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MINCER - EXAM 3 > Rat 5- 3/1/16 > Flashcards

Rat 5- 3/1/16 Flashcards

1
Q

True/ False

Primary bone tumors in L and T have a higher occurrence rate than C-spine

A

True

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2
Q

what organs more frequently metastasis to the C-Spine?

A

Cervical metastatic occurs more frequently in cancers of breast, lung, prostate, and melanoma

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3
Q

How frequent is metastasis to the C-Spine?

A

C-spine metastasis occurs in 8-20% of pts with known metastatic disease and is relatively uncommon

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4
Q

What are some criteria for referral when cancer is suspected?

A

Clinical judgment
Low hematocrit
Elevated ESR
Previous hx of cancer

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5
Q

Other criteria for referral when cancer is suspected?

A

Previous hx of non-skin cancer
Failure of conservative management in past month
Age >50
Unexplained wt loss of more than 4.5 kg in past 6 months

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6
Q

What’s the incidence of infection in C-spine

A

rare

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7
Q

Name and define one type of infection in C-spine

A

Cervical vertebral osteomyelitis- a type of bacterial infection inclusive of dis-kitis, spondylitis, and spondylodiscitis

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8
Q

Name 3 common sources of Cervical vertebral osteomyelitis

A

TB,
urinary and respiratory tract infections,
IV drugs

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9
Q

What are the risk factors for Cervical vertebral osteomyelitis

A

diabetes,
renal insufficiency,
heart or liver disease, alcoholism,
chronic immunosuppression

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10
Q

Where are the neurological deficits located with Cervical vertebral osteomyelitis

A

Most cases are reported between C5 to C6

Least cases reported between C2-C5

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11
Q

What are the lab tests used to diagnose Cervical vertebral osteomyelitis

A

ESR, WBC, C-reactive protein levels

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12
Q

What imaging tests are recommended to diagnose Cervical vertebral osteomyelitis

A

Radiographs- end plate erosion 2-4 wks post onset.

MRI- gold standard

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13
Q

True/False

C-spine fx. is rare.

A

Rare- prevalence of less than 4% of population

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14
Q

What is the MOI for C-spine fx?

A

MOI- trauma related; Falls, Motor vehicle collision (MVC), or Sports injury

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15
Q

What level is fx most commonly happening at?

A

Half occur at C6 or C7

⅓ at C2

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16
Q

What is the algorithm used to determine who would benefit form radiography?

A

Canadian C Spine rule recommended to determine who would benefit from radiographic evaluation

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17
Q

What are the 3 high risk factors that mandate imaging? (Canadian C Spine rule)

A 
Age > or = to 65
 or 
dangerous MOI
or 
paresthesias in extremities
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18
Q

What are the 5 low risk factors that allow safe assessment of ROM? (Canadian C Spine rule)

A 
Simple, rear-end MVC
sitting position in ED (emergency dept.) 
ambulatory ate any time
delayed onset of neck pain
absence of midline C-spine tenderness
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19
Q

What is the ROM value that added to the other two clusters of symptoms will help us decide whether imaging is needed or not?

A

45 degrees rotation bilaterally

able- no imaging needed

(after considering all the other symptoms:
Simple, rear-end MVC
sitting position in EO
ambulatory at any time
delayed onset of neck pain
absence of midline C-spine tenderness
and neither one of the following is present: 
Age > or = to 65
 or 
dangerous MOI
or 
paresthesias in extremities )
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20
Q

What is cervical arterial dysfunction?

A

CAD describes potential adverse events involving both the vertebrobasilar system supplying the hindbrain (Pons, Brainstem, Vestibular apparatus, Medulla Oblongata and Cerebellum) and the internal carotids supplying the cerebral hemispheres and the retina.

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21
Q

What are the 3 forms of CAD?

A

Stenotic
Occlusive,
Dissecting Aneurysms

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22
Q

How does cervical rotation and extension affect the vertebral artery?

A

It can cause Internal Carotid Artery Dissection. These movements compress the artery against the transverse process of the upper cervical vertebrae
Vertebral Artery Dissection is assoc. with contralateral cervical rotation that stretches or compresses the artery between the 1st two cervical vertebra

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23
Q

What are the symptoms of internal carotid artery dissection?

