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Lecture 1-28 Flashcards

Pain

1
Q

What type of model do we use to assess pain?

A

Biopsychosocial model

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2
Q

T/F: Pain is only physical

A

F

Pain has cognitive, sensory, and emotional influences, and behavioral manifestations

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3
Q

Back pain that is worsened by walking and improved by sitting, maybe suggestive of what?

A

Lumbar spinal stenosis

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4
Q

What does OPQRSTU stand for? What do we use this for?

A

Onset
Provocative/palliative
Quality
Region/radiation
Severity
Timing/treatment
U you/impact

To identify pain characteristics

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5
Q

What is catastrophizing?

A

A coping mechanism that is a negative cascade of distressing thoughts and emotions about actual or anticipated pain

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6
Q

What is kinesiophobia?

A

Fear of movement

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7
Q

What is catastrophizing associated with?

A

-Increase pain intensity
-Increase risk of chronic pain

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8
Q

What are your red flags of pain?

A

-bowel/bladder dysfunction
-saddle anesthesia
-bilateral leg weakness
-severe, sudden onset headache
-fever, weight loss, night sweats
-recent injury
-history of cancer

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9
Q

What scale is able to categorize Catastrophizing? What are the important ratings?

A

Mark Sullivan Scale

  1. I worry all the time about whether the pain will end.
  2. It’s terrible and I think it’s never going to get any better.
  3. It’s awful, and I feel that it overwhelms me.
  4. I become afraid that the pain will get worse.
  5. There’s nothing I can do to reduce the intensity of the pain.

Higher # is less intense

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10
Q

Pyschiartic conditions are associated with ________

A

Higher pain intensity & pain-related disabiity

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11
Q

Poor sleep is associated with ______

A

onset and worsening of chronic pain

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12
Q

Sleep disordered breathing may be caused by ______ and may increase your risk of ______________

A

opioid medication

respiratory depression or death

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13
Q

History of substance use disorder including tabacco is associated with increased likelihood of __________

A

prescription opioid misuses and abuse

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14
Q

What are the components of a pain exam?

A
  1. general appearance
  2. mental status
  3. vital signs
  4. posture & gait
  5. palpation
  6. ROM
  7. neuro
  8. special tests
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15
Q

What is Trendelenburg?

A

Drop of pelvis when lifting leg opposite to weak G. medius

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16
Q

What is another name for foot drop? What is this? What pathologies do you see this in?

A

“Steppage” or “slap-foot”

Unilateral - muscles that lift the front part of the foot become weak/paralyzed

common peroneal nerve palsy
L5 radiculopathy

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17
Q

How do you grade motor movement?

A

0 - 5

0- no movement

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18
Q

What is a myotome?

A

muscle group innervated by a specific spinal nerve

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19
Q

What is a normal reflex value?

A

2

0 - none
4 - hyper

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20
Q

During a physcial pain assessment, what do we exclude?

A

Red flags

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21
Q

What are CTs good at looking at vs MRIs?

A

CT: soft tissue & bony structures

MRI: soft tissue integrity, muscles, tendons, nerves

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22
Q

T/F: We use diagnostic imaging without red flags or red flag signs. Why?

A

F

Reinforces sick behaviors & worsen long term outcomes

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23
Q

How can you figure out if an abnormal finding on an MRI is age appropriate or a source of pain?

A

Dx block:
-selective nerve root block
-medial branch block

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24
Q

When can you do imaging on the lower back?

A

-red flags present or
-after 6 weeks

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25
Q

If there’s a HA thats brought on by excertion, what should you expect?

A

Increased ICP
Get imaging

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26
Q

If patient is immunocompromised or has a malignacy and is complaining of a HA, what do we do? Why?

A

Imaging

Possible mets to brain

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27
Q

I should always try to establish a specific pain _________ Dx. Which includes these 4 things:________

A

Patho-anatomic

  1. Acute/chronic
  2. Location.
  3. Mechanism
  4. Etiology
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28
Q

What is a BPI? When is this beneficial to use?

A

Brief pain inventory

It is short form used to answer questions about pain and previous treatment responses. Very useful in primary care.

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29
Q

What is a PEG? What is its benefits?

A

Pain, enjoyment, general activity

Assesses more function and quality of life
3 questions measurement derived from the BPI

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30
Q

What does a positive answer on the PC-PTSD screen indicate?

