Exam 2: UQS Flashcards
(78 cards)
The “Fundamental Four”
Present Illness (Chief complaint)
Past Health History
Family Health History**
Personal/Social History**
The “Sacred Seven”
Setting or Onset
Location/Radiation
Severity
Quality
Chronology/Timing
Associated Symptoms/Modifying Factors
Current Medical Management
location of pain
Local; Referred; Radicular; Regional
Canadian Cervical Spine Rules - high risk factors
age > 65
dangerous MOI
parathesia in the extremities
Red FlagsSpinal Neoplasm
Medical history is (+) for cancer, even if cleared or thought to be in remission
Night pain and other atypical pain manifestations
Worsening Pain
Unexplained weight loss
Fatigue, malaise, unwellness
No response to conservative management
Red Flags(Fractures/Dislocation)
Trauma, sufficient energy exchange
MVA, Falls, Direct blow or impact
Severe limitations of motion all planes
Muscular spasm; unwillingness to move
Deformity may be present
Must be ruled-out by diagnositc imaging
Canadian Cervical Spine Rules - low risk factors
safe to assess ROM
simple rear end motor vechile accident
normal sitting posture in ER
amb at anytime during injury
delayed onset of neck pain and absence of midline tenderness
Red FlagsInflammatory/Systemic Disease
Body Temperature > 100 F
Blood pressure > 160/95 mmHg
Resting pulse > 100 bpm
Resting respiration > 25
Redness, warmth, swelling
Discoloration (eg. Jaundice)
Fatigue, malaise, unwellness
Red FlagsReferred Pain: Visceral Cardiac Considerations
Chest, neck and arm pain
Jaw, posterior thorax, epigastrium
Classically, left sided, C8
angina
Associated symptoms:
Dyspnea, lower extremity edema, SOB, fatigued, syncope
Dysarthria
where you have difficulty speaking because the muscles you use for speech are weak
Dysphagia
hard time swallowing
Referred Pain: Visceral gall bladder
Recurrent, right thoracic/lower rib region, right scapular region
Increased intensity following meals
Fatty, greasy foods tend to worsen symptoms
At risk:
Obese, women, in their 40’s
Associated symptoms:
Nausea/heartburn, vomiting/diarrhea, difficulty swallowing, jaundiced, rectal bleeding/stool changes
Referred Pain: Visceral lungs and associated structures
Thoracic and chest regions
Possibly cervical region or shoulders
Pancost Tumors
Pulmonary Disease
Rarely manifests purely as pain
Infections, pleurisy, cancer
Difficulty with respiration, cough
Hoarseness, sore throat, wheezing
is Multi-segmental weakness
a red flag
yes
is double vision normal
no this is abnomral
what is Myelopathic Involvement
the result of compression of the spinal cord and nerve roots caused by inflammation, arthritis, bone spurs and spinal degeneration due to aging
Myelopathic Involvement presentation
More common in the cervical region than the thoracic region
Gait and balance disturbances, generalized weakness
May not be associated with any radiating pain
Bilateral P/N Arms and/or legs
May have local radicular involvement
Myelopathic Involvement positive test
(+) Signs of UMN involvement
Hoffman’s, Hyper-reflexic DTR’s, Clonus
Shoulder Component
Symptoms are primarily affected by movements of the shoulder joint
Stiff shoulder; Weakened shoulder; Unstable shoulder
Symptoms are essentially unaffected by head movements/positions
Thoracic Component
Symptoms may be diffuse and hard to localize without direct palpation
Thoracic Dermatome: Circumferential
Rib Involvement: Unilateral radiation
Symptoms may be affected by breathing
Vertebrobasilar insufficiency (VBI)
is defined by inadequate blood flow through the posterior circulation of the brain, supplied by the 2 vertebral arteries that merge to form the basilar artery.
symptoms of VBI
headache nausea redness of the face
how do you test VBI
hautards test
