Quizes for 5/6 Flashcards
Which of the following is most likely to occur in the cervical spine?
A. Infection
B. Fracture
C. Cancer
D. NA- these are only in the lumbar
C. Cancer
What active motion test is part of the Canadian C-Spine rule?
A. B rotation to 45*
B. Uni rotation to 45*
C. Flexion to 45*
D. Flexion and Extension to 45*
A. B rotation to 45*
Which of the following is NOT a classic symptom of vertebral artery dysfunction?
A. Double vision
B. Nausea
C. Fainting
D. Trouble swallowing
C. Fainting
Drop attack is different from fainting.
It is particularly important to know whether a cervical pt has RA bc if it is present
A. Exacerbations of neck P and stiffness are likely
B. Neurogenic P will complicate treatment
C. Spinal stenosis is the likely P generator
D. Upper cervical instability makes the treatment risky
D. Upper cervical instability makes the treatment risky
Symptoms of cervical myelopathy include all the following except
A. B weakness
B. Hyporeflexia of LE
C. UE anesthesia
D. Pain in 1 or both arms
B. Hyporeflexia of LE
Cervical radiculopathy most commonly involves
A. the C8 nerve root
B. elderly women with RA
C. B extremities
D. Arm P > neck P
D. Arm P > neck P
Neck P occurs most often in
A. Hypermobile young adults
B. Middle aged adults
C. Osteoarthritic elderly adults
D. Adults irrespective of age
B. Middle aged adults
Mechanical neck P is usually _____ in the morning after rest.
A. stiff for an hour or more
B. most severe
C. less painful
D. unpredictable
C. less painful
A diagnosis of ankylosing spondylitis
A. increases a pt’s risk of fracture
B. often follows a diagnosis of osteoporosis
C. is more common in elderly osteoporotic pts
D. is often associated with a history of childhood fracture
A. increases a pt’s risk of fracture
Which of the following is a most accurate statement related to the cluster of 4 tests for radiculopathy?
A. all 4 must be + to raise suspicion of radiculopathy
B. all 4 must be - to rule out radiculopathy
C. even if all 4 are -, it’s not necessarily ruled out
D. the more are +, the higher the suspicion
D. the more are +, the higher the suspicion
Your 45 your old self-referral neck P pt that you are evaluating today has no previous hx of cancer and her wt is stable. What is the risk that her P 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 out of 4 factors so her risk is pretty low
D. she is negative on 1 out of 4 factors so she should be referred
C. she is - on 3 out of 4 factors so her risk is pretty low
The four factors are:
over age 50
prev hx of non-skin cancer
Unexplained weight loss of more than 4.5 kg (~10lbs) in 6 months
failure of conservative Tx in past month (this is the only unknown for this question)
The absence of all 4 of these clinical findings essentially rules out cancer in the lumbar spine. Specific research has not address these findings for pts with neck pain.
How many of the following are NOT risk factors for vertebral osteomyelitis?
A. DM type 1 B. alcohol abuse C. illicit IV drug use D. pnumonia E. recent stem cell transplant F. severe torticollis G. tuberculosis H. unexplained fever I. urinary incontinence J. wt loss
F. severe torticollis– this is a sym of VO
H. unexplained fever– this is a sym of VO or a different infection
I. urinary incontinence– UTI is a risk factor, not UI
J. wt loss– this is a sym of VO
Your pt is a 62 year old male who self-referred to your PT clinic a few days after being rear ended by someone traveling at a moderately high speed. He has no sensory complaints besides severe P and soreness, which came on within a few hours of the accident. He ahs diffused upper, mid, and lower cervical tenderness midline and B and he can rotate 30* R and 40*L. He declined medical evaluation immediately after the accident bc he had no P initially. Should you refer?
A. Yes, but only if he doesn’t respond to initial treatment
B. Yes, even before I attempt initial treatment
C. No, he only has one read flag (>50)
D. Not yet, finish a thorough exam then decide
B. Yes, even before I attempt initial treatment
Which of the following is NOT a risk factor, feature, or symptom of cervical arterial dysfunction?
