Cardinal Manifistations and Presentation of Diseases

Question 1

What is acute pain? A _____ signal indicating _____ or _____ tissue damage that triggers a _____ reaction.

Answer 1

Warning. actual. potential. protective.

Question 2

What is acute pain injury associated with?

Answer 2

Trauma, surgery and acute illness.

Question 3

How long does acute pain last?

Answer 3

< 1 month

Question 4

How long does subacute pain last?

Answer 4

1–3 months

Question 5

How long does chronic pain last?

Answer 5

> 3 months

Question 6

_____ acute pain, chronic pain has _____ protective role in preventing further tissue damage

Answer 6

Unlike. no.

Question 7

What can trigger nociceptive pain?

Answer 7

Chemical, mechanical, thermal (noxious) stimuli

Question 8

Nociceptors are _____ nerve fibers that detect _____ or ______ _____ stimuli.

Answer 8

Specialized. actual. potential. noxious.

Question 9

What are the 2 types of nociceptive pain?

Answer 9

somatic and visceral

Question 10

Somatic pain is _____, _____ pain that _____ in duration and quality (which fibers?)

Answer 10

Localized. sharp. varies. (Aδ fibers).

Question 11

Visceral pain is _____, _____, _____ pain (which fibers?)

Answer 11

dull, diffuse, deep (C fibers)

Question 12

What can be a typical example of how (diffuse) visceral pain may shift to (localized) somatic pain?

Answer 12

Appendicitis

Question 13

Neuropathic pain is caused by _____ neural activity that arises secondary to _____, _____, or _____ of the nervous system

Answer 13

Abnormal. disease. injury. dysfunction.

Question 14

The clinical presentation of neuropathic pain _____, but patients often describe a _____ sensation.

Answer 14

Varies. burning.

Question 15

What are the 3 types of nociceptive pain?

Answer 15

Central, peripheral and sympathetic mediated.

Question 16

Which syndromes can be within central pain?

Answer 16

Poststroke Pain, Phantom Limb Pain.

Question 17

Which complications can be within peripheral pain?

Answer 17

Diabetic Neuropathy, Postherpetic Neuralgia.

Question 18

Which syndrome can be within sympathtic mediated pain?

Answer 18

Complex Regional Pain.

Question 19

Nociceptors detect a chemical, mechanical, or thermal noxious stimulus → _____ of stimulus to an electrical signal (action potential) → C fibers and Aδ fibers carry afferent input to the _____ horn of the spinal cord → secondary nociceptive neurons in the _____ tract carry afferent input to the _____ in the CNS → pain perception and a response sent along _____ pathways, which results in pain modulation and/or a reaction

Answer 19

Conversion. dorsal. spinothalamic. thalamus. efferent.

Question 20

When is action potential formed in the nociceptors?

Answer 20

When surpasses threshold of them.

Question 21

Withdrawal reflex is _____ _____ reflex that causes a part of the body to move away from a painful stimulus, via _____ of flexor muscles and _____ of extensor muscles

Answer 21

Polysynaptic. spinal. contraction. relaxation.

Question 22

What is Hyperalgesia?

Answer 22

Exaggerated response to painful stimuli
(increased sensitivity to painful stimuli)

Question 23

What is Allodynia?

Answer 23

Pain from non-painful stimuli

Question 24

_____ _____ pain disorders can be a significant driver to the sensitization of central nociceptive neurons, depends on _____, _____ and _____ predisposing factors of the CNS prior to and during the onset of injury.

Answer 24

Chronic. peripheral. psychological. biological. environmental.

Question 25

_____ changes of neuronal properties in the CNS result in a _____ threshold for what causes _____ pain.

Answer 25

Maladaptive. lower. continious.

Question 26

What is reffered pain?

Answer 26

different location from causative stimulus

Question 27

Dermatome is an _____ of the _____ that receives _____ innervation from a specific _____ root.

Answer 27

Area. skin. sensory. spinal.

Question 28

Myotome is a _____ of _____ that are innervated by a _____ spinal nerve root

Answer 28

Group. muscles. single.

Question 29

Visceral fibers from internal organs and somatic fibers from the skin and muscles _____ in the posterior _____ of the spinal cord and share _____ pathway to the _____.

Answer 29

Coverge. horn. common. brain.

Question 30

What can cause referred pain to the right shoulder?

Answer 30

Cholecystitis / perforated Peptic Ulcer Disease

Question 31

What can cause referred pain to the left shoulder?

