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Common Condition Revision > Head/Neck > Flashcards

Head/Neck Flashcards

1
Q

What are other common DD’s next to a HA/ Head pain?

A
  • Upper respiratory tract infection
  • Maxillary sinusitis
  • TMJ dysfunction
  • Anaemia
  • Depression
  • Dental disorders
  • Visual disorders (refractive error, glaucoma)
  • Exertional HA
  • Trigem neuralgia
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2
Q

What are some serious conditions to consider when a suspected HA comes in?

A
  • CAD
  • Subarachnoid or intracranial hemorrhage
  • Myocardial ischemia
  • Hypertensive Crisis
  • Keep in mind that interneurons link the solidary nucleus and trigeminal one
  • Phaeocycotoma – tumor of the chromaffin cells
  • Intra-cerebral tumor
  • Meningitis
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3
Q

What are some other factors often missed when patients have HA’s?

A
  • TMJ
  • Refractive errors
  • Glaucoma
  • Dental disorder
  • Trigeminal neuralgia
  • Exertional – sex or exercise
  • Depression
  • Anemia
  • Metabolic disorders- diabetes or thyroid
  • Drugs
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4
Q

What are some drugs/chemicals that can lead to HA’s?

A
  • Alcohol
  • Caffeine
  • Nicotine
  • Analgesics (rebound headaches) – aspirin, codeine, paracetamol
  • Antibiotics
  • Combined COOP
  • Vasodilators
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5
Q

HA Who am I:
S: unilateral
Q: pulsating quality
I: moderate to severe
R: Vision, senses and motor system
T: last minutes, recurrent
N: tingling in the hands and feet, vertigo, ringing in ears, double vision
Aggravating factors: medication, lack of sleep, bright louds, loud sounds, certain foods, hunger or dehydration
Relieving factors: medication, manual medicine.

A

Migraine with Aura

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6
Q

How are migraines with Aura diagnosed (criteria)?

A
  • Aura symptoms: visual, sensory, speech and/or language,
  • Atypical Aura symptoms: motor, brainstem, retinal
  • 5 HA’s to be diagnosed
  • Aura symptoms can last up to 1 hr
  • Fully reversible
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7
Q

Suspected Aetiology of migraine with Aura

A

It’s believed that the migraine with visual aura is like an electrical or chemical wave that moves across the part of your brain that processes visual signals (visual cortex) and causes these visual hallucinations. Many of the same factors that trigger migraines are responsible for triggering migraines with aura, including stress, bright lights, some foods and medications, too much or too little sleep, and menstruation.

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8
Q

What are the three pathophysiological theories of migraines?

A
  1. Vascular dysregulation – issue to do with vasoconstriction to the brain ischemia causing the aura and vasodilation is the pounding and pulsating (old)
  2. Spreading cortical depression – self prorogating depolarizing wave in their brain (also gone to back burner)
  3. Neuronal sensitization – both peripheral and central mechanisms are likely involved with the trigeminocervical nucleus. Having issues with pain modulation pathways and nociception activation (popular theory)
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9
Q

What is the suspected mechanism for feeling pain in the head, scalp and face during a HA?

A

Convergence of the spinal trigeminal nucleus which also supplies that meningitis (tunica adventitia), scalp and face

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10
Q

What are some endogenous factors that can precipitate a migraine?

A

hormonal changes, psychosocial stress, sleep deficit or surplus, hunger, exertion

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11
Q

What are some exogenous factors that can precipitate a migraine?

A

certain kinds of food; stimulation of different sensory modalities (ie smells/perfume)

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12
Q

HA Who am I:
S: Unilateral pain (strictly unilateral), can be a combination or one of the following sites: orbital, supraorbital, temporal
Q: intense, never-ending
I: 8-10/10, dependant on person on pain scales, pain will be severe
R: Pain can refer to other areas of the head, in particular in pathway of the trigeminal nerve
T: Attacks from 1-8 times a day, attack itself occurs for 15-180 minutes
N: autonomic symptoms ipsilateral to pain

A

Cluster HA

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13
Q

What are some associated features of a cluster HA?

A
  • Restless and agitated
  • Ipsilateral conjunctival injection (blood vessels in the eye are dilated)
  • Lacrimation (tears)
  • Nasal congestion
  • Rhinorrhoea (runny nose)
  • Sweating – face and forehead particularly
  • Miosis
  • Ptosis
  • Eyelid odema
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14
Q

HA Who am I:
• Bilateral pain
• Pressing/tightening quality
• Mild – moderate intensity
• Lasts minutes – days
• Pain doesn’t worsen with physical activity
• Photophobia or phonophobia may not be present

A

TTH

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15
Q

HA Who am I:
• side-locked pain
• provocation of typical headache by digital pressure on neck muscles and by head movement
• posterior-to-anterior radiation of pain
• Migrainous features such as nausea, vomiting and photo/phono phobia may be present, although to a generally lesser degree
• Tendency to become chronic

A

Cervicogenic HA

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16
Q

What are some extra-cranial causes of intracranial pressure?

