Neck 1

Question 1

What is inflammatory arthropathy?

Answer 1

Rheumatois arthritis
ankylosing spondylitis
polymyalgia rheumatica
inflam. bowel disease - ulcerative colitis, chrohns
systemic lupus erythematosus
osteomyelitis

Question 2

Define boundaries of the neck

Answer 2

Superiorly - Sup. nuchal line
Inferiorly - an imaginary line through tip of SP of T1
Laterally - sagittal planes at lateral borders of the neck

Question 3

What is radiculopathy?

Answer 3

A neurologic condition characterised by sensory & motor loss or impaired reflexes in a segmental distribution
Mainly loss of function - not pain
generally a C spine nerve is compressed/rendered ischemic

Question 4

What is cervical radicular pain?

Answer 4

Pain perceived deeply, not restricted to cutaneous afferents

Pain that explicitly relates to compression of a dorsal root ganglion

Question 5

What is somatic referred pain?

Answer 5

Pain perceived in a region innervated by nerves other than those that innervate the source of pain
In the neck patterns of referral are usually a function of whether the source is upper or lower

Question 6

Where will you feel referred pain from interspinous muscles?

Answer 6

Upper limb - referrals from Z joints and cervical IVDs are perceived in largely same distributions

Question 7

Describe sequestration

Answer 7

To set apart, detach or separate a small portion of tissue from the rest - may occur naturally or iatrogenically

Question 8

Vertebrae injured - what may be the cause?

Answer 8

trauma, fracture, tumour, bone disease

Question 9

Joint/synovial membrane injured - what may be the cause?

Answer 9

spondylosis, inflammation, infection, dislocation

Question 10

Capsule injured - what may be the cause?

Answer 10

sprain, inflammation

Question 11

Ligaments injured - what may be the cause?

Answer 11

damage to OA/AA membranes, alar,cruciate,tectorial membrane, ALL,PLL,intertransverse, flavum, inter/supraspinous

Question 12

Musculotendinous problem

Answer 12

pre & post vertebral muscles, strain, sprain, imbalance, Tp, TrP, muscle dysfunction/disease

Question 13

Disc injured - what may be the cause?

Answer 13

discitis, internal disc disruption, prolapse

Question 14

Dura injured - what may be the cause?

Answer 14

infection, compression, inflammation

Question 15

Neural injury - what may be the cause?

Answer 15

IVF compromise, central canal compromise, mobility, inflamm., radiculopathy, radicular pain

Question 16

Somatic referred - what may be the cause?

Answer 16

Intracranial bleed, tumour/abcess, meningitis, TrP

Question 17

Visceral referred - what may be the cause?

Answer 17

Heart, oesophagus, lung, thyroiditis, cervical adenitis

Question 18

Steps involved in IDD

Answer 18

Fraction of the vertebral end plate
Prolapsed nuclear material
inflammatory response
degradation of nuclear matrix
bracing effect reduced, AF bears compression alone
AF may creep under compression
narrower disc space, isolated disc resorption

Question 19

Define spondylosis

Answer 19

'wear & tear'
osteoarthritis
joint arthrosis
degenerative joint disease
Characterised by a progressive loss of joint cartilage, subchondral sclerosis within synovial joints
osteophytosis

Question 20

What are the clinical features of cervical disc disease?

Answer 20

Unilateral pain
Usually starts in C spine area, may diminish but commonly extends to scapula, shoulder, upper arm, possibly forearm & hand
Painful or restricted neck movements may be intermittent over several months
May be paraesthesia initially but DRG may become involved provoking radicular pain

Question 21

What is cervical mylopathy and its clinical features?

Answer 21

Sagittal diameter of vertebral column is less than 11mm suggesting spinal stenosis - could be from IVD degen. OA of facet joints, thickening of lig. flav. spondylolythesis

Clin features - neck pain, radicular pain in arm, neuro sym in upper extrem & lower extrem,
Classic picture - numbness in hands with weakness & spasticity/loss of function in lower extrem.

Question 22

List 6 serious but rare causes of neck pain

Answer 22

Vertebral tumours
meningitis
osteomyelitis
discitis
septic arthritis
epidural abscess

Question 23

3 DDxs of vertigo and list 2 signs/sym that would rule them out

Answer 23

BPPV (Benign paroxysmal positional vertigo) - disorder of the inner ear, debris in semi-circular canal, nystygmus on performing Hallpike - defining trait

Menieres disease - endolymphatic hydrops, disorder of vestibular system - attacks are greater than 20 mins, fluctuating or permanent

Hyperventialtion syndrome - breathing too deeply/rapidly, may present with chest pain/tingling in fingertips

Question 24

Sensitivity: If a person has a disease, how often will the test be positive (true positive rate)?

Answer 24

Put another way, if the test is highly sensitive and the test result is negative you can be nearly certain that they don’t have disease.

A Sensitive test helps rule out disease (when the result is negative). Sensitivity rule out or “Snout”

Sensitivity= true positives/(true positive + false negative)

Question 25

Specificity: If a person does not have the disease how often will the test be negative (true negative rate)?

Answer 25

In other terms, if the test result for a highly specific test is positive you can be nearly certain that they actually have the disease.

A very specific test rules in disease with a high degree of confidence Specificity rule in or “Spin”.

Specificity=true negatives/(true negative + false positives)