Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Skills 4 > Pain, Common Conditions (Session 1) > Flashcards

Pain, Common Conditions (Session 1) Flashcards

You may prefer our related Brainscape-certified flashcards:
WSET ® Level 4 D2 Business of Wine flashcards
1
Q

Definition of “Pain”

A

An unpleasant or sensory or emotional experience associated with or resembling, actual or potential tissue damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute Pain

A

Nociceptive:
- Localised tissue damage

  • Generally less than 3-6 months.
  • Normal physiological response to noxious stimulus.
  • Modified by fear, anxiety and previous experience.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic Pain

A

Nociplastic:
- Last beyond normal healing time after injury

  • Widespread pain (hyperalgesia / allodynia)
  • Results from neuroplastic changes to pain pathways: peripheral & central sensitisation, descending facilitation and dishinibition.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Neuropathic Pain

A
  • Lesion or disease affecting somatosensory system.
  • Central or peripheral, such as radicular pain from an injured nerve.
  • Burning, shooting, or pricking.
  • Sensory and/or motor deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mechanisms of “Nociceptive” pain

A
  • Localised pain, not widespread.
  • Proportionate to injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mechanisms of “Nociplastic” pain (Central Sensitisation)

A
  • Widespread or diffuse pain
  • Disproportionate to injury
  • Hyperalgesia & Allodynia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Types of referred pain

A
  • Radicular Pain (Neuropathic)
  • Referred somatic pain (Nociceptive)
  • Referred visceral pain
    (Nociceptive)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Referred somatic pain

A

Produced by noxious stimulation of nerve endings within spinal structures such as discs, zygapophysial joints, or sacroiliac joints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Radicular Pain

A

Pain created by ectopic discharges arising from a dorsal root or its ganglion.

  • Inflammation of the affected nerve (not compression).
  • Pain is lancinating (sharp), shocking, or electric in a narrow band like distribution down the leg.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common Lumbar Spine Conditions

A
  • Nonspecific LBP (‘mechanical’)
  • Degenerative joint disease
  • Intervertebral disc disease
  • Spondylosis, spondylolisthesis
  • Congenital anomalies
  • Inflammatory arthritis
  • Visceral referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Uncommon Lumbar Spine Conditions

A
  • Malignancy
  • Infection
  • Paget’s Disease
  • Diffuse idiopathic skeletal hyperostosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non-specific LBP (NSLBP)

A

‘NSBLP’ is used when the pathoanatomical cause of the pain cannot be determined:
- 90% of uncomplicated LBP
- Clincal tests cannot definitively identify the source of pain
- Can be acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Degenerative Joint Disease (DJD)

A

Synonymous with (OA)

Chronic degenerative condition of lumbar spine that affects, vertebral bodies, intervertebral discs, facet joints and contents of spinal canal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DJD occurs to a majority of what people?

A

To an extent, everybody as part of ageing degeneration.

> 90% of those are 50 years or over.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Typical presentation of DJD

A
  • Older age group
  • Gradual onset / chronic condition
  • Aching pain
  • Spinal tenderness
  • Stiffness
  • Aggravated by over use
  • Stiffness after periods of inactivity
  • Pain reduced by paracetamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risk factors of DJD

A
  • Heavy, physical work
  • Excess weight
  • Previous low back injury
  • Early onset can be familial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnosis of DJD

A
  • History
  • Physical examination
  • X-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Stenosis

A

“narrowing”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lateral Canal Stenosis (LCS)

A

Narrowing of intervertebral foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of Later Canal Stenosis

A
  • DJD
  • Disc protrusion of prolapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Conditions of Lateral Canal Stenosis

A
  • Can be asymptomatic
  • Usually unilateral
  • Nerve root and / or spinal nerve impact
    = Radicular Pain (lancinating, shocking, electric pain)
    = Radiculopathy (loss of function myotomes, dermatomes, reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Central Canal (Spinal) Stenosis (CCS)

A

Narrowing of the spinal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of Central Canal Stenosis

A
  • DJD
  • Disc protrusion or prolapse
  • Congenital
  • Spondylolisthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Conditions of Central Canal Stenosis

A
  • Can be asymptomatic
  • May impact spinal cord / cauda equina
    = Neurogenic Claudication: (pain, paraesthesia, cramping, heavy legs (one or both) on walking (relieved by flexion)

= Cauda Equina Syndrome: LBP, lower limb pain/weakness, perineal paraesthesia, bowel/bladder disturbance

25
Q

Cauda Equina Syndrome requires?

A

Immediate medical/surgical referral.

Most often due to IVD

26
Q

Conditions of Cauda Equina Syndrome

A
  • Back pain and/or unilateral/bilateral leg symptoms
  • Reduced perineal sensation
  • Altered bladder function
  • Loss of anal tone
  • Loss of sexual function
27
Q

Intervertebral Disc Disease

A
  • Degenerative
  • Prolapse & hernitation
  • Internal disc disruption
28
Q

Degenerative Disc Disease

A

Disc becomes less hydrated and thinner with age, lose capacity for shock absorption and become susceptible to tears in the pain sensitive outer annulus.

