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Physical & Health Assessment 2025 > Pain (Exam I) > Flashcards

Pain (Exam I) Flashcards

1
Q

What did Sir William Osler focus on?

A

Treating the patient, not just the disease

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2
Q

Goals of pain interview

A

-Build Trust
-Gather info
-Facilitate change
-Understand how pain interacts with comorbidities

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3
Q

Rule out Red Flags

A

Bowel/ Bladder Dysfunction
Saddle Anesthesia
Bilateral leg weakness
Severe, sudden onset headache
Fever, Wt loss, night sweats
Recent injury
History of Cancer

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4
Q

What can bilateral leg weakness be indicative of?

A

Motor lesion

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5
Q

Why are recent injuries a red flag?

A

They can change your medical history (ex: new blood clot)

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6
Q

OPQRSTU

A

O- onset
P- provocative/ palliative
Q- quality
R- region/ radiating
S- severity
T- timing, how long has it been going on
U- how is it impacting you

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7
Q

What is catastrophizing?

A

Negative cascade of distressing thoughts in which we believe something is worse than it is

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8
Q

What info about comorbidities do you need to gather with your assessment?

A

Medical comorbidities
Medication Hx
Psych comorbidities
Coping Strategies
Functional Assessment

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9
Q

Atypical emotions of patients in pain?

A

guilt, disengaging, pity, revulsion, anti-social/ borderline behavior

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10
Q

Typical emotions of patients in pain?

A

Angry, frustrated, doubtful, fearful

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11
Q

What is countertransference? Conscious or unconscious?

A

The clinicians emotional reaction to the patient based on their own feelings/ experiences

Partially conscious

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12
Q

What worsens sleep disordered breathing? How?

A

Opioids

Increase risk of respiratory depression and death

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13
Q

What is a history of substance use disorder (including tobacco) associated with?

A

increased likelihood of prescription opioid misuse and abuse

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14
Q

Components of clinical exam

A

General appearance
Mental status
VS
Posture/ gait
Palpation
ROM
Neuro exam
Special tests

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15
Q

How is motor movement graded?

A

0-5

0= no movement/ contraction
5= normal movement

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16
Q

What is a myotome?

A

muscle groups innervated by specific spinal nerves

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17
Q

What are X-rays most used to assess?

A

Boney structures

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18
Q

What are CTs most used to assess?

A

Bony structures and soft tissues

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19
Q

Why would you order an MRI over CT?

A

Better to evaluate nerves and soft tissue integrity

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20
Q

When are advanced images indicated? (CT/ MRI)

A

When referring for interventional or surgical intervention

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21
Q

An MRI shows abnormal findings. How can you difinitively diagnose as the source of pain?

A

Diagnostic block such as a selective nerve root or medical branch block

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22
Q

What is the first line treatment for post dural puncture headaches?

A

Positioning- lay down

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23
Q

When do you get imaging for headache?

A

With severe or progressive neurologic deficits or with features suggestive of serious or specific underlying condition

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24
Q

What is “Choose Wisely”?

A

an initiative of the American Board of Internal Medicine that is aimed to promote conversations between providers and patients & helping patients choose care that is:
-Evidence based
-Not duplicative
-Harm Free
-Truly necessary

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25
Q

How do patients presenting with headaches who have significant likelihood of structural disease usually get diagnosed?

A

Clinical screenings (non imaging)

Main point- imaging usually not indicated in patients with HA

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26
Q

What is the time frame in which you do not get imaging for acute low back pain?

A

First 6 weeks (unless red flags present, ex: BLE deficits)

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27
Q

What is the time frame to differentiate acute vs. chronic pain?

A

3 months

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28
Q

Which pain scale should be used as the first line?

A

Verbal Rating Scale VRS

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29
Q

How does the PEG help aid in pain assessment?

A

It can help focus on the whole-person assessment (treatment response, well-being) rather than just the pain itself

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30
Q

What 3 dimensions did Melzack suggest that pain assessment should include?

A

Sensory discriminative
Motivational- affective
Cognitive Evaluation

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31
Q

What 2 things does the PEG fail to assess?

A

Sleep and stress

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32
Q

What score on the GAD- 7 is considered positive for panic disorder, SAD, PTSD?

A

10 or greater

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33
Q

What does the STOP- BANG screening tool look at?

A

Snoring
Tired
Observed apnea
high BP
BMI >35
Age >50
Neck circumference >40cm
Gender is male

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34
Q

What score on the STOP- BANG indicates the presence of sleep apnea?

