Lecture Final Review II

Question 1

Why should cervicogenic vertigo be differentiated before adjusting?

Answer 1

Cervicogenic vertigo due to musculoskeletal dysfunction: upper cervical manipulation is indicated
Vertigo due to vascular pathology of vertebrobasilar system: manipulation is contraindicated

Question 2

What symptoms are nearly always present in patients suffering from cervicogenic vertigo?

Answer 2

Neck pain with muscle tenderness, stiffness, and guarding of cervical region

Question 3

Vertigo is a common complain following ___ injuries.

Answer 3

whiplash (CAD)

Question 4

With cervicogenic vertigo, headache complaints are common. They are ___ in origin, with ___ or ___ pain patterns.

Answer 4

occipital in origin, with retro-orbital or band-like referred pain patterns

Question 5

Cervicogenic vertigo comes with imbalance, but neck pain may precede these symptoms.
Pain is commonly located in the ___ with radiations to the ___.

Answer 5

occipital region with radiations to the temporomandibular region, temporal region, and into arms

Question 6

Upon swivel stool test, patient rapidly rotates head from side to side and it results in dizziness.
What is the differential diagnosis?

Answer 6

• Central vertigo (inner ear)
• Peripheral vertigo (cervicogenic)

Question 7

Upon swivel stool test, patient rapidly rotates head from side to side and it results in dizziness. Then, the doctor holds the head stationary with slight distraction as the patient closes their eyes and rotates their body.
If the patient experiences dizziness, the diagnosis is more likely ___.
If the patient does not experience dizziness, the diagnosis is more likely ___.

Answer 7

Dizziness indicates peripheral (cervicogenic) vertigo
No dizziness indicates central (inner ear) vertigo

Question 8

If a patient has peripheral vertigo, under which circumstances is manipulation indicated vs contraindicated?

Answer 8

Joint dysfunction means manipulation is indicated
Vascular insufficiency is contraindicated

Question 9

If a patient experiences immediate dizziness with pure cervical rotation in the swivel stool test, which cause of peripheral vertigo is more likely?

Answer 9

Joint dysfunction

Question 10

If a patient experiences delayed dizziness with pure cervical rotation in the swivel stool test, which cause of peripheral vertigo is more likely?

Answer 10

Vascular insufficiency
Other signs of vascular insufficiency are usually present

Question 11

orofacial pain syndromes

Temporomandibular joint disorders can be divided into which two subcategories?

Answer 11

• Muscle disorders
• TM joint disorders

Question 12

orofacial pain syndromes

What are three muscle disorders related to TMJ?

Answer 12

• Acute spasm
• Myofascial pain (trigger point activity)
• Bruxism (grinding teeth)

Question 13

orofacial pain syndromes

What are three TMJ disorders originating at the joint?

Answer 13

• Disc dislocation
• Hypomobility
• Hypermobility

Question 14

How does the TMJ present in the closed-packed position?

Answer 14

Condyles of mandible rest in the mandibular fossa

Question 15

How does the TMJ present in the loose-packed position?

Answer 15

Slight opening of the jaw, a freeway space of about 3-5mm between the teeth
Equilibrium between jaw-opening and closing muscles and gravity

Question 16

TMJ

Those who brux will have ___ freeway space resting posture.
Those who mouth breathe will have ___ freeway space.

Answer 16

Bruxism has decreased
Mouth breathing has increased

Question 17

TMJ

During opening, closing, protrusion, and retrusion, the convex surface of the ___ must move over the convex surface of the ___.

Answer 17

convex surface of the condyle must move over the convex surface of the articular eminence

Question 18

What is the function of the articular disc during the movement of the temporomandibular joint?

Answer 18

Compensate for incongruity between two convex surfaces: condyle and articular eminence

Question 19

Initial opening of the mandible will require ___ at the TMJ.
Full opening will require ___ at the joint.

Answer 19

Initial opening requires rotational movement
Full opening requires forward translation

Question 20

What are three muscle that can have trigger points referring to the jaw area?

Answer 20

• Temporalis
• Masseter
• Lateral pterygoid

Question 21

If a patient has referred pain in their jaw going into their top teeth, which muscles may be involved?

Answer 21

• Temporalis
• Masseter

Question 22

If a patient has referred pain in their jaw that focuses in and anterior to their ear, which muscles may be involved?

Answer 22

• Masseter
• Lateral pterygoid

Question 23

If a patient has trigger points around the body and angle of the mandible that refer pain anteriorly, what is likely causing their jaw pain?

Answer 23

Masseter muscle

Question 24

What is otitis media?

Answer 24

Inflammation of the middle ear
(not necessarily infection)

Question 25

What is the most common diagnosis for physician out-patient visits in children younger than age 15?

Answer 25

Otitis media

Question 26

Pediatric patient has discomfort in their ear and a noticeable behavior change. There is fluid in their middle ear without evidence of ear infection. What diagnosis is this characteristic of?

Answer 26

Otitis media with effusion (OME) aka nonsuppurative otitis media, serous otitis media, glue ear

Question 27

What is a common cause of otitis media with effusion?

Answer 27

Blockage of Eustachian tube and build-up of fluid in the middle ear with inflammation

Question 28

Studies have shown that middle ear aspirates from children with otitis media with effusion contain bacteria or provide a medium for bacterial pathogens to grow in ___% of cases.

Answer 28

27-50%

Question 29

True or False If a child has otitis media with effusion and bacteria is found in the middle ear, pathogens are most likely causing the effusion and antibiotic therapy will resolve the effusion.

Answer 29

**False**, evidence of bacteria is not proof that pathogens are causing the effusion

Question 30

What is the term for inflammation of the middle ear with signs of infection (fever, increased white blood cell count, pus-like discharge, etc.)?

