Lecture 1-28 Flashcards
Pain (122 cards)
1
Q
What type of model do we use to assess pain?
A
Biopsychosocial model
2
Q
T/F: Pain is only physical
A
F
Pain has cognitive, sensory, and emotional influences, and behavioral manifestations
3
Q
Back pain that is worsened by walking and improved by sitting, maybe suggestive of what?
A
Lumbar spinal stenosis
4
Q
What does OPQRSTU stand for? What do we use this for?
A
Onset
Provocative/palliative
Quality
Region/radiation
Severity
Timing/treatment
U you/impact
To identify pain characteristics
5
Q
What is catastrophizing?
A
A coping mechanism that is a negative cascade of distressing thoughts and emotions about actual or anticipated pain
6
Q
What is kinesiophobia?
A
Fear of movement
7
Q
What is catastrophizing associated with?
A
-Increase pain intensity
-Increase risk of chronic pain
8
Q
What are your red flags of pain?
A
-bowel/bladder dysfunction
-saddle anesthesia
-bilateral leg weakness
-severe, sudden onset headache
-fever, weight loss, night sweats
-recent injury
-history of cancer
9
Q
What scale is able to categorize Catastrophizing? What are the important ratings?
A
Mark Sullivan Scale
- I worry all the time about whether the pain will end.
- It’s terrible and I think it’s never going to get any better.
- It’s awful, and I feel that it overwhelms me.
- I become afraid that the pain will get worse.
- There’s nothing I can do to reduce the intensity of the pain.
Higher # is less intense
10
Q
Pyschiartic conditions are associated with ________
A
Higher pain intensity & pain-related disabiity
11
Q
Poor sleep is associated with ______
A
onset and worsening of chronic pain
12
Q
Sleep disordered breathing may be caused by ______ and may increase your risk of ______________
A
opioid medication
respiratory depression or death
13
Q
History of substance use disorder including tabacco is associated with increased likelihood of __________
A
prescription opioid misuses and abuse
14
Q
What are the components of a pain exam?
A
- general appearance
- mental status
- vital signs
- posture & gait
- palpation
- ROM
- neuro
- special tests
15
Q
What is Trendelenburg?
A
Drop of pelvis when lifting leg opposite to weak G. medius
16
Q
What is another name for foot drop? What is this? What pathologies do you see this in?
A
“Steppage” or “slap-foot”
Unilateral - muscles that lift the front part of the foot become weak/paralyzed
common peroneal nerve palsy
L5 radiculopathy
17
Q
How do you grade motor movement?
A
0 - 5
0- no movement
18
Q
What is a myotome?
A
muscle group innervated by a specific spinal nerve
19
Q
What is a normal reflex value?
A
2
0 - none
4 - hyper
20
Q
During a physcial pain assessment, what do we exclude?
A
Red flags
21
Q
What are CTs good at looking at vs MRIs?
A
CT: soft tissue & bony structures
MRI: soft tissue integrity, muscles, tendons, nerves
22
Q
T/F: We use diagnostic imaging without red flags or red flag signs. Why?
A
F
Reinforces sick behaviors & worsen long term outcomes
23
Q
How can you figure out if an abnormal finding on an MRI is age appropriate or a source of pain?
A
Dx block:
-selective nerve root block
-medial branch block
24
Q
When can you do imaging on the lower back?
A
-red flags present or
-after 6 weeks
25
If there's a HA thats brought on by excertion, what should you expect?
Increased ICP
**Get imaging**
26
If patient is immunocompromised or has a malignacy and is complaining of a HA, what do we do? Why?
Imaging
Possible mets to brain
27
I should always try to establish a specific pain _________ Dx. Which includes these 4 things:________
Patho-anatomic
1. Acute/chronic
2. Location.
3. Mechanism
4. Etiology
28
What is a BPI? When is this beneficial to use?
Brief pain inventory
It is short form used to answer questions about pain and previous treatment responses. Very useful in primary care.
29
What is a PEG? What is its benefits?
