Head, Neck and Back

Question 1

What are the major red flags for back pain?

Answer 1

Back pain with hip or abdominal pain, bowel/bladder changes, previous history of cancer, night pain, no improvement after 4-6 weeks of PT.

Question 2

What is the key difference between mechanical and non-mechanical back pain?

Answer 2

Mechanical accounts for 97% of cases, while non-mechanical includes visceral causes (2%) and neoplasm/infection (1%).

Question 3

What are the primary types of headaches?

Answer 3

Primary headaches include migraines and tension-type headaches.

Question 4

What are secondary headaches?

Answer 4

Secondary headaches include cervicogenic and those caused by systemic conditions like cancer.

Question 5

When should you refer a patient with headaches to a physician?

Answer 5

Refer if they have headaches with waking at night, personality changes, vision changes, seizures, or a history of HTN/tumor.

Question 6

What are the systemic origins of headaches?

Answer 6

Systemic causes include seizures, personality changes, vision changes, worse in the morning, etc.

Question 7

What are the mechanical causes of cervical spine pain?

Answer 7

Rheumatoid arthritis, cervical myelopathy.

Question 8

What are the red flags for cervical myelopathy?

Answer 8

+L’hermitte’s sign, gait changes, +Babinski, Hoffmann’s test.

Question 9

What are the vasculogenic causes of cervical spine pain?

Answer 9

Cardiac and vascular issues.

Question 10

How do you differentiate cervicogenic from systemic cervical pain?

Answer 10

Cervicogenic pain changes with activity and rest; systemic causes may not.

Question 11

What are the systemic causes of thoracic spine pain?

Answer 11

Cardiac (MI, aneurysm) and GI (peptic ulcers).

Question 12

What are the associated signs of systemic thoracic spine pain?

Answer 12

Constitutional symptoms like fever, pallor, high/low BP.

Question 13

What are key questions for identifying inflammatory back pain?

Answer 13

Does pain alternate sides? Morning stiffness >30 mins? Does rest relieve pain?

Question 14

What are the systemic causes of lumbosacral pain?

Answer 14

Inflammatory causes, systemic illness, and visceral pathology.

Question 15

What are neurogenic causes of pain?

Answer 15

Radicular pain, sciatica, other neuropathies.

Question 16

What are vasculogenic causes of pain?

Answer 16

AAA, vascular headaches, demand > supply issues.

Question 17

What are the red flags for oncologic back pain?

Answer 17

History of cancer, age >50, unexplained weight loss, failure to improve after one month of treatment.

Question 18

What are the clinical signs of oncologic back pain?

Answer 18

Pain with weight-bearing, midline tenderness, weakness, skin temperature differences.

Question 19

What are the gynecologic causes of back pain?

Answer 19

Endometriosis, ovarian cysts, cyclic pain, fluctuating hormone levels.

Question 20

What is the clinical presentation of endometriosis?

Answer 20

Back, pelvic, hip, or sacral pain, cyclic in nature, related to fluctuating hormone levels.

Question 21

What are the risk factors for infectious causes of back pain?

Answer 21

Fever, immunosuppression, IV drug use, HIV.

Question 22

What is vertebral osteomyelitis?

Answer 22

An infection of the vertebrae, often caused by MRSA, with risk factors including diabetes, IV drug use, or corticosteroids.

Question 23

What are the signs and symptoms of cancer-related back pain?

Answer 23

Unexplained weight loss, history of cancer, constant/intense pain worse with WB, red flags for metastatic disease.

Question 24

How do you differentiate cervicogenic from migraine headaches?

Answer 24

Cervicogenic: Pain varies with activity, neck stiffness. Migraine: Aura, photophobia, unilateral throbbing pain.

Question 25

What are the signs of vascular vs neurogenic pain?

Answer 25

Vascular: Throbbing, worsens with activity. Neurogenic: Sharp, shooting, follows nerve root patterns.

Question 26

What are the signs of psychogenic pain?

Answer 26

Cogwheel motion during muscle testing, amplified pain perception, reflexes inconsistent with complaints.

Question 27

What are the signs of rheumatoid arthritis-related cervical spine pain?

Answer 27

AA subluxation, C2 nerve involvement, risk of myelopathy with long-standing RA.

Question 28

What are viscerogenic causes of back pain?

Answer 28

GI (gallbladder, pancreas), renal (kidney stones), reproductive, pulmonary causes; shared innervation leads to referred pain.

Question 29

What are the signs of peptic ulcer-related thoracic pain?

Answer 29

Referred pain to T6-T10, worse with NSAID use, symptoms affected by food intake.

Question 30

What are the signs of gallbladder-related pain?

Answer 30

Referred pain at the 10th rib, onset after fatty meals, associated GI symptoms.

Question 31

What are the signs of ovarian cysts?

Answer 31

Often asymptomatic until large, cyclical pain patterns, fluctuating with hormone levels.

Question 32

What is the clinical presentation of vertebral osteomyelitis?

Answer 32

Gradual onset of severe pain over weeks, MRSA infection common, risk factors include diabetes, surgery, IV drug use.