Pain MCQ Flashcards by L SCM

Homer has developed post-hepatic neuralgia after the shingles. He cant tolerate his t-shirt. The term that can describe this is:

A) Hyperalgesia

B) Peripheral sensitization

C) Allodynia

D) Cutaneous pain

C) Allodynia

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The pain ada[tation argues that the activity of a muscle that is painful or produces a painful movement is uniformly inhibited whereas that of the antagonist are

facilitated
inhibited
ischaemic
down regulated

facilitated

Week 8 lecture slide 6

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In central nociceptive transmission, thalamic projections to the somatosensory cortex are predominantly involved in the:

a) Sensory–discriminative component of pain
b) Emotional arousal from pain
c) Escape from pain
d) Sensory-cognitive component of pain

a) Sensory–discriminative component of pain

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Peripheral sensitization may occur as a result of an increase in the release of excitatory neurotransmitters, such as:

a) Serotonin
b) GABA
c) Substance P and glutamate
d) Noradrenaline

c) Substance P and glutamate

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• Sluka, pg 38, “Spinal cord” last paragraph

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C) Increased pain from a stimulus that normally provokes pain

D) Increased sensitivity to pain

Week 2 lecture, slide 28.

Have moderated ALL attempts to ensure that either C or D is marked as correct.

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Which of the following statements about nociceptive pain is false?

A) Occurs when nociceptors respond to a noxious stimulus

B) caused by lesion of the somatosensory nervous system

C) Usually time limited

D) Resolves when damaged tissue heals

B) caused by lesion of the somatosensory nervous system

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The headache produced by cervical artery dissection is due to nociceptor activation in the:

Tunica intima

Tunica media

Tunica adventitia

All of the above

Tunica Adventitia

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Which of the following theories states that physical emotional and cognitive factors all contribute to the experience of pain?

A) specificity theory

B) Nociceptive theory

C) self-control theory

D) Gate control theory

E) Neuromatrix theory

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the phrase “pain memories” is associated with which pain theory?

pain adaptation theory
Classical conditioning
pain spasm theory
Hodges protection hypothesis

Classical conditioning

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The sacroiliac joint is a compound joint that is:

Part synovial and part fibrous

Part synovial and part symphysis

Part symphysis and part fibrous

Part symphysis and part synchrondrosis

Part synovial and part fibrous

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• Sluka, pg 56 “POTENTIAL MECHANISMS OF CENTRAL SENSITIZATION”

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Which of the following statements about acute pain is false?

A) Pain usually resolves upon healing

B) Is accompanied by increased nervous system activity

C) Usually has no protective function

D) There is usually obvious tissue damage

C) Usually has no protective function

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Regarding nociceptive transmission, the predominant role of the thalamus is to:

a) Execute movement commands to withdraw from the noxious stimuli
b) Execute the withdrawal reflex from the noxious stimuli
c) Integrate information regarding noxious stimuli
d) Release dopamine to increase the ability of descending inhibition

c) Integrate information regarding noxious stimuli

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Describe four clinical features that may be present in a case of C7 radiculopathy (4 marks)

Nerve root inflammation

Sensory deficit
motor deficit
numbness tingling.
Dermatomal distribution of sensory loss helps to determine segment of root compression
Radicular pain is felt over multiple dermatomes

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When you assess the sensation in a patient’s posterior thigh, the first order neuron being stimulated is the:

Sciatic nerve

Inferior gluteal nerve

Posterior femoral cutaneous nerve

Sural nerve

Posterior femoral cutaneous nerve

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Low back pain is generally understood to become chronic after a period of how long

A) 6 weeks

B) 12 weeks

C) 14 weeks

D) 1 month

B) 12 weeks

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According to the intact nociceptor hypothesis

Intact nociceptors that survive injury and innervate the region by the injured nerve or root are desensitized by the local degenerating nerve fibres and wholly denervated target tissue
Intact nociceptors that survive injury and innervate the region by the injured nerve or root are desensitized by the local degenerating nerve fibres and partly denervated target tissue
Intact nociceptors that survive injury and innervate the region by the injured nerve or root are sensitized by the local degenerating nerve fibres and partly denervated target tissue
Intact nociceptors that survive injury and innervate the region by the injured nerve or root are sensitized by the local degenerating nerve fibres and wholly denervated target tissue

