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1
Q

Scleratogenous pain is derived from ___. Primarily from the ___ joint.

A

connective tissue

facet joint

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2
Q

How does pt. describe scleratogenous pain?

A

Dull, achy, no descript

*pain @ site of origin may be sharp, pt. may have difficulty describing sensation.

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3
Q

Does scleratogenous pain follow dermatome/ peripheral N. pattern?

A

no

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4
Q

Scleratogenous pain in the C spine doesnt cross the ___ joint. In the L-spine, it doesnt cross the ___.

A

GH

Knee

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5
Q

Dermatagenous pain is derived from the ___ ___.in a ___ pattern

A

Nerve root

Dermatomal

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6
Q

Dermatogenous pain is ___ in nature. How does pt. describe pain?

A

radicular
Sharp or shooting, but not always.
*pt can usually pinpoint this pain

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7
Q

Radiculopathy is derived from a __ __ and follows a ___ pattern.

A

nerve root

dermatomal

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8
Q

Myotagenous pain comes from ___. What is the difference between myofascial pain syndrome and fibromyalgia pain?

A

muscles
Myofascial –> local and referring
Fibromyalgia –> Local without referral

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9
Q

Viscerogenic pain may be __ at the site of origin, but the referred pain is usually described how?

A

sharp

dull achy, non-descript

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10
Q

Teitze’s is normally seen in ___ > __ y/o. Whee is pain?

A

Women
50
Upper chest 2nd/3rd ICS
*Unilateral

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11
Q

How will pleurisy manifest?

A

Sharp pain in the chest related to coughing , sneezing and positional in nature.
Most noted with side bending to the same side or lying on the involved sided.
Will often have a history of coexisting or recent history of respiratory infection.

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12
Q

How will pukmonary embolism manifest?

A 
Middle Aged Male
Sudden Chest pain after pain in the calf
Low grade fever maybe
Pleuritic Pain 
Pain is severe and similar to a Myocardial Infarction
Very High Mortality Rate
	600,000 cases each year in US
	1/3 end in death
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13
Q

Angina Pectoralis is noted after ___ and rest will __ symptoms. Pain usually lasts around __ mins. Secondary to ___

A

exertion
decrease
30
atherosclerosis

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14
Q

What causes S1?

A

Closure of Mitral and Tricuspid (AV) valves

-normally lower pitched and longer than S2

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15
Q

S2 is best heard over ___ and is closure of __ and __ valves

A

Aorta
Pulmonic
aortic

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16
Q

When is S3 normal? What is it called in an adult?

A

Children and adolescent

Gallop

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17
Q

S4 is heard when? When may it be present?

A

Before s1

Infants and children

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18
Q

Pain on empty stomach indicates ___

A

ulcer

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19
Q

Pain with a full stomach indicates ___

A

reflux

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20
Q

What will be elevated with cholecystitis?

A

Alkaline phosphate

*use ultrasound to Dx

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21
Q

MC urethral stones are what?

A

Calcium Oxalate

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22
Q

What does Sinuvertebral N. innervate?

A

Outer 1/2 of IVD
PLL
Dura Mater
Spinal Canal Vessels

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23
Q

What is a bulge/ protrusion?

A

Bulges outward through a tear in the AF, but does not escape from the outer AF or the PLL.
Bulges against the PLL and dura generally producing dull, poorly localized pain in the lower back and SI region.
Pain is worse in the morning due to inhibition
Generally no leg symptoms
Pain is worse with sitting, because the noiceptors within the AF are irritated by the protrusion.

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24
Q

What is an extrusion>

A

Nuclear material remains attached but escapes the AF or PLL.
Extrusion is generally posterolateral in nature into the IVF.
Patient will have the same presentation as with a protrusion, though leg pain will generally be present and the pain levels maybe greater.