A. Cardiovascular risk factors such as diabetes, smoking, bacterial infection raise suspicion of this
B. Cervical rotation and/or extension movements compress and/or stretch the internal carotid and/or vertebral arteries
C. Contraceptives use is a risk factor
D. Dissecting aneurysms of the vertebrobasilar or internal carotid arteries are part of this
E. Dizziness associated with rotation of the head
F. Genetic disposition and/or family history of cardiovascular disease increases the suspicion
G. If symptoms don’t include one or more of the 5 D’s it can be ruled out
H. It is defined as both current and potential adverse events involving the blood supply to the brainstem and cerebrum
I. Provocation testing is always indicated prior to cervical exam and intervention
J. Recent cervical trauma is a risk factor
K. Recent surgical or nerve block increase the risk of this
L. Sudden recent onset of neck P without dizziness or neurological symptoms
M. Sudden recent onset of severe headache
N. Transient ischemic CNS symptoms are associated with this
G. If symptoms don’t include one or more of the 5 D’s it can be ruled out
I. Provocation testing is always indicated prior to cervical exam and intervention ((not always))
Which of the following are good descriptions of the DISEQUILIBRIUM associated with what is likely to be cervicogenic dizziness?
A. I feel lightheaded and woozy.
B. I sometimes feel weak and unsteady on my feet.
C. It feels like I’m about to fall for no good reason.
D. It feels like I’m going to faint or something.
E. It feels like the room is spinning around me.
F. It lasts for a few minutes generally.
G. It only happens when I turn my head quickly.
H. It usually lasts for a few seconds.
I. My legs suddenly buckle under me for no good reason.
J. Suddenly my vision goes kind of dark.
K. When I stand up quickly, I get sort of dizzy.
Disequilibrium::
B. I sometimes feel weak and unsteady on my feet.
C. It feels like I’m about to fall for no good reason.
F. It lasts for a few minutes generally.
H. It usually lasts for a few seconds.
Presyncope::
A. I feel lightheaded and woozy.
D. It feels like I’m going to faint or something.
J. Suddenly my vision goes kind of dark.
K. When I stand up quickly, I get sort of dizzy
Vestibular::
E. It feels like the room is spinning around me.
G. It only happens when I turn my head quickly.
Drop attack::
I. My legs suddenly buckle under me for no good reason.
Ligamentous instability is generally associate with which of the following
A. Early RA B. Genetic ligamentous instability C. History of major trauma D. - radiograph for instability E. pt preference for external support F. Radiographic instability G. soft end-fell with passive motion H. Subjective reports of neck locking or catching I. unpredictable symptoms
All of them
A. Early RA B. Genetic ligamentous instability C. History of major trauma D. - radiograph for instability E. pt preference for external support F. Radiographic instability G. soft end-fell with passive motion H. Subjective reports of neck locking or catching I. unpredictable symptoms
Note: Radiographs are not absolutely positively dependable.
(-) radiograph doesn’t mean no instability
but
(+) radiograph means likely instability
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 E. morning stiffness >45 minutes F. one or more of the '5 D's' G. paresthesia, maybe B H. suboccipital P and/or occipital headaches
C. excessive cervical ROM
Describe angina:
From the book:
Angina is a typical symptom of MI often described as a sensation of substernal or retrosternal chest pressure, squeezes, or heaviness during exertion of 70-90%. Only 33% or less complain of chest P. Some pts present with neck, jaw, ear, arm, or epigastic discomfort.
How does unstable angina differ from stable angina?
Stable angina lasts 5-15 minutes and comes on by a predictable level of function or emotional stress.
Unstable angina is an abrupt change in intensity or frequency that is not relieved by rest or nitroglycerin.
What is the key sign of acute coronary syndrome in women?
Severe fatigue that is unexplainable
Which of the following is NOT one of the common signs of heart attack?