A

> 3

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35
Q

What score indicates high probability of moderate to severe OSA?

A

5-8

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36
Q

What tool is used to assess fibromyalgia?

A

Widespread pain index (WPI)
Symptom Severity Score (SS)

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37
Q

What are the diagnosis criteria for fibromyalgia?

A
  • WPI >7, SS >5
  • Symptoms present or at similar level for at least 3 months
  • No other diagnosis present that would explain the pain
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38
Q

What is the ORT?

A

Screening tool used to detect risk for substance abuse

0-3= low
4-7 moderate
>8= high

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39
Q

How do you assess the effectiveness of your treatment?

A

4 A’s:
activity
analgesia
aberrant drug related behavior
adverse effects

2 A’s:
affect
adjuncts

40
Q

How is quality of life measured?

A

QOL scale (American Chronic Pain Association)
1-10

41
Q

What body parts define the boundaries of neck pain?

A

From base of the skull until the first T spinous process

42
Q

What level separates high neck pain from low neck pain?

A

C4

43
Q

Where can neck pain radiate to?

A

Head or arm

44
Q

Most neck pain will be _____ pain

A

Myofascial

45
Q

Another mnemonic for Red flag conditions (referencing neck pain)

A

N- neuro

S- steroids
W- wt loss
I- immunosuppression
F- fever
T- trauma

P- porosis
I- IVDU
C- cancer
S- severity of pain

46
Q

What factors can contribute to acute pain becoming chronic?

A

Stress, previous injuries, litigation (psychosocial factors)

47
Q

Whats the difference between referred pain and radiating pain?

A

Radiating- nerve itself is affected (dermatome)
Referring- follows the muscle distribution (myotome)

48
Q

What provides the best long term outcome for chronic neck pain?

A

Exercise, CBT and permanent ablative treatment

49
Q

How does acupuncture work?

A

Lateral inhibition

50
Q

Where can knee pain refer to?

A

thigh, lower back, and leg

51
Q

What type of pain can patients experience and will it increase with mechanical loading?

A

referred pain (cramping, poorly localized) and may not increase with mechanical loading

52
Q

Knee pain accounts for _____ ER visits and _____ PCP visits annually

A
  • 1 million
  • 1.9 million
53
Q

Symptomatic knee OA by age and gender per 100:

A
  • > 60 = 12.1 (10.0 F, 13.6 M)
  • > 45 = 16.7 (18.7 F, 13.5 M)
  • > 26 = 4.9 (4.9 F, 4.6 M)
54
Q

3 compartments of the knee

A
  1. tibiofemoral
  2. patellofemoral
  3. proximal tibiofibular
55
Q

which knee joint compartment is less often the site of problems?

A

proximal tibiofibular

56
Q

What is the meniscus and what its roles?

A
  • fibrocartilagenous
  • deepens the socket that the femoral condyles roll in to
  • stability
  • cushion
57
Q

which muscle works to extend the knee and flex the hip?

A

rectus femoris (one quad muscle that crosses the knee and hip)

58
Q

how do the hamstrings work?

A

extend the hip and flex the knee

59
Q

what is the main function of the gastrocnemius?

A
  • strong plantar flexor of ankle
  • also helps flex the knee
60
Q

When assessing knee pain, look for these 7 things:

A
  1. Grimace
  2. Groan
  3. Guarding
  4. Over reaction
  5. Inconsistencies
  6. Give-way weakness
  7. Shaking
61
Q

How do you assess for knee pain? (3)

A
  1. palpate knee and surrounding structures (slight flexion)
  2. assess for effusion (if swollen and lacks full extension –> may need to be drained)
  3. McMurray test (nonspecific) or Thessalay test
62
Q

Define patellofemoral pain

A
  • usually from overuse
  • under 45 yo
  • more in women than men
  • not surgical
  • aggravated by squatting, climbing, sitting w/ leg at 90* (movie-goer sign +), running, lifting
63
Q

Define osteoarthritis

A
  • knee pain and 3/6 of the following:
    1. > 50 yo, 2. morning stiffness < 30 minutes , 3. knee crepitus, 4. bony tenderness, 5. bony enlargement, 6. no palpable warmth
  • PT and NSAIDS = first line tx
64
Q

3 types of trauma in knees:

