Lecture Final Flashcards
The standard of judgement that applies to malpractice case is:
- A preponderance of evidence
- The same standard applies to a tort
A & C only
A 26 year old male computer programmer sees you for neck pain that began three days previously after he was driving a car that was struck from behind by another vehicle traveling about 5 mph. He describes the pain as mild to moderate in intensity, in the posterior neck and upper trapezius region, and in the right mid-thoracic region without upper extremity radiation. He denies a previous history of similar symptoms or other significant trauma. Other personal and family health history is noncontributory. Your examination is significant for mild to moderate tenderness and muscular hypertonicity in the posterior cervical muscles, trapezius and right rhomboid muscles. You also find mildly limited cervical ROM in all planes, and intersegmental motion restrictions (ie.. chiropractic spinal subluxations)in the cervical and thoracic spinal regions. Upper extremity muscle strength, reflexes and sensation are within normal limits. What is your recommended course of treatment?
A course of cervical spine mobilization and manipulation, and encouraging the patient to remain active and avoid work absences
You meet a local pediatrician (MD) at a party. She says some of her patients report success using chiropractic help kids with chronic ear problems. Briefly explain a plausible rationale for chiropractic treatment of otitis media in children that we discussed in class (using a bullet post outline or a brief essay format is acceptable)
- The cervical muscular hypertonicity extends into the jaw, soft palate, and muscles surrounding the Eustachian tube
- Treatment consists of cervical adjustments and soft tissue therapy for cervicals and TMJ
This serious condition may present with the “classic triad” of nuchal rigidity, sudden high fever and altered mental status:
Meningitis
An inflammatory, demyelinating disease of the central nervous system that can present with “weird” neurological symptoms is:
Multiple Sclerosis
Which of the following is considered the definitive test for meningitis?
Lumbar puncture with examination of the CSF
A 50 year old female presents one day after the sudden onset of a sub occipital headache that she describes as “the worst headache ever”. She notes that she is under increased stress after finding out that her mother was diagnosed with cancer last week. The primary differential diagnosis that should be considered is:
Headache due to vascular pathology such as arterial dissection or stroke
A history of corticosteroid use or endocrine disease is a possible red flag in a patient with neck pain because it may suggest:
Possible pathological fracture
When is a surgical consultation indicated for a patient who is being conservatively treated for cervical radiculopathy?
- If the patient has progressive neurological deficit (true loss of sensation) that does not improve under an adequate trial of non surgical care
- if there is evidence of progressing muscular atrophy
Both A and B only
A headache that is bilateral , inhibits activity and causes pain that is described as “tightening” is most likely:
A tension-type headache
In malpractice case, the standard care:
- is based on the defense attorney’s testimony
- is usually established through expert testimony
- requires DCs to always perform pre-manipulative screening maneuvers ( George’s test, etc) before performing cervical manipulation
- is based on what was taught when the defendant was in school, and can’t be changed
ALL OF THE ABOVE
Otitis media with effusion is:
Characterized by fluid in the middle ear without evidence of infection
T/F:
A chiropractor practicing in New York who claims that chiropractic adjustments can cure ear infection is breaking the law
true
A 62 year old female presents to your office with a 3 month history of gradual onset of pain in her neck, right shoulder and right mid- thoracic area, with progressive pain and paresthesia in the right middle finger. She denies any recent history of significant trauma. Examination findings include mild/moderate hyporeflexia of the right triceps (1+), although other upper extremity reflexes are graded as 2+ bilaterally. There is a mild loss of strength noted in the right wrist flexors and finger extensors. Spurling sign is positive for increased arm pain with extension and right lateral flexion, and cervical long axis distraction relieves the arm pain. Based on the history and exam findings outlined above, your initial treatment plan should most likely include:
A 6-12 visit trial course of conservative care including cervical traction, soft tissue therapies and gentle manipulative therapy to the patient’s tolerance
A 62 year old female presents to your office with a 3 month history of gradual onset pf pain in her neck, right shoulder and right mid- thoracic area, with progressive pain and paresthesia in the right middle finger. She denies any recent history of significant trauma. Examination findings include mild/moderate hyporeflexia of the right triceps (1+), although other upper extremity reflexes are graded as 2+ bilaterally. There is a mild loss of strength noted in the right wrist flexors and finger extensors. Spurling sign is positive for increased arm pain with extension and right lateral flexion, and cervical long axis distraction relieves the arm pain. Based upon your impression above, you would expect that a sensory disturbance, if present, would most likely involve:
