Case 12 - 67 yo F with neck pain

Question 1

Information gathering

Answer 1

Chief complaint

Onset

Precipitating event

Progression

Severity

Location

Radiation

Quality

Exacerbating and alleviating factors

Weakness/numbness

Recent trauma or heavy lifting

History of neck pain/trauma

Fever, night sweats, weight loss

HAs, dizziness, photophobia

N/V/D/C

PMHx

PSHx

FHx

Social Hx (occupation, tobacco, alcohol, drug use, diet and exercise)

Health maintenance

Current medications

Drug allergies

Question 2

Physical examination

Answer 2

Neck exam (inspection, palpation, stiffness, range of motion, Lhermitte’s sign by flexing neck, Spurling’s test by pivoting head to affected side and applying downward pressure)

Extremities (including palpation of peripheral pulses and range of motion)

Neurologic exam (motor, DTRs, sensory exam, Kernig’s and Brudzinksi’s signs for meningitis)

Question 3

Kernig’s (A) and Brudzinski’s (B) signs

Answer 3

Question 4

Closure

Answer 4

Imaging

Do you have any questions for me?

Question 5

Differential diagnosis

Answer 5

Disk herniation

Cervical fracture

Neck muscle strain

Question 6

Diagnostic work-up

Answer 6

XR - C-spine

MRI - C-spine

Nerve conduction studies

CBC, calcium and BUN/Cr (to detect anemia, hypercalcemia and renal failure, which may suggest multiple myeloma)

Serum and urine protein electrophoresis