A. chest discomfort with lightheadedness, dizziness, sweating, pallor, nausea, or SOB
B. P that spreads to the throat, neck, back, jaw, shoulders, or arms
C. Prolonged uncomfortable pressure, fullness, squeezing, or P in the center of the chest
D. Symptoms relieved by antacids, nitroglycerin, or rest
D. Symptoms relieved by antacids, nitroglycerin, or rest
(antacids should not relieve pain if it is heart attack - unless maybe in women, and if it is an actual heart attack the symptoms will not be relieve by any of the three things). They might help with angina but not a MI.
The following 5 findings assist in diagnosing cervical myelopathy: Age>45 \+ Babinski sign \+ inverted supinator \+ Hoffman Ataxic or wide-based gait
What is/are the criteria for ruling CM in?
3 out of 5 +
the best test for a + is Babinski and Hoffman
The following 5 findings assist in diagnosing cervical myelopathy: Age>45 \+ Babinski sign \+ inverted supinator \+ Hoffman Ataxic or wide-based gait
What is/are the criteria for ruling CM out?
0 or 1 out of 5 are +
the best is having a - inverted supinator
The following 4 findings assist in diagnosing cervical radiculopathy:
What is/are the criteria for ruling CR in?
ULTT A
Ipsilateral rotation less 60 degrees
distraction
Spurling’s A
3 out of 4 + is 65%
4 out of 4+ is 90%
**the more + the better chance
The following 4 findings assist in diagnosing cervical radiculopathy:
What is/are the criteria for ruling CR out?
ULTT A
Ipsilateral rotation less 60 degrees
distraction
Spurling’s A
the less + the more chance of ruling it out
**if ULTT A is negative, best to rule out
Which of the following screening tests is not useful for screening a cervical source of P?
A. Median neurodynamics tests
B. PA accessory testing
C. Palpation side glide
D. Spurling’s test
C. Palpation side glide
These 3 are good to use for screening cerival source of P. Whenever a person has S pain, should do these 3 and cervical ROM.
A. Median neurodynamics tests
B. PA accessory testing
D. Spurling’s test
Your pt with neck P also is noted to have significant FHP. Is this relevant to this pt’s P?
A. Have the pt retract and if the symptoms decrease then the posture is probably relevant
B. If the P is lower cervical, it can be assumed that the FHP is the cause of P
C. FHP pts both the upper and lower cervical spine in an abnormal position so it is relevant no matter where the neck P is located
D. It is only relevant if the pt’s agg factors include sitting or working at a computer
A. Have the pt retract and if the symptoms decrease then the posture is probably relevant
What single exam item is best for assessing whether the TMJ is part of a pt’s neck P problem?
A. Asking whether they have P during chewing
B. The presence of clicking now
C. Measuring depression AROM
D. The presence of clicking in the past
C. Measuring depression AROM
Which of the following are most indicative of a pt with a shoulder girdle component of his or her neck and shoulder P?
A. Shoulder P is reported during particularly heavy lifting and carrying tasks
B. Resisting shoulder flexion aggravates the pt’s neck and shoulder P
C. Abnormal scapular resting position is noted and the pt cannot correct it
D. Scapular repositioning significantly reduces shoulder P with lifting
B. Resisting shoulder flexion aggravates the pt’s neck and shoulder P
D. Scapular repositioning significantly reduces shoulder P with lifting
~~the book says shoulder or neck P, so this is correct. Mincer did not mean it to be correct. Her thinking was the it would be correct if the repositioning reduced shoulder and neck P.
The thoracic spine is often mobilized in a patient with neck P
A. Bc is reduces P and disability originating the cervical spine
B. When the pt’s neck P has a thoracic source instead of a cervical source
C. Only if the central PA’s in thoracic reproduces both thoracic and neck P
D. If there is at least one positive thoracic outlet syndrome tests
A. Bc is reduces P and disability originating the cervical spine