Exam 2 - Active Learning Pain Questions

Ectopic foci

35-year-old female with a history of transient blurred vision, ataxia, paresthesias alternating between the upper and lower extremities, had a recent CSF evaluation that showed oligoclonal bands present.

Which of the following types of pain transmissions is most likely the cause of the paresthesias?

- Ectopic foci

- Ephaptic transmission

- Structural reorganization

- Central sensitization

Complex Regional Pain Syndrome Type I (RSD)

A patient presents to your office with a complaint of severe 10/10 pain of the right hand that does not resolve with treatment and is exacerbated by touch. Three years prior he had a fall at work which required a labral surgical repair. On exam you notice that there is a loss of hair distribution over the hand and forearm, atrophy of the soft tissue of the hand, and bluish discoloration of the nail beds (pallor). There appear to be mild contractures of the flexors of the right hand as well. There is hypersensitivity to light touch on exam and weakness of all intrinsic hand muscles. Of the following what is the best diagnosis?

- Fibromyalgia

- Cervical radiculopathy

- Complex Regional Pain Syndrome Type I (RSD)

- Causalgia

Moderate exercise, manipulation, massage therapy

The best treatment options for fibromyalgia include:

- Manipulation alone 15-30 visits

- Physiotherapeutic modalities alone

- Strenuous exercise, manipulation, medication

- Moderate exercise, manipulation, massage therapy

Hypothyroidism, endometriosis, depression

Common comorbidities of fibromyalgia include which of the following:

- Hypothyroidism, endometriosis, depression

- CRPS, anxiety, cervical stenosis

- RSD, depression, thyroid disease

- Chronic pain, depression, smoking history

Visceral referral from the bladder

Choose the most correct diagnosis: This patient is a 50-year-old female dancer worker with pain in the lumbar and SI region following work for 2 weeks. She is complaining of increased frequency of urination, small stream, and lower abdominal pain. There is a loss of range of motion and pain on palpation of the right SI and L5 facet.

Orthopedic exam is normal. DTR's, Myotomes, Dermatomes are normal.

- Visceral referral from the bladder

- Prostate visceral referral

- Sclerotogenous referral from the L5 and SI joints

- Trigger Point stage 4 in the quadratus lumborum on the right

Radicular pain with referral L3 disc left

Choose the most correct diagnosis: This patient is a 20-year-old female construction worker with pain in the lumbar and SI region following work for 2 weeks that radiates into the left leg and foot to the medial surface of the foot. She noted the onset following lifting a 100 lb concrete block. There is a loss of range of motion and pain on palpation of the left SI and L3 and 4 facet. ROM reduced. Orthopedic exam is normal. DTR Achilles 2+R, 2+left, Quadricep 2+R, 1+ Left, Myotomal weakness at the inverters on the left, Dermatomes are normal

- Visceral referral uterus

- Psoas referral

- Sclerotogenous referral from the L4 and SI joints

- Radicular pain with referral L3 disc left

Allodynia

Which type of pain transmission is described as a sensation of pain in response to normally non-painful stimuli. This type of pain is observed with neuropathies due to diabetes and viral infection, trauma, migraine, and fibromyalgia

- Central sensitization

- Trigger point referral pain

- Allodynia

- Structural reorganization

Ectopic foci

Which type(s) of pain transmission is (are) seen in peripheral neuropathies from entrapment syndromes?

- Structural reorganization

- Visceral pain referral

- Cross-talk

- Ectopic foci

Piriformis trigger point referral

Choose the most correct diagnosis:

This patient is a 20-year-old female construction worker with pain in the lumbar and SI region following work for 2 weeks that radiates into the right leg and foot to the lateral surface of the foot.She noted the onset following repetitive motion turning to the right loading blocks. There is a loss of range of motion and pain on palpation of the right SI and L5 facet and pain on internal rotation of the right foot from the prone position with hip abduction. ROM; reduced. Orthopedic exam is normal. DTR normal, Myotomes normal, Dermatomes are normal. There is a palpable nodule in the right piriformis and gluteus medius. Pain on palpation of the piriformis right, with digital compression the pain radiates into the right leg to the foot

