CSP

Question 1

Visceral causes of CSP Px

Answer 1

Thyroid
Diaphragm
Lung
GORD

Question 2

Hyperthyroid

Answer 2

Inc. sweat
Heat intolerance
Nail thickening
Diarrhoea
Anxiety
Short/light periods

Question 3

Hypothyroid

Answer 3

Fatigue
Inc. sensitivity to cold
Dry skin
Constipation
Mms weakness/joint Px
Issues with memory/co-ordination
Brittle nails
Decreased sweating
Irregular and heavy periods

Question 4

Diaphragm irritation

Answer 4

Due to C3-5 phrenic nerve
Liver, spleen, gallbladder, pancreas, stomach all irritants

Question 5

GORD

Answer 5

Heartburn
Acid reflux
Sour taste in mouth
Bad breath
Bloating
Feeling/being physically sick

Question 6

Lung

Answer 6

Referral to neck, jaw and chest
Px when breathing
Dry cough
SOB
Fatigue
Cynosis
Shallow breathing

Question 7

Vascular causes

Answer 7

Angina
MI
Stroke
CAD
VBI
H/A

Question 8

Angina
Stable/Unstable
Symptoms

Answer 8

Stable - during activity, up to 5 mins, relived by rest.
Unstable - occurs at rest, 20 mins or longer, medical emergency due to risk of heart attack or failure.

Burning
Squeezing
SOB
Fatigue
Dizziness/nausea

Question 9

MI
Rf:
Symptoms:

Answer 9

Men 45+, women 55+
Smoking, hypertension, family Hx, high cholesterol, diabetes, alcohol, stress, sedentary life.

Tightness in chest
Nausea/vomiting
SOB
Cold sweat
Dyspnoea

Question 10

Normal cholesterol levels

Answer 10

Nice guidelines recommended LDL to be below 2.0 mmol/L
Others say 4.0mmol/L

Question 11

Type 1 diabetes blood sugar levels

Answer 11

Upon waking up - 5-7mmol/L
Before meals - 4-7
90+ post meals - 5-9

Question 12

Type 2 levels

Answer 12

Before meals - 4-7 mmol/L
90+ after eating - under 8.5 mmol/L

Question 13

Normal blood sugar levels

Answer 13

Between 4.0 to 5.4 mmol/L when fasting.
Up to 7.8 mmol/L 2 hours after eating.

Question 14

Pre-diabetes levels

Answer 14

Prediabetes (fasting): 5.5 to 6.9 mmol/L

Question 15

Stroke

Answer 15

F - facial drooping
A - arms weakness in LEXT or UEXT
S - speech
T - time, act fast

5Ds, 3Ns, 1A
Balance and co-ordination issues
Astrogenis - can’t identify by touch

Question 16

CAD

Answer 16

Pts younger than 55
Acute sudden H/A
Moderate severe progressive neck Px
Symptoms brought about by ext/rot
5Ds, 3Ns, 1A

RF: exposure to minor trauma, infection, genetics, migraine, CVS RF

Vertebral artery - unilateral neck Px
Internal carotid - unilateral neck Px and temple Px

Question 17

VBI

Answer 17

Inadequate blood flow to post circulation of Willis. (Vertebral + Basiliar arteries).
Atherosclerosis biggest RF - smoking, hypertension, age, genetics, hyperlipidema.

5Ds, 3Ns, 1A
Long standing neck stiffness
Hx of cvs
Ext or Rot causes symptoms
Risk of falls or stroke

Question 18

H/A

Answer 18

Tinnitus? Nosebleeds? Visual changes?
CVS risk factors?

Question 19

SNOOPPPP

Answer 19

Systemic signs
Neurological deficit
Older than 50
Onset of H/A is sudden and intense
Papilledema
Positional. Worse when lying down
Pattern change. Dull ache to stabbing
Precipitated by valsalva manoeuvre

Question 20

CSP Red flags

Answer 20

Fractures
Instability
CAD
Malignancy
Infection
Auto-immune
Myelopathy

Question 21

Fractures trauma

Answer 21

Motor vehicle collision (high speed <60 MPH, rollover, ejection)

Question 22

Fracture high risk factors

Answer 22

Age over 65
Dangerous mechanism
Paraesthisia in extremities
Inability to move 45deg left or right

Question 23

factors that don’t point to fracture

Answer 23

Ambulatory at the time
Delayed onset of neck pain
Absence of midline C-Spine pain

Question 24

CSP instability risk factors

Answer 24

Trauma
RA, AS
Connective tissue disorders
Congenital
Down’s syndrome

Question 25

CSP instability sings

Answer 25

Past medical history Feeling of laxity (better with support, locking, clicking, clunking) Inability to hold head up Significant muscular tension Occipital headaches Pain (referred, radicular or myelopathy)

Question 26

CSP instability objective signs

Answer 26

Pain with ROM Instability with movement: clunking, jerking Hyper mobility with mobilisation and palpation Neuro signs

Question 27

CAD 2 vascular symptoms

Answer 27

Posterior: vertebral artery - 20% to brain Anterior: carotid (Int/Ext) - 80% supply to brain

Question 28

Subjective signs

Answer 28

Haven’t felt this before, not mechanical pain 5Ds 3Ns 1A Risk factors – Smoking, CVR, migraine like H/A, diabetes, hypertension, anti-coagulants, clotting disorders. Neurology – Gait disturbance, loss of balance, co-ordination, short-term memory loss

Question 29

Objective signs

Answer 29

Babinski and clonus High BP Palpate ICA pulse – larger pulse pressure and faster Cranial nerve tests (Lower cranial nerve dysfunctions (VIII-XII) General neurology (Gait, co-ordination, proprioception)

Question 30

Systemic RED flags Malignancy, infection, Auto-immune

Answer 30

Night pain First presentation: Under 20 or over 55 Constant, progressive, Non-mechanical symptoms Thoracic pain Previous Hx of Ca., Drug abuse, HIV, steroids Systemic signs (Fever, exhaustion, weight loss) Multi-level neuro changes (widespread changes, myotomes > dermatomes)