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25
What is a sequestration?
The migrating disc material escapes the disc all together and becomes a free floating fragment. This fragment has potential to migrate up and down the central canal.
26
What are 3 causes of Foraminal encroachment?
SOL Spinal malposition Swelling/ inflammation
27
What is claudication?
Reproducible ischemic muscle pain --> cramp feeling in leg
28
Neurogenic Claudication pain is usually ___ and occurs where?
bilateral | lower back an extermity
29
MC injured nerve?
Radial
30
Lesion of Radial N causes __ __
Wrist drop AKA radial palsy --> can;t extend wrist or abduct thumb -loss of sensation esp. dorsum of hand
31
What causes radial tunnel syndrome?
Compression prior to entering the supinator by Fibrous band off anterior radial head, sharp medial edge of ECR Brevis, or Arcade of Froshe (thickened head of superficial head of supinator)
32
Cubital Tunnel syndrome: Compression of ___ nerve. Weakness of __ grip. Affects __ the most.
ulnar power men
33
Pisiform/ Hamate Syndrome: __ nerve compression within ____. Will have __ grip weakness.
ulnar tunnel of Guyon power
34
What causes claw hand?
Lesion of ulnar N
35
What causes ape hand deformity?
Median N. lesion
36
Carpal Tunnel Syndrome: Clumsiness with __ grip.
precision
37
Pronator teres syndrome: __ neuropathy due to __ of pronator teres muscle or entrapment. Also caused by excessive pronation/ supination
median edema/ hypertrophy *Phalen may be negative, but reverse phalens may be positive
38
Piriformis syndrome is entrapment of __ nerve as it passes under ___ muscle. What are some causes?
``` sciatic piriformis -females 6:1 -trauma to gluteal or SI region -Flexion contracture of hip --> Pelvic obliquity -Buttock pain but no lbp ```
39
what causes foot drop?
Deep peroneal N. entrapment | -different from L5 radilopathy
40
Tarsal Tunnel Syndrome: __ nerve entrapment between __ __ and __ __.
Tibial flexor Retinaculum Medial Malleolus
41
What are the Sensory tracts?
DCML | Spinothalamic
42
Anterior Spinothalamic senses...
touch and deep pressure
43
Lateral Spinothalamic Senses...
Pain and temp.
44
What is the motor tract?
Corticospinal (UMN Pathway)
45
What tract does Coordination?
Spinocerebellar
46
What do dorsal columns carry?
Vibration (pallesthesia) joint position sense pressure light touch
47
How to evaluate Spinothalamic System
Sharp vs. Dull | Pin prick
48
Tracts of Upper motor neuron and AKA. Where does it synapse?
Corticospinal corticobulbar AKA pyramidal system Synapses in Anterior Horn cell
49
Lower motor neuron originates in ___ and AKA is ___. Pathways of _(3)_. Terminates in ___.
AHC Nerve root, plexus, peripheal nerves Final Common Pathway NMJ
50
Cerebellum function
Fine motor control Postural reflexes (via CN VIII) Determines muscle range, velocity, strength Procedural Memory
51
Basal Ganglia Function
Modulates and adjusts tone of motor system | *NOT a part of upper or lower motor neuron
52
3 types of ataxia and where problem is
Motor --> Cerebellar Sensory --> Dorsal Columns Vestibular --> CN VIII (vestibular portion)
53
How will pt. present with motor ataxia?
Unstable with eyes open or closed worse when lying down Gait is wide, staggering, reeling (like theyre drunk) Tend to lean or stagger to side of lesion
54
How will pt. present with Vestibular ataxia?
- problem with vestibular nuclei, CN VIII, or labyrinth of inner ear - gravity dependent --> standing or sitting - lack of coordinated limb movements (not seen when supine, seen with standing/ walking) - Unilateral Nystagmus - Vertigo
55
How will pt. with Sensory Ataxia present?
Impaired joint position sense/ diinished vibration sense numbness and tingling slappage* and wide based gate + Romberg's
56
Syringomyelia is an idiopathic disease of the ___ and ___ associated with ___. MC onset range is __-__ y/o. Causes __ and __ pain.
``` brain stem spinal cord cavitation 30-50 headache shoulder ```
57
Syringomyelia presents with early loss of __ and __ in a __-like distribution. ___ is also often seen and __ syndrome can develop as a result.
``` pain temperature shawl* Scoliosis Horners* ```
58
What causes Tabes Dorsalis? What does it damage? What does pt. lose?
