OPQRST
Onset Provoking/Palliative Quality of Pain Radiation Severity Time
What should be included in the Informed Consent? (4)
your diagnosis,
management plan,
the date,
patient’s signature
What are SOAP notes?
Subjective findings
Objective findings
Assessment
Plan
When should you dismiss a patient for a particular condition?
When they have reached maximum medical improvement (MMI)
What type of structure is indicated with sharp pain without motion? with motion?
without motion: nerve
with motion: joint
What type of structure is indicated with a radiating dull or deep ache?
referred pain (scleratogenous pain)
What type of structure is indicated with a deep burning or dull pain?
bone/ligament
more of these on page 9
Injuries to ligaments often refer pain into other areas. What type of pattern is this?
scleratomal pattern
When pain is radiating, what must the doc establish?
pattern and quality
What scale is used to assess the severity of a patient’s pain by having them mark on a 100 mm (10 cm) line in regards to how they perceive their pain?
Visual Analog Pain Scale
What is the range of the Borg Pain Scale?
0-10
According to the AMA Guides Pain Grading System, what are the 4 levels of severity/intensity?
Minimal
Slight
Moderate
Marked
T/F: “Does the pain intensify at night?” is a question used to assess the O of OPQRST.
False; this helps assess T (Time/frequency)
What are the 4 ways to grade frequency of pain using AMA Guides?
Intermittent (less than 25% of the time)
Occasional (25-50%)
Frequent (50-75%)
Constant (75-100%)
Radiating, sharp, stabbing, and well demarcated pain with an area of sensation attributed to a particular nerve root level
Dermatome pain
Pain referral within muscular or fascial tissue
myogenous pain
dull, achy, diffuse, and difficult to pinpoint pain referred from somatic structures like cartilage, ligaments, joint capsules or bone
scleratogenous pain
What is a bruit?
an abnormal vascular noise from stenosis, compression, or just an anatomical variant
What score on the Mini Mental Status Exam would indicate disease/dementia?
20 or below (“normal” scores are from 24-30)
T/F: When assessing passive range of motion, the doc reaches end range of motion and feels for what is called “End Feel.”
True
What is the technique where the doc uses enough forces/weight to overcome the patient’s muscle in order to test muscle strength, comparing bilaterally?
Break Method
An electronic dynamometer is used to accurately assess what?
muscle strength
What proportion of fibers are torn with a second degree ligament sprain?
> 1/3 but <2/3
T/F: Only 1 of 2500 x-rays detects something not suspected on medical history and physical examination and has an impact on the patient’s care.
True
What kind of imaging involves the injection of a water-soluble imaging material directly into the nucleus pulposus of the disc?
Discography
cortico refers to?
bulbar refers to?
cortex;
brain stem
Where is the lesion most likely if it is affecting cranial nerves V, VII, and VIII unilaterally?
cerebellopontine angle
Where is the lesion most likely if it is affecting cranial nerves III, IV, V, and VI unilaterally?
cavernous sinus
Where is the lesion most likely if it is affecting cranial nerves IX, X, and XI unilaterally?
jugular foramen (syndrome)
What is the most common cause of intrinsic brain stem lesion in a younger patient? in older patients?
multiple sclerosis;
vascular disease
Where is the motor Nucleus of the Trochlear Nerve (CN IV) located?
in midbrain at level of inferior colliculus
Where is the motor nucleus of the Trigeminal Nerve (CN V) located?
at level of mid pons
Where is the motor nucleus of the Facial Nerve (CN VII) located?
near the caudal border of the pons
