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Differential Dx > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

What are the four categories of MSK conditions?

A
  1. Fractures
  2. Infection
  3. Cancer
  4. Inflammatory arthritis
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2
Q

Rheumatoid arthritis is (asymmetrical/symmetrical)

A

symmetrical

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3
Q

(true/false) patients can have RA masking their OA

A

true

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4
Q

(OA or RA?) Which has an ulnar windswept deformity in the DIP joints?

A

RA

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5
Q

(OA or RA?) Which has heberden’s nodes?

A

OA

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6
Q

What are Heberden’s nodes?

A

Bumps at the dorsal surface of the distal DIP joint

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7
Q

What regions does a subarachnoid hemorrhage affect?

A

head, face, TMJ

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8
Q

What are risk factors for subarachnoid hemorrhages?

A

HTN

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9
Q

Symptoms:
- Sudden severe HA
- brief LOC
- aphasia
- nuchal rigidity
- fever
- photophobia
- weakness
- neural dysfuntion
- N/V

A

Subarachnoid hemorrhage

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10
Q

What is indicated for treatment when a subarachnoid hemorrhage is suspected?

A

ED

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11
Q

What is VBI?

A

blood supply to the back of the brain is disrupted

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12
Q

Symptoms:
- Dizziness
- HA
- nausea
- LOC
- vertigo lasting for minutes
- visual disturbance
- apprehensive with end range neck movement
- UNILATERAL hearing loss
- vestibular dysfunction

A

VBI

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13
Q

What is meningitis?

A

inflammation of the meninges

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14
Q

(true/false) Meningitis is not life-threatening

A

FALSE (it is)

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15
Q

Symptoms:
- stiff neck
- high fever
- HA
- N/V

A

Meningitis

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16
Q

What are the types of meningitis? Which one is most common?

A
  1. bacterial *
  2. Fungal
  3. Viral –> least serious
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17
Q

What type of meningitis affects 10% of those with AIDS?

A

fungal meningitis

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18
Q

Bacterial meningitis occurs when bacteria crosses where?

A

blood brain barrier (BBB)

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19
Q

What are clinical signs for meningitis?

A

Kernig’s sign and brudzinski’s sign

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20
Q

Describe kernig’s sign. What is a (+) test?

A

Take patient’s hip @ 90 degrees and passively extend the knee

(+): pain

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21
Q

Describe Brudzinski’s sign.

A

Take the patient’s head and passively flex it

(+): patient flexing their hips and knees (“scooting up”)

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22
Q

What is the common site of metastases from a primary brain tumor?

A

CNS (bioccipital or bifrontal)

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23
Q

symptoms:
- intermittent nausea with increasing duration
- HA
- sore throat
- neck/facial pain
- neuro deficits
- mentation/vision changes
- vomiting
- Sz
- changes in speech

A

primary brain tumor

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24
Q

What is the initial symptom of a primary brain tumor?

A

intermittent nausea with increasing duration

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25
Q

Symptoms:
- personality changes
- calculation difficulties
- word selection difficulties
- decreased VOR
- nystagmus
- photophobia
- HA

A

post-concussive syndrome, TBI, Subdural hematoma

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26
Q

Symptoms:
- moderate to severe Throbbing or pulsating
- Periorbital/retroorbital (unilateral)
- Nausea, vomiting, & vision disturbances
- Preceded by visual aura, vertigo, paresthesias
- photophobia and phonophobia
- Normal exam

  • Childhood to early adulthood
  • Can occur after 50 y.o. (peri-menopausal women)
  • Family hx present
A

migraines

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27
Q

symptoms:
- Dull pressure (vise or band around head)
- Mild-moderate bilateral or global pain
- non-pulsating
- Posture related
- frontal head onset
- tight band around the head

  • No assoc signs/sxs
  • Phonophobia or photophobia
  • Current or hx of: anxiety, depression, or panic disorder
A

tension HA

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28
Q

symptoms:
- Severe/unilateral; temple/periorbital region
- Attacks occurs cyclical patterns or “clusters”
- horner’s syndrome
- ipsilateral lacrimation
- ipsilateral nasal congestion
- ipsilateral miosis
- ptosis
- ipsilateral lid edema

A

cluster HA

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29
Q

How long can cluster headaches last?