Intact nociceptors that survive injury and innervate the region by the injured nerve or root are sensitized by the local degenerating nerve fibres and partly denervated target tissue

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• Sluka, pg 23 “Neuropeptides”

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Define the term cervical spondylotic myelopathy?

nerve root compression caused by degeneration

Osteocytes build up in the canal
Disc calcification resulting in loss of disc height
ligamentous ossification PLL
ligamentous buckling LF

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One of the differentials for your patient is a strain of the scalenes muscle group. Which of the following is the superior attachment of anterior scalenes?

TPs of C1 – C4

SPs of C2 – C7

TPs of C3 – C6

TPs of C5 – C7

TPs of C3 – C6

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regarding motor control and pain theories, what did early scientist propose?

That a simplistic relationship between pain and motor control exists. meaning that would lead to either inhibition of muscle activity and spasm
That a simplistic relationship between pain and motor control exists. meaning that would lead to either inhibition of muscle activity and ischaemia
That a simplistic relationship between pain and motor control exists. meaning that would lead to either excitation of muscle activity and ischaemia
That a simplistic relationship between pain and motor control exists. meaning that would lead to either excitation of muscle activity and spasm

That a simplistic relationship between pain and motor control exists. meaning that would lead to either inhibition of muscle activity and spasm

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A cervical facet joint is an example of:

A saddle synovial joint
A plane synovial joint
A pivot synovial joint
A condyloid synovial joint

A plane synovial joint

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Consider the following clinical features:

Duration of 4 – 72 hours
Bears at least two of the following characteristics:
Unilateral location
Pulsating quality
Moderate or severe intensity
Aggravation by routine physical activity
AND associated with at least one of nausea, vomiting, photophobia and phobia

The headache most consistent with this clinical description is:

Cervicogenic headache
Cluster headache
Migraine
Tension type headache

Migraine

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During nociceptive transmission, the primary function of high threshold neurons is to respond to: a) Both innocuous stimulation and nociceptive stimulation b) Noxious stimulation c) Innocuous mechanical stimulation d) Both noxious stimulation and innocuous mechanical stimulation

b) Noxious stimulation

Sluka, pg 19 “Muscle and joint nociceptors”

D) Painful response to a non nociceptive stim • Figure 1.1 and table 1.1 Sluka “Allodynia is a term used to describe pain from a nonnociceptivestimulus”

• Sluka, pg 37 “Central nociceptive pathways”

D) Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system Week 2 Lecture – slide 10

Discuss three common injury mechanisms associated with a hamstring strain – please provide examples within your answer

1. Occurs in activities where the hamstrings can be stretched eccentrically at high speed. 2. Occurs with acute overstretching 3. Occurs with repetitive strain causing disruption of mm fibres examples: sprinters, soccer, football, dancers, hurdlers

Which of the following is NOT a feature of neuropathic pain presentations? Numbness or altered sensation Pain that is shooting or burning in nature Pain in an area of numbness Widespread, diffuse pain

Widespread, diffuse pain

• C) Stroke, MS or Guillain-Barre, Alcoholism & Vitamin deficiencies, Entrapment syndromes, Iatrogenic causes, Spinal Cord trauma Refer to slide 10 week 2, lecture

Which of the following structures form part of the coracoacromial arch? a) Acromion, acromioclavicular ligament, coracoid process b) Acromion, coracoacromial ligament, clavicle c) Acromion, coracoacromial ligament, coracoid process d) Acromion, subacromial bursa, coracoid process

b) Acromion, coracoacromial ligament, clavicle

Reading material for Central nociceptive pathways – Pg 8-9 “Areas of the brain involved in the perception, integration and response tonociception”

Due in part to anatomic and biochemical changes in the nervous system

Nociceptive signals are transmitted predominantly by: a) A Alpha fibres b) A Beta fibres c) A Delta fibres d) C fibres

d) C fibres

• Sluka, pg 22 “Neuropeptides”