Pain, enjoyment, general activity
Assesses more function and quality of life
**3 questions measurement derived from the BPI**
30
What does a positive answer on the PC-PTSD screen indicate?
pt may have PTSD or trauma related problem & needs further support
31
A score of ____ or higher on the GAD-7 means what?
10
pt may have panic disorder, social anxiety disorder, PTSD
32
What is the relevance of STOP-BANG? What does it mean?
Tool used to Dx/Tx sleep apnea
**If more than 3 yes, Tx for OSA**
5-8 = mod/severe OSA
Snoring
Tired
Observed apnea
High BP
BMI > 35
Age > 50
Neck > 40 cm (16 in)
Gender is male
33
What is fibromyalgia?
Chronic pain condition that includes:
-fatigue
-cognitive effect
-brain fog
34
How do you Dx fibromyalgia?
1. WPI ≥ 7 and SS ≥ 5
or
WPI 3 - 6 and SS ≥ 9
2. Symptoms have been present for 3 months
3. Pt doesnt have a disorder that would otherwise explain the pain
35
What is ORT? What are the risk ranges?
Opioid risk tool
low: 0-3
moderate: 4-7
high: ≥ 8
36
T/F: Scored for ORT are weighted equally for male & female
F
they are weighted differently
37
What screening tool do we use for people currently taking opioids?
COMM: Current opioid misuse measure
≥ 13 (idk what this is for but im including it)
38
What screening tool should we use in patients with a higher risk of misuse?
SOAPP-R: Screener & opioid assessment for patients with pain - revised)
39
What is the QoL scale? How are the numbers rated?
Quality of life scale
The higher the number = better
40
What point differentiates between upper & lower neck pain?
C4
41
What is the perimeter for neck pain?
Base of skull --> 1st thoracic spinous process (T1)
42
Headaches caused by neck pain are ________ headaches
cervicogenic
43
Most neck pain will be _______ pain
myofascial
44
What is N SWIFT PICS?
Another way to remember red flags
Neuro
Steriods
Weight loss
Immunospressed
Fever
Trauma
Porosis
IVDU (IV drug use)
Cancer
Severity of pain
45
What is the time for acute vs chronic neck pain?
acute: < 3 months
chronic: > 3 months
46
What type of imaging do we use to detect osteoarthrosis?
None
It cant be detected on imaging
47
What are chronic neck pain conditions with trauma that merit further investigation?
Zygapophyseal joints
internal disc disruption
48
In neck pain with no known origin and no red flags, what should we do?
No imaging
-explain & reassure
Consider median branch block for facet pain
- provactive discography for disc disruption
49
What is the difference between radiating and referring pain?
Referring: Muscle pain
-follows myotomes
-normal neuro exam
radiating: nerve pain
-follows dermatomes
-abnormal neuro exam
50
On the neck, I'd want to get an _____ done for imaging
MRI
51
If Dx block provides pain relief, what should we consider?
percutaneous radiofrequency neurotomy
-Sx
52
What is considered low back pain?
Tip of last thoracic spinous process (T12/rib12) --> tip of sacro-coccygeal joints
53
Everything under _____ is considered back pain
T1
54
What else can be refered to as back pain?
Lower extremity pain above and/or below the knee
55
Where is the vertebrae injury in Cauda Equina vs Conus Medularis?
Cauda Equina: L2 - sacrum
Conus Medularis: L1 - L2
56
Where is the spinal level injury in Cauda Equina vs Conus Medularis?
Cauda Equina: Injury --> lumbosacral nerve roots
Conus Medularis: Injury --> Sacral cord segment & roots
57
What are some of the main presentation difference between Cauda Equina vs Conus Medularis?