A

Last weeks to months (usually followed by complete remission periods)…1 to 2 attacks/yr

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30
Q

What is another name for a cluster HA?

A

histamine HA

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31
Q

What type of headache is a cluster HA?

A

histamine HA

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32
Q

symptoms:
- Constant pain (usu unilateral; occ bilateral)
- Intensity varies (mild to severe) with activity/postures
- Worse w/ sustained postures and neck movement

Assoc w/:
Chronic tension, acute whiplash, IV disc disease, Facet joint arthritis

A

cervicogenic HA

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33
Q

What commonly causes AO dislocation? Which population is more common to get this?

A

High energy trauma

Children

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34
Q

(true/false) AO dislocation is common and not fatal

A

FALSE (it is fatal and not common)

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35
Q

What causes AA dislocation?

A

HyperEXT and distraction of the odontoid Fx or transverse ligament

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36
Q

AA dislocation is when the occiput moves (backward/forward) on C1

A

forward

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37
Q

What measurement of slippage is indicative of a traumatic dislocation with AA dislocations?

A

> 3 mm

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38
Q

What dislocation is common with down syndrome?

A

AA dislocation

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39
Q

What causes a Jefferson Fx of C1?

A

compression

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40
Q

What are other names for a jefferson Fx of C1?

A

Burst Fx
Neural arch Fx

41
Q

What is a jefferson Fx of c1?

A

bilateral breaks in the anterior and posterior arches

42
Q

(true/false) jefferson fx of C1 are associated with neuro deficits

A

FALSE

43
Q

What is the most common Fx of C2?

A

Hangman’s Fx

44
Q

What is the most common Cx spine fx?

A

hangman’s Fx

45
Q

What causes a hangman’s fx of c2?

A

hyperEXT/compression

46
Q

What is a hangman’s fx?

A

Fractures through the pedicles of C2 with anterior slip of C2 on C3

47
Q

(true/false) Hangman’s Fx are not associated with neuro deficits

A

FALSE (it is)

48
Q

What is a clue to dx of a hangman’s fx?

A

Teardrop fracture of inferior aspect of C2 or C3

49
Q

What causes Dens Fx?

A

hyperextension

50
Q

What fx is most associated with forward subluxation of C1 on C2?

A

Dens Fx

51
Q

What type of dens fx is most common?

A

base of dens

52
Q

What is the cause of a simple compression fx?

A

compression and flexion

53
Q

Anterior wedging of a vertebrae of ____ mm or more suggests a simple compression fx

A

> 3 mm

54
Q

Simple compression fx usually involve what in the spine?

A

Superior end-plate of the vertebral body

55
Q

What is a clay-shoveler’s fx?

A

Avulsion fx of c6 or c7 spinous processes that occurs as a result of ROT of the trunk relative to the neck

56
Q

(true/false) clay shoveler’s fx are associated with neuro deficits.

A

FALSE

57
Q

What causes a FLX teardrop fx?

A

combination of FLX and compression

58
Q

Where does a teardrop fragment come from?

A

Anteroinferior aspect of the vertebral body

–> rest of the body is posteriorly displaced into the spinal canal

–> interspinous spaces and facet joints are usually widened

–> disc space may be narrowed

59
Q

(true/false) FLX teardrop fx do not have neuro deficits

A

FALSE (they do)

60
Q

What are red flags for Cx fx or ligamenous instability?

A
  • major trauma
  • RA
  • down syndrome
  • positive ligament test
  • midline cx spine tenderness
  • apprehension/unable to actively ROT the head > 45 degrees
61
Q

What are red flags for Cx central cord lesions?

A
  • > 45 y/o
  • major trauma
  • incontinence
  • gait dysfunction due to LE hyperreflexia
  • UE sensory and motor deficits
62
Q

symptoms:
- Non-segmental Cspine movement
- Vertigo, vision changes, nystagmus w/ combined movements

A

Vertebral artery syndrome

63
Q

What can thyroid cancer cause?

A

torticollis

64
Q

Symptoms:
- ant neck pain that is worse with swallowing

A

thyroid cancer

65
Q

What is a red flag with thyroid cancer?