During the neuropathic pain, sensitization can result in? 1. spontaneous nociceptor activity as well as increased threshold and increased response to suprathreshold stimuli 2. spontaneous nociceptor activity as well as increased threshold and decreased response to suprathreshold stimuli 3. spontaneous nociceptor activity as well as decreased threshold and decreased response to suprathreshold stimuli 4. spontaneous nociceptor activity as well as decreased threshold and increased response to suprathreshold stimuli

spontaneous nociceptor activity as well as decreased threshold and increased response to suprathreshold stimuli

Consider the arthrokinematics of the glenohumeral joint during shoulder abduction. The normal function of the supraspinatus and deltoid muscles is to produce: a) Superior glide of the humerus b) Superior roll of the humerus c) Inferior glide of the humerus d) Inferior roll of the humerus

b) Superior roll of the humerus

As part of your examination, you also decide to assess the patient’s reflexes. Which of the following structures must be functioning normally in order to produce a +2 Achilles reflex? The tibial nerve and the interneurons in the sacral cord The tibial nerve and the interneurons in the lumbar cord The tibialis posterior muscle and the interneurons in the sacral cord The tibialis posterior muscle and the interneurons in the lumbar cord

The tibial nerve and the interneurons in the sacral cord

Which of the following is the best example of a nociceptive pain mechanism? a) Complex regional pain syndrome b) Acute non-specific low back pain c) Chronic non-specific low back pain d) Fibromylagia

b) Acute non-specific low back pain

The C7/T1 facet joint is innervated by: The dorsal ramus of C7 The dorsal ramus of C8 The dorsal rami of C7 and C8 The dorsal rami of C8 and T1

The dorsal ramus of C8

During neuropathic pain, activation of microglial cells leads to an increased amount of pro-inflammatory cytokines which then may lead to: 1. allodynia and spread of pain neighbouring unhealthy tissue outside the nerve injury 2. hyperalgesia pain spread of pain to the neighbouring healthy tissue outside the nerve injury 3. hyperalgesia pain spread of pain to the neighbouring unhealthy tissue outside the nerve injury 4. allodynia and spread of pain neighbouring healthy tissue outside the nerve injury

allodynia and spread of pain neighbouring healthy tissue outside the nerve injury

Which of the following is the best example of a neuropathic pain mechanism? a) Complex regional pain syndrome b) Acute non-specific low back pain c) Chronic non-specific low back pain d) Fibromylagia

a) Complex regional pain syndrome

Provide two examples of Primary osteoporosis and two examples of Secondary osteoporosis

Secondary * RA * Liver failure * Cushins * anorexia nerviosa Primary * Menopause * Age

B) “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage“. Week 2 Lecture, slide 25

Which of these situations describes pain that has been classified from a temporal perspective? A) Nociceptive pain from temporal arteries B) Neuropathic pain in trigeminal neuralgia C) Acute pain from TMJ dysfunction D) Somatic pain in the temporal region

C) Acute pain from TMJ dysfunction

Define Scheuermann’s disease and describe the underlying pathophysiology of this condition

Characterised by vertebral endplate irregularities of 3+ adjacent vertebral bodies Usually in the Tx spine, but can also affect T/L junction Aetiology: Poorly understood - Hereditary component? Abnormal vertebral endplate ossification Disproportionate vertebral body growth resulting in anterior wedging

Which of the following is the best example of a nociplastic pain mechanism? a) Carpal tunnel syndrome b) Acute non-specific low back pain c) Chronic non-specific low back pain d) Complex regional pain syndrome

c) Chronic non-specific low back pain

Which of the following ligaments would most likely be injured by a direct valgus force to the knee? Medial Collateral Lateral Collateral Anterior Cruciate Posterior Cruciate

Medial Collateral

Regarding the motor control response of pain: recent work proposes different mechanism with different time courses such as: 1. reflex inhibition in the early phase: a possible role for the inflammatory system in the intermediate period and disuse in the chronic phase 2. reflex facilitaiton in the early phase: a possible role for the inflammatory system in the intermediate period and disuse in the chronic phase 3. A possible role for the inflammatory system in the early phase, reflex inhibition in the intermediate and disuse in the chronic phase 4. A possible role for the inflammatory system in the early phase, reflex facilitation in the intermediate and disuse in the chronic phase

reflex inhibition in the early phase: a possible role for the inflammatory system in the intermediate period and disuse in the chronic phase