Answer 30

Acute infectious otitis media

Question 31

What is required for treatment of infectious otitis media from a bacterial source?

Answer 31

Referral for antibiotic therapy

Question 32

What is the possible rationale for chiropractic treatment of otitis media with effusion in children?

Answer 32

* Upper cervical chronic muscular hypertonicity could cause referred pain into ears mimicking inflammation * Upper cervical chronic muscular hypertonicity could compress immature Eustachian tube and limit proper draining * Cervical adjustment and soft tissue with TMJ may relieve hypertonicity, encouraging middle ear drainage

Question 33

#red flags and complications If a patient has otitis media, clinical guidelines recommend antibiotics if a fever is greater than ___.

Answer 33

39 C (102.2 F)

Question 34

What are some rare, but serious complications of otitis media?

Answer 34

* Mastoiditis - abscess in mastoid air spaces * Meningitis - sepsis headache, vomiting, neck rigidity, photophobia, and positive Kernig's sign * Brain abscess - sepsis with neurological signs

Question 35

Why shouldn't chiropractors calim to "treat", "cure", or "help" **ear infections?

Answer 35

* There is no evidence chiropractic can cure **infectious** diseases * It is **illegal** in some states for chiropractors to treat **infectious diseases * It just sounds non-credible

Question 36

What is a plausible claim for chiropractors to make around their treatment of a patient with otitis media?

Answer 36

Chiropractors may be able to help some children with recurring earaches by helping to increase the drainage from the middle ear

Question 37

What is Arnold-Chiara malformation?

Answer 37

Herniation of the cerebellar tonsils (inferior aspect) into the foramen magnum

Question 38

What is the term for herniation of the cerebellar tonsils into the foramen magnum?

Answer 38

Arnold-Chiari malformation

Question 39

Arnold-Chiari malformation can cause crowing at the ___ and can interfere with normal ___.

Answer 39

crowing at the **craniocervical junction** and can interfere with normal **flow of CSF**

Question 40

What is the cause of Arnold-Chiari malformation?

Answer 40

Unknown Some speculate it is congenital or a result of trauma

Question 41

Adults and adolescents who are unaware they have Arnold-Chiari type I malformation may develop headache. How is this headache characterized?

Answer 41

Predominantly located in the back of the head and is increased by coughing or straining

Question 42

Arnold-Chiari malformation may include symptoms of ___ such as dizziness, impaired ability to coordinate movement, double vision, and involuntary, rapid, downward eye movements.

Answer 42

progressive brain impairment

Question 43

True or False Some individuals with a Chiari malformation may be completely asymptomatic.

Answer 43

True

Question 44

What is multiple sclerosis?

Answer 44

Inflammatory, demyelinating disease of central nervous system

Question 45

What is the etiology of MS?

Answer 45

Unkown May be primarily genetic and triggered by environmental factors such as viruses or vitamin D deficiency

Question 46

MS affects which sex more? What might this suggest?

Answer 46

Females more than males, especially with earlier onset Suggests a hormonal component to the disease process

Question 47

What is meningitis?

Answer 47

Inflammation of the meninges

Question 48

The mortality rate for **viral meningitis** (without encephalitis) is ___.

Answer 48

less than 1%

Question 49

The mortality rate for **bacterial meningitis** is ___.

Answer 49

approximately 25% (with antimicrobial therapy) Almost uniformly fatal if untreated

Question 50

The following is the classic triad of which pathology? * Nuchal rigidity * Sudden high fever * Altered mental status

Answer 50

Bacterial meningitis If none of these are present, meningitis is extremely unlikely

Question 51

Patient has nuchal rigidity, a sudden high fever, and altered mental status. Assuming they have bacterial meningitis, what other symptoms might you expect?

Answer 51

* Vomiting * Photophobia * Phonophobia

Question 52

Signs of meningeal irritation are observed in approximately ___% of patients with bacterial meningitis. What are two of these orthopedic signs?

Answer 52

50% Kernig's and Brudzinski's

Question 53

If a patient has positive Kernig's and Brudzinski's signs, it is possible that there is ___ irritation due to ___.

Answer 53

**meningeal** irritation due to **bacterial meningitis** Absence does **not** rule out meningitis

Question 54

Kernig's and Brudzinski's signs are both commonly used to screen for meningitis. They have ___ sensitivity, and ___ specificity for meningitis.

Answer 54

**poor** sensitivity**, and **very good** specificity (frequently false negative, rarely false positive)

Question 55

What is the water glass test for meningitis rash?

Answer 55

Press a clear water glass against any suspected rash: * Rash fades with pressure? Likely not meningitis * Rash visible through the glass? May be septicemia, especially with fever

Question 56

In someone suspected of having meningitis, blood tests and blood cultures are performed. In general, what should promptly be performed whenever the diagnosis of meningitis is strongly considered?

Answer 56

Lumbar puncture to examine CSF

Question 57

What is commonly seen as being the safest and most conservative pharmaceutical treatment for neck pain?

Answer 57

Simple analgesics e.g. acetaminophen

Question 58

What is the largest cause of drug overdoses in the US? Why is this so?

Answer 58

Acetaminophen: * narrow range between therapeutic dose and toxic dose * part of many OTC and prescription combination drugs

Question 59

New meta-analysis published in British Medical Journal found that acetaminophen is ___ in the treatment of low back pain and provides ___ benefit for people with osteoarthritis.

Answer 59

**ineffective** for low back pain **minimal short term benefit** for osteoarthritis

Question 60

What is the most common conventional first-line treatment for most musculoskeletal pain syndromes?

Answer 60

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Question 61

NSAIDs are generally considered safe, but have significant safety concerns regarding ___.

Answer 61

GI bleeding.