Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCM II Exam 1 > Neck and C spine > Flashcards

Neck and C spine Flashcards

1
Q

Cervical nerve root exits ______ the numbered vertebra

A

Above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the atypical cervical vertebrae

A

C1 = atlas — lacks a vertebral body and rotates around the dens of C2

C2 = axis — body extends superiorly to form dens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is the C2-C3 articulation considered typical?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

From C2-C7, the upper cervical facets align in a plane pointing toward the _____

The lower cervical facets point to the opposite _______

A

Eye; ASIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

For C3-C7, the lateral aspects of the bodies have superior projections (uncinated processes) articulating with superadjacent vertebrae, what is the function of this articulation?

A

Helps support lateral sides of cervical intervertebral discs and protect from herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

_______ joint = synovial joint between articular processes

A

Facet (zygopophyseal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

______ joint = vertebral bodies separated by fibrocartilaginous disc

A

Intervertebral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The 2 primary motions at the OA joint are ______ and ______, with minor motions being ____ and ______

The Occiput rotates and sidebends to the _______ sides

A

Flexion; extension; SB; rotation

Opposite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Primary motion at AA joint

A

Rotation

[atlas rotates around dens of C2]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does sidebending relate to rotation in typical cervical vertebrae from C2-C7?

A

R and SB typically occur in same direction (type II mechanics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some things to look for in your observation of the neck?

A

Trauma, scars, masses, goiter

Carrying angle

Increased or decreased lordosis

Distended external jugular vein (elevate head of bed 30 deg)

Tracheal deviation

Masses in the neck, mediastinal mass, atelectasis, large pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What landmarks are associated with the neck and C spine exam?

A 
Occiput
Mandible
Clavicle
Manubrium
SCM m.
Trapezius m.
Hyoid bone
Thyroid cartilage
Cricoid cartilage
Trachea
Spinous processes
Vertebral prominens (C7)
Interspinous ligament
Transverse processes
Facets
Articular pillars
Anterior and posterior triangles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 3 borders of the anterior triangle?

A

Mandible
SCM
Midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 3 borders of the posterior triangle?

A

SCM
Trapezius
Clavicle

[omohyoid crosses lower portion]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What lymph nodes are associated with a typical neck exam?

A 
Superficial and posterior cervical chain
Occipital
Pre/post auricular
Submandibular
Submental
Tonsillar
Supraclavicular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LNs are normally small, round or ovoid, and smooth. On exam you should note their size, shape, mobility, consistency, and tenderness. Increased size = lymphadenopathy. Generalized LAD is seen in what conditions?

A 
HIV/AIDS
Infectious mono
Lymphoma
Leukemia
Sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

______ = infectious cervical lymphadenitis

A

Scrofula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The ____ of the stethoscope can be used over the carotid arteries to assess for thrills and bruits

A

Bell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Assessing the ___________ assesses for the right atrial pressure as the right internal jugular vein is in direct line with the SVC

A

Jugular venous pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you assess jugular venous pressure?

A

Place pillow under pt head to relax SCM

Raise head of exam table to 30 deg and turn head slightly away of side you’re examining

ID the IJV using tangential lighting and table adjustments to identify the oscillation point/meniscus of IJV pulsations

ID the highest point of pulsation; extend an object horizontally from the apex. Place ruler vertical from sternal angle to create a right angle with the horizontal object

Distance in cm above sternal angle (right atrium) is JVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a normal JVP?

A

Less than 3-4 cm above the sternal angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Low JVPs are best seen in near ______ position — this would be a _______ patient

A

Supine; hypovolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

High JVPs are best seen in ______ position — this would be a _______ patient

A

Upright seated; hypervolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The trachea should be midline in the neck. Use spaces between _____ and _____ as landmarks.

A

Thyroid; SCMs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Lateral displacement of the trache can occur in what condition?