A

pt may have PTSD or trauma related problem & needs further support

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31
Q

A score of ____ or higher on the GAD-7 means what?

A

10

pt may have panic disorder, social anxiety disorder, PTSD

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32
Q

What is the relevance of STOP-BANG? What does it mean?

A

Tool used to Dx/Tx sleep apnea
If more than 3 yes, Tx for OSA
5-8 = mod/severe OSA

Snoring
Tired
Observed apnea
High BP

BMI > 35
Age > 50
Neck > 40 cm (16 in)
Gender is male

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33
Q

What is fibromyalgia?

A

Chronic pain condition that includes:
-fatigue
-cognitive effect
-brain fog

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34
Q

How do you Dx fibromyalgia?

A
  1. WPI ≥ 7 and SS ≥ 5
    or
    WPI 3 - 6 and SS ≥ 9
  2. Symptoms have been present for 3 months
  3. Pt doesnt have a disorder that would otherwise explain the pain
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35
Q

What is ORT? What are the risk ranges?

A

Opioid risk tool

low: 0-3
moderate: 4-7
high: ≥ 8

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36
Q

T/F: Scored for ORT are weighted equally for male & female

A

F

they are weighted differently

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37
Q

What screening tool do we use for people currently taking opioids?

A

COMM: Current opioid misuse measure

≥ 13 (idk what this is for but im including it)

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38
Q

What screening tool should we use in patients with a higher risk of misuse?

A

SOAPP-R: Screener & opioid assessment for patients with pain - revised)

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39
Q

What is the QoL scale? How are the numbers rated?

A

Quality of life scale

The higher the number = better

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40
Q

What point differentiates between upper & lower neck pain?

A

C4

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41
Q

What is the perimeter for neck pain?

A

Base of skull –> 1st thoracic spinous process (T1)

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42
Q

Headaches caused by neck pain are ________ headaches

A

cervicogenic

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43
Q

Most neck pain will be _______ pain

A

myofascial

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44
Q

What is N SWIFT PICS?

A

Another way to remember red flags

Neuro

Steriods
Weight loss
Immunospressed
Fever
Trauma

Porosis
IVDU (IV drug use)
Cancer
Severity of pain

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45
Q

What is the time for acute vs chronic neck pain?

A

acute: < 3 months
chronic: > 3 months

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46
Q

What type of imaging do we use to detect osteoarthrosis?

A

None

It cant be detected on imaging

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47
Q

What are chronic neck pain conditions with trauma that merit further investigation?

A

Zygapophyseal joints
internal disc disruption

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48
Q

In neck pain with no known origin and no red flags, what should we do?

A

No imaging
-explain & reassure

Consider median branch block for facet pain
- provactive discography for disc disruption

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49
Q

What is the difference between radiating and referring pain?

A

Referring: Muscle pain
-follows myotomes
-normal neuro exam

radiating: nerve pain
-follows dermatomes
-abnormal neuro exam

50
Q

On the neck, I’d want to get an _____ done for imaging

A

MRI

51
Q

If Dx block provides pain relief, what should we consider?

A

percutaneous radiofrequency neurotomy
-Sx

52
Q

What is considered low back pain?

A

Tip of last thoracic spinous process (T12/rib12) –> tip of sacro-coccygeal joints

53
Q

Everything under _____ is considered back pain

A

T1

54
Q

What else can be refered to as back pain?

A

Lower extremity pain above and/or below the knee

55
Q

Where is the vertebrae injury in Cauda Equina vs Conus Medularis?

A

Cauda Equina: L2 - sacrum

Conus Medularis: L1 - L2

56
Q

Where is the spinal level injury in Cauda Equina vs Conus Medularis?

A

Cauda Equina: Injury –> lumbosacral nerve roots

Conus Medularis: Injury –> Sacral cord segment & roots

57
Q

What are some of the main presentation difference between Cauda Equina vs Conus Medularis?

A

Both cause pain & sensory disturbances in SADDLE ANESTHESIA area

Cauda Equina: Asymmetric
Conus Medularis: symmetric

Cauda Equina: Symptoms usually severe
Conus Medularis: usually not severe

Cauda Equina: weakness to paralysis
Conus Medularis: normal to mild/mod weakness

Cauda Equina: late/less severe
Conus Medularis: Early/severe sphincter & sexual dysfunction –> impaired erections

Cauda Equina: more favorable outcomes
Conus Medularis: less favorable

58
Q

T/F: The prognosis for acute low back pain is favorable

A

T

59
Q

What is my 1st line test for suspected AAA?