Which aspect of a lumbar disc is most commonly injured? Anteromedial aspect Anterolateral aspect Posteromedial aspect Posterolateral aspect

Posterolateral aspect

What pathology is shown in the image below? * Bicipital tendinopathy * Infraspinatus tendinopathy * Supraspinatus tendinopathy * Subscapularis tendinopathy

Supraspinatus tendinopathy

Which nerve root would be most likely compromised by a posterolateral herniation of the C6-C7 intervertebral disc? C6 root C7 root C8 root T1 root

C7 root

List four risk factors for Achilles tendinopathy

* age * overuse * poor conditioning * high arched feet * pronation * activity * change of surface * flexibility

The sacroiliac joint is suspended between the iliac bones and is firmly attached to them by the: Sacrotuberous and sacroiliac ligaments Sacrotuberous and sacrospinous ligaments Sacroiliac and interosseous ligaments Sacrospinous and sacroiliac ligaments

Sacroiliac and interosseous ligaments

Reading material for Central nociceptive pathways – Pg 8-9 “Areas of the brain involved in the perception, integration and response tonociception”

Select the most correct response about chronic pain A) It does not serve a biological purpose B) It causes impairment that is akin to the extent of the injury C) It may be used as a synonym for post-surgical pain D) It usually resolves upon healing of tissue

A) It does not serve a biological purpose

Sluka, pg 17 – directly under Table 2.1

Pain threshold is defined as: a) The highest intensity of stimulus that causes pain b) The lowest intensity of stimulus that causes pain c) The highest duration of stimulus that causes pain d) The lowest duration of stimulus that causes pain

b) The lowest intensity of stimulus that causes pain

Consider the nerve supply to the supraspinatus muscle. This nerve: a) Arises from the upper trunk of the brachial plexus and also supplies the skin over the shoulder and clavicle b) Arises from the upper trunk of the brachial plexus and has no cutaneous branches c) Arises from the middle trunk of the brachial plexus and also supplies the skin over the shoulder and clavicle d) Arises from the middle trunk of the brachial plexus and has no cutaneous branches

b) Arises from the upper trunk of the brachial plexus and has no cutaneous branches

* The spinothalamic tract projects to S1 and S2. Sluka, pg 47 “Spinothalamic tract” * “The VPL projects to the primary (S1) and secondary (S2) somatosensory cortex, and this pathway is thought to be involved in the sensory–discriminative component of pain (i.e., its location, duration, quality, and intensity).”

Specificity theory Chapter 1 Sluka - Pain Theories: “The specificity theory suggests that there are separate nerve endings for each variety of sensation arising from cutaneous stimulation, that is, touch, cold, warmth, and pain. For pain, the theory suggests that there are “pain receptors” that when stimulated always produce the sensation of pain and only pain.

Polyneuropathy is defined as? 1. A relatively homogeneous process affecting many peripheral nerves, with the distal nerves usually affected most prominently 2. A relatively heterogeneous process affecting many peripheral nerves, with the distal nerves usually affected most prominently 3. A relatively homogeneous process affecting many peripheral nerves, with the proximal nerves usually affected most prominently 4. A relatively heterogeneous process affecting many peripheral nerves, with the distal nerves usually affected most prominently

A relatively homogeneous process affecting many peripheral nerves, with the distal nerves usually affected most prominently

C) Sensory discriminative, motivational affective and cognitive evaluative dimensions

According to the international study of pain, neuropathic pain is defined as 1. Pain that arises as a direct consequence of a disease affecting the somatosensory system 2. Pain that arises as a direct consequence of a lesion affecting the somatosensory system 3. Pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system 4. Pain that arises as a indirect consequence of a disease affecting the somatosensory system

Pain that arises as a direct consequence of a lesion or disease affecting the somatosensory system

During sacral nutation, the sacral promontory moves in an: Anteroinferior direction, and there is anterior rotation of the ilium on the sacrum Anteroinferior direction, and there is posterior rotation of the ilium on the sacrum Posterosuperior direction, and there is anterior rotation of the ilium on the sacrum Posterosuperior direction, and there is posterior rotation of the ilium on the sacrum

