final exam Flashcards

1
Q

Adult Patient Acute Neck Injury X-RAYS ARE INDICATED

• When ANY of the following CCSR criteria are fulfilled:

A
  • Over 65
  • Paraesthesias in extremities
  • Not a simple rear end collision
  • Immediate cervical pain onset
  • Presence of midline cervical tenderness
  • Patient unable to actively turn head to 45 degrees in both directions
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2
Q

In Acute Neck Injury X-RAYS NOT INDICATED

• When ALL of the following CCSR criteria are fulfilled:

A
  • Simple rear end collision
  • Delayed cervical pain onset
  • Absence of midline cervical tenderness
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3
Q

X-rays Are Indicated In Acute Uncomplicated Neck Pain In Certain Circumstances

A

• If prior to seeing you the patients has had treatment with no success
take X-rays
• Consider X-ray or other tests in the absence of expected response to
your care or if there is worsening of symptoms
• BE SURE TO RECOGNIZE CHRONIC RECURRENT PAIN VERSUS ACUTE
PAIN

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4
Q

X-rays ARE Indicated In Nontraumatic Neck Pain AND Arm Pain or Paraesthesia
true or false?

A

true

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5
Q

X-rays ARE Indicated In Uncomplicated Subacute and Chronic Neck Pain With or Without Radicular Symptoms
true or false?

A

true when present for 4 or more weeks

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6
Q

X-rays ARE Indicated In Uncomplicated Subacute and Chronic Neck Pain With or Without Radicular Symptoms

A

⦿ Patient < 20 and> 50, particularly with S&S suggesting systemic
⦿ Significant activity restriction > 4weeks
⦿ No response to care after 4 weeks
⦿ Intractable pain, constant or progressive S&S
⦿ Neck rigidity in the sagittal plain in the absence of trauma
⦿ Cont. next slide
disease
Dysphagia
• Impaired consciousness
• Cranial n signs, pathological reflexes, long
tract signs
• High risk lig laxity populations/suspected
atlantoaxial instability
• Arm or leg pain with movement
• Suspected neoplasm
• Euro Commission radiation protection 118, 2001
• Suspected infection
• Kim JCCA 2004; 48(2): 132-6
• Suspected failed surgical fusion
• Progressive painful or structural deformity
• Elevated lab exam and positive S&S

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7
Q

X-Rays ARE Indicated with Recent (<2 weeks) Acute T, L, or T/L Trauma With ANY of the Following:

A
  • Moderate to severe localized back pain
  • Midline tenderness on palpation
  • Neurological deficits
  • MVA > 50 mph
  • Fall of 10 ft or more
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8
Q

X-Rays Are NOT Indicated with Recent (<2 weeks) Acute T, L, or T/L Trauma With:

A
  • Absence of pain
  • Normal ROM
  • Absence of neurological deficits
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9
Q

X-Rays are NOT Indicated in Acute Patients with Uncomplicated LBP, T pain

A
  • Uncomplicated means:
  • Nontraumatic
  • No neurological deficits
  • No Red Flags
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10
Q

or worsening after 4-6 weeks X-Rays are NOT Initially Indicated with Subacute or Chronic LBP, T pain AND No Previous Treatment Trial

A

⦿ When no prior treatment has been attempted, a trial period of 4-6
⦿ X-rays are indicated in the absence of expected treatment response
weeks is suggested prior to radiographs

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11
Q

X-Rays are NOT Initially Indicated with Nontraumatic Acute LBP AND Sciatica (Suspicion of Disc Herniation)

A
  • Unless the patient is > 50
  • Or has progressive neurological deficits
  • Or has unexpected response to care after 4-6 weeks
  • Or worsens with care
  • MRI would be of value
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12
Q

Signs of Disc Herniation: Need 3 of 5 (consistent to same N level)

A
  • Primarily leg pain
  • Leg pain confined to dermatome
  • Neural stretch tests recreate or exacerbate the leg pain
  • At least 2 of 4 neurologic findings consistent with dermatome
  • Muscle weakness
  • Decreased reflex
  • Abnormal pinwheel
  • Atrophy
  • MR or CT correlating to dermatome
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13
Q

X-Rays ARE Indicated with Suspected Degenerative Spondylolisthesis/ Lateral Recess Stenosis
true or false?

A

true

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14
Q

Signs of Degenerative Spondylolisthesis in Lumbar Spine

A
  • Primarily scleratogenous leg pain (one or both legs)
  • Comes and goes
  • Often reduced by leaning forward or sitting down
  • No neurologic findings
  • Very common
  • 4 F’s: fat, female (I didn’t come up with this ladies), forty, L4
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15
Q

X-rays ARE Indicated in Complicated (Red Flag) Thoracic and Lumbar pain

A

⦿ S & S of systemic disease especially <20 or >50
⦿ Absence of expected treatment results or worsening after 4-6 weeks
⦿ Significant activity restriction > 4 weeks
⦿ Unrelenting pain at rest
⦿ Constant or progressive S & S ⦿ Cont. next slide

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16
Q

X-rays ARE Indicated in Complicated (Red Flag)

A
  • Suspected inflammatory spondyloarthropathy
  • Suspected compression fracture
  • Suspected neoplasm
  • Suspected infection
  • Suspected failed surgical fusion
  • Progressive or painful structural deformity
  • Elevated lab and positive S & S
17
Q

Criteria for Inflammatory Back Pain

A
  • Morning stiffness for > 30 minutes
  • Improvement of back pain with exercise but not rest
  • Awakening in the second half of the night due to back pain
  • Alternating buttock pain
18
Q

Signs of Suspected Neoplasm

A
  • Considerable LBP > 50 • Hx of CA
  • Unexplained weight loss
  • Failure of conservative care
  • Intractable pain
  • ESR >50 mm/hr
  • Systemically unwell
  • Lymphadenopathy
19
Q

Special Circumstances for X-Ray

A

• Pt unable to give a reliable Hx
• Crippling cancer phobia
• Need for immediate decision about career or athletic future or legal
evaluation
• Hx of significant radiographic abnormalities elsewhere
• Hx of finding from outside study (abdomen, etc.) that requires spine
evaluation

20
Q

X-Rays Are NOT Indicated with Non Painful Non Progressive Adult Scoliosis

A

• In a skeletally mature patient, scoliosis is > 10 degrees