A

Ultrasound

60
Q

What are my 1st line tests for suspected tumor?

A
  1. ESR (Erythrocyte sedimentation rate)
  2. CRP (C-reactive protein)
  3. MRI
  4. PSA (Prostate specific antigen)
  5. IEPG (Immuno-electrophoretogram)
  6. serum protein
  7. Electrophoresis
61
Q

What are my 1st line tests for a pathologic fx?

A

X ray

62
Q

What does CRP (C-reactive protein) tell me?

A

a marker of inflammation in the body

It is produced by the liver in response to infection, injury, or chronic disease.

63
Q

What does ESR (Erythrocyte sedimentation rate) tell me?

A

measures how fast red blood cells settle in a tube over one hour.

Higher ESR: inflammation, infection, autoimmune disease, or cancer

Lower ESR: sickle cell disease, polycythemia, or heart failure

64
Q

T/F: Osetopenia should be expected in all pts over 50

A

T

65
Q

What bones are the shoulder comprised of?

A

Scapula
Clavicle
Humerus

66
Q

What are the bony structures in the shoulder area?

A

Spine
Scapula
Gleno-humeral joint

67
Q

What should you expect if you cant lift your shoulder? What stabilizes the rotator cuff?

A

Compromised rotator cuff

Rotator cuffs are stabilized by: Pectoral girdle
-shoulder

68
Q

Where can shoulder pain be referred from/to? Why is this important?

A

Neck
Heart
Gallbladder

I need to be able to rule out other pathologies that could be causing shoulder pain like cervicogenic HA, MI, cholecystitits)

69
Q
A
70
Q

Which tests will identify a rotator cuff injury? How do you perform them?

A

Apley scratch: pain when reaching to opposite scapula

Neer: pain w/ shoulder flexion

Hawkin’s: pain w/ shoulder internal rotation

Drop arm: pain w/ shoulder abduction

O’Brian: pain w/ rotation & abduction

71
Q

Which test will identify bicep tendonitis? How do you perform it?

A

Speed’s & Yerguson: elbow flexion

72
Q

Which test will identify labral tear? How do you perform it?

A

Apprehension: pushing on humeral head

73
Q

Most shoulder conditions are _________. They need to be seen by who?

A

Musculoskeletal

physiatrist or ortho

74
Q

If rehabilitation fails, then what type of imaging should we get?

A

MRI

75
Q

What are the most common shoulder pain conditions?

A

Rotator cuff tear
-gleno-humoral/sub-acromial bursitis
-gleno-humoral instability (pendinitis)
-bicep tendinitis

76
Q

T/F: elderly patient tend to respond less to intra-articular injections, and rehab rehabilitation

A

T

77
Q

In elderly patients with limited functionality, what should we disuss with them?

A

Sx or
-palliative

78
Q

__________ is required to correct any shoulder instability

A

Arthroscopic Sx

79
Q

Hip pain is common & increases in people in ages over ____

A

60

80
Q

What does “hip joint” pain refer to?

A

Ball & socket: Femoral head & acetabulum

81
Q

What is mechanical hip pain?

A

Musculoskeletal

Normally localized and increased with loading (standing)

82
Q

What is referred hip pain?

A

poorly localized and may/may not be increased with loading (standing)

83
Q

What should I expect with hip pain at rest?

A

Rheumatologic
-infection
-cancer

84
Q

Where can hip pain be referred to/from?

A

low back
-thigh
-butt
-groin

85
Q

Where does extra-articular hip pain come from?

A

lumbar spine
-knee
-greater trochanter
-piriformis muscle

86
Q

Dislocation of the hip can NOT happen without ______

A

trauma

87
Q

What is “snapping hip syndrome”? What anatomy is involved?

A

ligament passing tightly over bony prominence

Ligament: iliofemerol ligament & pubofemoral ligament

bony prominences: greater trochanter & anterior iliac spine

88
Q

Hamstrings ______ the hip & ______ the knee

A

Extend

Flex

89
Q

Which quadricept muscle can cause both hip & knee pain? Why?

A

Rectus femoris

Crosses the knee & hip at the anterior inferior iliac spine

90
Q

What are the 4 quadriceps muscles?