- Visceral referral uterus

- Piriformis trigger point referral

- Sclerotogenous referral from the L5 and SI joints

- Kidney stone referral

Radicular pain referral disc L5 right

Choose the most correct diagnosis: This patient is a 40-year-old female construction worker with pain in the lumbar and SI region following work for 3 weeks that radiates into the right leg and foot to the lateral surface of the foot. She noted the onset following lifting a 50 lb concrete block. There is a loss of range of motion and pain on palpation of the right SI and L5 facet. ROM reduced. Orthopedic exam is normal. DTR Achilles 1+R, 2+left, Myotomes evertor R 4/5, L 5/5, Dermatomes are normal.

- Visceral referral uterus

- Psoas referral

- Sclerotogenous referral from the L5 and SI joints

- Radicular pain referral disc L5 right

Trigger point stage 4 in the quadratus lumborum on the right

Choose the most correct diagnosis: This patient is a 20-year-old male construction worker with pain in the lumbar and SI region following work for 2 weeks. There is a loss of range of motion and pain on palpation of the right SI to the right flank. ROM slightly reduced. Orthopedic exam is normal. DTR's, Myotomes, Dermatomes are normal. There is a palpable nodule of the quadratus lumborum that refers into the right flank and SI region with digital compression.

- Visceral referral from the bladder

- Prostate visceral referral

- Sclerotogenous referral from the L4 facet

- Trigger point stage 4 in the quadratus lumborum on the right

Sclerotogenous referral from the L5 and SI joints

Choose the most correct diagnosis: This patient is a 20-year-old male construction worker with pain in the lumbar and SI region following work for 2 weeks. There is a loss of range of motion and pain on palpation of the right SI and L5 facet.

ROM slight reduced. Orthopedic exam is normal. DTR's, Myotomes, Dermatomes are normal.

- Visceral referral from the bladder

- Prostate visceral referral

- Sclerotogenous referral from the L5 and SI joints

- Trigger point stage 4 in the quadratus lumborum on the right

Prostate visceral referral

Choose the most correct diagnosis: This patient is a 60-year-old male with a complaint of lower back pain radiating into the right leg and flank. No provocative factors. He also complains of nocturia, micturia - slow to start stream for 5-10 years. There is also an elevated PSA. ROM normal. SLR causes pulling in the hamstring. DTR's, Myotomes, Dermatomes are normal

- Cardiac visceral referral

- Prostate visceral referral

- Leg strain

- Kidney visceral referral

Angina with cardiac pain referral

Choose the most correct diagnosis of the pain syndrome:

The patient, 60-year-old male enters the office with left cervical spine pain radiating to the left arm, anterior chest on and off for two months after working as a waiter upon exertion. He has a 20 pack/year smoking history and previous comp injury to his neck, which had resolved. All neuro/orthos are negative. BP 200/110, pulse 90. Resp 28 and shallow. ROM cervical reduced 25 % all ranges.

- C6/7 disc herniation with radiculopathy

- Cervical sprain/strain

- Angina with cardiac pain referral

- Middle Cerebral Stroke in progress

Esophageal ulcerative disease (varicosities)

The patient enters with a 50 year history of alcohol use, and recent episodes of vomiting blood. He is a 75-year-old male complaining of neck/upper back pain radiating around to the costophrenic margins. All neuro findings are normal along with decreased ROM cervical spine. All ortho and neurologic tests are negative.

- Cervical Stenosis

- Thoracic outlet syndrome

- Esophageal ulcerative disease (varicosities)

- Angina

Xanthrchromatic change in the RBC's

In the lumbar puncture examination, which of the following results point toward the diagnosis of subarachnoid hemorrhage?

- Oligoclonal Bands

- Elevated protien

- Elevated opening pressure

- Xanthrchromatic change in the RBC's