DD Exam 1 questions with complete
solutions graded A+
what are the three types of mechanism of referred visceral pain? - correct answer ✔✔- embryogenic
development
- multisegmented innervation
- direct pressure and shared pathways
what is embryogenic development? - correct answer ✔✔- pain is referred to a site where the organ was
located in fetal development
- chest structures and pericardium were part of the gut embryologically.
what is multisegmented innervation? - correct answer ✔✔referred pain:
- pain originating in a visceral structure perceived as being from an area of skin innervated by the same
segmental level as the visceral afferent
- results from convergence of somatic and visceral afferents on the same segemental level of the spinal
cord
-cross talk in the dorsal horn
what is direct pressure and shared pathways for pain? - correct answer ✔✔- shoulder pain: direct
pressure from any inflamed, infected, or obstructed organ is contact with the respiratory diaphragm can
refer pain to the ipsilateral shoulder
- Neck and upper trap: irritation of the peritoneal or pleural surface of the central area of the respirtory
diaphragm can refer sharp pain to the upper trap, neck, and suprclavicular fossa.
what can be some sources of pain? - correct answer ✔✔-cutaneous
-somatic
-visceral
-neurogenic
-referred
,what is somatic pain: - correct answer ✔✔superficial somatic: skin, superficial fasciae, tendon sheaths,
and periosteum
deep somatic pain: periosteum bones, nerves, muscles, tensons, ligaments and blood vessels
what is visceral source of pain: - correct answer ✔✔-internal organs in the trunk or abdomen, such as
those of the respiratory, digestive, urogenital and endocrine system, as well as the spleen, heart and
great vessels.
describe somatic sourse of pain: - correct answer ✔✔-dull, aching or gnawing, cramping or described as
expanding pressure too diffuse to localize.
-considered nociceptive and is not caused by compression of spinal nerves or nerve root. referred to the
body surface becoming cutaneous.
- psychosomatic: emotional or psychologic distress produces physical symptoms
describe visceral source of pain: - correct answer ✔✔knife life quality of stabbing from inside out!
boring, deep aching, cutting, gnawing, throbbing.
** not well localized: ability to produce referred pain.
describe neurogenic source of pain: - correct answer ✔✔- damage to pathophysiologic changes of the
peripheral or CNS. it occurs as a result of injury or destruction to the peripheral nerves, pathways in the
spinal cord, or neurons located in the brain.
-can be acute or chronic depending on time frame.
-sharp, burning and shooting.
what is referred source of pain? - correct answer ✔✔-pain is felt in an area far from the site of lesion but
supplied by the same or adjacent neural segments.
-occurs by way of shared central pathways for afferent neurons and can originate from any somatic or
visceral source.
-pain patterns have different modalities according to the structure (somatic, visceral, neuro)
describe vascular pain: - correct answer ✔✔-throbbing, pounding, pulsing, beating
,describe neurogenic pain: - correct answer ✔✔sharp, crushing, pinching, burning, hot, searing, itchy,
stinging, pulling, jumping, shooting, electric, gnawing, pricking
describe MSK pain: - correct answer ✔✔aching, sore, heavy, hurting, deep, cramping, dull
describe emotional pain: - correct answer ✔✔tiring, miserable, vicious, agonizing, nauseating, frightful,
piercing, dreadful, punishing, exhausting, killing, unbearable, annoying, cruel, sickening, tortuing.
what are common patterns of pain referral for somatic pain? - correct answer ✔✔- c7, t1-5 vertebrae----
interscapular areas, posterior
-shoulder---neck, upper back
- l1-2--- sacroiliac joint and hit
- hip joint---si and knee
- pharynx--ipsilateral ear
-tempormanidular joint---head, neck, heart
what are common patters of pain referral for visceral pain? - correct answer ✔✔- diaphragm irritation---
shoulder, lumbar spine
-heart--shoulder, neck, upper back, TMJ
-urothelial tract--- back, inguinal region, anterior thigh, and genitalia
-pancrease, liver, spleen, gallbladder--- shoulder, midthoracic or low back
, -peritoneal or abdominal cavity--- hip pain from absecess of psoas or obturator muscle
what are common patters of pain referral for neuropathic pain? - correct answer ✔✔-nerve or plexus---
anywhere in distribution of peripheral nerve
-nerve root--- anywhere in corresponding dermatome
-CNS--- anywhere in region of body innervated by damaged structure
what do you look for during pain and symptom assessment? - correct answer ✔✔-location : show me
where its located, is it anywhere else (difficult to locate= red flag)
-description: what does it feel, has it change at all (knifelike throbbing= red)
-pattern: when does pain start and stop, morning to night? (gradual, progressive, cyclical pattern=red)
-frequency: how often does pain occur, does it come and go (constant=red)
-duration: how long does it last (constant= red flag)
-intensity: 0-10 scale, worst, best, present (intense pain=red)
-associated symptoms: any other symptoms you have?
*systemic disease: presence of symptoms bilaterally! (red flag)
-relieving factors: (unrelieved by change in position or rest=red)
screening for emotional and psychologic overlay: - correct answer ✔✔-anxiety: excessive and unrealistic
worry about day to day issues lasting or months or longer, increase muscle tension reducing blood flow.
-depression: deep and unrelenting sadness lasting 2 or more weeks, could be underlying cause of
disease.
