Week 1: Thu 1.14.16 General Subjective Exam

Question 1

What does NLDOCAT stand for?

Answer 1

Nature of the problem

Location

Duration

Onset

Course- Constant & intermittent

Agg/ ease

Treatments

Question 2

What is validity?

Answer 2

• The ability of a test or measure to to capture the phenomenon it is designed to capture. (Pg 290- Guide to evidence based PT practice)
• The extent to which the self-report instrument accurately qualifies what it intended to measure. (Setts & Carpenter pg 69)

Question 3

What is Reliability?

Answer 3

• The extent to which repeated measures agree with one another. Also referred to as Stability, Consistency, Reproducibility. (Pg 290- Guide to evidence based PT practice)
• The consistency with which a self-report instrument measures the variable of interest such as pain, health status, ROM, function, or work status. (Setts & Carpenter Pg 69)

Question 4

What is responsiveness?

Answer 4

The ability of a measure to detect change in the phenomenon of interest.

Question 5

What is MDC?

Answer 5

Minimal Detectable Change

• The amount of change that just exceeds the standard error of measurement of an instrument (Pg 125- Guide to evidence based PT practice)
• The amount of change necessary to exceed measurement error (Setts & Carpenter pg 69)

Question 6

What is MCID?

Answer 6

Minimal Clinically Important Difference

• The smallest treatment effect that would result in a change in patient management, given its side effects, costs, and inconveniences. (Pg 252- Guide to evidence based PT practice)
• Clinically meaningful level of change- the smallest meaningful change score that the patient perceives as beneficial. (Setts & Carpenter pg 69)

Question 7

What is the Neuromatrix Theory of Pain?

Answer 7

• Proposes that pain is produced by output of a widely distributed neural network in the brain rather than purely by sensory input evoked by trauma, inflammation, or other pathology.
• Neuromatrix is a combo of cortical mechanisms that produce pain when activated, but it requires no actual sensory input (i.e noxious stimulus) to produce pain experiences.

Question 8

How is pain produced by the brain according to the neuromatrix theory of pain

Answer 8

• Pain is produced by the brain when it perceives that body tissue is in danger and that action is required.
• Pain is a multifaceted, subjective, emotional experience produced by a characteristic neurosignature of widely distributed brain neural network called the body-self neuromatrix

Question 9

3 types of input the brain integrates which affect the perception of pain

Answer 9

1. Cognitive
2. Sensory
3. Motivational

Question 10

Components of cognitive input which affect the perception of pain (3ish)

Answer 10

evaluative

1. past experiences
2. context
3. beliefs

Question 11

Components of motivational input which affect the perception of pain (3ish)

Answer 11

affective

1. emotions
2. stress
3. immune system

Question 12

Components of sensory input which affect the perception of pain (2ish)

Answer 12

discriminative

1. cutaneous
2. visual

Question 13

3 different types of pain behavior

Answer 13

1. somatic
2. chemical
3. mechanical

Question 14

What is somatic pain?

Answer 14

• Pain caused by injury to muscles, bone, joint, and connective tissues (per google & modfied per Mincer notes

Question 15

Descriptive(ish) terms for somatic pain behavior (7)

Answer 15

• achy, vague, poorly localized
• covering a large area
• mechanical pattern of agg/ease
• mild or severe
• pain explanding distally as it worsens
• pain without other sensory components
• deep

Question 16

What is visceral pain?

Answer 16

• Pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs).
• Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation, but relatively insensitive to other stimuli that normally evoke pain such as cutting or burning. (wikipedia)

Question 17

Descriptive(ish) terms for visceral pain behavior? (10)

Answer 17

• achy, vague, poorly localized
• associated with certain days of the month
• lancinating
• associated with large meals
• not associated with movement or position
• mild or severe
• pain expands distally as it worsens
• pain without other sensory components
• referred pain can be superficial
• deep

Question 18

What is radicular pain?

Answer 18

• A type of pain that radiates into the lower extremity directly along the course of a spinal nerve root.
• Radicular pain is caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis. (via google)

Question 19

Descriptive(ish) terms for radicular pain behavior

Answer 19

• lancinating
• narrow band of superficial pain
• mechanical pattern of agg/ease
• mild or severe
• pain expands distally as problem worsens
• pain and paresthesia
• pain without other sensory complaint

Question 20

Typical behavior of mechanical pain (5)

Answer 20

• result of compressive or tensile force on normal tissue (end range stretch)
• typically intermittent (on/off) pattern
• clear agg/ease factors
• predictable response to examination
• appropriate for PT exam and interventions

Question 21

Typical behavior of chemical pain (4)

Answer 21

• result of chemical irritants in tissue due to inflammation or infection
• typically constant (unremitting)
• exam of source of chemical irritants guides initial course of treatment
• pain presenting without a mechanical component (some agg/ease) suggests acute disease state or serious pathology

Question 22

Typical behavior of neuropathic pain (4ish)

Answer 22

• generally, pain that persists beyond time of normal healing (not all chronic pain is neuropathic)
• has components of peripheral and central sensitization
• specific source of n.pain may be radiculopathy
• Widespread symptoms of peripheral and central sensitization:
  
  • hyperalgesia, allodynia, inconsistant aggravating and easing factors, S/S of ANS disruption (ie. poor appetite, depression, anxiety), and unpredictable or absent response to PT intervention

Question 23

What does SINSS stand for and what does each thing mean?

Answer 23

• Severity of disorder- patient vs clinician perception
• Irritability of symptoms –What provokes symptoms, severity when provoked, duration after provoked
• Nature of complaint –What tissue/structures/systems are involved, precautions to take when treating, individuals character
• Stage of Pathology –Acute or Chronic or Combination
• Stability of symptoms –Better, worse, the same? Does that make sense with condition

Question 24

Alternative terms for Acute and Chronic pain

Answer 24

Acute = nociceptive

Chronic = neuropathic

Question 25

What is nociceptive pain?

Answer 25

pain arising from the stimulation of nerve cells (often as distinct from that arising from damage or disease in the nerves themselves)

Question 26

What is neuropathic pain?

Answer 26

pain that results from direct stimulation of the myelin or nervous tissue of the peripheral or central nervous system (except for sensitized C fibers), generally felt as burning or tingling and often occurring in an area of sensory loss. It is seen commonly in patients with uncontrolled diabetes.

Question 27

What is a red flag?

Answer 27

• Signs of serious pathology
• Examples: Cauda equina syndrome, fracture, tumor
• Some S/S: unremitting night pain, sudden weight loss of 10 pounds over 3 months, bladder & bowel incontinence, previous history of cancer, saddle anaesthesia

***pg 52 also says

• 10% loss of weight during a 4-week period unrelated to intential diet is sugestive oa neoplasm
• 5%-10% unexplained weight loss or gain over 6-12 month period is a warning sign of underlying disease.

Question 28

What is an orange flag?

Answer 28

• Psychiatric symptoms
• Examples: Clinical depression, personality disorders

Question 29

What is a yellow flag? Identify 3 categories and examples.

Answer 29

• caution – slow down and think about possible further screening/referral.
  1. Beliefs, appraisals and judgements: Unhelpful beliefs about pain- indication of injury as uncontrollable or likely to worsen. Expectations of poor treatment outcome, delayed return to work.
  2. Emotional Responses: Distress not meeting criteria for diagnosis of mental disorder. Worry, fears, anxiety.
  3. Pain Behaviors (including pain coping strategies): avoidance of activities due to expectations of pain and possible reinjury. Over-reliance on passive treatments (hot packs, cold packs, analgesics)

Question 30

What is a freak flag?

Answer 30

A characteristic, mannerism, or appearance of a person, either subtle or overt, which implies unique, eccentric, creative, adventurous or unconventional thinking.

Question 31

What is a blue flag?

Answer 31

• Perceptions about the relationship between work and health
• Examples: Belief that work is too onerous and likely to cause further injury. Belief that workplace supervisor and workmates are unsupportive.

Question 32

What is a black flag?

Answer 32

• A popular punk band 1976-1986
• Also, System or contextual obstacles
• Examples: Legislation restricting options for return to work. Conflict with insurance staff over injury claim. Overly solicitous family and health care providers. Heavy work, with little opportunity to modify duties.

Question 33

General symptoms you may see with a Musculoskeletal Disorder

Answer 33

• Pain generally lessens at night
• Sharp or superficial ache
• Usually decreases with cessation of activity
• Usually continuous or intermittent
• Is aggravated by mechanical stress

Question 34

General symptoms you may see with Non-Musculoskeletal disorders

Answer 34

• Disturbs sleep
• Deep aching or throbbing
• Reduced by pressure
• Constant or waves of pain and spasms
• Not aggravated by mechanical stress