OSCE: Cervical Spine Flashcards
How would you inspect the trachea?
- Inspect and palpate trachea for any deviation. Trachea should be midline.
- Place finger along one side of the trachea and another finger on the other side of trachea. Use spaces between thyroid and SCM as landmarks.
- Note the spacing between the trachea and SCM. Spacing should be symmetrical.
What can cause tracheal deviations?
- Neck mass
- Mediastinal mass
- Atelectasis
- Pneumothorax
Where can you check carotid pulse?
- Medial to the SCM and inferior to the corner of the jaw.
- Assess for thrills and bruits with bell of stethoscope.
- Do not asses both carotid pulses simultaneously!
How would you palpate the thyroid?
- To locate, use cues from visual inspection. Isthmus overlies 2nd-4th tracheal rings. Have patient flex neck slightly to relax SCM.
- Place fingers of both hands on patient’s neck so that index fingers lie just below cricoid cartilage.
- Have patient swallow so thyroid rises up under finger pads. Observe for contour and symmetry.
- Displace trachea to right and palpate right lobe. Repeat for left lobe.
How would you detect an enlarged thyroid lobe?
After finding an enlarged thyroid from palpation, listening for a bruit can help identify hyperthyroidism & toxic multinodular goiter but it will not always be heard
Compression Test
How do you perform this test?
What does a positive test indicate?
Test:
- Physician position: standing behind seated patient.
- Physician applies an axial compression of the head in neutral.
Positive test: Pain down the arm in the nerve root distribution and/or paresthesia
Indicates: Nerve root compression (central neuropathy)
Spurling’s Maneuver
How do you perform this test?
What does a positive test indicate?
Physician position: standing behind seated patient.
The test is done in three stages, each of which is more provocative. If symptoms are produced, the test is considered positive and there is no need to proceed to the next stage.
- Compression of the head in neutral.
- Compression of the head with head in extension.
- Side bend away from the affected side then rotate toward/away the affected side and add compression.
Positive test: pain down the arm in the nerve root distribution and/or paresthesia
Indicates: nerve root compression (central neuropathy)
Neck Distraction Test
How would you preform this test?
What would a positive test indicate?
Test:
- Physician places one hand under the patient’s chin and places the other hand around the occiput.
- The physician slowly distracts the head.
Positive Test: Alleviation of symptoms
Indication: Central neuropathy
Adson’s Test
How would you perform this test?
What does a positive test indicate?
Test:
- Physician locates radial pulse on affected arm. While standing behind patient, physician then abducts, extends, and externally rotates the shoulder while
palpating the radial pulse. - First, patient’s head is extended and rotated toward affected side as they inhale and hold it. Then the patient’s head is extended and rotated away from affected side as they hold inhalation.
Positive Test: Loss or change in pulse; reproduction of symptoms (pain/paresthesia)
Indication: Thoracic Outlet Syndrome
In a positive Addison’s test, what compresses the subclavian artery when the patient is looking toward affected side?
1st rib
In a positive Addison’s test, what compresses the subclavian artery when the patient is looking away affected side?
Scalene muscles
Roos or EAST Test (Elevated Arm Stress Test)
How would you perform this test?
What does a positive test indicate?
Test:
- Patient abducts shoulder to 90° and externally rotates with elbow flexed to 90°.
- Physician instructs patient to open and close fist for up to 3 minutes
Positive Test: Loss or change in pulse; reproduction of symptoms (pain/paresthesia)
Indication: Thoracic Outlet Syndrome
Nuchal Rigidity
How do you perform this test?
What does a positive test indicate?
Test:
- Patient supine.
- Place hands behind patient’s head, flex neck forward until chin touches chest.
Positive Test: Marked neck stiffness/resistance to flexion
Indicates: Meningitis (inflammation in subarachnoid space) or subarachnoid hemorrhage
Brudzinski’s Sign
How do you perform this test?
What does a positive test indicate?
Test:
- Patient supine.
- Place hands behind patient’s head, flex neck forward until chin touches chest.
Positive Test: Flexion in both hips and knees
Indicates: Meningitis (inflammation in subarachnoid space) or subarachnoid hemorrhage
Kernig Sign
How do you perform this test?
What does a positive test indicate?
Test:
- Place patient supine and flex hip and knee to 90°.
- Attempt to passively extend the leg at the knee
Positive Test: Increased resistance to extension and pain behind knee.
Indicates: Meningeal/dural irritation
What is a Jefferson fracture?
Axial compression in C1
What is a wedge fracture?
Flexion and compression injury