Answer 31

Hemoperitoneum (classically secondary to splenic rupture)

Question 32

What can cause referred pain to the left-sided chest and arm?

Answer 32

Myocardial Infarction (MI)

Question 33

What can cause referred pain to the periumbilical?

Answer 33

early stages of Appendicitis.

Question 34

Reffered pain from important internal organs: (dermatome+projection): A) diaphragm B) heart C) esophagus D) stomach E) liver, bladder F) small bowel G) colon H) bladder I) kidneys, tetsicles

Answer 34

A) C4, shoulder B) T3-4, left chest C) T4-5, retrosternal D) T6-9, epigastrium E) T-10-L-1, right upper quadrant F) T-10-L-1, periumblical G) T-11-L-1, lower abdomen H) T-11-L-1, suprapubic I) T-10-L-1, groin

Question 35

Pain scales are used to _____ a patient's pain and _____ to pain _____ over time

Answer 35

Assess. response. management.

Question 36

What is the name of the 3-step algorithm for the management of acute and chronic pain?

Answer 36

WHO analgesic ladder

Question 37

What to give in mild pain? (step 1)

Answer 37

nonopioid analgesics (Acetaminophen, NSAIDs...)

Question 38

What to give in moderae pain? (step 2)

Answer 38

nonopioid analgesics, consider mild opioids (codeine, hydrocodone, tramadol...)

Question 39

What to give in severe pain? (step 3)

Answer 39

nonopioid, mild opioids, consider strong (morphine, hydromorphone, fentanyl...)

Question 40

Which modification has been done about treatment management of the WHO analgesic ladder?

Answer 40

Step 4 for persistent pain (ex. nerve block)

Question 41

For both opioid and nonopioid analgesics, use the _____ effective dose for the _____ duration of time to minimize _____ effects.

Answer 41

Minimal. shortest. adverse.

Question 42

For Acetaminophen - how to administer?

Answer 42

325–1000 mg PO every 4–6 hours as needed (max. dose 4000 mg/day)

Question 43

NSAIDs - how to administer for: A) Aspirin B) Ibuprofen C) Diclofenac D) Naproxen E) Indomethacin F) Meloxicam

Answer 43

A) 325–975 mg PO every 4–6 hours as needed (max. dose 4000 mg/day) B) 400–800 mg PO every 6–8 hours as needed C) 50 mg PO every 6–8 hours or 75 mg every 12 hours as needed. D) 250–500 mg PO every 12 hours as needed E) 25–50 mg PO every 8–12 hours as needed F) 7.5–15 mg PO once daily as needed

Question 44

For Celecoxib - how to adminiser?

Answer 44

400 mg PO once on the first day, then 200 mg every 12 hours as needed.

Question 45

Opioids - how to administer for: A) Oxycodone (immediate-release) B) Hydromorphone (immediate-release) C) Tramadol

Answer 45

A) 5–30 mg PO every 4–6 hours as needed. B) 2–4 mg PO every 4–6 hours as needed C) 50–100 mg PO every 4–6 hours as needed

Question 46

Combination analgesics -how to administer for: A) Codeine/acetaminophen B) Hydrocodone/acetaminophen C) Hydrocodone/ibuprofen D) Oxycodone/acetaminophen

Answer 46

A) Codeine 15–60 mg/acetaminophen 300 mg 1 to 2 tablets PO every 4 hours as needed for pain B) Hydrocodone 5 mg/acetaminophen 325 mg 1–2 tablets PO every 4–6 hours as needed C) Hydrocodone 2.5–7.5 mg/ibuprofen 200 mg PO every 4–6 hours as needed D) Oxycodone 2.5–10 mg/acetaminophen 300–325 mg PO every 6 hours as needed

Question 47

When Acetaminophen is contraindicated?

Answer 47

Liver failure / active hepatic disease

Question 48

Which 2 analgesics drugs are the preferred first-line for mild to moderate pain? which drug is not preferred?

Answer 48

Preferred: Ibuprofen, Naproxen. Not: Indomethacin.

Question 49

When NSAIDs are contraindicated?

Answer 49

Recent MI, perioperative period CABG (exception: low-dose aspirin in the management of acute MI)

Question 50

When NSAIDs preferred not to be used?

Answer 50

Bleeding disorders, before invasive procedures.

Question 51

When NSAIDs preferred to be used with caution?

