Deck 1 Flashcards
Patient has sensitivity to light, nausea, bright spots in her field of vision, and blurry peripheral vision.After 20 minutes, she has severe pounding headache on the L side. Age 27, female. No prior hx of severe headaches. CN exam normal. BP 140/80
Which of the following would NOT be a likely cause of her symptoms?
A. Migraine
B. Optic disc pathology
C. Cervicogenic HA
D. Aneurysm
C. Cervicogenic HA
Patient has sensitivity to light, nausea, bright spots in her field of vision, and blurry peripheral vision.After 20 minutes, she has severe pounding headache on the L side. Age 27, female. No prior hx of severe headaches. CN exam normal. BP 140/80
What is the most likely diagnosis?
A. Migraine
B. Optic disc pathology
C. Cervicogenic HA
D. Aneurysm
A. Migraine
Patient has sensitivity to light, nausea, bright spots in her field of vision, and blurry peripheral vision.After 20 minutes, she has severe pounding headache on the L side. Age 27, female. No prior hx of severe headaches. CN exam normal. BP 140/80
Which imaging modality would be most recommended?
A. Radiograph
B. CT head without IV contrast
C. MRA without and with IV contrast
D. MRI head without IV contrast
B. CT without IV contrast
Characteristics diagnostic for migraine
- pulsing/pounding headache
- unilateral
- duration 4-72 hrs
- nausea
What is the most highly recommended imaging modality for a sudden onset of severe headache?
CT without IV contrast
With C1-2 rotary HVLAT to the left, the cavitation should occur where?
A. single audible pop of L unilateral C1-2
B. single audible pop of R unilateral C1-2
C. multiple audible pops unilaterally at C1-2
D. multiple audible pops bilaterally at C1-2
D. multiple audible pops bilaterally at C1-2
Concern for upper cervical instability. You perform a Sharp-Purser test and it is positive. Even though the test is positive, why should you be skeptical that the patient has upper cervical instability?
A. Test is highly specific but not sensitive
B. Test is only diagnostic for subjects with RA
C. Test is highly sensitive but not specific
D. Test is only diagnostic for subjects involved in MVA
B. Test is only diagnostic for subjects with RA
Sharp-Purser test: this test is a (sensitive/specific) test for compromise of what ligament?
specific
transverse ligament
Sharp-Purser test: only validated in what patient populations?
- RA
- Downs syndrome
Pt has (+) flexion rotation test for C1-2 PROM. Which will result in the most immediate relief?
A. DNF strengthening
B. C1-2 manipulation and upper thoracic manipulation
C. C1-2 mobilization and upper thoracic mobilization
D. AO manipulation
B. C1-2 manipulation and upper thoracic manipulation
For mechanical neck pain localized to C1-2, (mobilization/manipulation) showed better short term effects
manipulation
Which of the following statements is most true?
A. There’s inc risk of VBI for chiropractic care vs. care by a PCM
B. There’s no inc risk of VBI for chiropractic care vs. care by a PCM
C. There’s inc risk of VBI for chiropractic care
D. There’s inc risk of VBI for care by PCM
B. There’s no inc risk of VBI for chiropractic care vs. care by a PCM
When should you absolutely include the Sharp-Purser test in your evaluation of the cervical spine?
A. 7 yo with neck pain > 3 mos
B. 45 yo with RA and neck pain
C. 70 yo with chronic neck pain > 6 mos
D. 40 yo with acute neck pain after MVA
B. 45 yo with RA and neck pain
Sharp Purser test is most often indicated in patients with what?
neck pain and RA
All of the following patient types are at increased risk for upper cervical instability except patients with…
A. RA
B. Down syndrome
C. Metastatic cancer
D. Hx of cervical spine trauma
C. Metastatic cancer
Metastatic cancers are (commonly/rarely) associated with upper cervical instability
rarely
Metastatic cancers: can have primary tumors that predispose a patient to
spinal fracture
In regard to the VBI test, which of the following is most accurate?
A. The test is reliable and valid
B. Negative test rules out VBI
C. Positive test rules in VBI
D. The test has not been validated
D. The test has not been validated
What is the most commonly affected CN if a patient has an internal carotid artery dissection?
hypoglossal nerve (CN XII)
Which of the following is suggestive of alar ligament instability?
A. Neck-tongue syndrome
B. Positive Sharp-Purser test
C. Horner’s syndrome
D. (+) CFR test
A. Neck-tongue syndrome
Neck-tongue syndrome is highly suggestive of
alar ligament instability
Neck-tongue syndrome: what is it?
When the patient rotates their head, they may have numbness along half the tongue
A Sharp-Purser test can indicate compromise to what ligament in subjects with RA, Downs, or post-trauma
transverse ligament
Horner’s syndrome is common after what type of arterial dissection?
internal carotid dissection
Which of the following statements is accurate about upper cervical instability testing?
A. Both valid and reliable
B. Not valid or reliable
C. 100% sensitive
D. Yields more true positives than false negatives in all patient types
B. Not valid or reliable
When preparing to perform a cervical manipulation on a patient, you always put the patient in a pre-manipulative hold. What is your reasoning for this?
A. Assess comfort and response to position
B. Assess for cervical artery dysfunction
C. Assess for upper cervical instability
D. All of the above
A. Assess comfort and response to position
You are seeing a pt s/p MVA for neck pain. Neck flexion reproduces paresthesia into hands and feet. All of the following are appropriate except what?
A. Refer to ED
B. Perform Sharp Purser test
C. Fit pt for cervical collar
D. Refer for imaging
B. Perform Sharp Purser test
The Sharp Purser test could be dangerous if the patient has
- instability
- myelopathy
Which spinal segments do not have an intervertebral disc?
- occiput and 1st cervical vertebrae
- between 1st and 2nd cervical vertebrae
What ligament prevents the dens of the axis from pressing on the SC during active cervical flexion and is commonly compromised during trauma?
transverse ligament
When the transverse ligament is compromised, symptoms are typically reproduced with what motion?
cervical flexion
Where are the joints of Luschka located?
A. Cervical
B. Thoracic
C. Lumbar
D. All of the above
A. Cervical
Where specifically are the joints of Luschka located?
between 3rd and 7th cervical vertebrae
The joints of Luschka are commonly associated with what conditions?
- degenerative changes
- cervical radiculopathy
What part of the cervical IV disc is the weakest?
A. Anterior
B. Posterior
C. Lateral
D. Anterolateral
B. Posterior
In the cervical spine, the annulus fibrosis is (thick/thin) anteriorly and (thick/thin) posteriorly
thick anteriorly
thin/weak posteriorly
During passive cervical RR, where does the vertebral artery get compressed
A. between 1st and 2nd cervical vertebrae on the R
B. Between 1st and 2nd cervical vertebrae on the L
C. Between 2nd and 3rd cervical vertebrae on the R
D. Between 2nd and 3rd cervical vertebrae on the L
B. Between 1st and 2nd cervical vertebrae on the L
Rotating the head to the R will stress which artery on the LEFT
vertebrobasilar artery
