1. What is the best follow-up question for someone who tells you that the pain is constant?
a. Can you use one fnger to point to the pain location?
b. Do you have that pain right now?
c. Does the pain wake you up at night after you have fallen asleep?
d. Is there anything that makes the pain better or worse?
2. A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After asking a series of follow-up questions, you are able to determine that she had trouble falling asleep because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the most likely explanation for this pain behavior?
a. Minimal distractions heighten a person’s awareness of musculoskeletal discomfort.
b. This is a systemic pattern that is associated with a neoplasm.
c. It is impossible to tell.
d. This represents a chronic clinical presentation of a musculoskeletal problem.
3. Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in:
a. The left shoulder
b. The right shoulder
c. The mid-back or upper back, scapular, and right shoulder areas
d. The thorax, scapulae, right shoulder, or left shoulder
4. Associated signs and symptoms are a major red ﬂag for pain of a systemic or visceral origin compared to musculoskeletal pain.
5. Words used to describe neurogenic pain often include:
a. Throbbing, pounding, beating
b. Crushing, shooting, pricking
c. Aching, heavy, sore
d. Agonizing, piercing, unbearable
6. Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:
b. Assault or trauma
c. Drug dependence
7. Joint pain can be a reactive, delayed, or allergic response to:
d. Artifcial sweeteners
e. All of the above
8. Bone pain associated with neoplasm is characterized by:
a. Increases with weight bearing
b. Negative heel strike
c. Relieved by Tums or other antacid in women
d. Goes away after eating
9. Pain of a viscerogenic nature is not relieved by a change in
10. Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved.
11. A 48-year old man presented with low back pain of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps (accidents and falls), and engages in repetitive motions of all kinds using his arms, back, and legs. The pain is intense when he has it, but it seems to come and go. He is not sure if eating makes the pain better or worse. He has lost his appetite because of the pain. After conducting an examination including a screening exam, the clinical presentation does not match the expected pattern for a musculoskeletal or neuromuscular problem. You refer him to a physician for medical testing. You fnd out later he had pancreatitis. What is the most likely explanation for this pain pattern?
a. Toxic waste products from the pancreas are released into the intestines causing irritation of the retroperitoneal space.
b. Rupture of the pancreas causes internal bleeding and referred pain called Kehr’s sign.
c. The pancreas and low back structures are formed from the same embryologic tissue in the mesoderm.
d. Obstruction, irritation, or inﬂammation of the body of the pancreas distends the pancreas, thus applying pressure on
the central respiratory diaphragm.