Answer 51

PUD and renal disease.

Question 52

Which drug is preferred to be second-line analgesic for mild to moderate pain?

Answer 52

Celecoxib (Selective COX-2 inhibitor, more expensive than NSAIDs)

Question 53

Which drug is preferred for patient with PUD?

Answer 53

Celecoxib

Question 54

When Celecoxib preferred to be used with caution?

Answer 54

Renal or cardiovascular disease

Question 55

When Opioids are contraindicated? (5)

Answer 55

Asthma respiratory depression Bowel obstruction Biliary colic Head injury

Question 56

Which drug is not recommended for patients with epilepsy, as it lowers the seizure threshold?

Answer 56

Tramadol

Question 57

Which drug is not recommended for perioperative or postoperative analgesia in opioid-naive patients?

Answer 57

Oxycodone

Question 58

Monitor for respiratory _____ in the first _____ hours after _____ or _____ the opioid dose.

Answer 58

Depression. 72. initiating. increasing.

Question 59

When to consider management of combination analgesics?

Answer 59

moderate to severe pain

Question 60

Headache red flags (SNOOP10): S - ? Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache or recent onset Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 60

S- ystemic symptoms (nonspecific e.g., fever, malaise)

Question 61

Headache red flags (SNOOP10): Systemic symptoms N - ? Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache or recent onset Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 61

N - eoplasm in history

Question 62

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history N - ? Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache or recent onset Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 62

N - eurological deficits/dysfunction

Question 63

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction O - ? Older age at onset Pattern changes of headache or recent onset Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 63

O - nset of headache is sudden

Question 64

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt O - ? Pattern changes of headache or recent onset Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 64

O - lder age at onset (>50)

Question 65

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset P - ? Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 65

P - attern changes of headache

Question 66

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache P - ? Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 66

P- ositional headache

Question 67

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache P - ? Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 67

P - recipitated by sneezing, coughing, exercise

Question 68

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise P - ? Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 68

Papilledema signs of increase ICP

Question 69

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP P - ? Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 69

P- rogressive headache and atypical features

Question 70

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features P - ? Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 70

P - regnancy or postpartum period

Question 71

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period P - ? Posttraumatic onset Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 71

P - ain eye + autonomic + visual features

Question 72

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits P - ? Pathology of the immune system Painkiller overuse or new drug at onset of headache

Answer 72

P - osttraumatic onset

Question 73

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset P - ? Painkiller overuse or new drug at onset of headache

Answer 73

P - athology of the immune system

Question 74

Headache red flags (SNOOP10): Systemic symptoms Neoplasm in history Neurological deficits/dysfunction Onset of headache is sudden or abrupt Older age at onset Pattern changes of headache Positional headache Precipitated by sneezing, coughing, or exercise Papilledema and other signs of increased ICP Progressive headache and atypical features Pregnancy or postpartum period Pain of the eye with autonomic features and visual deficits Posttraumatic onset Pathology of the immune system P - ?

Answer 74

P - ainkiller overuse, new drug onset

Question 75

Headache is a pain related to _____ and/or _____ of _____ or _____ structures with _____ receptors

Answer 75

Irritation, inflammation, intracranial, extracranial, pain.

Question 76

What is a primary headache?

Answer 76

Not by another underlying condition

Question 77

What are included in the primary headache?

Answer 77

Migraine, tension, trigeminal autonomic cephalalgias (TACs)

Question 78

What is a secondary headache?

Answer 78

Caused by another underlying condition.

Question 79

What is the classical triad of Meningitis?

Answer 79

Fever, headache, and neck stiffness.

Question 80

What can be other signs of Meningitis?

Answer 80

Meningismus (meningeal irritation, ex. photophobia) + Altered mental status, GI, seizures.

Question 81

What are the characteristics of the Meningitis pain?

Answer 81

Dull, diffuse (holocephalic) worsens over h/d.

Question 82

What is the other name of Intracerebral hemorrhage? (ICH)

Answer 82

Intraparenchymal hemorrhage

Question 83

What are the characteristics of the ICH pain?

Answer 83

Acute, severe, nonspecific headache.

Question 84

What are the symptoms of ICH?

Answer 84

GI, decreased consciousness, seizures.

Question 85

Can ICH can lead to an injury of specific anatomical region in NS?

Answer 85

Yes, focal neurological signs.

Question 86

In which condition, patients often describe their headaches as "the worst headache they have ever experienced"?