**Both cause pain & sensory disturbances in SADDLE ANESTHESIA area**
Cauda Equina: Asymmetric
Conus Medularis: symmetric
Cauda Equina: Symptoms usually severe
Conus Medularis: usually not severe
Cauda Equina: weakness to paralysis
Conus Medularis: normal to mild/mod weakness
Cauda Equina: late/less severe
Conus Medularis: Early/severe sphincter & sexual dysfunction --> impaired erections
Cauda Equina: more favorable outcomes
Conus Medularis: less favorable
58
T/F: The prognosis for acute low back pain is favorable
T
59
What is my 1st line test for suspected AAA?
Ultrasound
60
What are my 1st line tests for suspected tumor?
1. ESR (Erythrocyte sedimentation rate)
2. CRP (C-reactive protein)
3. MRI
4. PSA (Prostate specific antigen)
5. IEPG (Immuno-electrophoretogram)
6. serum protein
7. Electrophoresis
61
What are my 1st line tests for a pathologic fx?
X ray
62
What does CRP (C-reactive protein) tell me?
a marker of inflammation in the body
It is produced by the liver in response to infection, injury, or chronic disease.
63
What does ESR (Erythrocyte sedimentation rate) tell me?
measures how fast red blood cells settle in a tube over one hour.
**Higher ESR: inflammation, infection, autoimmune disease, or cancer**
Lower ESR: sickle cell disease, polycythemia, or heart failure
64
T/F: Osetopenia should be expected in all pts over 50
T
65
What bones are the shoulder comprised of?
Scapula
Clavicle
Humerus
66
What are the bony structures in the shoulder area?
Spine
Scapula
Gleno-humeral joint
67
What should you expect if you cant lift your shoulder? What stabilizes the rotator cuff?
Compromised rotator cuff
Rotator cuffs are stabilized by: Pectoral girdle
-shoulder
68
Where can shoulder pain be referred from/to? Why is this important?
Neck
Heart
Gallbladder
I need to be able to rule out other pathologies that could be causing shoulder pain like cervicogenic HA, MI, cholecystitits)
69
70
Which tests will identify a rotator cuff injury? How do you perform them?
Apley scratch: pain when reaching to opposite scapula
Neer: pain w/ shoulder flexion
Hawkin's: pain w/ shoulder internal rotation
Drop arm: pain w/ shoulder abduction
O'Brian: pain w/ rotation & abduction
71
Which test will identify bicep tendonitis? How do you perform it?
Speed's & Yerguson: elbow flexion
72
Which test will identify labral tear? How do you perform it?
Apprehension: pushing on humeral head
73
Most shoulder conditions are _________. They need to be seen by who?
Musculoskeletal
physiatrist or ortho
74
If rehabilitation fails, then what type of imaging should we get?
MRI
75
What are the most common shoulder pain conditions?
Rotator cuff tear
-gleno-humoral/sub-acromial bursitis
-gleno-humoral instability (pendinitis)
-bicep tendinitis
76
T/F: elderly patient tend to respond less to intra-articular injections, and rehab rehabilitation
T
77
In elderly patients with limited functionality, what should we disuss with them?
Sx or
-palliative
78
__________ is required to correct any shoulder instability
Arthroscopic Sx
79
Hip pain is common & increases in people in ages over ____
60
80
What does "hip joint" pain refer to?
Ball & socket: Femoral head & acetabulum
81
What is mechanical hip pain?
Musculoskeletal
Normally localized and increased with loading (standing)
82
What is referred hip pain?
poorly localized and may/may not be increased with loading (standing)
83
What should I expect with hip pain at rest?
Rheumatologic
-infection
-cancer
84
Where can hip pain be referred to/from?
low back
-thigh
-butt
-groin
85
Where does extra-articular hip pain come from?
lumbar spine
-knee
-greater trochanter
-piriformis muscle
86
Dislocation of the hip can NOT happen without ______
trauma
87
What is "snapping hip syndrome"? What anatomy is involved?
ligament passing tightly over bony prominence
Ligament: iliofemerol ligament & pubofemoral ligament
bony prominences: greater trochanter & anterior iliac spine
88
Hamstrings ______ the hip & ______ the knee
Extend
Flex
89
Which quadricept muscle can cause both hip & knee pain? Why?
