Deck 2 Flashcards
Which of the following are not absolute contraindications for manual therapy?
A. Osteomyelitis
B. Nerve root compression with increasing neuro deficits
C. Influenza with fever
D. Pregnancy
D. Pregnancy
Which of the following would indicate the patient is not a good candidate for cervical manipulation
A. Mechanical neck pain that started 30 days ago
B. Severe spondylosis without radiculopathy
C. Radicular symptoms to mid-forearm
D. Score on NDI of 10
C. Radicular symptoms to mid-forearm
Which of the following has the lowest risk of causing post-treatment adverse reactions?
A. NSAIDs for OA
B. Mid-lower cervical manipulation in mid-ranges
C. Amitriptyline
D. C1-2 cervical manipulation at end-range rotation
B. Mid-lower cervical manipulation in mid-ranges
Cervical manipulation where has been associated with a higher risk of cervical artery dissection
C1-2 ENDRANGE rotation
During cervical artery dissection, which arteries would you expect to be involved?
- vetebrobasilar
- internal carotid
The vertebrobasilar artery is the (anterior/posterior) arterial system that perfuses what?
- posterior arterial system
- perfuses the hindbrain
The internal carotid artery is the (posterior/anterior) arterial system and perfuses what?
- anterior arterial system
- perfuses the cerebral hemispheres and eyes
Differentiating dizziness from cervical artery dissection or nonvascular vestibular dizziness. What would you expect if the pt had dizziness secondary to CAD vs. nonvascular cause?
A. Dizziness reproduced with AROM cervical rotation and AROM trunk rotation with head stable
B. Dizziness is not reproduced with AROM cervical rotation but IS reproduced with active trunk rotation only with head stable
C. Dizziness is reproduced with AROM cervical rotation, but not reproduced with AROM trunk rotation with head stable
D. Dizziness decreases with cervical rotation but increases with cervical flexion
A. Dizziness reproduced with AROM cervical rotation and AROM trunk rotation with head stable
Pt with posterolateral neck pain after MVA. Concern for VBI. VBI testing is negative. What can you infer from the findings?
A. You can r/o vertebrobasilar insufficiency because the tests have high sensitivity
B. You cannot r/o vertebrobasilar insufficiency because the tests have low sensitivity
C. You can rule in vertebrobasilar insufficiency because the tests have high specificity
D. You cannot rule in vertebrobasilar insufficiency because the tests have low specificity
B. You cannot r/o vertebrobasilar insufficiency because the tests have low sensitivity
VBI testing has (high/low) sensitivity
LOW sensitivity
Pt with neck pain starts developing sx’s related to hindbrain ischemia, all of the following CN would likely be involved except…
A. CN V and VI
B. CN III and IV
C. CN XI and XII
D. CN I and II
D. CN I and II
Symptoms related to hindbrain commonly affect the cranial nerves that originate in what ares?
vertebrobasilar
VBI is unlikely to cause dysfunction of which cranial nerves?
I and II
50 yo with inc’d neck pain after falling backwards off a chair. Has been in 3x MVA over the past 2 years. (+) hx of HTN. Describes pain as different than before. Denies dizziness, diplopia, dysarthria, dysphagia, drop attacks, facial numbness/tingling, nausea, nystagmus. What condition can you rule OUT with this information?
A. Cervical artery dissection
B. WAD
C. Instability
D. Cannot rule out any pathology above
D. Cannot rule out any pathology above
What CN is most commonly affected during an acute dissection of the internal carotid artery?
CN XII (hypoglossal nerve)
4 most commonly affected CN with internal carotid artery most to least
- CN XII (hypoglossal)
- CN IX (glossopharyngeal)
- CN X (vagus cranial nerve)
- CN XI (accessory nerve)
Which CN would not be affected by an internal carotid artery dissection?
A. CN I
B. CN II
C. CN III
D. CN IV
A. CN I
CN I aka
olfactory nerve
Which syndrome is common after internal carotid artery dissection and results in ptosis, mitosis, anhidrosis, and enopthalmosis?
A. Parasympathetic nervous system response
B. Sympathetic nervous system response
C. Locked in syndrome
D. Horner’s syndrome
D. Horner’s syndrome
Horner’s syndrome typically occurs due to changes in (sympathetic/parasympathetic) activity
parasympathetic
61 yo Caucasian woman with neck and shoulder pain. Radiates into 4th and 5th digits of L hand, started 4 weeks ago. (+) night pain but can sleep through it. Intense at first but overall improved and intermittent. Pain started as a knot between shoulder blades
Aggs: weight training, lifting arms, opening jar, lifting heavy with personal trainer
Denies hx of cancer. Has dx of osteopenia of spine and hips. Has arthritis in hands and lower spine
Meds: gabapentin, seeking counseling for depression
Cervical ROM restricted. Reproducible radiculopathy with L cervical rotation
Most likely dx?
A. Spondylosis
B. C7-T1 disc herniation
C. Radial neuropathy
D. C5-6 disc herniation
A. Spondylosis
What kind of malignancy will cause radiculopathy in a C8-T1 nerve root distribution?
A. tumor affecting prostate
B. tumor affecting thyroid
C. pancoast tumor affecting the lung
D. Wilms’ tumor affecting the kidney
C. pancoast tumor affecting the lung
What visceral structure can cause radiculopathy in a C8-T1 nerve root distribution pattern?
A. Liver
B. Spleen
C. T4 syndrome
D. Heart
D. Heart
Which is not part of the cluster of tests used to rule in cervical radiculopathy?
A. Spurling’s
B. Distraction
C. ULTT A
D. AROM cervical rotation < 45˚
D. AROM cervical rotation < 45˚
If the pt tested positive for cervical radiculopathy, what is the best intervention for this patient?