A

Tension pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The ______ of the thyroid overlies the 2nd-4th tracheal rings. Have the patient _____ the neck slightly to relax SCMs

A

Isthmus; flex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

While examining the thyroid, once the neck is flexed, you place fingers of both hands on pt’s neck so that index fingers lie just below the ______cartilage. Have the pt swallow so that the thyroid rises up under finger pads. Observe for ____ and _____

A

Cricoid; contour; symmetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

While exampining the thyroid, displace the ______ to the right and left to palpate each individual lobe. The anterior surface of a lateral lobe is approximately the size of the distal phalanx of the ______ and feels somewhat _____

A

Trachea; thumb; rubbery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

If the thyroid is noted to be enlarged on palpation, what is your next step in the exam?

A

Listen over lateral lobes to detect bruit - which may be heard in hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A simple, non-nondular, or possibly multinodular thyroid enlargement may indicate what condition?

A

Goiter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A soft non-rubbery thyroid would indicate what condition?

A

Grave’s disease

32
Q

A firm, non-rubbery thyroid may indicate what condition?

A

Hashimoto’s thyroiditis or mlaignancy

33
Q

A tender thyroid may indicate what condition?

A

Thyroiditis

34
Q

Muscles involved in C-spine flexion

A

SCM
Scalenes
Paravertebral muscles

35
Q

Normal ROM of neck flexion

A

45-90

36
Q

Muscles involved in C-spine extension

A

Splenius capitus
Splenius cervicis
Intrinsic spinal mm

37
Q

Normal ROM of neck extension

A

70-90

38
Q

Muscles involved in C-spine rotation

A

SCM

Intrinsic spinal mm

39
Q

Normal ROM of neck rotation

A

70-90

40
Q

Muscles involved in C-spine sidebending

A

Scalenes

Intrinsic spinal mm

41
Q

Normal ROM for neck sidebending

A

20-45

42
Q

______ ______ = nerve entrapment by musculoskeletal or myofascial tissue that produces paresthesias in the area of the distribution of the nerve and creates sensory dysfunction/pain and may also decrease muscle strength

A

Central neuropathy

43
Q

What are 2 common sites for central neuropathy to occur

A

Intervertebral foramen

Thoracic outlet

44
Q

Describe test — positive finding? — what does it indicate?

Compression test

A

With head an neck in neutral position, add axial loading force caudally looking for upper extremity pain, paresthesias, or numbness

+ test = reproduction of symptoms (pain/paresthesia in distribution of nerve root)

Indicates central neuropathy

45
Q

Describe test — positive finding? — what does it indicate?

Spurling’s

A

Tests nerve root compression/irritation. Tested with an axial force in neutral, then extension, then SB/rotation toward. Test of high specificity

+ test = reproduction of symptoms (pain/paresthesia in distribution of nerve root)

Indicates central neuropathy

46
Q

Describe test — positive finding? — what does it indicate?

Neck distraction test

A

Doc places one hand under pt chin and places the other hand around the occiput, slowly distracting the head

+ test = alleviation of symptoms

Indicates = central neuropathy

47
Q

Describe test — positive finding? — what does it indicate?

Valsalva test

A

Pt holds breath and bears down, which increase intrathecal pressure

+ test = increased symptoms (pain/paresthesia in distribution of nerve root)

Indicates = space occupying lesion in cervical canal

48
Q

What are the boundaries of the thoracic outlet

A

1st ribs
1st thoracic vertebra
Manubrium

49
Q

The thoracic outlet is best thought of as what 3 zones?

A

Scalene triangle
Costoclavicular space
Retropectoralis minor

50
Q

What structures pass through the thoracic outlet?

A

Brachial plexus
Subclavian v
Subclavian a
Thoracic duct (L)

51
Q

What is the difference between the thoracic duct and the right lymphatic duct?

A

Thoracic duct drains majority of body

Right lymphatic duct drains body’s right upper quadrant

52
Q

Describe test — positive finding? — what does it indicate?

Roos or EAST test

A

Abduct shoulder to 90 and externally rotate with elbow flexed to 90. Physician instructs patient to open and close fist for up to 3 mins

+ test = reproduction of symptoms (pain/paresthesias)

Indicates = thoracic outlet syndrome, specifically compression of subclavian a

53
Q

Describe test — positive finding? — what does it indicate?

