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Primary Care > Chapter 14 > Flashcards

Chapter 14 Flashcards

1
Q

Many mechanical causes of back pain resolve in

A

1-4 weeks

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2
Q

SI pain can mimic low back pain and discover if disease effecting pain

A

Below the knee to the foot

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3
Q

SI dysfunction is the primary cause of low back pain in

A

30% of cases with low back pain

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4
Q

RA effects the ____ early but may go unrecognized at first

A

C spine

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5
Q

Although the ____ of back pain caused by NSAIDS is low, the ________ in PT clinics is high

A

Incidence, prevalence

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6
Q

What is the most important part of the history in relation to back pain

A

History of cancer - long ago

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7
Q

_____ to ____ of increasing back ache often may be a signal of ______ especially with a history of _____

A

6 weeks to 6 months, lumbar metastasis, cancer

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8
Q

Long term use of _______ can lead to vertebral compression fractures

A

Corticosteroids

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9
Q

_________ (antibiotic) can cause neck, chest or back pain

A

Fluoroquinolones

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10
Q

Age risk factors for viscerogic or systemic causes of back pain

A

Under 20 or over 50

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11
Q

Most cases of back pain in the adult is due to

A

Age related degenerative process, physical loading and musculoligamentous injury

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12
Q

Typically systemic back pain is ___ relieved by recumbency

A

Not

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13
Q

Bone pain of metastasis or myeloma tends to be more ______ when the client is in this position

A

Continuous, progressive and prominent when the client is recumbent

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14
Q

Unable to lie still with pain indicates

A

Systemic origin

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15
Q

Visceral diseases often have a systemic backache that causes the client to go into these positions

A

Curl up, sleep in a chair or pace the floor at night

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16
Q

Review of systems questions

A

Fevers, excessive weight gain or loss and appetite loss should be followed up with additional questions

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17
Q

Red flag age:

A

Less than 20 or over 50

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18
Q

Red flag previous history of…

A

Cancer

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19
Q

Red flag signs of infection:

A

Constitutional symptoms

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20
Q

Red flag recent ____

A

Urinary tract infection

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21
Q

Red flag history of _____ drug use

A

Injection

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22
Q

Red flag _______ condition

A

Immune compromised

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23
Q

Red flag failure to improve with

A

Conservative care in 4-6 weeks

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24
Q

Red flag pain is not relieved by

A

Rest or recumbency

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25
Q

Red flag pain at this time of day

A

Night

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26
Q

Red flag neurological symptom

A

Saddle parasthesia

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27
Q

Red flag back pain Accompanied by

A

Abdominal, pelvic or hip pain

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28
Q

Red flag trauma or

A

History of falls

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29
Q

Red flag significant ____ stiffness with limitation in ___ spinal movements can indicate ____

A

Morning, all, ankylosing spondylitis

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30
Q

Red flag skin _____

A

Rash

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31
Q

Primary headaches include

A

Migraine, tension headache, cluster headache.

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32
Q

Secondary headache is

A

Cervicogenic headache

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33
Q

Cervicogenic headache is defined as

A

Referred pain in any part of the head caused by musculoskeletal tissues innervated by cervical nerves c1-c4

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34
Q

Cervical genie headaches are frequently associated with

A

Chronic tension or acute whiplash, intervertebral disc disease, or progressive facet joint arthritis

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35
Q

Sudden severe headache is a classic symptom of

A

Temporal vasculitis

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36
Q

Important measure to take when assessing vascular induced headache

A

BP

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37
Q

Headaches due to cancer are worse in the

A

Upon awakening due to differences in CNS drainage in the supine or prone position, and goes away after they stand up

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38
Q

Headache due to cancer is intensified when

A

There is an activity that increases intracranial pressure

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39
Q

Migraines may present with _____ mimicking a stroke

A

Paralysis or weakness on one side

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40
Q

Physical therapy is most effective for migraines when combined with

A

Thermal biofeedback and relaxation training

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41
Q

Radicular symptoms accompanied by weakness, coordination impairment, gait disturbance, bowel or bladder retention or Incontinence and sexual dysfunction can occur where

A

Cervical myelopathy occurs

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42
Q

Torticollis of the sternocliedomastoid may be a sign of underlying

A

Thyroid involvement

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43
Q

___ neck pain that is worse with _____ and ______ may be present with thyroiditis

A

Anterior, swelling and turning the head

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44
Q

Anterior disc bulge into the esophagus or pharynx or an osteophyte of the vertebrae may give sensations of ____ and should be followed up with screening what cranial nerves