Rectus femoris
Crosses the knee & hip at the anterior inferior iliac spine
90
What are the 4 quadriceps muscles?
1. Vastus lateralis
2. medialis
3. intermedialis
4. rectus femoris
91
In the hip, where is blood supply most vulnerable?
femoral neck
92
When history & exam suggest avascular necrosis, what should we do? Why?
Perform imaging
blood supply to the fermoal neck is vulnerable and can lead to bone weakness, limited movement, arthritis.
93
How do we test ROM in the hip?
3 planes w/ 2 directions each
Flex/extend in supine
internal/external rotation in seated position
abduction/adduction in supine
94
What is the test that detects hip flexion contraction?
Thomas test
95
What the test that detects hip labral injury or sacroiliac joint problem?
FABER
-Patrick's test
McCarthy: bilateral hip flexion = labral tear
-Fitzgerald: similar to FABER w/o pressing on hip
96
What test suggests an iliotibial band problem?
Ober: hip extension
97
What is normally affected in arthritis?
Worn out cartilage in a joint
Bone rubbing against bone
98
What is a common his disorder in the elder?
hip osteoarthritis
99
_________ hip disorders appear in the very young
congenital
100
What is a hip disorder common for pediatric patients? What are they?
**Slipped Capital femoral epiphysis (SCFE):** femoral head slips off the femoral neck at the growth plate (physis)
**Legg-Clave-Perthes Disease (LCP):** caused by avascular necrosis of the femoral head, leading to bone death and eventual regeneration; usually unilateral
101
What is a hallmark symptom of Trochanteric bursitis?
Pain upon palpation of middle of lateral greater trochanter
102
What are the gender, race & genetic effects on Osteoarthritis?
gender: more common in women
race: none
genetics: clear components exist
103
Hip replacement may be indicated in mostly _______
trauma
104
Transient trochanteric bursitis relief can be given by ________
intra-articular steroid injections
105
T/F: I can do intra-articular steroid injections with avascular necrosis
F
106
Where can knee pain refer to?
Thigh
lower back
leg
107
T/F: referred pain into the knee region is typically poorly localized, and will often not increase with mechanical loading
T
108
If there's referred pain suspected into the knee, what areas should I investigate?
Hip
-lumbar spine
-leg
109
What are the 3 joints in the knee? Which is the main one? What is its relevance?
**Tibiofemoral**: fibrocartilagenous meniscus deepens socket for femoral condyles to roll into; provides cushion & stability
Patellofemoral
Proximal tibiofibular
110
Where does the patella sit?
in the quadricep tendon & attaches to the tibial tuberosity
111
The hamstrings cross the hip as the ________ attachment is on the ___________ and ________ cross the knees
Proximal
ischial tuberosity
distally
112
What muscle cross the knee proximally & crosses the ankle at the achilles tendon?
gastrocnemius
113
The gastrocnemius muscle is a strong _______ of the ankle and helps ________ the knee
plantarflexor
flex
114
What test should be used for meniscus lesions?
Thessaly test: Stand on 1 leg, hold arms of pt, and rotate over knee joint.
-complains of pain = positive
115
Patellofemoral pain is more common in people under the age of _______.
45 years old
116
What is Patellofemoral pain characterized by?
Positive Moviegoer sign: pain when sitting for long periods w/ knee @ 90 degree
117
T/F: There is Sx for Patellofemoral pain
F
Do not consult nobody. They wont help you.
118
What is common w/ osteoarthritis after twisting the knee w/ a fixed foot? What can this lead to?
Meniscal tear
knee locking
-effusion
-pain with loading
119
Where is bursitis of the knee common at? What may it require?
pre-patellar
aspiration
120
Knee ligament injuries are common with _______ and should warrant what?
trauma
Early bracing & rehab --> possible Sx after these 2
121
Most acute knee injuries are __________
soft tissue injuries
122
What type of imgaing is appropriate for 1st line for the knee? What should we move to after this?
plain radiography such as Xray
MRI