A
  • Fracture of the cranium
  • Haemorrhage in subdural, epidural or subarachnoid space
  • Infections of the meninges
  • Onset of the neurological symptoms delayed- depends on pathology
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17
Q

What is meningitis?

A

Infection of the lining tissues of the brain

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18
Q

What are some signs and symptoms of meningitis?

A
  • Headache -severe
  • Neck pain
  • Vomiting
  • Drowsiness, difficult to wake
  • Confusion and irritability
  • Severe muscle pain
  • Pale, blotchy skin- spots/ Rash
  • Severe headache
  • Stiff neck
  • Dislike bright lights
  • Convulsion/seizures
  • Confusion- very big factor
  • Positive brudzonki sign
  • Positive kernig sign
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19
Q

What is cervical myelopathy?

A

A serious and disabling condition arising from cervical cord compression

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20
Q

What degenerative changes can lead to cervical myelopathy?

A
  • Osteophyte encroachment in the central (+/- lateral) canal
  • Disc calcification and loss of disc height
  • Ligamentous buckling (LF) or ossification (PLL)
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21
Q

Clinical features present in cervical myelopathy?

A

Onset of symptoms is usually insidious:
•Hypersensitivity and clumsiness in the hands and feet
•“Tightness” in the legs (spasticity)

Initially subtle, but UMN signs predominate below the level of the lesion:
•Hyperreflexia, clonus, Babinski sign (sometimes asymmetrical)
•Weakness, ataxia

The clinical picture may be complicated by:
•Radiculopathy, if there is lateral canal stenosis at the level of the lesion
•Dorsal column involvement
•Low back pain, leg pain

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22
Q

What is a whiplash associated disorder?

A

An acceleration-deceleration mechanism of energy transfer to the neck

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23
Q

Clinical features of a whiplash associated disorder?

A
  • Tinnitus, deafness
  • Visual problems, dizziness
  • TMJ pain, Dysphagia
  • Depression, anxiety, sleep disturbance, memory loss
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24
Q

What is thoracic outlet syndrome?

A

Compression of brachial plexus and subclavian vessels due to entrapment at the scalenes, clavicle/1st rib and pectoralis minor muscle

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25
Q

Neurogenic features of thoracic outlet?

A
  • Pain in head/neck/face/chest
  • Paraesthesia
  • Early fatigability, dyscoordination
  • Atrophy/weakness/intermittent cramping/paresis
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26
Q

Arterial features of thoracic outlet?

A
  • Ischaemic pain head/face/neck/chest wall
  • Extertional fatigue
  • Paraesthesia
  • Coldness
  • Pallor
  • Atrophy/weakness/cramping
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27
Q

Venous features of thoracic outlet?

A
  • Pain, heaviness, fatigue
  • Upper limb oedema (non-pitting)
  • Cyanosis, ecchymosis
  • Engorged superficial veins
28
Q

What test can be performed for diagnosing thoracic outlet syndome?

A

Elevated arm stress test (EAST)/ Roos test in conjunction with a neurodynamic tension test

29
Q

What are the nerve root/s of the greater occipital nerve?

A

C2

30
Q

What are the nerve root/s of the greater auricular nerve?

A

C2/3

31
Q

What are the nerve root/s of the transverse cervical nerve?

A

C2/3

32
Q

What are the nerve root/s of the supraclavicular nerve?

A

C3/4

33
Q

What are the nerve root/s of the phrenic nerve?

A

C3-5

34
Q

Where does the anterior scalene arise from and insert into? and N supply

A

C3-6
scalene tubercle of the 1st rib
N: C5-7

35
Q

Where does the middle scalene arise from and insert into? and N supply

A

C2-7
Superior surface of the first rib (behind the subclavian artery)
N: C3-8

36
Q

Where does the posterior scalene arise from and insert into? and N supply

A

C5-7
Lateral surface of the second rib
N: C7-8

37
Q

Where does the trapezius arise from and insert into? and N supply

A

Attachments: Originates from the skull, nuchal ligament and the spinous processes of C7-T12. The fibres attach to the clavicle, acromion and the scapula spine.
Innervation: Motor innervation is from the accessory nerve. It also receives proprioceptor fibres from C3 and C4 spinal nerves.

38
Q

NICE guidelines for the three drugs to be used for HA’s?

A
  1. Triptans
  2. NSAIDS/ Paracetamol
  3. Antiemetics (vomiting/ nausea)
39
Q

List some red flag symptoms for Neck conditions

A
  • steroids
  • trauma
  • Hx malignancy
  • unexplained WL
  • dysphagia, HA, vomiting
  • cerebrovascular symptoms
  • Neurological
40
Q

Definition of myelopathy?

A

Spinal cord is being compressed by some lesion

41
Q

Definition of cervical lymphadenitis and risk factors?