Anteroinferior direction, and there is posterior rotation of the ilium on the sacrum

List the contents of the carpal tunnel

1. Its bound by the Carpal bones (trapezium, trapezoid, capatate, hamate) 2. median nerve 3. 9 flexor tendons in flexor retinaculum - flexor pollicis longus, 4x flexor digitorioum superficialis, 4 flexor digitorium profundus

During neuropathic pain, what changes occur at the cellular level? 1. decreased response to suprathreshold stimulation, recruitment of low threshold, high threshold and silent nociceptors 2. Increases response to suprathreshold stimulation, recruitment of silent nociceptors 3. decreased response to suprathreshold stimulation, recruitment of low threshold, low threshold and silent nociceptors 4. Increased response to suprathreshold stimulation, recruitment of low threshold, low threshold and silent nociceptors

Increases response to suprathreshold stimulation, recruitment of silent nociceptors

The suboptimal tissue loading hypothesis is best described by which rationale 1. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of nociceptive afferents with ot without tissue injury and ultimately pain 2. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of agonist muscle and their associated non-nociceptive afferents with or without tissue injury and ultimately pain 3. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of agonist muscle and their associated non-nociceptive efferents with or without tissue injury and ultimately pain 4. The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of agonist muscle and their associated nociceptive afferents with or without tissue injury and ultimately pain

The fundamental basis of this hypothesis is that suboptimal tissue loading leads to excitation of nociceptive afferents with ot without tissue injury and ultimately pain

A) Typically intermittent, sharper on movement and duller at rest, local to the injury, Relates proportionately to the injury and aggravating and relieving factors (stimulus dependant pain).

Differentiate between the terms spondylolysis, spondylolisthesis and spondylosis

1. spondylolisthesis: slippage of a vertebra most common C5/S1 2. spondylolysis: # pars interarticular 3. Spondylosis: degeneration of a vertebral disc or joint

• C Fibres Week 2 Lecture slide 12

A disc herniation in which the displaced material has lost all connection with the disc of origin is called a: Disc sequestration Disc protrusion Disc extrustion Intravertebral herniation

Disc sequestration

During neuropathic pain, what changes occur at the dorsal ganglion? 1. Altered gene expression and ectopic firing 2. Decreased inhibitory tone and altered signal transmission 3. Decreased nociceptor sensitivity and altered signal transmission 4. Increased inhibitory tone and increased glial activation

Altered gene expression and ectopic firing

The nerve supply to cervical intervertebral discs includes which of the following? Meningeal branches of cervical spinal nerves Transverse cervical nerve and ansa cervicalis Spinal accessory nerve Lesser occipital and great auricular nerves

Meningeal branches of cervical spinal nerves

• Sluka, pg 18 “Cutaneous nociceptors”

Facet joints of the cervical spine (C2-C7) are oriented: At 45 degrees, approximately halfway between the frontal and horizontal planes At 45 degrees, approximately halfway between the frontal and sagittal planes At 60 degrees, approximately halfway between the frontal and horizontal planes At 60 degrees, approximately halfway between the frontal and sagittal planes

At 45 degrees, approximately halfway between the frontal and horizontal planes

Phantom limb pain - neuromatrix explains phantom limb pain Melzack and Wall: The gate control theory of pain, proposes that a mechanism in the dorsal horns of the spinal cord acts like a gate that inhibits or facilitates transmission from the body to the brain on the basis of the diameters of the active peripheral fibers, as well as the dynamic action of brain processes. The gate control theory, however, is not able to explain several chronic pain problems, such as phantom limb pain, which require a greater understanding of brain mechanisms..