A

Ipsilateral frontotemporal headaches upper/mid cervical or anterolateral neck pain or facial pain

Neck pain occurs in 9% -20% of symptomatic pts

Facial pain present in 34%-53% of pts.

Headaches usually reported in the frontotemporal or hemicranial regions.

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24
Q

What are the symptoms of vertebral artery dissection?

A

Neck pain: usually sudden, severe & sharp ipsilaterally in the upper posterior to middle cervical spine, usually with or without occipital headache alone.

Neck pain occurs in 34%-46% of symptomatic pts.

Facial pain not usually present

Headaches usually reported as an ipsilateral, constant ache in the occipital or parieto-occipital regions

Rarely C5-C6 nerve root impairment

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25
Q

What are the classic symptoms of vertebral artery insufficiency?

A 
5 Ds
Drop attack, 
Dizziness, 
Diplopia,
Dysarthria,
Dysphagia),

Ataxia, Nausea, Numbness of the unilateral face, Nystagmus

NB: strict use of these signs and symptoms may be misleading and lead to poor understanding of the pts. presentation.

Some non-classic s/s:
also hindbrain stroke (also known as wallenberg syndrome)
Cranial nerve palsies

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26
Q

What factors raise the index of suspicion that a patient may have cervical arterial dysfunction?

A

Careful history and review of cardiovascular risk factors, such as hypertension, hypercholesterolemia, coagulation abnormalities, direct vessel trauma, DM, a hx of smoking, bacterial infection and family hx of cardiovascular disease (CVD).

Other pertinent info includes a history of trauma (MVC, fall, lifting or coughing), recent cervical spine surgery, nerve blocks, radiation therapy, intubation, central venous catheterization, or connective tissue disorders.

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27
Q

What is the course of action for the PT when CAD is suspected?

A

Therapists should develop a high index of suspicion with acute onset of neck and head pain described as “unlike any other,” and consider the signs & symptoms associated with nonischemic and ischemic phases of CAD.

If the index of suspicion is high, based on the pts. hx, - end range provocative test is not indicated and the patient is referred appropriately……….

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28
Q

How successful are the provocative tests for identifying arterial dysfunction?

A

In general, functional positioning tests have poor diagnostic utility as predictors of risk and will not assist the clinician with decision making related to the presence or absence of CAD

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29
Q

What are the 4 stages recommended by the Australian Physiotherapy Association in assessing for the presence of S/S associated with VBI

A

during 4 stages:

  1. History
  2. Physical examination
  3. During Treatment
  4. Following C-spine Tx
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30
Q

What are the 4 types of dizziness other than Cervicogenic Dizziness (CD)

A

Presyncope
Vestibular
Disequilibrium
Dizziness

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31
Q

How can a PT differentiate cervicogenic dizziness from other types?

A

Cervicogenic Dizziness (CD) is considered a diagnosis of exclusion. When all other causes of dizziness have been ruled out.,CD is considered. Therefore a thorough Hx and physical exam are necessary to identify pts. with CD, MSK impairments and vestibular disorders appropriate for PT.

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32
Q

Define Presyncope

A

Lightheadedness,

impending faintness,

Tiredness from altered blood supply, oxygen or glucose

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33
Q

What is vestibular dizziness

A

Vertigo (spinning sensation)

34
Q

What is Disequilibrium?

A

unsteadiness,
imbalance,
weakness & sense that fall will occur.

Assoc. with poor vision, Peripheral neuropathy or MSK disturbance.

35
Q

What is dizziness?

A

reports of floating, anxiety, depression & fatigue, suggesting a psychiatric disorder

36
Q

which two types of dizziness will need a referral?

A

Symptoms of
- presyncopal and
-other dizziness
may indicate the need for a referral.

37
Q

Define Cervicogenic Dizziness

A

-“a specific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activities from the neck”

38
Q

What words would a pt use to complain of dizziness?

A

Lightheadedness, Faintness, Heavy headedness, Falling, Waving, Imbalance, Swimming sensation, Floating, Unsteadiness or Spinning.

39
Q

Which types of dizziness are appropriate for PT and which are not?

A

Dizziness caused by cardiovascular or metabolic disorders may result in precautions or contraindications to PT and require medical referral., whereas dizziness related to the cervical spine, musculoskeletal impairments, and the vestibular system may be appropriate for PT intervention

40
Q

Why is cervical spine ligamentous instability so important to identify and

A

CSI (Cervical Spine Instability) may be a life threatening instability appreciated with imaging

41
Q

What typical disvascular or metabolic disorders may result in precautions or cont?

