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47 Cards in this Set
- Front
- Back
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the aggregate of signs and symptoms associated with any morbid process, and constituting together the picture of the disease
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Syndrome
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A group of disorders in which physical symptoms suggest physical disorders for which there are no demonstrable organic findings or known physiologic mechanism, and for which there is positive evidence, or a strong presumption that the symptoms are linked to psychological factors (i.e. hysteria, conversion disorder, hypochondriasis)
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Somatoform Disorder
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A mental disorder in which the individual intentionally produces symptoms of illness or feigns illness for psychological reasons rather than for environmental goals
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Factitious Disorder
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Feigning illness or disability to escape work, excite sympathy, or gain compensation
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Malingering
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For nearly every autoimmune disease, studies show that ____ of affected persons have the concomitant expression of FMS
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25% to 30%
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Fibromyalgia and Nociception: Originating body site
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Where stimulus occurs
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Fibromyalgia and Nociception: Spinal cord
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Where the signal is chemically processed
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Fibromyalgia and Nociception: Brain
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Where the pain message is interpreted
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In FMS, nociceptive mechanisms are activated and pain is chemically amplified in the spinal cord by a process known as ____
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central sensitization
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Normally, a stimulus from the peripheral tissue is transmitted to the spinal cord by the ____, ___, ____
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unmyelinated A delta fibers and C fibers
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During central sensitization, ____ can be recruited to participate in nociceptive transmission.
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large myelinated fibers
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In a normal person, Usually the large myelinated fibers carry messages of ___, ___, ___
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proprioception, positional sense, and soft touch
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During central sensitization, excitation of large myelinated fibers by relatively normal stimuli is interpreted by the cord and brain as___.
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pain
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What are Some chemical agents of proprioception that facilitate the transmission of this message
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substance P, a potent vasoactive peptide that also appears to be involved in pain, temperature, and touch signals. excitatory amino acids such as glutamate or aspartate. nerve growth factor. and prostaglandins.
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The participation of ___ in this process may explain why NSAIDs have some effect on FMS pain despite the apparent absence of inflammation
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prostaglandins
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Four independent investigations conducted in the US and in Scandinavia have shown that the CSF of persons with FMS contain markedly elevated levels of ___ compared to controls
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substance P
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What is the blood level of serotonin in patients with FMS?
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LOW
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In FMA, what is decreased in platelets?
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Serotonin levels in platelets were significantly lower in patients with FMS
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How does serotonin affect pain and mental status in patients with FMS?
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Levels correlated with the average pain threshold but did not correlate with depression in the FMS patient
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What are the GH and ATP levels in a patient with FMS?
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LOW
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What is the following Adjunctive Natural Remedy for? Ginko Biloba
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memory and circulation
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What is the following Adjunctive Natural Remedy for? Ginger
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muscle/joint pain, thermogenesis, migraines, dysequilibrium, HTN, N/V
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What is the following Adjunctive Natural Remedy for? Kava Kava
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sleep
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What is the following Adjunctive Natural Remedy for? Lemon Balm
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sleep
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What is the following Adjunctive Natural Remedy for? Valerian root
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sleep
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What is the following Adjunctive Natural Remedy for? Tyrosine
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energy tonic, precursor of Dopamine
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What is the following Adjunctive Natural Remedy for? Peppermint Oil
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bowel spasms
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What is the following Adjunctive Natural Remedy for? St. John’s Wort
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Depression
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What is the following Adjunctive Natural Remedy for? Feverfew
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headaches
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What is the following Adjunctive Natural Remedy for? Glucosamine sulfate
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aches and pains
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What is the following Adjunctive Natural Remedy for? Essential Fatty Acids
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hormone and immune function, inflammation
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What is the following Adjunctive Natural Remedy for? Pantothenic Acid
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adrenal function and weight loss
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What are the following Pharmacologics used for? COX-2 inhibitors
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inflammation
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What are the following Pharmacologics used for? Ultram, NSAIDs, Elavil, Neurontin, IV Lidocaine, Lithium, Ketamine, Calcitonin
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pain
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What are the following Pharmacologics used for? Skelaxin, Zanaflex, Baclofen, Norflex
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muscle relaxers
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What are the following Pharmacologics used for? Klonopin, Soma, Flexeril, Elavil
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sleep
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What are the following Pharmacologics used for? Dextromethorphan
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potentiates narcotics
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The pain in FMS is predominantly in the___
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soft tissue
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Demonstrable tissue injury
Continuous high level nociceptive input Limited duration |
Acute Pain
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Tissue damage if present not obvious
Continuous low level nociceptive input Duration greater than six months Alteration of central processing pathways |
Chronic Pain
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What are the ACR criteria for FMS?
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Widespread pain for at least 3 months experienced on both sides of the body and above and below the waist
Axial skeletal pain (cervical, anterior chest, thoracic, lumbar) Pain present upon palpation at 11 of 18 predefined tender point sites |
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Fibromyalgia Tenderpoints
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Occiput
Lower cervical Trapezius Supraspinatus Second rib Lateral epicondyle Gluteal Greater trochanter Knee |
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Females 20-60 years of age
Affects 3-6 million Americans Generalized achiness Axial locations (neck, low back) Decreased pain threshold Diffuse stiffness Symptoms worse in morning Exacerbated by environmental stimuli Exercise, inactivity, poor sleep, stress, weather |
Clinical Features of Fibromyalgia
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Not an inflammatory process
Blood chemistries (CBC, ESR) are normal Patients may have underlying disease RA, OA, Lyme disease, sleep apnea Tenderpoints Decreased blood serotonin |
Other Features of Fibromyalgia
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Initial therapeutic approach for Fibromyalgia should include
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Pt. education, reassurance, and self empowerment
OMT and exercises Begin exercise at a low energy level, concentrating mostly on stretching, and then progress gradually to more strenuous aerobic exercises OMT: increase mobility and improve ADLs Antidepressants Sleep aids |
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What are the Chronic Fatigue Syndrome Criteria
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Fatigue severe enough to limit daily activities for 6 months or longer
4 out of 8 minor criteria Muscle pain Multi joint pain without redness or swelling Tender nodes Sore throat Headache Postexertional malaise lasting more than 24 hours Impaired concentration and short term memory Unrefreshing sleep |
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What lab results would show FMS?
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There are no routine laboratory or radiographic tests whose abnormal findings would indicate FMS.
However, nuclear magnetic resonance spectroscopy does indicate a decreased capacity for muscle work. |