The right middle finger
A 62 year old female presents to your office with a 3 month history of gradual onset pf pain in her neck, right shoulder and right mid- thoracic area, with progressive pain and paresthesia in the right middle finger. She denies any recent history of significant trauma. Examination findings include mild/moderate hyporeflexia of the right triceps (1+), although other upper extremity reflexes are graded as 2+ bilaterally. There is a mild loss of strength noted in the right wrist flexors and finger extensors. Spurling sign is positive for increased arm pain with extension and right lateral flexion, and cervical long axis distraction relieves the arm pain. Your initial clinical impression should most likely be:
C7 Cervical Radiculopathy likely due to lateral canal stenosis
A 35 year old female presents to your office complaining of dull pain radiating down the lateral left upper arm and into the first two digits of the left hand. She reports the onset as occurring two days ago after spending an hour on the phone with the receiver cradled between her ear and left shoulder. She denies further trauma or previous history of similar complaints. Examination reveals significantly limited cervical ROM with pain and stiffness throughout. Upper extremity deep tendon reflexes, sensation and muscle strength are within normal limits bilaterally. At this point, the most appropriate step in managing this patient would be:
- A cervical MRI
- An upper extremity electrodiagnostic study
(Choice A & B only)
The Loose-Packed position of the TMJ is…
An equilibrium between the jaw-opening and jaw-closing muscles and gravity
The “water glass test” is used to:
Determine if a patient’s rash is due to meningitis/ septicemia because the rash will NOT fade when pressed with the side of water glass
In our discussions of the Bone and Joint decade’s summary of evidence for treatment of cervical-related conditions (spine 2008; volume 33, Number 8), I noted that the most invasive interventions for cervical conditions generally had:
Less evidence of effectiveness than many less-invasive treatments
During the “swivel stool test”, a patient says their dizziness gets worse when you hold their head still and their body rotates on the swiveling stool. This result most likely indicates:
Cervicogenic vertigo
A 21 year old male reports to your office with a 1 day history of sudden onset of progressive paresthesia in the right thumb and index finger, with accompanying moderate to severe neck pain and pain in the right radial upper arm and forearm. He works as a house painter, and describes a recent history of an on-the- job accident when a paint can fell off the top of the ladder and onto the top of his head. Examination findings include mild weakness of the right biceps and brachioradialis (graded +4/+5), and mild/moderate sensory loss in the right thumb and index finger during pinwheel examination. Spurling sign is positive for increased arm pain with extension and right lateral flexion, and cervical long axis distraction relieves arm pain. Based upon your clinical impression above, the most likely location of motor weakness would be:
The right brachioradialis and wrist extensor muscles
A 26 year old male computer programmer sees you for neck pain that began three das previously after he was driving a car that was struck from behind by another vehicle traveling about 5 mph. He describes the pain as mild to moderate in intensity, in the posterior neck and upper trapezius region, and in the right mid-thoracic region without upper extremity radiation. He denies a previous history of similar symptoms or other significant trauma. Other personal and family health history is noncontributory. Your examination is significant for mild to moderate tenderness and muscular hypertonicity in the posterior cervical muscles, trapezius and right rhomboid muscles. You also find mildly limited cervical ROM in all planes, and intersegmental motion restrictions (ie.. chiropractic spinal subluxations)in the cervical and thoracic spinal regions. Upper extremity muscle strength, reflexes and sensation are within normal limits. What imaging is required prior to treatment?
None of the above; due to the absence of any specific risk factors, it would be appropriate to perform a trial treatment without radiographs
A 26 year old male computer programmer sees you for neck pain that began three das previously after he was driving a car that was struck from behind by another vehicle traveling about 5 mph. He describes the pain as mild to moderate in intensity, in the posterior neck and upper trapezius region, and in the right mid-thoracic region without upper extremity radiation. He denies a previous history of similar symptoms or other significant trauma. Other personal and family health history is noncontributory. Your examination is significant for mild to moderate tenderness and muscular hypertonicity in the posterior cervical muscles, trapezius and right rhomboid muscles. You also find mildly limited cervical ROM in all planes, and intersegmental motion restrictions (ie.. chiropractic spinal subluxations)in the cervical and thoracic spinal regions. Upper extremity muscle strength, reflexes and sensation are within normal limits. What is your recommended treatment plan?
Daily treatments for 8 weeks and re-evaluate