A
  1. meniscal tears = common with OA and twist injury w/ fixed foot; “locking”, effusion, and pain w/ activity; tx = PT/rest/ice/NSAIDS
  2. bursitis = common w/ pre-patellar before infection (may need draining)
  3. ligamentous injuries =common w/ trauma, tx = brace, crutches, RICE, PT; can also see popliteal vascular tears (limb threatening from knee hyperextension)
65
Q

Ottawa Rules for imaging (knee)

A
  1. > 55 yo
  2. tenderness at head of fibula
  3. isolated tenderness of patella
  4. inability to flex knee at 90
  5. inability to walk 4 weight bearing steps
  6. plain radiography (1st step)
  7. MRI (if XR = nothing)
66
Q

knee pain treatments (5)

A
  1. exercise therapy and weight loss
  2. active PT > passive PT (OA)
  3. image guided steroid injections (can increase joint degradation)
  4. knee sx (OA/trauma)
  5. disco-supplementation, prolotherapy, acupuncture
67
Q

The ball and socket joint consists of what?

A

femoral head articulating with the acetabulum

68
Q

2 types of hip pain that can be aggravated/increases by loading

A
  • mechanical
  • referred (poorly localized)
69
Q

where can hip pain refer to?

A
  • lateral aspect of proximal thigh
  • buttock
  • groin
  • low back
70
Q

hip pain increases at what age

A

60 yo

71
Q

snapping hip syndrome

A

ligament passes over bony prominence (“dislocated” feeling)

72
Q

Hip pain vs SI joint positioning

A
  • hip = want to sit down
  • SI joint = don’t want to sit down/can’t
73
Q

where is blood supply most vulnerable in the hip and what can happen:

A
  • femoral neck
  • avascular necroses (seen in etoh, corticosteroids, systemic dx like lupus/RA)
74
Q

which test will detect a hip flexion contraction

A

Thomas test

75
Q

what does FABER stand for and what does it test

A
  • Flexion ABduction External Rotation
  • SI joint
76
Q

Describe a patrick’s test

A
  • detect a hip labral injury or SI joint problem
77
Q

what is a trendelenberg sign

A
  • hip drop during gait due to weakness of hip abductors
78
Q

What is common in the elderly hip

A

OA

79
Q

What level separates low back pain?

A

Tip of the last thoracic spinous process to the top of the sacro-coccygeal joing

80
Q

two diseases that occur in peds (congenital hip)

A
  1. slipped capital femoral epiphysis (SCFE) = growth plate fx
  2. Legg-Clave-Perthes disease (LCP) = disruption of blood flow leading to avascular necrosis

can also have avascular necrosis (idiopathic)

81
Q

tx for hip pain (5)

A
  1. exercise therapy
  2. active PT (OA)
  3. image guided steroid injection (trochanteric bursitis)
  4. hip replacement (OA/trauma)
  5. disco-supplementation, prolotherapy, acupuncture
82
Q

Where does back pain frequently radiate?

A

Down the leg

83
Q

What s/s do you look for in cauda equine syndrome and what can happen if not recognized?

A

Loss of bowel and bladder
Hx of trauma, tumor, recent epidural (hematoma)

If not recognized pt can become paralyzed

84
Q

What level is the conus medullaris at?

A

L1- L2

85
Q

What is a common diagnosis that is confused for musculoskeletal back pain?

A

Aortic Aneurysm (dissection)

86
Q

What age do you suspect osteopenia?

A

> 50 yo

87
Q

What is contraindicated treatment with back pain?

A

Bed rest

88
Q
A
89
Q

what comprises the shoulder and pectoral girdle

A

scapula, clavicle, and humerus (glens-humeral joint)

90
Q

rotator cuff does what

A

stabilizes shoulder and pectoral girdle (if torn = pain with movement)

91
Q

where can shoulder pain refer to? where can it be referred from?

A
  • To: neck
  • From: heart, gallbladder (common in laparoscopic procedures)
92
Q

tests for rotator cuff injury

A

apley (pain when reaching posterior to opposite scapula), neer (pain with shoulder flexion, gravity helps bring arm down), Hawkins (pain with internal/across rotation), drop arm (pain with shoulder ABduction), lift off (pain with internal rotation and push down on shoulder), obrian (pain with rotation and ABduction)

93
Q

tests for biceps tendonitis

A

speeds and yerguson (elbow flexion, bring elbow up and flex bicep)

94
Q

red flags for shoulder pain in elderly:

A
  • metastases
  • infection
  • systemic disease
95
Q
A

Physical & Health Assessment 2025 (25 decks)

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