SBO6-WorkshopMaterialWeek4

C) Nociception is information transmitted about noxious or potentially harmful stimuli. Pain isn’t just a reporting system for tissue damage but a prediction and prevention system also

D) Nociception Table 1.1 Sluka: Pain Terminology Slide 38 – Week 2 “nociceptors transform the ‘energy of tissue damage’ (mechanical, thermal or chemical) into electrical energy for neural transmission”

Pheriperal and central nervous system lesions have been shown to sensitize primary afferent fibres by: 1. Non-neural cells and high threshold nociceptor 2. activating spinal cord glial cells 3. inhibiting chemokines 4. activating high threshold nociceptors

activating spinal cord glial cells

what rationale is argued to explain many chages in motor control after an injujry for example the early athrophy of multifidus muscle pain? 1. non nociceptive efferent imput, via interneurons can inhibit and facilitate motoneuros 2. nociceptive efferent imput, via interneurons can inhibit and facilitate motoneurons 3. nociceptive afferent imput, via interneurons can inhibit and facilitate motoneurons 4. non nociceptive afferent imput, via interneurons can inhibit and facilitate motoneuros

non nociceptive afferent imput, via interneurons can inhibit and facilitate motoneuros Sluka, Section: Pain/Injury Interference/Inaccuracy Hypothesis Start of 3rd paragraph.

The phrase "pain memories" is associated with which hypothesis about how pain affects motor control? a) Pain adaptation theory b) Classical conditioning c) Pain spasm pain theory d) Hodges protection hypothesis

b) Classical conditioning

Which theory sugests that tactile stimulation can modulate pain A) specificity theory B) Strong' theory C) Sensory-discriminative theory D) Gate control theory

D) Gate control theory

# Choose the most correct response. Silent nociceptors are: a) Mechanically insensitive neurons which are likely activated by inflammatory mediators such as prostaglandins b) Mechanically sensitive neurons which are likely activated by inflammatory mediators such as prostaglandins c) Mechanically insensitive neurons which are likely activated by neuronal substances such as substance P and glutamate d) Mechanically sensitive neurons which are likely activated by inflammatory mediators such as substance P and glutamate

a) Mechanically insensitive neurons which are likely activated by inflammatory mediators such as prostaglandins

Sluka, pg 24 “NONNEURONAL ACTIVATORS AND INFLAMMATORY MEDIATORS” middle of first paragraph

• SBO6 Week 6 Workshop Material “STEP 2 – TRANSMISSION/CONDUCTION Once the PAN has been transduced, the action potential must be transmitted to the CNS and through the CNS before pain is perceived. Three steps are involved in nociceptive signal transmission: 1) projection to the CNS; 2) processing within the dorsal horn of the spinal cord; and 3) transmission to the brain. Each step in the transmission process is important to pain perception.”

Which of the following is NOT a feature of nociceptive pain presentations? Deep pain Shooting pain Aching pain Steady pain

Shooting pain

This theory refers to the presence of dedicated pathways for each somatosensory modalitiy A) specificity theory B) Neuromatrix theory C) Sensory-discriminative theory D) Gate control theory

A) specificity theory

Which aspect of an intervertebral disc is innervated by sensory fibres? The annulus fibrosus and outer 1/3 of the nucleus pulposus The annulus fibrosus and outer 2/3 of the nucleus pulposus The outer and inner fibres of the annulus fibrosus, but not the nucleus pulposus The outer fibres of the annulus fibrosus

The outer fibres of the annulus fibrosus

How many adults with chronic pain are estimated to have neuropathic symptoms? 1. 7-8% 2. 10-11% 3. 4-5% 4. 6-7%

7-8%

Which of the following headaches is classified as a primary headache? Cervicogenic headache Sinus headache Temporomandibular joint headache Tension type headache

Tension type headache

Sluka, pg 39 “Spinal Cord” - first sentence pg 39

Discuss the pathoanatomical changes associated with cervical spondylotic myelopathy

Osteocytes build up in the canal Disc calcification resulting in loss of disc height ligamentous ossification PLL ligamentous buckling LF

B) This mechanism is likely reliant on the same inhibitory interneurons as supraspinal mechanisms for attenuation. Cant be C) – this states ‘peripheral’ And cant be A) this answer states that it relies on the fact that mechanisms developed from an evolutionary standpoint in order to survive

Outline the potential sites of neurovascular compromise in thoracic outlet syndrome

1. Interscalene triangle 2. Costo clavicular space (clavicle and 1st rib) 3. Under pec minor

Pain MCQ Flashcards

(98 cards)