Quiz 1 Flashcards by Omoikane Kamisama

Clinical reasoning can be impaired by:

Fragmentation of interpretation, Overreliance on classical interpretations, Less adequate knowledge

How well did you know this?

Not at all

Perfectly

T/F experience is a safeguard against judgement errors

How well did you know this?

Not at all

Perfectly

Voytovich and Rippey studied errors in what four categories?

Wrong synthesis (data contradiction), Omission (ignoring a clue), Inadequate synthesis (conclusion not completely supported by data), and premature closure

How well did you know this?

Not at all

Perfectly

What is anchoring?

Tendency to retain hypothesis in spite of subsequent information

How well did you know this?

Not at all

Perfectly

What is countertransference?

Fears of harming the patient, loss of control, and performance anxiety

How well did you know this?

Not at all

Perfectly

Engler suggests that data-gathering requires what?

Communication and rapport with the client

How well did you know this?

Not at all

Perfectly

What are some common problems of history-taking?

Omission of probing questions, Leading questions, Complex vocabulary, Not allowing enough time for the patient to speak, ignoring silence, and missing non-verbal signs

How well did you know this?

Not at all

Perfectly

T/F Leavitt et al. shows back pain malingering is not strongly tied to workers’ compensation

How well did you know this?

Not at all

Perfectly

Pain is a _____ not a diagnosis

Symptom

How well did you know this?

Not at all

Perfectly

What % of back pain originates from musculoskeletal problems?

75-85%

How well did you know this?

Not at all

Perfectly

10% of back pain orignate form ______ _______.

Unknown etiology

How well did you know this?

Not at all

Perfectly

What % of the population suffers from LBP at some point?

50-80%

How well did you know this?

Not at all

Perfectly

What % of back pain reoccurs?

30-70%

How well did you know this?

Not at all

Perfectly

What portion of the vertebra bears most compressive loads?

How well did you know this?

Not at all

Perfectly

What portion of the annulus is innervated?

The outer half

How well did you know this?

Not at all

Perfectly

What are the soft tissue components of the motion unit supplied by?

The sinu-vertebral nerve

How well did you know this?

Not at all

Perfectly

Large afferent fibers transmit what?

Mechanoreception

How well did you know this?

Not at all

Perfectly

Where do the large afferent fibers travel?

The dorsal horn -> substantia gelatinosa -> dorsal columns -> medial lemnisucs -> VPL thalamus -> post-central gyrus

How well did you know this?

Not at all

Perfectly

What do small afferent fibers carry?

Nociception

How well did you know this?

Not at all

Perfectly

Where do the small afferent fibers travel?

The tract of Lissauer -> dorsal horn -> anterior white commisure -> anterolateral tract -> VPL and VPM thalamus -> limbics, hypothalamus, medullary RF

How well did you know this?

Not at all

Perfectly

C fiber stimulation causes?

Hyperpolarization of the substantia gelatinosa inhibitory interneurons

How well did you know this?

Not at all

Perfectly

What does A-beta fiber stimulation cause?

Depolarization of the inhibitory interneurons

How well did you know this?

Not at all

Perfectly

What cell type is an inhibitory interneuron?

T-cells

How well did you know this?

Not at all

Perfectly

What substances produce an endogenous analgesic effect?

Endogenous opiates and enkephalins

How well did you know this?

Not at all

Perfectly

Soft tissue irritation causes cell membrane breakdown and the formation of what substances?

prostaglandins, thromboxane, monohydroxy fatty acids, and leukotrienes

What 3 reactions determine whether a person finds a stimulus painful?

Neurologic, Biomechanic, and Emotional reaction

How many persons with low back pain are functioning again within a week?

75%

What is the timeline for acute and chronic pain formation?

Acute 0-1 week Subacute 0-7 weeks Chronic 7+ weeks

Fatigue, anxiety, and lack of activity increase with what?

Chronic pain

What factors correlate with the ability to return to work?

Length of sickness, absence period, need for analgesics, attitude to the problem, cervical and lumbar pain

What type of strength reduces pain?

isokinetic extensor strength

What is the most common psychological condition seen in chronic pain?

Depression/Intermittent depressive disorders

What pain is associated with worse coping mechanisms, myofascial or low back pain?

LBP

What types of dermotogenous pains are there?

Fast and Slow

Describe dermatogenous pain.

Sharp, lancinating, and clearly localized

What part of the motion unit is the source of most pain?

DRG or dorsal root

Where do most disk herniation occur?

L4-5 or L5-S1

Which side and disk has a greater propensity for injury?

L4-5 on the right side

What structure makes posterolateral disc (lumbar) protrusions more likely?

PLL (Tapers at the bottom)

Rank positions of disk pressure from least to greatest.

Supine -> standing -> sitting -> forward flexion + standing or sitting

What is another name for a medial disc protrusion?

Axillary

If a disk bulge irritates the apophysis, what type of motion produces pain?

Any motion

What structure are involved in scleratogenous pain?

Periosteum, joint capsule, subchondral bone, tendon, ligaments, articular cartilage, and synovium

What scleratogenous structures are most sensitive to pain?

Joint capsules and periosteum

Describe scleratogenous pain

Dull and vague at rest and more intense with activity

What types of symptoms often accompany scleratogenous pain?

Autonomic; pallor, sweating, nausea, low blood pressure

What is myotogenous pain?

Deep muscle pain

Describe muscle pain

Subtle at rest and aggravated by movement of said muscle group

What might muscle spasm become?

Trigger points

Where can trigger points occur?

Muscle, fascia, ligaments, pericapsular tissue and tendons

What types of trigger points are there?

Acute and latent

What are potential treatments for trigger points?

Local injection, massage, exercise, stretching, vapo-coolants, ischemic compression, ice massage, TENS, periosteal therapy, heat, and ultrasound

What are primary sensory modalities?

Pain, Temperature, Light touch, Position, and Vibration

What are secondary sensory modalities?

Higher cortical integration (parietal lobe), i.e. two point discrimination, awareness, graphesthesia, stereognosis

What do thoracic dermatomes tend to follow?

Intercostal nerves

T/F Thoracic dermatomes are easily distinguishable

False, they are difficult to separate

What lumbar discs are unusual to have lesions in?

L1-L2; L2-L3

Does proprioception ascend the contralateral or ipsilateral side of origin?

Ipsilateral

What is lost early in peripheral neuropathy?

Vibratory sensation

What levels may be involved in a large protrusion?

Anything below the level of disc protrusion

What is integrated to control posture?

Vestibular, Visual, and Proprioception

Most muscles are in what state?

Semi-contracted

L3-L4 motion unit pathology may lead to atrophy of what?

Quadriceps

L4-L5 motion unit pathology may lead to atrophy of

Anterior Tibial muscles

L5-S1 motion unit pathology may lead to atrophy of

Gastrocnemius and Soleus muscles

Deep tendon reflex is contingent on the function of what structures?

Muscle spindle, afferent nerves, DRG, efferent pathway, peripheral nerves

Does a DTR perform better or worse in the cold?

Worse

Protective reflex of paravertebral muscles reduces what motion?

Flexion

Organic pain is likely to be associated with what?

Lumbar kyphosis

What is often the result of osteoporotic vertebral compression?

Thoracic kyphosis

Asymmetric paravertebral muscle spasm may lead to what in a patient with disk herniation?

Scoliotic postures

What does the osteopathic evaluation of manipulative lesions mnemonic A.R.T stand for?

A - Asymmetry R - RoM T - Tissue/texture abnormalities

T or F: If one sagittal curve of the spine is increased, the other curves will increase