Answer 86

Subarachnoid hemorrhage.

Question 87

What are the characteristics of the SAH pain?

Answer 87

Acute onset of thunderclap headache.

Question 88

Can SAH can lead to an injury of specific anatomical region in NS?

Answer 88

Yes, focal neurological signs.

Question 89

What are the symptoms of SAH?

Answer 89

Meningismus, rapidly worsening neurological status.

Question 90

What can be the result of extensive hemorrhage and / parenchymal injury in SAH?

Answer 90

Seizures.

Question 91

What are the characteristics of Subdural hematoma? (SDH)

Answer 91

Diffuse headache, worse side hematoma.

Question 92

How long does lucid interval in SDH may last?

Answer 92

Days to weeks.

Question 93

What are the signs of SDH?

Answer 93

Impaired consciousness, confusion, focal deficits.

Question 94

Which symptoms can be in chronic subdural hemorrhage?

Answer 94

Psychomotor impairment, memory loss.

Question 95

What are the characteristics of Epidural hematoma? (EDH)

Answer 95

Headache localized side of hematoma.

Question 96

How long does lucid interval in EDH may last?

Answer 96

Minutes to hours.

Question 97

Which symptom can be in EDH?

Answer 97

Contralateral focal symptoms/hemiplegia.

Question 98

What other symptoms can be in EDH?

Answer 98

Mental, loss consciousness, seizures, GI.

Question 99

What are the characteristics of Cerebral venous sinus thrombosis?

Answer 99

Nonspecific headache (rarely sudden-onset)

Question 100

What are the risks factors for CVST?

Answer 100

Pregnancy, prothrombotic, vasculitis, smoking, oral contraceptives.

Question 101

Which syndrome can be caused by CVST?

Answer 101

Cavernous sinus syndrome.

Question 102

Which symptoms can be in CVST?

Answer 102

Seizures, impairment consciousness, increase ICP.

Question 103

What is the other names of Giant cell arteritis? (GCA, 2)

Answer 103

Horton disease, Temporal arteritis.

Question 104

What are the characteristic of GCA?

Answer 104

Unilateral headache, temporal/occipital area .

Question 105

Which artery is more prominent and tender in GCA?

Answer 105

Temporal artery

Question 106

Which symptoms can be in GCA?

Answer 106

Jaw claudication, scalp tenderness, B.

Question 107

What is the other names of Hypertensive crisis?

Answer 107

Acute severe hypertension

Question 108

What are the characteristic of Hypertensive crisis?

Answer 108

Diffuse, pulsating, exacerbated physical activity.

Question 109

What are the other symptoms of Hypertensive crisis?

Answer 109

> 180/120 mm Hg, signs of end-organ damage.

Question 110

What are characteristics of Ischemic stroke headache?

Answer 110

Tension-type headache

Question 111

What are the other symptoms of Ischemic stroke headache?

Answer 111

Focal neurological deficits, Altered mental.

Question 112

What are the characteristics of Intracranial space-occupying lesions?

Answer 112

Dull, usually bifrontal, worsen w/m.

Question 113

Which signs will be seen in intracranial space-occupying lesions?

Answer 113

Increased ICP

Question 114

What other symptoms will be intracranial space-occupying lesions?

Answer 114

Focal neurological, altered mental, seizures, GI.

Question 115

What are the characteristics of Medication overuse headache?

Answer 115

Variable characteristics

Question 116

Which symptoms will be in Medication overuse headache?

Answer 116

Autonomic, cognitive or behavioral.

Question 117

Which history is needed to be checked in Medication overuse headache?

Answer 117

Analgesic overuse

Question 118

What are the other names of Trigeminal neuralgia? (2)

Answer 118

Tic douloureux, Prosopalgia.

Question 119

What are the characteristics of Trigeminal neuralgia?

Answer 119

Paroxysmal (sec-2 min) and stabbing pain

Question 120

What can be the triggers of Trigeminal neuralgia?

Answer 120

Chewing, talking, cold, touching specific.

Question 121

_____ and _____ of Trigeminal neuralgia episodes usually _____ over time

Answer 121

Frequency, intensity, increase.

Question 122

What are the characteristics of Acute angle-closure glaucoma?

Answer 122

Sudden unilateral, severe ocular pain / headache

Question 123

What may be presented with palpitation of Acute angle-closure glaucoma?

Answer 123

Hard palpitation of the eye