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PTMMD > Cervicothoracic Medical Screening > Flashcards

Cervicothoracic Medical Screening Flashcards

1
Q

What are Red Flags?

A

Warning signs that may indicate need for re-evaluation by a medical specialist

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2
Q

What are Yellow Flags?

A
  • Warning signs used specifically to assess for pain-associated psychological distress
  • May indicate higher risk for delayed recovery of the development of chronic symptoms
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3
Q

When conducting a Cervicothoracic Medical Screen, what are medical considerations we should look for?

A

Viscerogenic Conditions
- Neoplastic conditions
- Inflammatory or systemic disease
- Cardiopulmonary conditions
- Cervical vascular pathology

Neuromusculoskeletal
- Spinal Fracture
- Upper Cervical Ligamentous instability
- Cervical Myelopathy

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4
Q

With Viscerogenic Conditions, what are the Neoplastic conditions for the Cervical Spine?

A
  • Metastatic lesions (leukemia, Hodgkin’s Disease)
  • Cervical bone tumors
  • Cervical Cord tumors
  • Lung Cancer; Pancoast’s tumor
  • Esophageal cancer
  • Thyroid cancer
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5
Q

With Viscerogenic Conditions, what are the Neoplastic conditions for the Thoracic Spine?

A
  • Mediastinal tumors
  • Metastatic lesions
  • Pancreatic cancer
  • Breast Cancer
  • Multiple Myeloma
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6
Q

What are the Clinical Findings for Neoplastic Conditions?

A
  • Age > 50 years
  • History of Cancer
  • Unexplained weight loss
  • Constant pain; no relief with best rest
  • Night Pain
  • Cant reproduce pain
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7
Q

What are clinical finding for those patients with Viscerogenic conditions with Inflammatory systemic disease?

A
  • Temperature > 37°C/98.6°F
  • Blood Pressure > 160/95 mmHG
  • Resting Pulse > 100 BPM
  • Resting respiration > 25 breathes per minute
  • Fatigue
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8
Q

What are clinical finding for those patients with Viscerogenic conditions with Pulmonary Conditions?

A
  • Tracheobronchial Irritation
  • Chronic bronchitis
  • Pneumothorax
  • Pleuritis involving the diaphragm
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9
Q

What are clinical finding for those patients with Viscerogenic conditions with Cardiac Conditions?

A
  • Angina
  • Myocardial infarction
  • Aortic aneurysm
  • Occipital migraine
  • Cervical artery ischemia or dissection
  • Arteritis
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10
Q

With Viscerogenic conditions, what is the pain pattern for Cervical Vascular Pathology?

A
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11
Q

With Viscerogenic conditions, what are the Risk Factors for Cervical Vascular Pathology?

A
  • Current or past smoker
  • Hypertension
  • High cholesterol
  • Migraine
  • Vascular anomaly
  • Family history of stroke
  • Oral Contraception
  • Recent infection
  • Recent trauma (Mid-moderate to include OMPT)
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12
Q

With Viscerogenic conditions, what are Subjective findings you may see with Cervical Vascular Pathology

A
  • Recent onset of neck pain and headache within 30 days
  • Moderate to high severity
  • “First and worst” neck pain and headache
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13
Q

When screening patients for Cervical Vascular pathology, what are the 5 Ds, 3 Ns, and 1 A?

A
  • Dizziness
  • Diplopia
  • Drop attacks
  • Dysphagia
  • Dysarthria
  • Numbness
  • Nystagmus
  • Nausea
  • Ataxia
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14
Q

With Viscerogenic conditions, what objective measure should be done for Cervical Vascular Pathology?

A

Vitals

Neurological Exam
- CN
- Reflexes/Pathological reflexes
- Strength
- Sensation
- Gait

Cervical active and passive ROM

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15
Q

With Neuromusculoskeletal conditions, what are the Risk Factors for Spinal Fractures in the Cervical and Thoracic Spine?

A

Cervical
- C1, C2 subaxial (C3-C7)
- Falls, MVA, cycling and diving accidents

Thoracic
- Thoracic (T1-T9), Thoracolumbar junction (T10-L2)
- Blunt trauma or High-velocity injuries
- Pathological fractures (e.g. Osteoporosis)

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16
Q

With Neuromusculoskeletal conditions, what are the Red Flags for Spinal Fractures in the Thoracic Spine?

A

Minor Trauma
- >50 years of age, Osteoporosis, Corticosteroids

Major Trauma

17
Q

With Neuromusculoskeletal conditions, In the Thoracic Spine, what are the Test-Item Clusters for Osteoporotic Compression Fracture?

A
  • > 52 years
  • No presence of leg pain
  • BMI <22
  • Does not regularly exercise
  • Female Gender

–2/5 or fewer positives (low likelihood ratio)
–4/5 positives (high likelihood ratio)

18
Q

With Neuromusculoskeletal conditions, what are the Risk Factors for Upper Cervical Ligamentous Instability?

A
  • Recent trauma
  • Throat infection
  • Congenital collagenous compromise (Down syndrome, Ehlers-Danlos)
  • Inflammatory arthritides (Rheumatoid arthritis and Ankylosing Spondylitis)
  • Recent neck, head, dental surgery
19
Q

With Neuromusculoskeletal conditions, what may you find in the Subjective history with Upper Cervical Ligamentous Instability?

A
  • Neck and head pain
  • Feeling of instability
  • Constant need for support
  • Worsening symptoms
  • Facial and limb paresthesia, reproduced with active neck movements
  • Overt LOB with head movements
  • Feeling of a lump in the throat or metallic taste
  • Limb weakness and loss of coordination
20
Q

With Neuromusculoskeletal, what should take part in the Objective Examination for Upper Cervical Ligamentous Instability?

A
  • Neurological Exam (CN, Reflexes, Derm/Myo, Gait)
  • Upper Cervical Lig. Integrity Testing
    –Sharp-purser Test (Sn 19-96%, Sp 71-100%)
    –Alar Ligament Stress Test (Sn 80%, Sp 76.9%)
    –Anterior Shear Test
  • Cervical AROM/PROM
21
Q

With Neuromusculoskeletal Conditions, what is the Pathoanatomy of Cervical Myelopathy?

A

Spinal Cord Compression
- Spondylosis with stenosis
- Disk herniation
- Spondylolisthesis
- Tumor

22
Q

With Neuromusculoskeletal Conditions, what may you find in the Subjective history with patients with Cervical Myelopathy?

A
  • Age >45 years
  • Gait unsteadiness
  • LOB and coordination
  • Limb weakness and paresthesias
  • Bowl and bladder dysfunction
23
Q

With Neuromusculoskeletal Conditions, what must take part in the Objective part?

A

Neurological Examination
- Reflexes/Pathological reflexes
- Strength (UE/LE)
- Sensation (UE/LE)
- Gait, Balance, and Coordination

24
Q

With Neuromusculoskeletal Conditions, what are the Test Item Clusters for Cervical Myelopathy?

A
  • Gait Deviation
  • (+) Hoffman
  • Inverted Supinator Sign
  • (+) Babinski
  • Age > 45 years

–1/5 positive (Low likely hood ratio)
–3/5 positive (High likely hood ratio)

PTMMD (40 decks)

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