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Pain Pathophysiology

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Common causes of acute abdominal pain in adults include

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(A) intussusception in an adolescent patient

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(B) abdominal aortic aneurysm in an adult population, which most likely presents with excruciating abdominal pain

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(C) diabetic ketoacidosis in an elderly patient without a previous history of diabetes

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(D) drug-induced pain from polypharmacy that is rarely a cause of abdominal pain in the elderly

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(E) interstitial cystitis

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(C) Diabetic ketoacidosis needs to be ruled out (in addition to myocardial infarction, pneumonia, pyelonephritis, and inflammatory bowel disease) as a cause of abdominal pain. The most common cause of abdominal pain in infants is intussusception. Although abdominal aortic aneurysms, which are a manifestation of atherosclerosis, do occur in an adult population, they usually do not present with specific clinical symptom of abdominal pain. Finally, drug-related abdominal pain is very common in the elderly.

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A 35-year-old woman has right arm pain. Which of the following statements regarding her pain is true?

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(A) It is more likely she will have arterial thoracic outlet syndrome than neurogenic thoracic outlet syndrome

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(B) If it began in the ulnar nerve distribution after an injury to the ulnar nerve, she may have complex regional pain syndrome (CRPS) type I

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(C) If she also has pain radiating into her occiput, she may have involvement of the sensory portion of the C1 nerve

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(D) If she has clawing of the small finger, the median nerve is likely involved

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(E) The ulnar nerve is commonly compressed at the cubital tunnel

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(E)

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  1. The majority of cases of thoracic outlet syndrome are categorized as neurogenic thoracic outlet syndrome.

  2. CRPS type II is when an identifiable neural injury is present.

  3. The first cervical nerve does not have a sensory branch.

  4. Ulnar neuropathy often has clawing of the small finger.

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You suspect a patient is having cluster headaches. The most convincing evidence of this type of headache would be if

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(A) the patient is female

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(B) although it is worse on the right side of the head, the symptoms are usually bilateral

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(C) the headaches are occurring at the same time each night

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(D) the patient is having a rebound headache due to excessive use of medication and the most ...

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