Week 3 Panopto

Question 1

Three characteristics of Angina

Answer 1

exercise
relieved by rest
chest pain

Question 2

Can unstable angina occur without activity?

Answer 2

Yes

It can even occur when asleep

Question 3

Atypical cardiac pain

Answer 3

Pain that is not associated with chest but may have other symptoms

Question 4

What percent of MI in men and women go unrecognized?

Answer 4

Men - 26%; Women - 34%

Half had no symptoms and half had atypical presentation

Question 5

What populations are more likely to have an atypical cardiac presentation?

Answer 5

Older patients, non-smokers, no previous history of angina

These patients had a mortality rate of 50% vs 18% in typical presentations

Question 6

Presentations of MI in the elderly

Answer 6

1/3 have a classic presentation
1/3 present primarily with confusion and restlessness
1/3 combination of dyspnea, palpitations, and sweating

Question 7

Intervention strategy

Answer 7

Ask for meds
Call 911
Chew a 325 mb aspirin
Monitor vitals
Give O2 or CPR
Alert PCP

Question 8

Big 5 orthopedic tests

Answer 8

Cervical compression
Cervical distraction
Shoulder abduction
Valsalva
ULTT - Median nerve

Question 9

Clinical deep referred pain in cases may present as

Answer 9

Pain present in an extremity but neuro tests are all largely negative

Question 10

5 clues for nerve pain

Answer 10

pain distal to the joint, stabby, dermatomal, greater than neck
Dermatomal paresthesia
SMR changes
Big 5 orthos
Change in Sx with spinal loading

Question 11

Possible pathoanatomical diagnosis for non-traumatic neck pain with no neuro findings

Answer 11

Facet syndrome (start)
Disc derangement (start)
Sprain
Strain

Question 12

Cervical distraction should not increased pain in what Dx?

Answer 12

Disc derangement

Question 13

Three common biomechanical Dx to look for

Answer 13

Joint dysfunction
Myofascial pain syndrome
Myospasm

Question 14

What information should not be provided for a biomechanical diagnosis of cervical joint dysfunction?

Answer 14

Do not give level or listing

Do not give restriction

Question 15

What are complicatiors?

Answer 15

Pre-existing non-painful findings

Question 16

Key exam findings for facet syndrome

Answer 16

Tenderness over facet (palp)
Palpable local spasm (palp)
Joint restriction
Extension or compression may reproduce or worsen local pain

More than one of these

Question 17

Pertinent negatives for facet syndrome

Answer 17

Radicular syndrome
Neuro deficits
Distal arm sx that are reproduced with orthopedic tests or tension tests

Question 18

Treatment for facet syndrome

Answer 18

Manipulation
Activity/behavior modification (avoid extension)
STM on tight muscles
Isotonic for neck muscles

Question 19

Clues for C8 radiculopathy

Answer 19

Weak finger flexors

Paresthesia to the pinkie

Question 20

Three Most common causes of cervical radiculopathy

Answer 20

Osteophytes spurs
Soft disc herniations
Spinal Canal stenosis

Question 21

B List for cervical radiculopathy (5)

Answer 21

Tumor
infection
NR adhesions
Trauma to NR 
Structural Instability (trauma, inflammatory arthritis, degeneration)

TINTS

Question 22

Clues that a disc may be injured

Answer 22

Flexion sensitivity pattern
Positive Valsalva
Aggravated by  cervical compression
Relieved by cervical distraction
Midline tenderness (not facets)

Question 23

Most common age for cervical disc herniations

Answer 23

40-60 years old

Question 24

Most dependable clues for identifying a specific NR

Answer 24

Deficits and paresthesia

Question 25

C8 radiculopathy LRs

Answer 25

Sensory loss of little finger (41.2) Diminished triceps reflex (28.3) Weak finger flexion (3.8)

Question 26

Pure patches for C6, 7, 8

Answer 26

C6 - Thumb, LR 8.5 C7 - Poor LR C8 - 41.8

Question 27

Which of the Big 5 Orthos are more specific to NR/disc problems than sensitive?

Answer 27

Maximum cervical compression and lateral compression Cervical distraction Shoulder abduction Valsalva

Question 28

Which of the big 5 orthos are more sensitive for NR/disc problems than specific?

Answer 28

ULTT - median

Question 29

What are the three best LRs for NR/disc in the big 5 orthos

Answer 29

LR +4.4 - Cervical distraction LR +3.5 - Maximum cervical distraction LR +3.5 - Valsalva

Question 30

5 broad indications for taking a radiograph

Answer 30

``` Moderate to high load trauma Red flags for disease Cord signs/symptoms Radicular signs/symptoms Nonresponsive cases ```

Question 31

Indications for MRI

Answer 31

LOW - signs/sx of radiculitis (medical necessity) MED - only if there are deficits (doesn't meet standard of care) HIGH - only if there is suspicion of myelopathy, progressive [motor] deficit, non-response to care, presurgical exam (standard of care) - severe motor weakness on the first visit

Question 32

Motions to perform with McKenzie protocol

Answer 32

Protrusion and retraction Seated retraction with extension mb any other direction

Question 33

How long should you wait to start neuromobilization?

Answer 33

Usually a couple of weeks

Question 34

Is McKenzie an immediate care approach?

Answer 34

Yes

Question 35

Prognosis for conservative care of cervical disc herniations

Answer 35

Good for improvement in a few weeks | If not improved for 3 months refer for surgical consultation

Question 36

Causes of pain paresthesia into the hand

Answer 36

Disc/NR Lower brachial plexus injury Ulnar nerve entrapment MFTPs (lats, serratus, pecs)

Question 37

Language for plexus, nerve, NR injuries

Answer 37

- plexitis - neuritis - neuropathy

Question 38

What device can be used to associate MFTPs and hand symptoms using the armpit?

Answer 38

Thumb on pecs Palm on SA little fingers on latissimus dorsi

Question 39

What device can be used to associate MFTPs and hand symptoms using the neck

Answer 39

Thumb on scalenes Palm on supraspinatus Fingers on infraspinatus

Question 40

LR ratio for C6 radiculopathy

Answer 40

LR +14.2 - decreased biceps or brachioradialis reflex LR +8.5 - sensory loss over the thumb LR +2.3 - weak wrist extension