A

Lymph node inflammation

from: Hodgkins, recent URTI, Glandular fever

42
Q

Match description with definition:

Clearly localised, sharp pain caused by nociceptor activation in superficial non-neural tissues

A

Superficial somatic pain

43
Q

Match description with definition:

Poorly localised, dull/aching pain from nociceptor activation in non-neural tissues

A

Deep somatic pain

44
Q

Match description with definition:

Pain caused by a lesion off the somatosensory system

A

Neuropathic pain

45
Q

Match description with definition:

Pain caused by inflammation/ compression of a nerve root

A

Radicular pain

Radiculopathy: umbrella term including radicular pain, paraesthesia, numbness, motor phenomena

46
Q

How can you distinguish discogenic pain from other pathologies?

A

compression

Sharp pain on intrathecal pressure: coughing, sneezing, valsalva manoeuvre

47
Q

How can you distinguish facet joint pain from other pathologies?

A

Passive movements reproducing familiar pain

Palpation of facet

48
Q

How can you distinguish myofascial pain from other pathologies?

A
  • diffuse pain

- specific tender points

49
Q

How can you distinguish spondylosis pain from other pathologies?

A
  • older
  • undergone trauma
  • diagnose through imaging
50
Q

How can you distinguish somatic refer pain from other pathologies?

A

Pressing local region and you cant reproduce pain, but palpate different region and it causes the other region to produce familiar pain

51
Q

What part of the intervertebral disc is innervated?

A

Outer 1/3rd of the annulus fibrosis

52
Q

Sequestration vs protrusion vs extrusion

A

extrusion: base of protrusion is outside of the disc
protrusion: base of the protrusion is inside the disc
sequestration: the nucleus pulposes has broken off/disconnected from the parent disc

53
Q

If a disc is bulged between C6/7 IVD, which nerve root is affected?

A

C7

54
Q

In radicular pain, which part of the axon is compressed/irritated/inflammed causing the ectopic firing?

A

Dorsal root or its ganglion

55
Q

What defines the inter scalene triangle?

A

Between ant/middle scalene as well clavicle

56
Q

3 sites of compression of TOS?

A
  • inter scalene space
  • between 1st rib and clavicle
  • under pec minor
57
Q

What are some of the common virus’ responsible for a URTI?

A
  • Rhinovirus
  • Adenovirus
  • Echovirus
58
Q

What is the pathological process of a virus becoming a URTI?

A
  1. Virus invade the epithelium in the nose
  2. This causes an acute inflammation of nasal mucosa (Increase vascular permeability, swelling – “blocked nose”and mucous secretion )
  3. Nasal congestion, blocked nose, rhinorrhea
  4. Can spread to: sinusitis, pharyngo-tonsillitis, otitis media (middle ear)

(Remember virus’ do not cause cell death)

59
Q

What are the more serious causes of viral sore throat?

A
  • HIV
  • Streptococcus A (step throat)
  • Epstin-Barr Virus (increases risk of neoplasia)
60
Q

Why can the flu become deadly?

A

It causes cell destruction and if someone is immunocompromised (children and elderly) it can be fatal

61
Q

What is TMJ dysfunction?

A

A disorder of the jaw muscles and nerves caused by injury or inflammation to the temporomandibular joint. The injured or inflamed temporomandibular joint leads to pain with chewing, clicking, crackling, and popping of the jaw; swelling on the sides of the face; nerve inflammation; headaches, including migraines; tooth grinding (bruxism); Eustachian tube dysfunction; and sometimes dislocation of the temporomandibular joint.

62
Q

What are the 3 functional and 2 accessory ligaments of the TMJ?

A

3 Functional Ligaments: Collateral (discal) lig, Capsular lig and TM lig
2 Accessory Ligaments: Sphenomandibular lig and Stylomandibular lig

63
Q

What are some abnormalities that could alter TMJ biomechanics?

A
  • over/under bite: An overbite or underbite position can lead to overuse dysfunction of both main functions of Pterygoids
  • Altered cervical spine dynamics changing the trajectory of jaw closure.
  • Internal derangement of the disc-condyle complex (disc displacement)
64
Q

What are some medical risk factors for a CAD?

A
  • History of cervical trauma
  • Recent URTI (within previous week)
  • Cardiovascular disease risk factors
  • Past/family history of migraines
65
Q

Presentation of a CAD may include symptoms such as…

A
  • Acute onset unilateral head/neck/face pain
  • Horner’s syndrome characterized by: miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face)
  • Tinnitus
  • HA- “never felt before”, “worse they’ve ever experience”
  • Pain relates to Cx movements
  • Dizziness
  • Neuro signs: ataxia, unsteadiness
  • stroke-like symptoms: change in personality, speech, fine-motor control
66
Q

What particular arteries can CAD affect?

A
  • Internal carotid

- Vertebral

67
Q

What are the classifications of Whiplash Associated Disorder?

A
  1. No neck pain or physical signs but WAD signs (depression, mood changes, lack of sleep, tinnitus)
  2. Neck pain (stiffness/tenderness) with no other signs
  3. Neck pain (stiffness/tenderness) with musculoskeletal signs: decreased ROM and point tenderness
  4. Neck pain with Neuro signs: diminished reflexes, weakness, sensory deficits
  5. Neck pain with # or dislocation

Common Condition Revision (6 decks)

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