A

Difficulty swelling, lump in throat, V-VIII

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45
Q

A sign that a patient has Vertebral artery syndrome caused by structural changes in the cervical spine is characterized by

A

The client turning the whole body rather than just the neck

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46
Q

VBI occurs when

A

There is decreased vertebral height, osteophyte formation, postural changes and ligamentous changes reduce the foraminal space and encroach on the vertebral artery

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47
Q

Systemic origins of musculoskeletal pain in the thoracic spine is usually accompanied by

A

Constitutional symptoms

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48
Q

What are the three most likely cardiac causes of thoracic pain

A

Thoracic aortic aneurysm, angina and acute MI

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49
Q

Peptic ulcer can refer pain to the mid thoracic spine between

A

T6 and T10

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50
Q

What kind of disorders can cause scapular pain

A

Cardiac, pulmonary, renal and GI

51
Q

Sacral or sacroiliac pain in the absence of _____ and in the presence of negative____ must be evaluated more closely

A

Trauma, spring test

52
Q

The most common cause of serious pathology in the sacral or sacroiliac region is

A

Spondyloarthropathies

53
Q

Spondyloarthropathies are characterized by

A

Morning pain accompanied by prolonged stiffness that improves with activity. Limitation of movement in all directions and tenderness over the spine and sacroiliac joints

54
Q

The most significant finding in ankylosing spondylitis is that the client has

A

Night pain in the back and morning stiffness. They may have asymmetric SI involvement radiating to the buttock and thigh

55
Q

Colicky pain is associated with

A

Spasm of a hollow viscus

56
Q

Severe tearing pain with sweating and dizziness may originate from

A

An expanding abdominal aortic aneurysm

57
Q

Burning pain may originate from a

A

Duodenal ulcer

58
Q

Muscle spasm and tenderness along the vertebrae may be elicited in the presence of

A

Visceral impairment

59
Q

Spasm on the right side at the 9th and 10th costal cartilages can be a symptom of

A

Gallbladder problems

60
Q

The spleen can cause spasm and tenderness at…..

A

Level of t9 through 11 on the left side

61
Q

The kidneys are likely to cause tenderness, spasm and possible pain or sensitivity at the level of

A

The 11th and 12th ribs

62
Q

Rad ocular pain results from

A

Irritation of axons of a spinal nerve or neurons in the dorsal root ganglion

63
Q

Referred pain results from

A

Activation of nociceptive free nerve endings in somatic or visceral tissue

64
Q

Neurological signs are produced by

A

Conduction block in motor and sensory nerves, but conduction block does not cause pain.

65
Q

Finding the cause of back pain will also identify the neurological symptoms true or false

A

False

66
Q

Systemic origins of musculoskeletal pain in the thoracic spine is usually accompanied by

A

Constitutional symptoms

67
Q

What are the three most likely cardiac causes of thoracic pain

A

Thoracic aortic aneurysm, angina and acute MI

68
Q

Peptic ulcer can refer pain to the mid thoracic spine between

A

T6 and T10

69
Q

What kind of disorders can cause scapular pain

A

Cardiac, pulmonary, renal and GI

70
Q

Sacral or sacroiliac pain in the absence of _____ and in the presence of negative____ must be evaluated more closely

A

Trauma, spring test

71
Q

The most common cause of serious pathology in the sacral or sacroiliac region is

A

Spondyloarthropathies

72
Q

Spondyloarthropathies are characterized by

A

Morning pain accompanied by prolonged stiffness that improves with activity. Limitation of movement in all directions and tenderness over the spine and sacroiliac joints

73
Q

The most significant finding in ankylosing spondylitis is that the client has

A

Night pain in the back and morning stiffness. They may have asymmetric SI involvement radiating to the buttock and thigh

74
Q

Colicky pain is associated with

A

Spasm of a hollow viscus

75
Q

Severe tearing pain with sweating and dizziness may originate from

A

An expanding abdominal aortic aneurysm

76
Q

Burning pain may originate from a

A

Duodenal ulcer

77
Q

Muscle spasm and tenderness along the vertebrae may be elicited in the presence of

A

Visceral impairment

78
Q

Spasm on the right side at the 9th and 10th costal cartilages can be a symptom of

A

Gallbladder problems

79
Q

The spleen can cause spasm and tenderness at…..

