A. Present with acute chest pain, abdominal pain, or bone pain
B. Dehydration can worsen the effects of sickling
C. Oxygen therapy is mandatory
D. Treating pain has no effect in shortening the duration ofthe acute phase.
4. The following statement is true regarding electro therapy for ischemic pain
A. Spinal cord stimulation is an option for relieving pain and salvaging the limb
B. TENS has a role in rehabilitation
C. Both A and B are true
D. Both A and B are false
1. The answer is A. Raynaud's commonly affects fingers and toes. It is precipitated by cold and emotional stimuli and relieved by the application ofheat.
2. The answer is D. Vagolytics such as atropine can be used to treat spasmodic visceral pain.
3. The answer is D. Sickling of red cells occurs when the hemoglobin becomes desaturated. Dehydration worsens the effects of sickling. Sickle cell crisis occurs secondary to vascular occlusion by the sickled red cells, leading on to ischemia. This can affect lungs, bone marrow, and the abdomen, and present as a sickle crisis. Correction of hypoxia and dehydration is vital in reversing sickling and its effects.
Chapter 25: Fibromyalgia, Arthritic, and Myofascial Pain
1. The following statements are true regarding fibromyalgia EXCEPT;
A. It more commonly affects male population
B. It is associated with unidentifiable structural and inflammatory causes
C. It is associated with co-morbid conditions such as anxiety and depression
D. It affects approximately 5 million people in the United States
2. Which of the following is (are) seen in fibromyalgia?
A. Decreased levels of excitatory amino acids in the CSF
B. Hypothalamus-pituitary and adrenal axis suppression
C. None of the above
D. All of the above
3. Which of the following is a feature of myofascial pain syndrome?
A. Presence of trigger points in the skeletal muscles
B. Absence of referred pain from trigger points
C. Taunt bands in the muscles are not a feature
D. Botox injection is not an effective therapeutic option
4. A 70-year-old woman presents with pain and morning stiffness of her right knee. She has been suffering from this for the past 6 months. She mentions that the pain and stiffness improve with activity. What would be the most likely finding if an X-ray of the right knee was ordered?
A. Narrowing of the joint space
B. A hairline fracture of the patella
C. Presence of osteophytes
5. In the above patient, you make a diagnosis of osteoarthritis. On routine blood testing you notice that she has elevated serum creatinine. Given this finding, the following medication can be used to control her pain:
1. The answer is A. Fibromyalgia has female preponderance with a ratio of 9:1.
2. The answer is C. In fibromyalgia, there is activation of hypothalamo-pituitary-adrenal axis and elevated levels of excitatory amino acids, neurotropins, and substance P have been noted in the CSF.
3. The answer is A. Pressure on trigger points, which could be felt as taunt bands, often reproduces the typical pain experienced by the patient. Botox injection is a treatment option.
4. The answer is D. She is most likely to be suffering from osteoarthritis.
5. The answer is C. It is desirable to avoid NSAIDs in view of the elevated serum creatinine.
Chapter 26: Head, Neck, and Back Pain
1. About 60% of patients suffer from back pain and majority of these cases have benign etiology. Which of the following symptoms/signs may indicate pathology related to a malignant/infectious disease process
A. Fever and night sweats
B. Loss of bladder or bowel control
C. Weight loss
2. A 40-year-old male is complaining of lower back pain radiating to the buttocks and thighs. On examination, there is localized tenderness over the paravertebral muscles and the neurological examination is normal. Which of the following could be true?
A. He could be suffering from nerve root pain
B. He could be suffering from facet joint pain
C. Blocking the medial branch of the posterior rami at one level can be diagnostic
3. Risk factors for neck pain include
A. Psychological factors
B. Presence of degenerative disc disease and facet disease
C. Sitting for long periods at work
D. Stress at work
4. Which of the following statements regarding neck pain is FALSE?
A. Pain in the upper neck is likely to originate from C1-2
B. Pain in the lower neck is likely from C5-6 and C6-7
C. Neck pain can be referred to the head
D. Neck pain can result from a pathological lesion in the throat
5. Which of the following is the most effective treatment for acute neck pain?
A. NSAIDs combined with muscle relaxants
B. Opioids, which are effective as potent analgesics
C. Simple neck exercises to keep the neck mobile and increase the range of motion
D. Immobilization of the neck using cervical collar for 3 months
1. The answer is D. History of cancer and progressive neurological deficit are other red flags.
2. The answer is B. For diagnosis, two medial branches need to be blocked at each level. Nerve root pain usually radiates below the knees.
4. The answer is A. The upper neck pain is likely to originate from C2-3
Chapter 27: Headache
1. A 20-year-old woman with a BMI of 35 is complaining of a headache that she has had for the last 6 months. She feels it "all over the head" as a constant dull pain, associated with diplopia. CT scan of the head shows cerebral edema and small lateral ventricles without any midline shift. Possible diagnostic and therapeutic considerations are
A. She is suffering from benign intracranial hypertension and lumbar puncture is contraindicated as the intracranial pressure is elevated
B. The diagnosis is tension headache and it is likely to respond to NSAIDS, caffeine, tricyclic antidepressants, or TENS
C. She has a space-occupying lesion and the treatment is surgery or chemotherapy
D. None of the above
2. In the classic migraine
A. There is absence of aura
B. There is a stronger familial inheritance
C. One of the diagnostic criteria is at least five headaches lasting 4-72 h each
D. scintillating lights and visual scotomas are not presenting symptoms
3. Which of the following supports the diagnosis of a cluster headache?
A. Unilateral ocular pain associated with lacrimation
C. Headache lasting less than 15 min
D. The headache never occurs during sleep
4. Cluster headache is managed by
A. Oxygen therapy for an established headache
B. Intranasal capsaicin to reduce the intensity of headache
C. Ergotamine, which is useful during the acute phase
D. Non-opioids to minimize the risk of addiction to opioids
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