PULMONARY CAUSES OF SHOULDER PAIN SCREENING FOR CARDIOVASCULAR CAUSES OF SHOULDER PAIN Angina or Myocardial Infarction Complex Regional Pain Syndrome Thoracic Outlet Syndrome Bacterial Endocarditis Pericarditis Aortic Aneurysm Deep Venous Thrombosis of the Upper Extremity SCREENING FOR RENAL CAUSES OF UPPER QUADRANT/SHOULDER PAIN SCREENING FOR GASTROINTESTINAL CAUSES OF SHOULDER PAIN SCREENING FOR LIVER AND BILIARY CAUSES OF SHOULDER/UPPER QUADRANT SYMPTOMS Carpal Tunnel Syndrome SCREENING FOR RHEUMATIC CAUSES OF SHOULDER PAIN SCREENING FOR INFECTIOUS CAUSES OF SHOULDER PAIN SCREENING FOR ONCOLOGIC CAUSES OF SHOULDER PAIN Primary Bone Neoplasm Pulmonary (Secondary) Neoplasm Pancoast’s Tumor Breast Cancer SCREENING FOR GYNECOLOGIC CAUSES OF SHOULDER PAIN Ectopic Pregnancy PHYSICIAN REFERRAL Guidelines for Immediate Medical Attention Clues to Screening Shoulder/Upper Extremity Pain Past Medical History Cancer Cardiac Pulmonary Renal Gastrointestinal Gynecologic General Systemic Cardiac Pulmonary Gastrointestinal Gynecologic Urologic Trauma APPENDICES APPENDIX A: SCREENING SUMMARY APPENDIX B: SPECIAL QUESTIONS TO ASK (SCREENING FOR) APPENDIX C: SPECIAL FORMS TO USE APPENDIX D: SPECIAL TESTS TO PERFORM A-2 - RED FLAGS PAST MEDICAL HISTORY (PERSONAL OR FAMILY) RISK FACTORS CLINICAL PRESENTATION Pain Pattern Neurologic Signs and Symptoms General Cauda Equina Syndrome Cervical Myelopathy ASSOCIATED SIGNS AND SYMPTOMS FOLLOW-UP QUESTIONS A-3 SYSTEMIC CAUSESOF JOINT PAIN A-4 - THE REFERRAL PROCESS FOLLOW-UP QUESTIONS FOLLOW-UP QUESTIONS FOLLOW-UP QUESTIONS FOLLOW-UP QUESTIONS B-1 - SCREENING FOR AUDIT QUESTIONNAIRE KEY B-2 - SCREENING FOR ALCOHOL ABUSE: CAGE QUESTIONNAIRE KEY ALCOHOL-RELATED SCREENING QUESTIONS KEY B-3 - ASSAULT, INTIMATE PARTNER ABUSE, OR DOMESTIC VIOLENCE INDIRECT QUESTIONS (APTA, 2005) FOLLOW-UP QUESTIONS (APTA, 2005) B-4 SCREENINGBILATERAL CARPAL TUNNEL SYNDROME TO THE THERAPIST B-5 - SCREENING BLADDER FUNCTION CHANGES IN BLADDER FUNCTION FOR WOMEN FOR MEN (SEE ALSO APPENDIX: SPECIAL QUESTIONS PROSTATE) B-6 SCREENINGBOWEL FUNCTION B-7 SCREENINGTHE BREAST B-8 - SCREENING FOR CHEST/THORAX MUSCULOSKELETAL NEUROLOGIC PULMONARY CARDIAC EPIGASTRIC B-9 SCREENING FOR DEPRESSION/ANXIETY (SEE ALSO APPENDIX B-10, SCREENING FOR DEPRESSION IN OLDER ADULTS) FOR THE ASIAN CLIENT B-10 SCREENING FOR DEPRESSIONIN OLDER ADULTS GERIATRIC DEPRESSION SCALE (Short Form) B-11 SCREENING FOR DIZZINESS FOR THE THERAPIST B-12 SCREENING FOR DYSPNEA (SHORTNESS OF BREATH [SOB]; DYSPNEA ONEXERTION [DOE]) FOR THE THERAPIST B-13A SCREENING FOR EATING DISORDERS B-13B RESOURCES FOR SCREENING FOR EATINGDISORDERS B-14 - SCREENING ENVIRONMENTAL AND WORK HISTORY WHEN TO SURVEY QUICK SURVEY FOLLOW-UP B-15 SCREENING FOR FIBROMYALGIASYNDROME (FMS) B-16 SCREENINGFOR GASTROINTESTINAL (GI)PROBLEMS B-17 - SCREENING HEADACHES HISTORY SITE ONSET FREQUENCY INTENSITY DURATION DESCRIPTION PATTERN AGGRAVATING FACTORS RELIEVING FACTORS ASSOCIATED SYMPTOMS FOR THE THERAPIST B-18 - SCREENING JOINT PAIN (SEE ALSO APPENDIX A-3: SYSTEMIC CAUSES OF JOINT PAIN) FOR THE CLIENT WITH SUDDEN ONSET OF JOINT PAIN TO THE THERAPIST QUICK