-panic disorder: episodes of sudden unprovoked terror or impending doom with associated physical
symptoms such as racing, pounding heart beat, breathless, nausea. can mimic respiratory or heart
problems
solutions graded A+
what are the three types of mechanism of referred visceral pain? - correct answer ✔✔- embryogenic
development
- multisegmented innervation
- direct pressure and shared pathways
what is embryogenic development? - correct answer ✔✔- pain is referred to a site where the organ was
located in fetal development
- chest structures and pericardium were part of the gut embryologically.
what is multisegmented innervation? - correct answer ✔✔referred pain:
- pain originating in a visceral structure perceived as being from an area of skin innervated by the same
segmental level as the visceral afferent
- results from convergence of somatic and visceral afferents on the same segemental level of the spinal
cord
-cross talk in the dorsal horn
what is direct pressure and shared pathways for pain? - correct answer ✔✔- shoulder pain: direct
pressure from any inflamed, infected, or obstructed organ is contact with the respiratory diaphragm can
refer pain to the ipsilateral shoulder
- Neck and upper trap: irritation of the peritoneal or pleural surface of the central area of the respirtory
diaphragm can refer sharp pain to the upper trap, neck, and suprclavicular fossa.
what can be some sources of pain? - correct answer ✔✔-cutaneous
-somatic
-visceral
-neurogenic
-referred
,what is somatic pain: - correct answer ✔✔superficial somatic: skin, superficial fasciae, tendon sheaths,
and periosteum
deep somatic pain: periosteum bones, nerves, muscles, tensons, ligaments and blood vessels
what is visceral source of pain: - correct answer ✔✔-internal organs in the trunk or abdomen, such as
those of the respiratory, digestive, urogenital and endocrine system, as well as the spleen, heart and
great vessels.
describe somatic sourse of pain: - correct answer ✔✔-dull, aching or gnawing, cramping or described as
expanding pressure too diffuse to localize.
-considered nociceptive and is not caused by compression of spinal nerves or nerve root. referred to the
body surface becoming cutaneous.
- psychosomatic: emotional or psychologic distress produces physical symptoms
describe visceral source of pain: - correct answer ✔✔knife life quality of stabbing from inside out!
boring, deep aching, cutting, gnawing, throbbing.
** not well localized: ability to produce referred pain.
describe neurogenic source of pain: - correct answer ✔✔- damage to pathophysiologic changes of the
peripheral or CNS. it occurs as a result of injury or destruction to the peripheral nerves, pathways in the
spinal cord, or neurons located in the brain.
-can be acute or chronic depending on time frame.
-sharp, burning and shooting.
what is referred source of pain? - correct answer ✔✔-pain is felt in an area far from the site of lesion but
supplied by the same or adjacent neural segments.
-occurs by way of shared central pathways for afferent neurons and can originate from any somatic or
visceral source.
-pain patterns have different modalities according to the structure (somatic, visceral, neuro)
describe vascular pain: - correct answer ✔✔-throbbing, pounding, pulsing, beating
,describe neurogenic pain: - correct answer ✔✔sharp, crushing, pinching, burning, hot, searing, itchy,
stinging, pulling, jumping, shooting, electric, gnawing, pricking
describe MSK pain: - correct answer ✔✔aching, sore, heavy, hurting, deep, cramping, dull
describe emotional pain: - correct answer ✔✔tiring, miserable, vicious, agonizing, nauseating, frightful,
piercing, dreadful, punishing, exhausting, killing, unbearable, annoying, cruel, sickening, tortuing.
what are common patterns of pain referral for somatic pain? - correct answer ✔✔- c7, t1-5 vertebrae----
interscapular areas, posterior
-shoulder---neck, upper back
- l1-2--- sacroiliac joint and hit
- hip joint---si and knee
- pharynx--ipsilateral ear
-tempormanidular joint---head, neck, heart
what are common patters of pain referral for visceral pain? - correct answer ✔✔- diaphragm irritation---
shoulder, lumbar spine
-heart--shoulder, neck, upper back, TMJ
-urothelial tract--- back, inguinal region, anterior thigh, and genitalia
-pancrease, liver, spleen, gallbladder--- shoulder, midthoracic or low back
, -peritoneal or abdominal cavity--- hip pain from absecess of psoas or obturator muscle
what are common patters of pain referral for neuropathic pain? - correct answer ✔✔-nerve or plexus---
anywhere in distribution of peripheral nerve
-nerve root--- anywhere in corresponding dermatome
-CNS--- anywhere in region of body innervated by damaged structure
what do you look for during pain and symptom assessment? - correct answer ✔✔-location : show me
where its located, is it anywhere else (difficult to locate= red flag)
-description: what does it feel, has it change at all (knifelike throbbing= red)
-pattern: when does pain start and stop, morning to night? (gradual, progressive, cyclical pattern=red)
-frequency: how often does pain occur, does it come and go (constant=red)
-duration: how long does it last (constant= red flag)
-intensity: 0-10 scale, worst, best, present (intense pain=red)
-associated symptoms: any other symptoms you have?
*systemic disease: presence of symptoms bilaterally! (red flag)
-relieving factors: (unrelieved by change in position or rest=red)
screening for emotional and psychologic overlay: - correct answer ✔✔-anxiety: excessive and unrealistic
worry about day to day issues lasting or months or longer, increase muscle tension reducing blood flow.
-depression: deep and unrelenting sadness lasting 2 or more weeks, could be underlying cause of
disease.
-panic disorder: episodes of sudden unprovoked terror or impending doom with associated physical
symptoms such as racing, pounding heart beat, breathless, nausea. can mimic respiratory or heart
problems
