M5: Reading Guide 1

Question 1

High risk factors mandating radiograph

Answer 1

• age over 65
• dangerous MOI
• paresthesia in extremities

Question 2

Low risk factors mandating radiograph

Answer 2

• MVA
• Not able to assume sitting in ED
• not able to amb at any time since surgery
• immediate onset neck pain
• midline C spine tenderness

Question 3

Canadian C-spine rules: neck rotation

Answer 3

radiograph if not able to rotate neck actively 45˚ L and R

• only need to consider if they are a yes to low risk factors
• If they can’t rotate 45, they need a radiograph

Question 4

What is CAD?

Answer 4

• involves vertebrobasilar system supplying hindbrain and internal carotids supplying the retina
• could be stenotic, occlusive, or dissecting aneurysms and subsequent hemorrhaging

Question 5

How does cervical rotation and extension affect the vertebral artery

Answer 5

• compresses cerebral artery against transverse process of upper cervical vertebra
• contralateral rotation stretches or compresses vertebral artery between C1 and 2

Question 6

classic sx of VAI

Answer 6

• 5 D’s
• ataxia
• nausea
• numbness of unilateral face
• nystagmus

Question 7

What factors raise the index of suspicion that a pt may have CAD?

Answer 7

• acute onset neck and head pain “unlike any other”

- consider s/s of both ischemic and nonischemic sx of CAD

Question 8

What are the functional tests for CAD?

Answer 8

• Functional positional test
• BP examination
• Cranial nerve exam
• Eye exam
• Handheld doppler US

Question 9

Functional positional test for CAD incorporates

Answer 9

cervical flexion/rotation

Question 10

utility of functional tests for CAD identification

Answer 10

• poor dx utility as predictors of risk

- don’t assist with decision making relative to presence or absence of CAD

Question 11

What are the types of dizziness?

Answer 11

• cardiovascular
• neurological
• metabolic
• psychiatric
• vestibular
• cervicogenic

Question 12

vestibular dizziness:

Answer 12

spinning sensation, either of body or environment

Question 13

presyncope dizziness:

Answer 13

• lightheadedness

- tiredness resulting from altered blood supply, O2, or glucose

Question 14

dysequilibrium dizziness:

Answer 14

• unsteadiness, imbalance, weakness
• sense that a fall will occur
• often associated with visual impairment, neuropathy, or MSK disturbances

Question 15

other dizziness:

Answer 15

reports of

• floating
• anxiety/depression
• fatigue

psychiatric disorder

Question 16

cervicogenic dizziness

Answer 16

• dx of exclusion when all other causes have been ruled out

- altered orientation in space and dysequilibrium originating from abn afferent activities from neck

Question 17

cervicogenic dizziness: dx associated with these findings

Answer 17

• pain or discomfort in neck (often post-trauma)
• persistent occipital HA
• jaw pain and/or UE radicular sx
• limited cervical ROM
• dizziness of short duration