A

CSI (Cervical Spine Instability) is often related to the transverse ligament in RA, AS, Down Syndrome, Klippel-Feil Syndrome, Congenital presence of an immature dens leading to compression of neurovascular structures, or described as a minor non-radiographic clinical instability.

42
Q

How would you describe a minor clinical CSI?

A

A minor clinical CSI is considered a movement impairment with subtle clinical features theorized to involve the active and neutral stabilizing systems without disruption of the passive systems.

43
Q

Why is rheumatic disease important to identify?

A

RA is the most common inflammatory disease that affects the C spine.

44
Q

What structures are mostly affected by Cervical RA?

A

The diarthrodial joints are primarily affected, but extra-articular features manifest in the skin, eyes, lungs, and nervous system.

45
Q

What are the risk factors for RA cervical disease?

A

Male gender, Seropositive rheumatoid factor, rheumatoid nodules, early bone erosion, long standing disease, prolonged steroid use.

46
Q

How does ankylosing spondylitis affect the risk of cervical fracture?

A

Neck pain can become more of a complaint than LBP in older individuals who have had the disease longer due to bony ankylosis and osteoporosis, the cervical spine is at increased risk of spinal fracture. Low energy falls such as trips and slips involving hyper-extension, may result in neurological deficits from these unstable fractures.

47
Q

What are the symptoms of acute coronary syndrome in both men and women?

A

Chest pain most common symptom for both men and women.

48
Q

What is acute coronary syndrome?

A

ACS, caused by insufficient blood supply to the myocardium, is a spectrum of clinical presentations, ranging from— unstable angina, to MI with non-ST elevation segment elevation myocardial infarction, or ST segment elevation

49
Q

What are the symptoms of acute coronary syndrome

A

A key sign of ACS in women is: unexplained severe, episodic fatigue that interferes with performing daily activities.
Less common signs of MI, especially in women, include:
Chest pain (angina) that feels like burning, pressure or tightness
Pain elsewhere in the body, such as the left upper arm or jaw (referred pain)
Nausea
Vomiting
Shortness of breath (dyspnea)
Sudden, heavy sweating (diaphoresis)

Women more likely to have atypical symptoms (compared to men)
Younger women more often experience dyspnea compared to younger men.

50
Q

What are the symptoms of cervical myelopathy in the LE and UE?

A

Clinical features of CM varies, making early diagnosis difficult.

The LEs may be affected first with weakness and spasticity, or hyperreflexia affecting gait, often producing a wide-based gait and balance problems.

UE changes present as weakness, atrophy, and problems with finger fine motor control.

Sensory changes, although inconsistent, may occur later rather than early in the UE and more than in the LE, but UE symptoms have also been an early presentation.

51
Q

What are the 5 tests of the cluster used to rule in or rule out cervical myelopathy?

A

Hoffman,
Babinski’s,
Clonus, and
Deep tendon reflexes associated with hyperreflexia
are more specific than sensitive, and therefore considered better tests for ruling in CM.

The inverted supinator sign (i.e. finger flexion or elbow extension during the brachioradialis reflex test) may be the most sensitive test for ruling out CM.

52
Q

What are some additional manifestations of cervical Myelopathy?

A

Additional manifestations include neck stiffness or pain, pain in the upper quarter region (shoulder, scapula), widespread numbness, paresthesias in both arms or hands, and sensory and ataxic changes of the LE.

53
Q

What are the symptoms of advanced CM?

A

Advanced CM findings may include paresthesias, quadriparesis and bowel and bladder changes.

54
Q

Talk briefly about the incidence of Cervical myelopathy

A

Cervical Myelopathy is the most common spinal cord dysfunction in persons over the age of 55., and is present in persons 70 or older, affecting most often persons of Asian descent and males.

55
Q

How can the cluster of 5 tests be used to rule in or rule out cervical myelopathy?

A

Absence of a + finding, or presence of 1 of 5 tests, provides a moderate level of confidence that the patient does not have CM, whereas 3 of 5 positive test findings assists with ruling in CM.

If CM is suspected. based on clinical examination, a referral for additional testing is warranted.