A

firm, immovable mass

66
Q

How many headaches/month leads to a primary PT referral for headache Dx?

A

15+ days/month

67
Q

(true/false) 20% of HA cases seen in outpatient pain management clinics are cervicogenic HA

A

True

0.4-4% of the general population experiences CG HA

68
Q

What type of HA has the highest annual prevalence?

A

tension

Cluster is the least prevalent

69
Q

What are the categories of HA?

A

Non-mechanical and mechanical

70
Q

What are causes of non-mechanical HA?

A
  • stroke
  • infections
  • MS
  • vasculitis
  • meningitis
  • emotional/psychological
  • visual disturbance
  • drug rebound
  • tumors
71
Q

What are causes of mechanical HAs?

A
  • trauma
  • degenerative changes in Cx spine
  • posture
  • TMJ related
72
Q

Whiplash headaches commonly originate from what joints of the neck?

A

C2 and C3

73
Q

When are cluster headache bouts?

A

spring or fall

74
Q

How long are bouts of cluster headaches?

A

15 minutes - 3 hours

75
Q

How long do migraines with aura occur?

  • visual phenomenon
  • ensory disturbance
  • speech disturbance
  • odd smell
  • cravings
  • euphoria
  • fatigue
  • neck stiffness
A

5-60 minutes

76
Q

What are the phases of a migraine with an aura attack?

A
  1. premonitory phase
  2. aura
  3. HA
  4. resolution phase
77
Q

Phase of migraine with aura attack:
- irritable
- depressed
- tired
- food cravings
- s/s can occur hours or days before the onset of HA

A

premonitory phase

78
Q

Phase of migraines with aura:
- HA gradually fades
- patient may feel tired, irritable, depressed
- difficulty concentrating

A

resolution phase

79
Q

What is the duration of migraines without aura?

A

< 72 hours

80
Q

What structures do cervicogenic HAs involve?

A
  • trigeminal nerve
  • structures Innv. by C1-C3
81
Q

presentation:
- constant pain
- unilateral burning, aching, throbing pain
- TTP over C2 and C3
- radiating pain to the posterior and lateral head
- pain over the neck, temple, frontal, and TMJ regions

A

occipital neuralgia

82
Q

Where does pain from occipital neuralgia originate?

A

suboccipitals

83
Q

What movements are normally worse when occipital neuralgia is present?

A

EXT and ROT

84
Q

What types of medications are commonly used for HAs?

A
  • antidepressants
  • antiepileptics
  • muscle relaxants
  • NSAIDS
  • narcotic analgesics
  • beta blockers
  • calcium channel blockers
85
Q

What are red flags for HA?

A
  • progressive worsening
  • sudden, severe onset
  • HA after exertion
  • > 50 y/o
  • Hx of major trauma and/or cancer
  • N/V
  • visual disturbance
  • sore throat/resp. infection
  • speech/swallowing problems

**- HA with the following: Weakness, convulsions, blackouts, mental changes, fever, rash, systemically unwell **

86
Q

What types of HAs have mild to moderate pain intensity?

A

tension

87
Q

What types of HA have moderate to severe HA?

A

migraines, cervicogenic

88
Q

What types of HA has excruitiating pain?

A

cluster

89
Q

What type of HA has shooting pain?

A

Occipital neuralgia

90
Q

What types of HAs last minutes to hours?

A

cluster
occipital neuralgia

15 minutes- 3 hours

91
Q

What types of HAs last hours to days?

A

migraines and cervicogenic

4 hours to 3 days

92
Q

What type of HA lasts minutes to days?

A

tension

30 minutes to 7 days

93
Q

What is the pain quality of tension HA?

A

squeezing
dull
pressing
band-like
non-pulsating

94
Q

What is the pain quality of migraines?

A

throbbing and pulsating

95
Q

What is the pain quality of cervicogenic HAs?

A

dull, deep, boring, non-throbbing

96
Q

What is the pain quality of cluster HAs?

A

drilling and boring

97
Q

What coefficient determines consistency b/n evaluators?

A

kappa coefficient

98
Q

Manual therapy is a good (short/long) term treatment for HAs

A

short term

Combination of manual therapy to cervical spine and exercises is effective: short and long-term.

Differential Dx (13 decks)

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