Tertiary Syphilis Dorsal roots and post. columns Loss of proprioception and vibratory sensation *Sensory ataxia
59
Hypotonia due to cerebellar dysfunction can cause what?
Loss of resistance offered by muscles to palpation or passive ROM -floppy, loose-jointed, rag doll appearance, inebriated appearance
60
4 things Cerebellar dysfunction can cause
Intention tremors Dysmetria Dysdiadochokinesia Dysarthria
61
4 things Basal ganglia dysfunction can cause
``` Resting tremors (*the ONLY BG tremor) (parkinsons) -present at rest, usually decreases with action -In hands --> pill rolling tremor Chorieform Movements Athetoid Movements Rigidity -Cogwheel--> Parkinson's -Lead pipe ```
62
What are choreiform movements?
Rapid, abrupt, highly complex jerky movements that appear well coordinated but are involuntary
63
What are Athetoid Movements?
Involuntary, ceaseless, irregular, slow continuos writhing wormlike motions (MC in hands and fingers)
64
What is Cogwheel rigidity?
Has underlying tremor, seen in parkinson's
65
What is lead pipe rigidity?
Smooth, no underlying tremor
66
5 causes of generalized weakness
``` Depression Infection hormonal Chronic Fatigue Metabolic ```
67
How will cervical myelopathy present?
Neck pain, lower extremity abnormal sensations, balance problems, numbness in hands and fingertips, difficulty with fine movements, possible hyper-reflexia
68
Parkinsons 2 AKAs
Paralysis Antigans | Shaking Paralysis
69
How will MS present?
``` **Younger patient Hx of dizziness, numbness, tigling, weakness that resolved in a few days relapses mc 2-3 months after childbirth **possible urinary dysfunction -possible diplopia ```
70
What causes MS?
Patchy demyelinization with reactive gliosis - spinal cord - optic N - White matter of brain (including cerebellum) - Thought to be autoimmune
71
What will lab work on a pt. with MS be like?
Mild lymphocytosis | Increased protein in CSF
72
How Will Guillan barre present?
- Bilateral leg weakness - Possible distal paresthesia - *Possible post immunization or viral infection - lost DTR - Motor weakness - possible autonomic involvement --> BP fluctuation, sweating, sphincter dysfunction
73
How will ALS present?
- Complaint of muscle weakness and cramping in hand - S&S progressively increase --> difficulty chewing, swallowing, coughing, breathing - 30-60 y/o - ***Sensory exam is normal
74
What causes ALS?
degeneration of AHC, motor nuclei of lower CNs, Corticospinal and bulbar tracts - Death within 2- 2 1/2 years - No treatment
75
How will Myesthenia Gravis present?
- Young female - Compaint of Double vision, dysphagia, arm weakness w/ repetitive use, weak jaw mm from chewing - Ptosis - **NO sensory findings
76
What causes myasthenia gravis?
neuromuscular transmission is blocked by auto antibodies that bind to ACH receptors aking the receptors unavailable
77
Nuchal Rigidity with fever indicates...
Meningitis
78
Nuchal rigidity without fever indicates...
Subarachnoid Hemorrhage
79
What is classic migrane?
``` Migrane with aura usually female *increasing blidn spot and flashing lights which lasts 30 mins can last 1-3 days photo and phonophobia possible nause and vomiting -considered neurologic ```
80
What is a migrane without an aura?
Common migrane Similar to classic, but no aura Severe, but pt. can continue ADLs No neuro findings
81
Tension HA description
Frequent occurrence Worse in afternoon/ early evening Suboccipital/ Supraorbital OTC NSAIDs provide relief
82
Cervicogenic HA description
Referral from soft tissue structures of C spine No neuro findings Can overlap with other HAs
83
How does a cluster HA present?
``` Middle aged male painful, orbital in location lasts for ~30 mins Cluster for days to weeks, then appears weeks to months late *Hx of smoking or alcohol abuse ```
84
How does Neurologic HA present?
``` Sudden onset Progressive Dizziness/ nausea **CN findings possible -Immediate referral ```
85
What are the 5 Ds and 3 Ns of Neurogenic HA?
``` Diplopia Dizziness Drop Attacks Dysarthria Dysphagia Ataxia Nausea Numbness Nystagmus ``` ****If suspected Cerebral vascular compromise, MUST refer to ER and DO NOT adjust

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