OCCUPATIONAL/WORK SURVEY B-19 SCREENINGQUESTIONS FOR KIDNEY ANDURINARY TRACT IMPAIRMENT OBSERVATIONS B-20 SCREENING FORLIVER (HEPATIC) IMPAIRMENT TO THE THERAPIST B-21 SCREENING SOFT TISSUE LUMPS OR SKIN LESIONS B-22 SCREENINGLYMPH NODES B-23 SCREENINGMEDICATIONS B-24 SCREENING MEN EXPERIENCING BACK, HIP, PELVIC, GROIN, OR SACROILIAC PAIN B-25 SCREENINGNIGHT PAIN B-26 SCREENING FOR SIDE EFFECTS OF NONSTEROIDALANTI-INFLAMMATORIES (NSAIDS) ASK ABOUT THE PRESENCE OF GASTROINTESTINAL SIGNS AND SYMPTOMS TIMING OF SYMPTOMS BLOOD PRESSURE (BP) VISUAL INSPECTION B-27 - SCREENING UNUSUAL ODORS IF YOU SUSPECT URINARY INCONTINENCE IF YOU SUSPECT FECAL INCONTINENCE IF YOU DETECT BREATH ODOR B-28 - SCREENING PAIN LOCATION OF PAIN DESCRIPTION OF PAIN FREQUENCY AND DURATION OF PAIN PATTERN OF PAIN AGGRAVATING AND RELIEVING FACTORS ASSOCIATED SYMPTOMS ARE YOU HAVING ANY PAIN ANYWHERE ELSE IN YOUR BODY? ANXIETY/DEPRESSION (SEE TABLE 3.11) FOR THE CLIENT WHO FOLLOWS EASTERN MEDICINE PRACTICES JOINT PAIN NIGHT PAIN PSYCHOGENIC SOURCE OF SYMPTOMS B-29 PALPITATIONS (CHEST OR HEART) TO THE THERAPIST B-30 - SCREENING FOR PROSTATE PROBLEMS ENLARGED PROSTATE 0 1 2 3 4 5 B-31 SCREENING FOR PSYCHOGENIC SOURCE OF SYMPTOMS FOR THE THERAPIST B-32A TAKING A SEXUAL HISTORY REFERENCES B-32B TAKING A SEXUAL HISTORY B-33 - SEXUALLY TRANSMITTED DISEASES SPECIAL QUESTIONS TO ASK PHYSICIAN REFERRAL B-34 - SPECIAL QUESTIONS TO ASK: SHOULDER AND UPPER EXTREMITY GENERAL SYSTEMIC CARDIAC PULMONARY GASTROINTESTINAL GYNECOLOGIC UROLOGIC TRAUMA B-35 SCREENING SLEEP PATTERNS B-36 SCREENING FOR SUBSTANCE USE/ABUSE B-37 - WOMEN EXPERIENCING BACK, HIP, PELVIC, GROIN, SACROILIAC (SI), OR SACRAL PAIN PAST MEDICAL HISTORY MENSTRUAL HISTORY FOR THE YOUNG FEMALE ADOLESCENT/ATHLETE REPRODUCTIVE HISTORY C-1 FAMILY/PERSONAL HISTORY (SAMPLE) C-2 INTAKE FORM(SAMPLE) C-3 PATIENT ENTRYQUESTIONNAIRE C-4 - CHECKLIST FOR RED/YELLOW FLAGS BOGDUK’S CHECKLIST FORYELLOW FLAGS Work Beliefs Behaviors Affective C-5A SIMPLIFIED WELLS’ CLINICAL DECISION RULE FOR DVT C-5B SIMPLIFIED WELLS’ CRITERIA FOR THE CLINICAL ASSESSMENT OF PULMONARY EMBOLISM C-5C UPPEREXTREMITY DVT SCALE C-6 OSTEOPOROSIS SCREENING EVALUATION C-7 PATIENT ASSESSMENTRECORD FORM C-8 RISK FACTORASSESSMENT FOR SKIN CANCER C-9 EXAMINING A SKIN LESION OR MASS D-1 GUIDE TOPHYSICAL ASSESSMENT DURING A SCREENING EXAMINATION D-2 EXTREMITYEXAMINATION CHECKLIST D-3 - HAND AND NAIL BED ASSESSMENT OBSERVE THE HANDS FOR OBSERVE THE FINGERS AND TOENAILS FOR D-4 - PERIPHERAL VASCULAR ASSESSMENT INSPECTION PALPATION Pulses (see Fig. 4.1) Characteristics of Pulses ARTERIAL INSUFFICIENCY OF EXTREMITIES VENOUS INSUFFICIENCY OF EXTREMITIES SPECIAL (QUICK SCREENING) TESTS D-5 - REVIEW OF SYSTEMS* GENERAL QUESTIONS INTEGUMENTARY (INCLUDE SKIN, HAIR, AND NAILS) MUSCULOSKELETAL/NEUROLOGIC RHEUMATOLOGIC CARDIOVASCULAR PULMONARY PSYCHOLOGIC GASTROINTESTINAL HEPATIC/BILIARY HEMATOLOGIC GENITOURINARY GYNECOLOGIC ENDOCRINE CANCER IMMUNOLOGIC D-6 SELF-BREASTEXAMINATION (SBE) D-7 TESTICULARSELF-EXAMINATION INDEX A B C D E F G H I J K L M N O P Q R S T U V W X Y Z IBC
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