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Med Screening > Screening for Head, Neck, and Back > Flashcards

Screening for Head, Neck, and Back Flashcards

1
Q

what are possible origins of HAs

A

from head, C1, C2, or C3

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2
Q

what are 9 HA sx that are red flags

A
  1. persistent unrelenting HAs
  2. supine inc HA
  3. onset w exertion, cough, sneeze
  4. visual changes, nystagmus, pupil dilation, diplopia
  5. CNS s/sx (CN or extremity focal deficits, ataxia, fatigue, irritability)
  6. change in mentation
  7. associated fevers, temp, wt loss/gain
  8. associated trauma
  9. associated sz
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3
Q

what does a HA that inc w supine or has an onset w exertion, cough, or sneeze indicate

A

inc ICP

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4
Q

what does a HA associated w fevers, temps, wt loss/gain indicate

A

CA or infection

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5
Q

what does a HA associated w trauma indicate

A

head bleed

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6
Q

what does a HA associated w sz indicate

A

anything in brain could be encroaching and putting pressure on different part of brain that cause sz
- this could be d/t tumors, edema

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7
Q

what are 4 possible dx related to the red flags for HAs

A

meningitis/encephalitis
brain tumor
subarachnoid or other intracranial hemorrhage
temporal arteritis associated w polymyalgia rheumatica

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8
Q

what are risk factors for meningitis

A

young children
college students
elders
exposure

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9
Q

if a pt has a HA w a high fever what is the first thing you have to r/o

A

meningitis

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10
Q

what is meningitis caused by

A

bacterial or viral
- mortality for bacterial is double that of viral
super contagious

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11
Q

what are sx of meningitis (6)

A

HA w high fever
(+) meningeal slump

flu-like sx
confusion
sz
lethargy

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12
Q

what is a meningeal slump

A

bring chin to chest
puts meninges on stretch
- will cause inc pain and HAs if (+)

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13
Q

what population of pts is there crossover of meningitis sx with - esp confusion

A

diabetics

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14
Q

triage for suspected meningitis?

A

red flag: ER medical emergency

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15
Q

what type of brain tumor would a pt likely have

A

primary brain tumor
- insular brain tumors have a very low incidence

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16
Q

risk factors for a brain tumor

A

not really known
radiation exposure loosely tied
- ie children w childhood cancer treated w radiation, develop a brain tumor later

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17
Q

what are 7 associated sx with a brain tumor

A

focal motor/sensory abnormalities
ataxia/imbalance
speech deficits
progressive severe HA (often positional if inc ICP)
visual changes
altered mental status
sz

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18
Q

triage for suspected brain tumor

A

red flag: ER medical emergency, urgent imaging - if have any of these w HAs

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19
Q

risk factors for subarachnoid hemorrhage (4)

A

recent head trauma
hx of intracranial aneurysm
HTN
smoking

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20
Q

s/sx of subarachnoid hemorrhage (4)

A
  1. sudden onset of “thunderclap HA”
    - worst HA you ever had
  2. LOC - may be brief, could be d/t head trauma
  3. s/sx of brain tumor
  4. s/sx of meningitis
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21
Q

triage for suspected subarachnoid hemorrhage

A

red flag: ER today, medical emergency
call ambulance
- could decline fast, if brain swells enough - could shut down breathing centers

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22
Q

what are 3 risk factors for TMJ fx or infection

A

trauma (fx)
recent surgery (infection)
recent infection (infection)

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23
Q

what are 3 sx of TMJ infection

A

inability to open mouth
fever
cold sore

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24
Q

what flag is TMJ infection

A

yellow - urgent call to surgeon
- not necessarily to ER

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25
Q

what is a cold sore

A

abscess of tooth
infection in tooth

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26
Q

how should a cold sore be managed by us

A

keep an eye on it
if sore hasn’t healed in couple weeks, then refer to dentist

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27
Q

what are 2 sx of TMJ fx

A

ecchymosis
significant pain w clenching

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28
Q

how should you assess ecchymosis indicative of TMJ fx

A

if on skin = subacute
- took time to work its way up to surface

under tongue = acute
- check here first

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29
Q

triage suspected TMJ fx

A

put them in sling and stabilize as much as possible
- then red flag and send to ER for imaging (possibly surgery)

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30
Q

what are 6 red flags for suspected neck dx

A

pancoast tumor/neoplastic conditions
cervical fx
cervical myelopathy
ligamentous instabilities/injury
cervical vascular path
cardiac

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31
Q

what are 2 risk factors for neoplastic conditions

A

> 50yo
hx of cancer

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32
Q

what are 3 s/sx of neoplastic conditions

A

wt loss - unexplained 10# in 6mo
no relief w PT in past month
constant pain w no relief/night pain

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33
Q

what is a pancoast tumor

A

carcinoma in upper lung (apex) and can erode ribs and lower brachial plexus

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34
Q

4 associated s/sx w pancoast tumor

A

shoulder and arm pain
C7/C8 - T1 and ulnar n. palsy
- aka lower brachial plexus
weakness/neuropathies of intrinsic hand ms
horner’s syndrome
- miosis, ptosis, and anhidrosis of face