A. Manipulation or mobilization of cervical spine and chin tucks
B. Constant mechanical traction
C. Repeated cervical extension (at least 10 reps)
D. Intermittent mechanical traction
D. Intermittent mechanical traction
Cervical radiculopathy patient. Pt reports her neck feels great and hasn’t had numbness in her hand. Now c/o inability to move the thumb. Normal sensation. No swelling or atrophy. CTS testing negative. UA to oppose tip of thumb to tip of index finger. What nerve has been affected based on these symptoms?
A. Ulnar nerve
B. Anterior interosseous nerve
C. Posterior interosseous nerve
D. Median nerve
B. Anterior interosseous nerve
Patient no longer has radiculopathy in 4th and 5th digits, but despite STM and stretching, has not regained function of her thumb. What is the most likely dx if no nerve entrapment or neuropathy is present?
A. Ulnar half of FDP rupture
B. Adductor pollicis rupture
C. FPL rupture
D. FDS rupture
C. FPL rupture
MRI revealed an intact FPL tendon. Suspicion that the patient cannot bring the thumb to tip of finger together due to nerve pathology. What is the most likely dx?
A. Parsonage-Turner syndrome
B. Wartenburg’s disease
C. CRPS
D. Guillain-Barré syndrome
A. Parsonage-Turner syndrome
If patient is older, should suspect what as primary dx over a disc herniation?
spondylosis
Arthritic changes: more common in cervical or thoracic/lumbar?
cervical
Disc herniations are most common in which region
lumbar spine
Pancoast tumor: pulmonary symptoms
rare
This serious pathology can often mimic radicular symptoms into the arm
MI
Metastases (do/do not) commonly occur in the cervical region
do not
The liver typically causes increased pain where?
RUQ
can refer to neck
Patient with pancreatitis commonly present with pain where?
back pain
upper abdominal pain
In the CPG, repeated cervical extension for centralization was given this recommendation
C
With anterior interosseous nerve involvement, will have weakness of which muscles?
- FPL
- FDP
- pronator quadratus
A person with ulnar nerve neuropathy will likely have paresthesias in digits 4 and 5 and may have a (+) ____ sign
Wartenberg
posterior interosseous nerve entrapment aka
supinator syndrome
Median n entrapment - motor or sensory?
both
In ulnar neuropathy, what muscle may be affected, demonstrating positive Froment’s sign
adductor pollicis
FDS flexes the finger where?
PIP
Wartenberg’s syndrome is characterized by entrapment of
sensory branch of radial nerve
CRPS may be suspected with changes in
skin temperature
color
swelling
According to the McKenzie method, a pt with neck pain can be classified into one of 3 syndrome. Which is not one of these syndromes?
A. Derangement
B. Dysfunction
C. Disorder
D. Postural
C. Disorder
According to the McKenzie method, if a patient’s unilateral radicular symptoms centralize from their hand to their elbow with repeated cervical retraction, the pt should be classified into which group?
Derangement
68M presents with FHP and hx of decompression and laminectomy at C3-4 2 years ago. Pt only has PAER with cervical retraction. According to McKenzie method, which group should you classify the patient?
Dysfunction
Pts are classified into dysfunction group if they experience
PAER
68M presents with FHP and hx of decompression and laminectomy at C3-4 2 years ago. Pt only has PAER with cervical retraction. According to McKenzie method, which would be the best treatment?
A. C3 PA grade II mobilizations
B. Manual traction
C. PROM upper cervical flexion stretch
D. Cervical retraction
D. Cervical retraction
If a patient fits into a dysfunction syndrome, should perform exercises (into/away from) direction that causes their pain
into
Which of the following is not a sign of cervical myelopathy?
A. Gait disturbance
B. Grade 1+ biceps tendon reflex
C. + Babinski
D. + Inverted supinator
B. Grade 1+ biceps tendon reflex
1+ reflex indicative of (LMN/UMN) pathology
LMN
Pt with R lateral cervical foramen narrowing at C5/6 resulting in radiculopathy. What is the most likely position of the patient’s head to avoid reproduction of their radiculopathy
A. Head rotated and SB to R, slightly flexed
B. Head rotated to L and SB to R, slightly flexed
C. Head rotated to R and SB to L, slightly flexed
D. Head rotated and SB to L, slightly flexed
D. Head rotated and SB to L, slightly flexed
Pt with pain between shoulder blades and numbness of L hand in a stocking glove pattern. What is the most likely diagnosis?
T4 syndrome
The pattern of paresthesias for T4 syndrome can mimic symptoms of…
DM
radiculopathy
Which muscle is not innervated by the anterior interosseous nerve branch?
A. Radial half of FDP
B. Pronator teres
C. FPL
D. Pronator quadratus
B. Pronator teres
The pronator teres is innervated by what nerve?
median nerve
This nerve branches off the median nerve after it passes through the pronator teres muscle
anterior interosseous nerve
When ruling out sinister pathology, a PT should use highly sensitive tests to decrease the…
A. likelihood of a false negative result
B. likelihood of a false positive result
C. likelihood of a true negative result
D. likelihood of a true positive result
A. likelihood of a false negative result
Highly specific tests help to rule (in/out) those without a condition
out
55 yo M with pain and B radicular symptoms into UE/LE, resolve completely with sitting. New onset weakness B LEs causing gait changes. Now walks with WBOS due to poor balance. Clinical exam significant for sensory loss in nonspecific pattern. What is the most likely dx?
cervical myelopathy
Whenever a patient has B symptoms in the legs, you should consider
cervical myelopathy
lumbar stenosis
Pt has thoracic spine pain. Long term hx of corticosteroid use. What would increase your suspicion of a compression fx?
A. previous hx of back pain
B. insidious onset
C. male
D. Age > 50
D. Age > 50
