Exam 1 - Pain Assesment

Question 1

What are the red flags during a pain assessment?

Answer 1

• Bowel/bladder dysfunction
• Saddle anesthesia (perineal numbness)
• Bilateral leg weakness
• Severe, sudden onset headache
• Fever, weight loss, night sweats
• Recent injury
• History of cancer

Question 2

What mnemonic guides the pain interview?

Answer 2

OPQRSTU
* Onset
* Provocative/Palliative
* Quality or Character
* Region/Radiation
* Severity
* Timing/Treatment
* U (You/Impact on Patient)

Question 3

What is associated with greater pain intensity and pain related disability?

Answer 3

Psychiatric comorbidities

Question 4

Why are pain interviews often confrontational?

Answer 4

Doubt and frustration

Question 5

What are the components of the clinical pain exam?

Answer 5

• Inspection and General Appearance
• Mental Status
• Vital Signs
• Posture and Gait
• Palpation
• Range of Motion (active and passive)
• Neurological Examination
• Special Tests

Question 6

What is trendelenburg gait?

Answer 6

Drop of pelvis when lifting leg opposite to weak gluteaus medius

Question 7

Damage to what nerve causes foot drop?

Answer 7

Common peroneal nerve

Question 8

What is 5 and 0 on the motor grading scale?

Answer 8

5 = normal
0 = no contraction

Question 9

What are myotomes?

Answer 9

muscle groups innervated by specific spinal nerve

Question 10

When should an uncomplicated headache be imaged?

Answer 10

• Neurologic exam is abnormal
• Unable to diagnose by history and exam
• Headache is sudden or explosive, different from prior ones, especially over 50 y/o
• Progressively worsening
• Brought on by exertion
• Accompanied by fever, seizure, vomiting, a loss of coordination, vision/speech/alertness changes
• The patient is immuno-compromised or with a known malignancy

Question 11

When does acute pain become chronic pain?

Answer 11

> 3 months

Question 11

What is the name of these pain scales?

Answer 11

Verbal Rating Scale (VRS)
Numeric Rating Scale (NRS)

Question 12

What is the name of this pain scale?

Answer 12

Numeric Pain Intenstiy Scale

Question 13

What is the PEG assessment?

Answer 13

3 question assesment regarding pain, enjoyment, and general activity to get a more comprehensive view of a patients pain.

Question 14

What screening tool is used to assess the presence of sleep apnea?

Answer 14

STOP-BANG
Snoring?
Tired?
Observed apnea?
High Blood Pressure?
BMI > 35?
Age > 50?
Neck circumference > 40 cm (16 inches)?
Gender is male?

Question 15

What 2 assessment tools are used to assess and diagnose fibromyalgia

Answer 15

Widespread Pain Index (WPI)
Symptom Severity (SS)

Question 16

What is the ORT?
What do the scores indicate?

Answer 16

Opioid Risk Assessment - used to screen patients prior to opioid initiation or supplement the clinical interview
0-3: low risk
4-7: moderate risk
> 8: high risk

Question 17

How cna you assess the effectiveness of your pain management interventions?

Answer 17

Check the 4 + 2 A’s
- Activity
- Analgesia
- Aberrant behavior
- Adverse effects

• Affect
• Adjunct

Question 18

What are the anatomical markers for neck pain?

Answer 18

Neck pain is from base of the skull to first thoracic spinous process
Pain above C4 is upper necks, pain below C4 is lower neck

Question 18

What are the joints called between the facets called?

Answer 18

Zygapophyseal joints

Question 19

What is referring and radiating pain?

Answer 19

Referring pain follows myotome (muscle) distribution and the neurological exam is normal

Radiating pain follows a dermatome (nerve) and is accompanied with neurological signs such as paresis, hyper-reflexia or hypoesthesia.

Question 20

What are some treatments to manage the symptoms of neck pain?

Answer 20

Acupuncture, stretch, heat packs
NSAIDS, muscle relaxants, and opioids typically not indicated or effective

Question 21

What 2 methods provide the best outcomes for long-term neck pain?

Answer 21

Exercise and CBT

Question 22

Where is low back pain anatomically?

Answer 22

Between the tip of the last thoracic spinous process to the tip of the sacro-coccygeal joints

Question 23

What dangerous medical conditions can be caused by an epidural hematoma? What are the differentiating symptoms?

Answer 23

Cauda Equina Syndrome and Conus Medullaris | Know main differences

Question 24

What are the preferred tests when red flags are present with spinal pain, based upon suspected pathology?

Answer 24

Question 25

_ should be suspected in all patients over 50?

Answer 25

Osteopenia - causes increased risk for vertebral fracture

Question 26

What is the name of this joint?

Answer 26

Gleno-humeral joint

Question 27

What three bones make up the shoulder?

Answer 27

Scapula, clavicle, and humerus

Question 28

What stabilizes the shoulder and pectoral girdle?

Answer 28

The rotator cuff

Question 29

What tests are for rotator cuff injuries?

Answer 29

* Apley scratch test: pain when reaching to opposite scapula * Neers test: pain with shoulder flexion * Hawkin’s test: pain with shoulder internal rotation * Drop arm test: pain with shoulder abduction * Lift off test: pain with internal rotation and push * O’ Brian’s test: pain with rotation and abduction ##Footnote AN OLD H

Question 30

What do Speed's and Yerguson tests detect?

Answer 30

Biceps tendonitits

Question 31

What test detects labral tear?

Answer 31

Apprehension test

Question 32

Where can hip pain be referred from?

Answer 32

Low back, thigh, buttocks, groin

Question 33

What might be happening if a patient complains that they dislocated there hip without trauma?

Answer 33

Snapping hip syndrome - ligament passing tightly over a bony prominence

Question 34

What muscle can cause hip and knee pain?

Answer 34

Rectus femoris

Question 35

What muscle extends the hip and flexes the knee?

Answer 35

Hamstring

Question 36

What could be a serious vascular condition causing hip pain?

Answer 36

Avascular necrosis Caused by the vulnerability of blood supply at the femoral neck

Question 37

What test may detect a hip flexion contraction?

Answer 37

Thomas test

Question 38

What test may detect a hip labral injury?

Answer 38

FABER test (Flexion ABduction External Rotation)

Question 39

What are the 2 congenital hip disorders?

Answer 39

Legg-Clave-Perthes Disease (LCP)- initiated by a disruption of blood flow to the femoral head causing avascular necrosis, leads to loss of bone mass Slipped Capital Femoral Epiphysis (SCFE) - a fracture of the growth plate and is a pathology of adolescence, usually causes hip and groin pain, often can cause thigh and knee pain

Question 40

What are the three compartments of the knee?

Answer 40

* Tibiofemoral * Pattellofemoral * Proximal tibiofibular

Question 41

What muscle is the main strong plantarflexor of the ankle and also helps flex the knee?

Answer 41

Gastrocnemius

Question 42

What is a positive moviegoer's sign?

Answer 42

Pain in the knee after sitting with legs flexed at 90°

Question 43

What are the symptoms of osteoarthritis in the knee?

Answer 43

3/6 of the following: Greater than 50 years of age, morning stiffness < 30 min, crepitus, bony tenderness, bony enlargement, no palpable warmth

Question 44

What alternative to stem cells can help with joint, tissue, and muscle injuries/pain?

Answer 44

PRP therapy - platelet rich plasma