A

Level of t9 through 11 on the left side

80
Q

The kidneys are likely to cause tenderness, spasm and possible pain or sensitivity at the level of

A

The 11th and 12th ribs

81
Q

Back pain has been linked to atherosclerotic changes in the

A

Posterior wall of the abdominal aorta

82
Q

Continuous ______ can be a symptom of MI especially in ____ women with a positive family history

A

Mid thoracic, post menopausal

83
Q

Spondylogenic back pain is characterized by

A

Bone tenderness and pain on weight bearing

84
Q

Associated signs and symptoms of spondylogenic impairment

A

Weight loss, fever, deformity, and night pain

85
Q

The most common primary malignancy involving the spine is

A

Multiple myeloma

86
Q

Multiple myeloma often results in

A

Diffuse osteoporosis and pain that is not relieved in recumbent position

87
Q

The two areas of the spine most effected by oncologic causes

A

Thoracic and lumbosacral

88
Q

As a general rule thoracic Pain must be screened for

A

Metastatic carcinoma

89
Q

Metastasises spread to the spine via

A

The para vertebral venous plexus

90
Q

Heart is innervated by

A

C3-t4

91
Q

Neurogenic/vascular back or leg pain is alleviated by rest within 1 to 3 minutes

A

Vascular

92
Q

Activity will bring back or leg pan on in 3 to 5 minutes if it is vascular or neurogenic?

A

Vascular

93
Q

Neurogenic or vascular symptoms often occur immediately with use of the affected body part or with certain positions

A

Neurogenic

94
Q

It is not likely that positions of the spine will relive pain if it is of a ___ origin

A

Vascular

95
Q

Auto splinting is

A

When the patient prefers to lie on the involved side

96
Q

Pancoast’s tumor may invade the brachial plexus causing pain in this region

A

C8-t1

97
Q

The reproductive organs are where the ___ are in the adult in utero

A

Kidney

98
Q

Lower urinary tract infections will refer pain to the

A

Low back, pelvic, or sacral areas not shoulder

99
Q

Upper urinary tract may refer pain to the shoulder because

A

It comes in contact with the diaphragm

100
Q

Acute pyelonephritis refers pain to

A

Muscles lateral to t12-l1

101
Q

Most common visceral origin of back pain

A

GI

102
Q

What is the pain pattern for epigastic pain from esophagitis

A

Starts anterior, radiates around the Chest wall to the back around t5/T6

103
Q

Stomach and duodenum refers pain at the level of lesion in what areas

A

T6-T10

104
Q

Small intestines shally refers pain around the

A

Umbilicus

105
Q

Back pain from being pregnant usually begins

A

In second trimester, 5-7 months

106
Q

The risk of developing chronic back pain postpartum doubles with use of

A

Epidural anesthesia

107
Q

Vertebral osteomyelitis affects most commonly the

A

First and second lumbar vertebrae

108
Q

The most common organism responsible for vertebral osteomyelitis

A

MRSA

109
Q

Pudendal nerve entrapment is characterized by

A

Pain relief when sitting on a toilet seat or standing

110
Q

Three most likely muscles to refer pain to the pelvic area

A

Abdominals, quadratus lumborum, and iliopsoas

111
Q

Muscle that acts as a sling around pelvic structures

A

Puborectalis

112
Q

Most common gynecological cancer in women

A

Endometrial / uterine cancer

113
Q

Endometrial cancer typically occurs in those

A

Between 50 and 70, obesity, endometrial hyperplasia, prolonged estrogen therapy and tamoxifen used for,breast cancer

114
Q

Majority of endometrial cancers occur

A

Post menopausally

115
Q

Most common presentation of endometrial cancer is

A

Abnormal vaginal bleeding or discharge

116
Q

Most common complaint in PT of those with endometrial cancer is

A

Pelvic pain without abnormal bleeding

117
Q

Second most commonly reported gynecological cancer is

A

Ovarian cancer

118
Q

Ovarian cancer incidence peaks between th ages of

A

40 and 70

119
Q

Factors that may influence the development of ovarian cancer besides the obvious

A

Nulliparity, giving birth to fewer than 2 children, giving birth for first time after age 35, bRCA1 or 2 gene, infertility, early menopause

120
Q

Extra ovarian primary peritoneal carcinoma is a ___

A

Abdominal cancer without ovarian involvement . It Aries in the peritoneum and mimics the symptoms, appearance and pattern of spread of ovarian cancer

121
Q

Third most common gynecological cancer

A

Cervical cancer

122
Q

Most common cause of death from gynecological cancer is

A

Cervical cancer

123
Q

A sexually active female with back or shoulder pain of unknown cause should be screened for

A

Ectopic pregnancy

Primary Care (8 decks)

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