M5: Class Notes 1 Flashcards
Which of the following best describes the PT use of Canadian C-spine rules?
a. Help decide what type of imaging is needed
b. Help detect a likely non-musculoskeletal cause of pain
c. Help clarify when to refer for further exam
d. NA- these are only used by emergency physicians
c. Help clarify when to refer for further exam
What active motion test is part of the Canadian C-spine rule?
a. Bilateral rotation to 45 degrees
b. Unilateral rotation to 45 degrees
c. Flexion to 45 degrees
d. Flexion and extension to 45 degrees
a. Bilateral rotation to 45 degrees
Which of the following is NOT a classic symptom of vertebral artery dysfunction?
a. Double vision
b. Nausea
c. Fainting
d. Trouble swallowing
fainting
How is fainting different from a drop attack?
- fainting » loss of consciousness
- drop attack ≠ LOC
It is particularly important to know whether a cervical pt has RA b/c if it is present…
a. Exacerbations of neck pain and stiffness are likely
b. Neurogenic pain will complicate tx
c. Spinal stenosis is the likely pain generator
d. Upper cervical instability makes tx risky
d. Upper cervical instability makes tx risky
Sx’s of cervical myelopathy include all of the following EXCEPT
a. B leg incoordination
b. Hyporeflexia of extremities
c. UE anesthesia
d. Pain in 1 or both arms
b. Hyporeflexia of extremities
Cervical radiculopathy most commonly involves
a. HAs and stiffness
b. Elderly women w/ RA
c. B extremities
d. Arm pain > neck pain
d. Arm pain > neck pain
Neck pain occurs most often in
a. Hypermobile young adults
b. Middle aged adults
c. Osteoarthritic elderly adults
d. Adults irrespective of age
b. Middle aged adults
Mechanical neck pain unrelated to sleep position is usually ____ in the morning after rest
a. Stiff for an hour or more
b. Most severe
c. Less painful
d. unpredictable
c. Less painful
A dx of ankylosing spondylitis
a. Increases patient’s risk of fracture
b. Often follows a dx of osteoporosis
c. Is more common in elderly OP patients
d. Is often associated with a history of childhood fractures
a. Increases patient’s risk of fracture
Which of the following is a most accurate statement related to the cluster of 4 tests for radiculopathy?
a. If 4 are positive, then should refer back to MD
b. All four must be negative to rule out radiculopathy
c. Even if all 4 are (-), it’s not necessarily ruled out
d. The more that are (+), the higher the suspicion
d. The more that are (+), the higher the suspicion
Your 45 y.o self-referred neck pain pt that you are evaluating today has no previous hx of cancer and her weight is stable. What is the risk that her pain is associated with metastatic cancer?
a. These factors essentially rule out metastatic cancer in the spine
b. The factors only apply to lumbar and shouldn’t be extrapolated to cervical
c. She is negative on 3 of the 4 key factors so her risk is pretty low
d. She is negative on 1 of 4 key factors so she should be referred
c. She is negative on 3 of the 4 key factors so her risk is pretty low
What are the 4 key factors of cancer?
- age over 50
- hx of non-skin cancer
- unexplained WL over 4.5kg in 6 months
- failure of conservative mgmt in past month
Your pt is a 62 y/o male who self-referred to your PT clinic a few days after being rear-ended by someone travelling at a moderately high speed. He has no sensory complaints besides severe pain and soreness, which came on within a few hours of the accident. He has diffuse upper, mid and lower cervical tenderness midline and bilaterally and he can rotate ~30 degrees R and 40 degrees L. He declined medical evaluation immediately after the accident bc he had no pain initially. Should you refer?
a. Yes, but only if he doesn’t respond to initial tx
b. Yes, even before I attempt initial tx
c. No - he only has 1 red flag (age > 50)
d. Not yet - finish a thorough exam then decide
b. Yes, even before I attempt initial tx
Your pt is a 62 y/o male who self-referred to your PT clinic a few days after being rear-ended by someone travelling at a moderately high speed. He has no sensory complaints besides severe pain and soreness, which came on within a few hours of the accident. He has diffuse upper, mid and lower cervical tenderness midline and bilaterally and he can rotate ~30 degrees R and 40 degrees L. He declined medical evaluation immediately after the accident bc he had no pain initially.
Why should you refer this pt?
- 62 y.o.