  • Normal part of ageing
  • Often asymptomatic
  • Diagnosis by MRI
  • Cause pain in middle age (30-50yrs)
29
Q

Intervertebral Disc Prolapse

A
  1. Protrusion or budge (posteriorly)
  2. Prolapse (nucleus contained)
  3. Extrusion (annulus fibrous disrupted)
  4. Sequestration (Free nuclear material)
30
Q

Mechanism of Intervertebral Disc Prolapse Injury

A
  • Repetitive mechanical twists such as bending and twisting (no breaks)
  • Fully flexed spine for repeated or long time (under load)
  • Forceful rotation
  • Heavy lifting
31
Q

Presentation of Intervertebral Disc Prolapse

A
  • Young to middle age (20-50yrs)
  • Rare in children or elderly
  • Male to female 2:1
  • Typically occurs suddenly but can develop gradually over weeks
32
Q

Symptom presentation of lumbar disc prolapse

A

Common:
- Severe, actue LBP
- Antalgic posture
- Paraspinal muscle spasm/gaurding
- Radiating pain in lower limb (Radicular pain)
- Lower limb paraesthesia (Radiculopathy)

33
Q

Aggravation of lumbar disc prolapse

A

Flexion:
- Sitting
- Bending

Bearing Down:
- Sneezing
- Toilet

34
Q

Relief of lumbar disc prolapse

A

Lying down

35
Q

Internal Disc Disruption

A

Condition which internal architecture of disc is disrupted but external surface remains normal.

36
Q

Grades of Internal Disc Disruption

A

Grade 1: Disruption of inner third annulus fibrosus.

Grade 2: Disruption of inner two-thirds of annulus.

Grade 3: Disruption of outer third of annulus (pain sensation area)

Grade 4: Grade 3 fissure spreads around between lamellae of outer annulus.

37
Q

Symptoms of internal disc disrutpion

A
  • Constant deep aching pain
  • Aggravated by any movement that stresses disc (mechanical LBP)
    (Cannot be diagnosed clinically)
38
Q

Spondylolysis

A

Defect or stress fracture in pars interarticularis of vertebral arch

39
Q

Spondylolysis results from

A
  • Repetitive mechanical load/stress
40
Q

Spondylolysis occurs in who

A

Young athletic population (cricket, tennis, gymnast)
- Male to female 2:1

41
Q

Spondylolysis effects what percentage of population?

A

3-6% of the population

42
Q

Symptoms of spondylolysis

A
  • Focal LBP with buttock pain.

Aggravated:
- Extension & Rotation
- Hyperlordosis

Relief:
- Rest

43
Q

Spondylolisthesis

A

The slippage of one vertebra on the next, causing pain and/or radicular symptoms

44
Q

Spondylolisthesis frequently occurs in which spinal levels

A

Frequently L5/S1

  • If severe can produce canal stenosis (rare)
45
Q

Presentation of spondylolisthesis

A
  • Intermittent, localised LBP
  • Agg. by flexion/extension
  • Pain on palpation
  • Step-off sign
  • Relieved lying supine
  • Hamstring tension/discomfort
46
Q

Spondylolisthesis is diagnosed by what?

A

X-Ray

47
Q

Types of Congenital Anomalies

A
  • Spina bifida occulta
  • Facet Tropism
  • Transitional Vertebrae
    = Lumbarisation
    = Sacralisation
48
Q

Spina Bifida Occulta

A

Asymptomatic non-union of the posterior vertebral elements (no spinal cord impact)

49
Q

Observation of spina bifida occulta

A
  • Hairy patch
  • Dimple in back
  • Fatty deposits
  • Port wine mark
50
Q

Facet Tropism

A

Asymmetry in the sagittal orientation of the facet joints.

  • May be associated with instability and degeneration
51
Q

Lumbarisation

A

S1 is not fully fused with sacrum (appears as 6 lumbar vertebras)

52
Q

Sacralisation

A

L5 is fully or partially fused to the base of sacrum
(can appear as 4 lumbars)

53
Q

Ankylosing Spondylitis

A

Form of inflammatory arthritis. Predominately effects the spine by creating inflammation of joints.

54
Q

Ankylosing Spondylitis affects what percentage of population?

A

About 1% percent of population

  • Male to female 2:1
55
Q

What age group do Ankylosing Spondylitis symptoms onset ?

A

20-40 y.o.
(<5% >45% y.o.)

56
Q

Typical presentations of Ankylosing Spondylitis

A
  • Low back/buttock/SI pain is often the first symptom
  • Insidious onset
  • Spinal stiffness (loss of ROM)
  • Morning stiffness (>30min)
  • Chronic in nature
  • Relieved by activity
  • Aggravated by rest
57
Q

Diagnosis of Ankylosing Spondylitis

A
  • Clinical presentations
  • Blood Tests
  • Xray
58
Q

What are uncommon causes of LBP?

A
  • Osteomyelitis (bone infection)
  • Malignancy (cancer)
  • Paget’s Disease (Metabolic disease causing abnormal bone formation)
    Diffuse Idiopathic skeletal hyperostosis (DISH)

Clinical Skills 4 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions