1. The most common sites of referred pain from systemic diseases are:
a. Neck and back
b. Shoulder and back
c. Chest and back
d. None of the above
2. To screen for back pain caused by systemic disease:
a. Perform special tests (e.g., Murphy’s percussion, Bicycle test)
b. Correlate client history with clinical presentation and ask about associated signs and symptoms
c. Perform a Review of Systems
d. All of the above
3. What are two ways of classifying back pain (as presented in the text)?
Back pain can be examined and classified in many ways. We have presented Sources of Back Pain (e.g., visceral, neurogenic, vasculogenic, spondylogenic, psychogenic, neoplasm; see Table 3-3) and Location of Back Pain (e.g., cervical spine, scapula, thoracic spine, lumbar spine, sacrum, sacroiliac; see Table 14-1).
4. Which statement is the most accurate?
a. Arterial disease is characterized by intermittent claudication, pain relieved by elevating the extremity, and history of smoking.
b. Arterial disease is characterized by loss of hair on the lower extremities, throbbing pain in the calf muscles that goes away by using heat and elevation.
c. Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed.
d. Arterial disease is characterized by loss of hair on the toes, intermittent claudication, and redness or warmth of the legs that is accompanied by a burning sensation.
5. Pain associated with pleuropulmonary disorders can radiate to:
a. Anterior neck
b. Upper trapezius muscle
c. Ipsilateral shoulder
d. Thoracic spine
e. All of the above
6. Which of the following are clues to the possible involvement of the GI system?
a. Abdominal pain alternating with TMJ pain within a 2-week period of time
b. Abdominal pain at the same level as back pain occurring either simultaneously or alternately
c. Shoulder pain alleviated by a bowel movement
d. All of the above
7. Percussion of the costovertebral angle resulting in the reproduction of symptoms signifes:
b. Pseudorenal pain
c. Has no signifcance
d. Medical referral is advised
8. A 53-year-old woman comes to physical therapy with a report of leg pain that begins in her buttocks and goes all the way down to her toes. If this pain is of a vascular origin she will most likely describe it as:
a. Sore, hurting
b. Hot or burning
c. Shooting or stabbing
d. Throbbing, “tired”
9. Twenty-fve percent of the people with GI disease, such as Crohn’s disease (regional enteritis), irritable bowel syndrome, or bowel obstruction, have concomitant back or joint pain.
10. Skin pain over T9 to T12 can occur with kidney disease as a result of multisegmental innervation. Visceral and cutaneous sensory fbers enter the spinal cord close to each other and
converge on the same neurons. When visceral pain fbers are stimulated, cutaneous fbers are stimulated, too. Thus visceral pain can be perceived as skin pain.
11. Autosplinting is the preferred mechanism of pain relief for back pain caused by kidney stones.
12. Back pain from pancreatic disease occurs when the body of the pancreas is enlarged, inﬂamed, obstructed, or otherwise impinging on the diaphragm.
13. A 53-year-old postmenopausal woman with a history of breast cancer 5 years ago with mastectomy presents with a report of sharp pain in her mid-back. The pain started after she lifted her 2-year-old granddaughter 3 days ago. Tylenol seems to help, but the pain is keeping her awake at night. Once she wakes up, she cannot fnd a comfortable position to go back to sleep. What are the red ﬂags? What will you do to screen for a medical cause of her symptoms?
- Red flags include age (over 50), previous history of cancer, and lack of pain relief with recumbency. Screening should follow the decision-making model presented in Chapter 1.
- Conduct a careful history of symptoms, and ask about symptoms anywhere else in the body.
- Find out when the last medical follow-up was done by the oncologist and when the patient had her last clinical breast examination and mammogram. Clinical assessment should include vital signs, lymph node palpation, skin inspection that includes the mastectomy site, and a neurologic screening examination. Palpate the painful area, and perform a percussive Tap test