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Flashcards in Cervicothoracic Screening Deck (20)
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1
Q

If a patient received trauma to their cervical neck (such as an MVA) what high risk factors would warrant an imaging referral?

A
  • If they are over 65 years old
  • Dangerous mechanism (fall from over 3 ft/5 stairs, MVC over 60mph or rollover/ejection, or bicycle collision)
  • Upper extremity parasthesia
2
Q

If a patient has no high risk factors after receiving trauma to their cervical spine and they have a low risk factor which allows range-of-motion assessment (such as a simple rear-end MVC, sitting position in ext. rotation, ambulatory at any time, delayed onset neck pain, or absence of midline cervical spine tenderness) what is the last factor which would warrant a referral for imaging?

A

The patient is not able to rotate their neck 45* to the left or right

3
Q

True or False: the Canadian Cervical spine rule is more sensitive than the NEXUS low-risk criteria.

A

True, the Canadian Cervical Spine Rule is 99.4% sensitive and great for ruling out a cervical fracture

4
Q

What are the mechanical causes of cervical myelopathy?

Systemic Causes of myelopathy?

A
  • Trauma
  • Spinal Cord Compression
  • Degenerative changes
  • bulging disks, thickened ligamentum flavum
  • RA with subsequent atlanto-acial subluxation
  • MS, ALS
  • Guillain-Barre
  • Multipfocal motor myopathy
5
Q

What five tests are used in the cervical myelopathy rule?

how many tests need to be positive to achieve a 99% specificity?

A
  • gait deviation
  • +hoffman’s test
  • inverted supinator sign
  • +babinksi sign
  • Age over 45 years old

3 out of 5 positive tests = 99% specificity

6
Q

What are the signs and symptoms of upper cervical ligamentous laxity?

what are some causes of this laxity?

A
  • occipital headache and numbness
  • severe limitation during neck AROM in all directions
  • signs of cervical myelopathy

causes

  • trauma
  • RA with atlanto-axial subluxation, down syndrome, kleepel-feil
  • Os odontoideum
  • odontoid fracture
7
Q

What signs suggest a patient has a spinal infection?

what do you do if they have positive spinal infection signs?

A
  • spine pain that is unrelenting, worse at night and does not change substantially with positional changes
  • history of diabetes
  • potential fever and chills or fatigue
  • concurrent infection or IV drug use
  • local tenderness over spinous processes
  • spinal percussion is painful

Refer out for imaging and clinical lab tests

8
Q

What MSK complaints will a patient that suffered a cardiovascular event have?

A
  • jaw, neck, shoulder, arm and back pain
  • myalgias, muscular fatigue, and muscle atrophy
  • weakness and fatigue
  • poor exercise tolerance
9
Q

What signs and symptoms are common with cardiovascular events?

A
  • chest pain
  • abdominal pain
  • shortness of breath
  • heart palpitations
  • irregular heartbeat
  • dizziness, nausea
  • syncope
  • peripheral edema
10
Q

What are the 5 D’s And 3 N’s of cervical arterial dysfunction?

A
  • Dizziness
  • drop attacks
  • dysphagia
  • dysarthria
  • diplopia

-Ataxia

  • Nausea
  • numbness
  • nystagmus
11
Q

How will a patient who suffered a pulmonary event describe their pain?

What would be there signs and symptoms?

A

Pain

  • sharp, localized
  • aggravated by breathing
  • better in upright/worse in recumbent
  • better with autosplinting

SxS

  • Shortness of breath (Dyspnea)
  • persistent cough
  • fevers, chills, and general malaise
  • weak rapid pulse with fall in BP
  • cyanosis
12
Q

What are the signs of a pneumothroax?

A
  • shortness of breath
  • acute sharp pain in chest (upper and lateral chest wall_
  • can refer pain to ipsilateral shoulder/upper trapezius region
  • change in respiratory movements
  • drop in blood pressure, increased venous distention in neck
  • more pain in recumbent positions/better in sitting
13
Q

What are common signs of GI issues? (stomach, duodenal, or pancreatic conditions)

A
  • gnawing, cramping, burning, “heartburn” or aching
  • constant or suddent onset, weight loss, nausea, vomiting, fever, malaise
  • may have pain in waves or may be related to eating or drinking in timing
  • early satiety, black “tarry” or light colored stools (pancreatic cancer)
14
Q

True or False: cervical spine is the most common location for spinal metastases.

A

False, metastases are rare in C-spine, more common in thoracic (60%) and lumbar (40%) spine

15
Q

What cancers can commonly cause spinal pain?

A
Prostate
breast
kidney
thyroid
lung
lymphoma
16
Q

Which cancers more commonly effect the cervico-thoracic spine?

A
thyroid and esophageal cancer
Hodgkin's lymphoma
Pancoast's tumor
Multiple myeloma
breast cancer
17
Q

Ture or False: If a patient has an injury to a C-spine artery pain is usually not a common complaint due to arteries not being innervated.

A

False, pain is a predominant symptoms in these patients as arterial walls are liberally supplied with pain fibers

18
Q

What are the components of the neruovascular physical exam?

A
BP
BMI
Pulse check
Neuro exam
Functional positional tests
Ligamentous Tests
Eye exam
19
Q

True or False: Generally we as PTs should avoid performing cervical thrust manipulations to patients with recent onset of head and neck pain but we should perform thoracic manipulations

A

True, as well as ROM exercises for the neck and scapulothoracic and upper extremity stretching and strengthening

20
Q

When do roughly 72% of patients that reported feeling adverse symptoms say they felt their symptoms start?

A

Withing minutes after manipulation, most commonly they report onset during the manipulation