- self-referral
- severe pain
- decreased rotation ROM
T/F: Cardiovascular risk factors such as diabetes, smoking, bacterial infection raise suspicion of CAD
true
T/F: Dissecting aneurysms of the vertebrobasilar or internal carotid arteries are part of CAD
true
T/F: Dizziness associated w/ rotation of the head is associated with CAD
true
T/F: If sx’s don’t include one or more of the 5 D’s, CAD can be ruled out
false
T/F: CAD is defined as both current (e.g. dissecting) AND potential (about to dissect) adverse events involving the blood supply to the brainstem and cerebrum
true
T/F: Provocative testing is always indicated prior to cervical exam and intervention
false
T/F: Recent cervical trauma is a risk factor for CAD
true
T/F: Recent neck surgery or nerve blocks increase the risk of CAD
true
T/F: Sudden recent/unexplained onset of neck pain without dizziness or neuro symptoms may still indicate CAD
true
T/F: Sudden recent onset of severe HA is associated with CAD
true
duration of cervicogenic dizziness is usually
short
What type of dizziness?
“I feel lightheaded and woozy”
syncope
What type of dizziness could this be?
I sometimes feel weak and unsteady on my feet
dysequilibrium associated with cervicogenic dizziness
What type of dizziness?
It feels like I’m going to faint
syncope
What type of dizziness?
It feels like the room is spinning around me
- vertigo
- vestibular
What type of dizziness could this be?
It lasts for a few minutes generally
dysequilibrium associated with cervicogenic dizziness
What type of dizziness?
My legs suddenly buckle under me for no good reason
cardiovascular (drop attack)
What type of dizziness?
Suddenly my vision goes kind of dark
- presyncope
- cardiovascular
What type of dizziness?
When I stand up quickly, I get sort of dizzy
- orthostatic hypotension
- cardiovascular
descriptors: vertigo
spinning
descriptors: presyncope
- lightheadedness
- faintness
descriptors: dysequilibrium
- unsteadiness
- imbalance
- sense of fall
- weak (not drop attacks)
descriptors: other
floating
potential causes: vertigo
vestibular
potential causes: presyncope
- postural hypotension
- vertebral artery dysfunction
potential causes: dysequilibrium
- cervicogenic dizziness
potential causes: other
psych
How do visual disturbances listed under cervicogenic differ from presyncope?
more blurriness, fuzzy, spotty as opposed to the room just going dark
Distinguishing between postural hypotension and VAD:
BP
- hypotension: drops
- VAD: remains same
Distinguishing between postural hypotension and VAD:
When it happens
- hypotension: positional change
- unexpectedly
Distinguishing between postural hypotension and VAD:
chronic cardiovascular RFs
more likely VAD
Distinguishing between postural hypotension and VAD:
Recent surgery
hypotension
Distinguishing between postural hypotension and VAD:
5 D’s
VAD
Ligamentous instability is generally associated with (all that apply)
a. Early RA
b. Genetic ligamentous instability
c. Hx of major trauma
d. Negative radiographs for instability
e. Pt preference for external support
f. Radiographic instability
g. Soft end-feel with passive movements
h. Subjective reports of neck locking or catching
i. unpredictable sx
all are correct
ligamentous instability: early and late RA
late RA is worse, but can occur early in the disease progression
RA is not associated with which of the following:
a. ataxic gait and/or LE weakness
b. cervical myelopathy
c. excessive cervical ROM
d. hand dexterity problems
3. morning stiffness over 45 mins
f. 1 or more of the 5 D’s
g. Paresthesia, maybe B
h. suboccipital pain and/or occipital HA
c. excessive cervical ROM
Which of the following is an incorrect description of the common signs of a heart attack?
a. Chest discomfort with lightheadedness, dizziness, sweating, pallor, nausea or SOB
b. Pain that spreads to the throat, neck, back, jaw, shoulders or arms
c. Prolonged uncomfortable pressure, fullness, squeezing or pain in the center of the chest
d. Sx relieved by antacids, nitroglycerin, or rest
d. Sx relieved by antacids, nitroglycerin, or rest
What is/are the criteria for ruling CM in using the 5 key findings for dx cervical myelopathy?
3 or more of the following are positive
- age over 45
- (+) Babinski
- (+) Inverted supinator sign
- (+) Hoffman
- Gait dysfunction described as spastic, wide-based gait or ataxic
What is/are the criteria for ruling CM out using the 5 key findings for dx cervical myelopathy?
≤ 1 tests are positive
2 positives: throws into clinical reasoning based on rest of exam
What are the 4 key findings for dx cervical radiculopathy?
- ULTT A
- cervical rotation less than 60˚ to involved side
- distraction test
- Spurling A
What is the criteria for ruling CR IN using the 4 key findings
the more positives you have the more likely it is
What is the criteria for ruling CR OUT using the 4 key findings for radiculopathy?
(-) ULTT A (median bias)
most useful test when used alone for ruling out CR