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35
Q

what are 3 risk factors for pancoast tumors

A

smokers
men
>40-50yo

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36
Q

triage for suspected pancoast tumor

A

refer to PCP urgently for imaging
- its giving yellow? or red but urgent
- depends on if anything that PT can treat going on besides the n palsy

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37
Q

what does proper imaging clearance of C-spine mean

A

full imaging scan
- ant/post
- lat
- open mouth (so see odontoid process)

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38
Q

risk factors for a cervical fx

A

major trauma
minor trauma in pts w
- severe osteoporosis
- prolonged corticosteroid use

both of these traumas didn’t have the proper imaging clearance

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39
Q

determining whether someone needs radiographs or is safe to treat depends on what:

A

age
type of injury and severity
amt of active motion/rotation have currently

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40
Q

triage for cervical fx

A

red flag
stabilize neck w hard collar
send to ER

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41
Q

what is cervical myelopathy

A

cord compression in c-spine
- worse w ext

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42
Q

4 risk factors of cervical myelopathy

A

loosely linked to:
- fam hx (stenosis common in arthritis)
- smoking
- repetitive stress or occupation
- trauma

43
Q

what population is cervical myelopathy more common in

A

elderly

44
Q

what are 5 s/sx of cervical myelopathy

A
  1. neck/shoulder pain and associated stiffness
  2. balance and gait issues related to inc LE tone
  3. UE - look at hand - paresis and atrophy dexterity (depending on location)
  4. incontinence
  5. UMN signs
    - (+) babinski or (+) clonus
45
Q

triage this patient: suspected cervical myelopathy, not presenting w incontinence or progressive neurological sx

A

send to PCP

46
Q

triage this patient: suspected cervical myelopathy, PT not working after 4wks

A

send to PCP

47
Q

triage this patient: suspected cervical myelopathy, aggressive neurological sx and/or incontinence

A

send to ER for urgent imaging
- may lead to decompression

48
Q

triage pt w suspected cervical myelopathy

A

if not responding to PT care after 4wks or neurological progression
- need to be referred to PCP
- if new dx referral back to PCP indicated

49
Q

what are ligamentous instability risk factors for the alar and transverse ligament (4)

A

major trauma/fx - tears or strains
immune insufficiency
os odontoideum - separation of dens from axis
down syndrome

50
Q

what 3 immune system insufficiencies can lead to alar and transverse ligament instability and how

A

RA or ankylosing spondylitis
psoriatic arthritis
systemic lupus erythematous (SLE)

immune response causes an irritation that eats away at the ligament causing it to loosen

51
Q

what are pediatric specific risk factors for alar and transverse ligamentous instability (2)

A

retropharyngeal abscess / grisel syndrome
- spontaneous AA dislocation

recurrent upper respiratory track infection

52
Q

what are 7 s/sx of upper cervical ligamentous instability

A
  1. severe limitation during neck AROM (all directions)
  2. cervical myelopathy
  3. occipital HA and numbness
  4. heavy head
  5. dizzy
  6. brain fog
  7. lump in throat difficulty swallowing
53
Q

function of the transverse and alar ligaments and what the danger is to their laxity as a result

A

hold odontoid process ant against bone
- if not, process moves into spinal cord and compresses at C1 and C2

respiratory centers are right there, if compressed could result in immediate death

54
Q

triage suspected upper cervical ligamentous instability

A

stabilize neck w hard collar
send to ER
- adequate imaging needed to see relationship of dens to arch of atlas post fx

55
Q

what are risk factors for vertebrobasilar insufficiency

A

analogous to those that inc risk of atherosclerosis
- age
- obesity
- smoking
- HTN
- DM
- hyperlipidemia

56
Q

what are s/sx of vertebrobasilar insufficiency

A

5 D’s
- dizziness
- diplopia - visual disturbances (nystagmus)
- dysarthria
- dysphagia
- drop attack

nausea, occipital HA, neck pain, facial numbness, ataxic gait

57
Q

triage pt for suspected chronic vertebrobasilar insufficiency

A

refer to PCP for further investigations

58
Q

triage pt for suspected vertebrobasilar insufficiency w progressive neurological signs

A

ER - suspecting tear

59
Q

what are the 6 main categories of red flags for the lumbar spine

A

trauma/fx/stress fx
progressive neurological signs
cancer
infection
vascular
systemic involvement

60
Q

what are risk factors for trauma/fx/stress fx in lumbar spine (4)

A

osteoporosis
prolonged steroid use
>70yo
trauma

61
Q

what are 3 progressive neurological signs specific to the lumbar spine

A
  1. cauda equina syndrome
  2. acute bowel and bladder dysfunction, retention/frequency
  3. foot drop / bilateral sciatica
62
Q

what are 2 sx of a lumbar fx

A

unrelenting pain
significantly limited ROM

63
Q

triage a suspected lumbar fx

A

send to ER for imaging

64
Q

what are risk factors for cauda equina

A

any spinal injury that inc risk as well as large disc herniation and spinal stenosis

