Illness scripts

Question 1

Neck: Disc herniation

5

Answer 1

1 - severe unilateral arm and neck pain
2 - obligate function loss
3- neuropathic pain or dermatomal parasthesia
4 - severe ROM limitation ALL ranges affected
5 - signs of radiculopathy

Question 2

Neck: lateral stenosis

3

Answer 2

1 - dermatomal parasthesia
2 - aching in neck and arm
3 - dermatomal sensory hypoesthesia

Question 3

Neck: central stenosis

4

Answer 3

1 - aching or pain in neck and both arms
2 - bilateral upper limb parasthesia (abnormal -tingling, pins/needles, shocks, burning, buzzing, falling asleep)
3 - bilateral upper limb hypoesthesia (numbness)
4 - (+/-) CNS signs

Question 4

Neck - biomechanical dysfunction

7

Answer 4

1 - short duration episodic pain
2 - moderate pain
3 - moderate referral
4 - non-obligate or no function loss
5 - flexion OR extension impairment
6 - flexion OR extension ROM loss
7 - (-) scan

Question 5

Neck: Dizziness

5

Answer 5

1 - Type 2
2 - never present without neck pain
3 - progresses with neck pain
4 - no neurological symptoms
5 - related to head/neck movement/posture

Question 6

Neck: Headache

4

Answer 6

1 - occipito-frontal-retroorbital
2 - clearly delineated
3 - superficial
4 - related to head/neck movements/posture

Question 7

Neck: Whiplash - Major Fracture/Dislocation (5)

others - post-traumatic arthritis, labyrinthine concussion

Answer 7

1 - immediate onset severe pain
2 - immediate fixed torticollis
3 - immediate loss of function
4 - severe limitation of movement in all directions
5 - Canadian C-spine rules (65+, dangerous MOI, extremity parasthesia, unable to AROM rotation >45 deg

Question 8

Neck pain: Whiplash - Post traumatic arthritis

5

Answer 8

1 - delayed onset of pain
2 - obligate or non-obligate function loss
3 - moderate to severe pain
4 - full or unilateral capsular pattern
5 - multi level PAs (+)

Question 9

Neck Pain: Whiplash - Labyrinthine Concussion

5

Answer 9

1 - immediate onset severe vertigo
2 - non-persistent vertigo
3 - directionally consistent vertigo
4 - body tilt test (+) 
5 - BPPV

Question 10

LBP: segmental dysfunction

6

Answer 10

1 - short duration episodic unilateral pain
2 - moderate pain and referral 
3 - flexion or extension impairment 
4 - flexion or extension ROM loss 
5 - non-obligate function loss
6 - no neuro signs or symptoms

Question 11

LBP: Sacroiliitis

6

Answer 11

1 - severe Fortin's area pain 
2 - sharp pain on walking. Progressive ache on sitting
3 - pain wakes pt on turning in bed
4 - Tender in Fortin's area
5 - Pain provocation tests (+) 
6 - Extension ROM loss dominates picture

Question 12

LBP: Viscerogenic

3

Answer 12

1 - diffuse wave-like pain
2 - little relationship to physical activity and posture except lying
3 - little found on physical exam

Question 13

LBP: Metastases

6

Answer 13

1 - late middle-aged to older pt
2 - non-episodic central pain
3 - bilateral expanding pain
4 - insidious onset or minor trigger
5 - later systemic effects 
6 - progressive

Question 14

LBP: disc herniation

5

Answer 14

1 - severe unilateral back and leg pain
2 - antalgic gait 
3 - flexion and extension impairments
4 - All ROMs limited and painful
5 - SLR (+) usually below 60 deg.

Question 15

LBP: central stenosis

7

Answer 15

1 - older male
2 - moderate to severe bil back and leg pain
3 - extension impairments
4 - leg pain wakes pt
5 - lumbar kyphosis
6 - ROM stiff in all directions
7 - lumbar spine is generally stiff on all PAs

Question 16

LBP: spondylolysthesis - degenerative (vs isthmic)

5

Answer 16

1 - middle age female > male
2 - central back and bil leg pain
3 - Extension impairment 
4 - FROM? with pain on extension
5 - minor dural/neural signs may be present

Question 17

LBP: spondylolysthesis -isthmic

7

Answer 17

1 - adolescent to young adult male > female
2 - severe central and bil leg pain
3 - bil neurological symptoms and signs often present
4 - severe extension obligate impairment
5 - kyphotic
6 - severe limitation of extension and often flexion
7 - bil SLR (+)

Question 18

LE - non-traumatic - general tendonopathy (4)

Achilles, tiabialis anterior, peroneus longus

Answer 18

• pain around tendon distribution
• tendon to palpation of tendon
• passive stretch painful
• isometric contraction painful

Question 19

plantar fasciitis (5) 
(non-traumatic foot/ankle pain)

Answer 19

• medial under-heel pain
• pain with WBing activities
• pain worse after periods of NWB
• relieved with continuation of activity in early stages
• tender over medial calcaneal tubercle

Question 20

Gouty arthritis  (4) 
(non-traumatic foot/ankle pain)

Answer 20

• pain at great toe
• shiny redness of toes
• pain on WBing increased
• often throbs continually

Question 21

Anterior subluxed talus (4)

non-traumatic foot/ankle pain

Answer 21

• pain anterior ankle
• pain on stepping over foot
• decreased ankle DF and posterior glide
• pathomechanical end-feel.

Question 22

Inferior tib-fib joint instability (3)

non-traumatic foot/ankle pain

Answer 22

• previous inversion injury
• pain on stepping over foot
• positive stability test

Question 23

Subtalar subluxation (5) 
(non-traumatic foot/ankle pain)

Answer 23

• pain medial or lateral ankle
• pain mainly on heel strike
• IV or EV painful and decreased
• anteromedial or posteromedial glides restricted
• End feel = pathomechanical

Question 24

Sever’s disease (5)

non-traumatic foot/ankle pain

Answer 24

• young usually male
• pain posterior ankle
• calcaneus tender
• passive DF painful
• isometric PF may be painful

Question 25

Calcaneal bursitis (3) 
(non-traumatic foot/ankle pain)

Answer 25

• pain posterior ankle
• passive PF painful
• tender behind Achilles tendon

Question 26

Talar dome

Answer 26

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