Adson test

A

Locate radial pulse on affected arm. Physician abducts, extends, and externally rotates the shoulder while palpating the radial pulse. First, pt’s head is extended and rotated toward affected side; then, pt’s head is rotated away from affected side

+ test = loss or changes in pulse; reproduction of symptoms (pain/paresthesias)

Indicates = thoracic outlet syndrome, specifically compression of subclavian a. between scalenes (when looking away from affected side) or 1st cervical rib (when looking toward affected side)

54
Q

Describe test — positive finding? — what does it indicate?

Wright’s hyperabduction test

A

Physician locates and monitors the radial pulse on the affected side. Abduct the patient’s arm above his/her head with some extension

+ test = loss or change in pulse; reproduction or symptoms (pain/paresthesias)

Indicates = thoracic outlet syndrome, specifically neurovascular entrapment by pectoralis minor m

55
Q

Describe test — positive finding? — what does it indicate?

Costoclavicular test (aka military/halstead)

A

Physician locates and monitors the radial pulse on affected side. With the elbow extended and supinated, extend the shoulder and apply caudal pressure on the shoulder

+ test = loss or change in pulse; reproduction of symptoms (pain/paresthesia)

Indicates = thoracic outlet syndrome, specifically neurovascular entrapment between 1st rib and clavicle

56
Q

What 4 special tests are used to detect central neuropathy?

A

Compression test
Spurling’s maneuver
Neck distraction
Valsalva test

57
Q

What are the 4 special tests used to detect and differentiate thoracic outlet syndrome?

A

Roos (EAST) test
Adson test
Wright’s hyperabduction test
Costoclavicular test (military/halstead)

58
Q

What are the 3 exam findings/special tests are used to detect subarachnoid irritation?

A

Nuchal rigidity on exam
Brudzinski’s sign
Kernig sign

59
Q

Describe test — positive finding? — what does it indicate?

Nuchal rigidity

A

Patient supine. Place hands behind pt head, flex neck forward until chin touches chest

+ test = marked neck stiffness/resistance to flexion

Indicates = inflammation in subarachnoid space (e.g., meningitis or subarachnoid hemorrhage)

60
Q

What PE finding is present in 57-92% of cases of acute bacterial meningitis, and 21-86% of subarachnoid hemorrhage?

A

Nuchal rigidity

61
Q

Describe test — positive finding? — what does it indicate?

Brudzinski’s sign

A

Patient supine. Place hands behind patient’s head, flex neck forward until chin touches chest

+ test = flexion in both hips and knees

Indicates = inflammation in subarachnoid space (e.g., meningitis or subarachnoid hemorrhage)

62
Q

T/F: for both brudzinski’s sign and kernig sign, the sensitivity is low and specificity data is limited

A

True

63
Q

Describe test — positive finding? — what does it indicate?

Kernig sign

A

Place patient supine and flex hip and knee to 90. Attempt to passively extend the leg at the knee

+ test = increased resistance to extension and pain behind knee, +/- back pain radiating to posterior thigh (sources vary)

Indicates = meningeal/dural irritation

64
Q

Cervical spinal cord injuries can occur in any sport, but particularly in what 3 sports?

A

Football
Hockey
Lacrosse

65
Q

What type of injury accounts for over half of c-spine injuries?

A

Axial load — force transmitted to bone and disc

66
Q

Cervical spinal cord injuries may occur when the neck is flexed to _______ degrees, because the lordosis is lost and protective soft tissues are no longer protective

A

30

67
Q

Fracture of C1 due to axial compression

A

Jefferson fracture

68
Q

Fracture due to flexion and compression injury

A

Wedge fracture

69
Q

C2 odontoid fractures typically occur at the junction of _____ and ______, often requiring surgery

A

Process; body

70
Q

C2 bilateral arch fracture due to hyperextension injury

A

Hangman’s fracture

71
Q

Spinous process fractures may occur with ________ or ________ force from muscle contraction

A

Hyperextension; avulsion

72
Q

At what vertebral level(s) would you see a Clay Shoveler’s fracture?

A

C6 or C7

73
Q

Flexion and compression injury may lead to anterior-inferior _____ fragment

A

Teardrop

[this is a teardrop fracture]

74
Q

Comminuted fracture that can result in severe spinal cord injury

A

Burst fracture

75
Q

Flexion injury leading to facet dislocation without fracture

A

Anterior subluxation

PCM II Exam 1 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions