4 - THORACIC/CHEST PAIN ASSESSMENT & MANAGEMENT, CLINICAL REASONING SCALENo

Question 1

Pain:
- definition
- non verbal expression

Answer 1

Definition
= unpleasant sensory & emotional experience associated with actual or potential tissue damage or described in
terms of such damage

Non-verbal expressions of pain
- Facial expressions: grimacing, frowning, crying or clenched jaw
- Body movements: guarding body part, withdrawing from touch, restlessness, limping or becoming immobile
- Vocalizations: moaning, groaning, whimpering, or sudden changes in vocal tone
- Changes in behavior or moor: increased irritability, aggression, agitation, confusion or becoming unusually quiet or withdrawn
- Physiological signs: increased heart rate, sweating, rapid breathing or flushing
- Changes in daily activities: refusal to eat, difficulty sleeping, reluctance to move or participate in usual
routines

Question 2

Pain: BPS model

Answer 2

• In Tx pain, structural findings alone rarely explain full picture
• Effective assessment & management require considering interactions between biological, psychological & social domains
• BPS model provides clinical reasoning framework to explore & prioritize hypotheses beyond tissue damage

Table

Question 3

Types of pain

Answer 3

Table

Helps in clinical reasoning, identifying dominant pain mechanism helps tailor approach:
- Nociceptive: address biomechanics & loading
- Neuropathic: consider neurodynamic tests & neural mobilizations
- Nociplastic: focus on education, pacing & graded activity

Question 4

SINSS model: definition & description of each letter

Answer 4

Clinical reasoning model helps guide:
- How to structure subjective examination
- How vigorous physical examination should be
- How to plan early management strategies

Table

Question 5

High sin / low sin

Answer 5

• High severity + high irritability → minimal testing, passive techniques, strong education focus
• Low severity + low irritability → active treatment, functional testing, progressing
   Help reduce diagnostic & treatment errors

Question 6

Clinical reasoning:
- definition
- CR cycle
- CR strategies
- Variability

Answer 6

Definition
= reflective process of enquiry & analysis undertaken by health professional in collaboration with patient to
understand person, context & clinical problem to guide evidence-based practice

CR cycle
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CR strategies
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Complexity of patients requires that students be taught hypothetical-deductive analytical reasoning process involving generating & testing hypotheses rather than relying solely on recognition of clinical patterns

Variability
Rehab depends on each physio but should follow same types

Question 7

SCALENEo

Answer 7

Table