65
Q

what are 6 s/sx of cauda equina

A
  1. saddle anesthesia
  2. acute onset urinary frequency/incontinence
  3. global LE weakness in L4-S1 (bilateral)
  4. radicular pain (frequently multiple levels)
  5. fecal incontinence
  6. gait disturbance
66
Q

triage a suspected cauda equina syndrome

A

ER for urgent imaging and likely surgical decompression if needed

67
Q

what are 2 specific sx to colon cancer

A

change in bowel sx
bloody stool

68
Q

incidence of colon cancer and the course of dz

A

3rd most common
common metastasis site

thoracic spine and rib mets common

69
Q

triage a suspected colon cancer

A

refer to PCP - that day and w follow up phone call

70
Q

what are 3 risk factors of infection or osteomyelitis

A

recent infection - UTI, pneumonia, cellulitis
recent surgery/procedure
IV drug use
immunosuppression

71
Q

s/sx specific to infection/osteomyelitis

A

no relief w rest

72
Q

triage a suspected osteomyelitis/infection

A

ER for emergent imaging
- cluster of findings w risk factors

73
Q

what is a common vascular red flag in the lumbar area

A

AAA

74
Q

2 risk factors for AAA

A

hx of vascular dz
>50yo

75
Q

s/sx of AAA (4)

A

LBP
pulsating mass
throbbing pulsing at rest or recumbent
>3cm

76
Q

what is a key part of the PT exam for objective data on AAA

A

abdominal exam

77
Q

triage a suspected AAA

A

ER today
- consider location and pt scenario of ambulance or not

78
Q

what are 4 systemic involvement flags relating to the lumbar spine

A

gynecologic reasons
urological
referred pain from abdominal
referred pain from lungs
ankylosing spondylosis

79
Q

what are 3 gynecological causes of LBP

A

endometriosis
ovarian cysts
ectopic pregnancy

80
Q

what are s/sx of gynecologic disorders (11 - just think to be familiar)

A

irregular periods
breast tenderness
n/v
chronic constipation
pain w defecation
fever, night sweats
drop in BP - bleeding
vaginal discharge
abnormal bleeding (spotting, heavy)
postmenopausal bleeding
urinary sx (dysuria, freq, urgency)

81
Q

what are male reproductive causes of LBP (3)

A

prostate path
- BPH
- prostate cancer

testicular cancer

82
Q

triage suspected gynecologic, prostate path, or testicular cancer

A

refer to PCP or urologist/gynecologist w/i week
- follow up w phone call

83
Q

what 5 sx are emergent referrals of gynecologic, prostate, or testicular path

A

unable to urinate
blood in urine or stool
unrelenting pain
progressive neurological signs
constitutional s/sx

84
Q

what is a risk factor for pancreatitis

A

alcohol abuse

85
Q

what is a risk factor for appendicitis

A

younger

86
Q

what are 6 s/sx of appendicitis and pancreatitis

A

rebound tenderness
- at McBurney’s point for appy
RLQ pain
abdominal exam reproduced back pain
constitutional signs
GI signs
possible temp

87
Q

triage a suspected appendicitis

A

ER today

88
Q

triage a suspected pancreatitis

A

ER today

89
Q

what are 4 types of abdominal hernias

A

umbilical
incisional
epigastric
diastis recti

90
Q

risk factors for abdominal hernias (3)

A

men
obesity
heavy lifting

91
Q

s/sx of abdominal hernia

A

pain or discomfort
- in groin
- when bending over
- w coughing
- w lifting

92
Q

PT exam for abdominal hernia

A

palpate - mass or hernia?
- have them do a sit up or bear down and see if it gets bigger (d/t intra abdominal pressure)

93
Q

triage suspected abdominal hernia

A

refer to PCP if undiagnosed

94
Q

what is a lung path that can refer to back pain

A

pneumonia

95
Q

3 s/sx of pneumonia to sus out if that is what is referring to back pain

A

s/sx associated w pulm sx
fever
auscultate

96
Q

triage a suspected ankylosing spondylosis

A

needs a medical diagnosis
- if suspect send to PCP

97
Q

what is a sx of ankylosing spondylosis

A

lot of stiffness
- >30min every morning for >3mo

98
Q

2 risk factors of ankylosing spondylosis

A

males > females
younger (20s)

99
Q

why does ankylosing spondylosis need a medical diagnosis

A

goes into active phases
- body attacks ligaments and lays down scar tissue

then goes into remission and get more stiff
- this is when we treat them, not when in active phase

100
Q

what is systemic involvement at the lumbar spine that can come from urologic system (3)

A

urolithiasis
renal tumors
perinephric abscesses

101
Q

what are red flag urgent situations in cases of sciatica

A

acute radiculopathy w urinary retention, saddle anesthesia, or bilateral neurological findings

102
Q

what are yellow flag complicated cases of back pain

A

age > 50
systemic s/sx
risk factors: fever, wt loss, hx of cancer, hematuria, adenopathy, IV drug use

103
Q

in cases of suspected stenosis (back/leg pain relieved by sitting) what are reasons that lead you to want imaging as opposed to just treating the sx? what flag is this considered?

A

intolerable sx or neurologic deficits
yellow flag

Med Screening (17 decks)

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