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Advanced Spine > M5: Class Notes 1 > Flashcards

M5: Class Notes 1 Flashcards

1
Q

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

A

c. Help clarify when to refer for further exam

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2
Q

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

a. Bilateral rotation to 45 degrees

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3
Q

Which of the following is NOT a classic symptom of vertebral artery dysfunction?

a. Double vision
b. Nausea
c. Fainting
d. Trouble swallowing

A

fainting

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4
Q

How is fainting different from a drop attack?

A
  • fainting » loss of consciousness

- drop attack ≠ LOC

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5
Q

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

A

d. Upper cervical instability makes tx risky

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6
Q

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

A

b. Hyporeflexia of extremities

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7
Q

Cervical radiculopathy most commonly involves

a. HAs and stiffness
b. Elderly women w/ RA
c. B extremities
d. Arm pain > neck pain

A

d. Arm pain > neck pain

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8
Q

Neck pain occurs most often in

a. Hypermobile young adults
b. Middle aged adults
c. Osteoarthritic elderly adults
d. Adults irrespective of age

A

b. Middle aged adults

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9
Q

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

A

c. Less painful

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10
Q

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

a. Increases patient’s risk of fracture

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11
Q

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

A

d. The more that are (+), the higher the suspicion

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12
Q

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

A

c. She is negative on 3 of the 4 key factors so her risk is pretty low

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13
Q

What are the 4 key factors of cancer?

A
  1. age over 50
  2. hx of non-skin cancer
  3. unexplained WL over 4.5kg in 6 months
  4. failure of conservative mgmt in past month
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14
Q

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

A

b. Yes, even before I attempt initial tx

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15
Q

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?

A
  • 62 y.o.
  • self-referral
  • severe pain
  • decreased rotation ROM
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16
Q

T/F: Cardiovascular risk factors such as diabetes, smoking, bacterial infection raise suspicion of CAD

A

true

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17
Q

T/F: Dissecting aneurysms of the vertebrobasilar or internal carotid arteries are part of CAD

A

true

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18
Q

T/F: Dizziness associated w/ rotation of the head is associated with CAD

A

true

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19
Q

T/F: If sx’s don’t include one or more of the 5 D’s, CAD can be ruled out

A

false

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20
Q

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

A

true

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21
Q

T/F: Provocative testing is always indicated prior to cervical exam and intervention

A

false

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22
Q

T/F: Recent cervical trauma is a risk factor for CAD

A

true

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23
Q

T/F: Recent neck surgery or nerve blocks increase the risk of CAD

A

true

24
Q

T/F: Sudden recent/unexplained onset of neck pain without dizziness or neuro symptoms may still indicate CAD

A

true

25
Q

T/F: Sudden recent onset of severe HA is associated with CAD

A

true

26
Q

duration of cervicogenic dizziness is usually

A

short

27
Q

What type of dizziness?

“I feel lightheaded and woozy”

A

syncope

28
Q

What type of dizziness could this be?

I sometimes feel weak and unsteady on my feet

A

dysequilibrium associated with cervicogenic dizziness

29
Q

What type of dizziness?

It feels like I’m going to faint

A

syncope

30
Q

What type of dizziness?

It feels like the room is spinning around me

A
  • vertigo

- vestibular

31
Q

What type of dizziness could this be?

It lasts for a few minutes generally

A

dysequilibrium associated with cervicogenic dizziness

32
Q

What type of dizziness?

My legs suddenly buckle under me for no good reason

A

cardiovascular (drop attack)

33
Q

What type of dizziness?

Suddenly my vision goes kind of dark

A
  • presyncope

- cardiovascular

34
Q

What type of dizziness?

When I stand up quickly, I get sort of dizzy

A
  • orthostatic hypotension

- cardiovascular

35
Q

descriptors: vertigo

A

spinning

36
Q

descriptors: presyncope

A
  • lightheadedness

- faintness

37
Q

descriptors: dysequilibrium

A
  • unsteadiness
  • imbalance
  • sense of fall
  • weak (not drop attacks)
38
Q

descriptors: other

A

floating

39
Q

potential causes: vertigo

A

vestibular

40
Q

potential causes: presyncope

A
  • postural hypotension

- vertebral artery dysfunction

41
Q

potential causes: dysequilibrium

A
  • cervicogenic dizziness
42
Q

potential causes: other

A

psych

43
Q

How do visual disturbances listed under cervicogenic differ from presyncope?

A

more blurriness, fuzzy, spotty as opposed to the room just going dark

44
Q

Distinguishing between postural hypotension and VAD:

BP

A
  • hypotension: drops

- VAD: remains same

45
Q

Distinguishing between postural hypotension and VAD:

When it happens

A
  • hypotension: positional change

- unexpectedly

46
Q

Distinguishing between postural hypotension and VAD:

chronic cardiovascular RFs

A

more likely VAD

47
Q

Distinguishing between postural hypotension and VAD:

Recent surgery

A

hypotension

48
Q

Distinguishing between postural hypotension and VAD:

5 D’s

A

VAD

49
Q

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

A

all are correct

50
Q

ligamentous instability: early and late RA

A

late RA is worse, but can occur early in the disease progression

51
Q

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

A

c. excessive cervical ROM

52
Q

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

A

d. Sx relieved by antacids, nitroglycerin, or rest

53
Q

What is/are the criteria for ruling CM in using the 5 key findings for dx cervical myelopathy?

A

3 or more of the following are positive

  1. age over 45
  2. (+) Babinski
  3. (+) Inverted supinator sign
  4. (+) Hoffman
  5. Gait dysfunction described as spastic, wide-based gait or ataxic
54
Q

What is/are the criteria for ruling CM out using the 5 key findings for dx cervical myelopathy?

A

≤ 1 tests are positive

2 positives: throws into clinical reasoning based on rest of exam

55
Q

What are the 4 key findings for dx cervical radiculopathy?

A
  1. ULTT A
  2. cervical rotation less than 60˚ to involved side
  3. distraction test
  4. Spurling A
56
Q

What is the criteria for ruling CR IN using the 4 key findings

A

the more positives you have the more likely it is

57
Q

What is the criteria for ruling CR OUT using the 4 key findings for radiculopathy?

A

(-) ULTT A (median bias)

most useful test when used alone for ruling out CR

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