56
Q

What are the 5 Findings that assist in the diagnosis of CM

A

Age > 45 years

Positive Babinski sign

Positive inverted supinator sign

Positive Huffman

Gait dysfunction described as spastic, wide-based gait, or ataxic

57
Q

What are the two main causes of cervical radiculopathy?

A

Most common is degeneration of the c-spine (which includes loss of disc height, degeneration of disc, osteophytes), second most common is due to disc herniation.

58
Q

What ages does cervical radiculopathy peak at?

A

Peak age: 4th or 5th decade (50-54 females>males)

59
Q

What is the relative frequency of cervical radiculopathy by level?

A

C6-7 most common level , 70% of cases (affecting 7th spinal nerve).
C5-6 next most common level (affects 6th spinal nerve).

60
Q

What are the typical symptoms for cervical radiculopathy?

A

Severe burning, shooting, stabbing, or lancinating pain traveling distally into the extremity to a dull ache in the neck and UE

61
Q

How can the cluster of 4 tests help identify cervical radiculopathy ?

A

4 cluster test CPR:

  • ULTT A (most useful test when used alone for ruling out CR)
  • Cervical rotation less than 60 degrees to the involved side
  • Distraction test
  • Spurling test A

If 3 items are positive, the probability of CR increases 65%

If all 4 items are present, the probability of CR increases to 90%.

The test item cluster produces larger posttest probability changes for diagnosis of CR than any single test item.

62
Q

Which is more reliable, valid and responsive in neck pain, the NDI or the PSFS?

A

PSFS

63
Q

Is the interpretation for the FABQ the same in neck pain as for back pain?

A

NO. The relationship between. Fear related behavior and pain and disability among patients with neck pain is weaker than among LBP.

64
Q

In what age ranges does neck pain peak?

A

35 to 49 and declines later in life.

Younger persons have a better prognosis

65
Q

What body areas should be cleared when examining a patient with neck pain?

A

Neck circumferentially and thoracic spine
Both UE circumferentially
Chest and abdomen
Head and neck

66
Q

What are some things we should ask for when evaluating C-spine?

A

Specifically ask for:
Numbness,
tingling,

Other sensory symptoms like: cold,
heaviness, 
dizziness, 
unsteady
nausea, 
visual disturbances
Areas that do not feel normal
67
Q

What are the typical areas of pain referral from somatic structures of the cervical spine?

A

Local to the neck or referred into the thorax, head, face or upper extremity (perceived in an area that shares the same segmental innervation as its source)

68
Q

What is the MCID for neck pain on the NPRS?

A

MCID of 1.3 = meaningful improvement has occurred from the pt’s perspective
In a population with CR the MCID is 2.2

69
Q

Describe the mechanical pattern of night pain

A

Pt reports inability to lie on the involved side

Symptoms relieved by change in position

70
Q

What do we have to consider if the Pt reports: “pain is most intense at night and is unsure of what wakes her”; reports she must get up and walk around, and has difficulty returning to sleep

A

Active inflammatory component

Neoplasm

71
Q

What do you need to determine about the 24 hour behavior of pain for a good differential diagnosis?

A

Need to determine: frequency, provocative position and symptoms produced

72
Q

True/False

Most musculoskeletal conditions are better in the morning

A

True

73
Q

True/False

If degenerative- stiffness relieved with movement after 30-60 min,

A

True

74
Q

True/False

AS stiffness lasts longer than 60 min

A

True

75
Q

What is your evaluation of Symptoms that do not vary with daily activities

A

are minor mechanical problems or suggestive of more serious pathology…

76
Q

Pain Worse in the morning may be due to ……..

A

poor sleeping posture

77
Q

Pain Unchanged in the morning is…

A

nonmechanical or minor mechanical

78
Q

Improved in the morning and remain better with movement is…..

A

mechanical with good prognosis

79
Q

Pain Worsen in the morning is …..

A

mechanical with limited prognosis

80
Q

what is Klippel-Feil syndrome

A

Klippel-Feil syndrome is a bone disorder characterized by the abnormal joining (fusion) of two or more spinal bones in the neck (cervical vertebrae). The vertebral fusion is present from birth.

81
Q

What is a diarthroidal joint?

A

A synovial joint, also known as diarthrosis, joins bones with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones’ articulating surfaces. The synovial (or joint) cavity is filled with synovial fluid.

MINCER - EXAM 3 (9 decks)

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