A
  1. Vastus lateralis
  2. medialis
  3. intermedialis
  4. rectus femoris
91
Q

In the hip, where is blood supply most vulnerable?

A

femoral neck

92
Q

When history & exam suggest avascular necrosis, what should we do? Why?

A

Perform imaging

blood supply to the fermoal neck is vulnerable and can lead to bone weakness, limited movement, arthritis.

93
Q

How do we test ROM in the hip?

A

3 planes w/ 2 directions each

Flex/extend in supine

internal/external rotation in seated position

abduction/adduction in supine

94
Q

What is the test that detects hip flexion contraction?

A

Thomas test

95
Q

What the test that detects hip labral injury or sacroiliac joint problem?

A

FABER
-Patrick’s test

McCarthy: bilateral hip flexion = labral tear
-Fitzgerald: similar to FABER w/o pressing on hip

96
Q

What test suggests an iliotibial band problem?

A

Ober: hip extension

97
Q

What is normally affected in arthritis?

A

Worn out cartilage in a joint

Bone rubbing against bone

98
Q

What is a common his disorder in the elder?

A

hip osteoarthritis

99
Q

_________ hip disorders appear in the very young

A

congenital

100
Q

What is a hip disorder common for pediatric patients? What are they?

A

Slipped Capital femoral epiphysis (SCFE): femoral head slips off the femoral neck at the growth plate (physis)

Legg-Clave-Perthes Disease (LCP): caused by avascular necrosis of the femoral head, leading to bone death and eventual regeneration; usually unilateral

101
Q

What is a hallmark symptom of Trochanteric bursitis?

A

Pain upon palpation of middle of lateral greater trochanter

102
Q

What are the gender, race & genetic effects on Osteoarthritis?

A

gender: more common in women

race: none

genetics: clear components exist

103
Q

Hip replacement may be indicated in mostly _______

A

trauma

104
Q

Transient trochanteric bursitis relief can be given by ________

A

intra-articular steroid injections

105
Q

T/F: I can do intra-articular steroid injections with avascular necrosis

A

F

106
Q

Where can knee pain refer to?

A

Thigh
lower back
leg

107
Q

T/F: referred pain into the knee region is typically poorly localized, and will often not increase with mechanical loading

A

T

108
Q

If there’s referred pain suspected into the knee, what areas should I investigate?

A

Hip
-lumbar spine
-leg

109
Q

What are the 3 joints in the knee? Which is the main one? What is its relevance?

A

Tibiofemoral: fibrocartilagenous meniscus deepens socket for femoral condyles to roll into; provides cushion & stability

Patellofemoral

Proximal tibiofibular

110
Q

Where does the patella sit?

A

in the quadricep tendon & attaches to the tibial tuberosity

111
Q

The hamstrings cross the hip as the ________ attachment is on the ___________ and ________ cross the knees

A

Proximal

ischial tuberosity

distally

112
Q

What muscle cross the knee proximally & crosses the ankle at the achilles tendon?

A

gastrocnemius

113
Q

The gastrocnemius muscle is a strong _______ of the ankle and helps ________ the knee

A

plantarflexor

flex

114
Q

What test should be used for meniscus lesions?

A

Thessaly test: Stand on 1 leg, hold arms of pt, and rotate over knee joint.
-complains of pain = positive

115
Q

Patellofemoral pain is more common in people under the age of _______.

A

45 years old

116
Q

What is Patellofemoral pain characterized by?

A

Positive Moviegoer sign: pain when sitting for long periods w/ knee @ 90 degree

117
Q

T/F: There is Sx for Patellofemoral pain

A

F

Do not consult nobody. They wont help you.

118
Q

What is common w/ osteoarthritis after twisting the knee w/ a fixed foot? What can this lead to?

A

Meniscal tear

knee locking
-effusion
-pain with loading

119
Q

Where is bursitis of the knee common at? What may it require?

A

pre-patellar

aspiration

120
Q

Knee ligament injuries are common with _______ and should warrant what?

A

trauma

Early bracing & rehab –> possible Sx after these 2

121
Q

Most acute knee injuries are __________

A

soft tissue injuries

122
Q

What type of imgaing is appropriate for 1st line for the knee? What should we move to after this?

A

plain radiography such as Xray

MRI

Assessment (7 decks)

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