Screening for Head, Neck, and Back Flashcards
1
Q
what are possible origins of HAs
A
from head, C1, C2, or C3
2
Q
what are 9 HA sx that are red flags
A
- persistent unrelenting HAs
- supine inc HA
- onset w exertion, cough, sneeze
- visual changes, nystagmus, pupil dilation, diplopia
- CNS s/sx (CN or extremity focal deficits, ataxia, fatigue, irritability)
- change in mentation
- associated fevers, temp, wt loss/gain
- associated trauma
- associated sz
3
Q
what does a HA that inc w supine or has an onset w exertion, cough, or sneeze indicate
A
inc ICP
4
Q
what does a HA associated w fevers, temps, wt loss/gain indicate
A
CA or infection
5
Q
what does a HA associated w trauma indicate
A
head bleed
6
Q
what does a HA associated w sz indicate
A
anything in brain could be encroaching and putting pressure on different part of brain that cause sz
- this could be d/t tumors, edema
7
Q
what are 4 possible dx related to the red flags for HAs
A
meningitis/encephalitis
brain tumor
subarachnoid or other intracranial hemorrhage
temporal arteritis associated w polymyalgia rheumatica
8
Q
what are risk factors for meningitis
A
young children
college students
elders
exposure
9
Q
if a pt has a HA w a high fever what is the first thing you have to r/o
A
meningitis
10
Q
what is meningitis caused by
A
bacterial or viral
- mortality for bacterial is double that of viral
super contagious
11
Q
what are sx of meningitis (6)
A
HA w high fever
(+) meningeal slump
flu-like sx
confusion
sz
lethargy
12
Q
what is a meningeal slump
A
bring chin to chest
puts meninges on stretch
- will cause inc pain and HAs if (+)
13
Q
what population of pts is there crossover of meningitis sx with - esp confusion
A
diabetics
14
Q
triage for suspected meningitis?
A
red flag: ER medical emergency
15
Q
what type of brain tumor would a pt likely have
A
primary brain tumor
- insular brain tumors have a very low incidence
16
Q
risk factors for a brain tumor
A
not really known
radiation exposure loosely tied
- ie children w childhood cancer treated w radiation, develop a brain tumor later
17
Q
what are 7 associated sx with a brain tumor
A
focal motor/sensory abnormalities
ataxia/imbalance
speech deficits
progressive severe HA (often positional if inc ICP)
visual changes
altered mental status
sz
18
Q
triage for suspected brain tumor
A
red flag: ER medical emergency, urgent imaging - if have any of these w HAs
19
Q
risk factors for subarachnoid hemorrhage (4)
A
recent head trauma
hx of intracranial aneurysm
HTN
smoking
20
Q
s/sx of subarachnoid hemorrhage (4)
A
- sudden onset of “thunderclap HA”
- worst HA you ever had - LOC - may be brief, could be d/t head trauma
- s/sx of brain tumor
- s/sx of meningitis
21
Q
triage for suspected subarachnoid hemorrhage
A
red flag: ER today, medical emergency
call ambulance
- could decline fast, if brain swells enough - could shut down breathing centers
22
Q
what are 3 risk factors for TMJ fx or infection
A
trauma (fx)
recent surgery (infection)
recent infection (infection)
23
Q
what are 3 sx of TMJ infection
A
inability to open mouth
fever
cold sore
24
Q
what flag is TMJ infection
A
yellow - urgent call to surgeon
- not necessarily to ER
25
what is a cold sore
abscess of tooth
infection in tooth
26
how should a cold sore be managed by us
keep an eye on it
if sore hasn't healed in couple weeks, then refer to dentist
27
what are 2 sx of TMJ fx
ecchymosis
significant pain w clenching
28
how should you assess ecchymosis indicative of TMJ fx
if on skin = subacute
- took time to work its way up to surface
under tongue = acute
- check here first
29
triage suspected TMJ fx
put them in sling and stabilize as much as possible
- then red flag and send to ER for imaging (possibly surgery)
30
what are 6 red flags for suspected neck dx
pancoast tumor/neoplastic conditions
cervical fx
cervical myelopathy
ligamentous instabilities/injury
cervical vascular path
cardiac
31
what are 2 risk factors for neoplastic conditions
>50yo
hx of cancer
32
what are 3 s/sx of neoplastic conditions
wt loss - unexplained 10# in 6mo
no relief w PT in past month
constant pain w no relief/night pain
33
what is a pancoast tumor
carcinoma in upper lung (apex) and can erode ribs and lower brachial plexus
34
4 associated s/sx w pancoast tumor
shoulder and arm pain
C7/C8 - T1 and ulnar n. palsy
- aka lower brachial plexus
weakness/neuropathies of intrinsic hand ms
horner's syndrome
- miosis, ptosis, and anhidrosis of face
35
what are 3 risk factors for pancoast tumors
smokers
men
>40-50yo
36
triage for suspected pancoast tumor
refer to PCP urgently for imaging
- its giving yellow? or red but urgent
- depends on if anything that PT can treat going on besides the n palsy
37
what does proper imaging clearance of C-spine mean
full imaging scan
- ant/post
- lat
- open mouth (so see odontoid process)
38
risk factors for a cervical fx
major trauma
minor trauma in pts w
- severe osteoporosis
- prolonged corticosteroid use
both of these traumas didn't have the proper imaging clearance
39
determining whether someone needs radiographs or is safe to treat depends on what:
age
type of injury and severity
amt of active motion/rotation have currently
40
triage for cervical fx
red flag
stabilize neck w hard collar
send to ER
41
what is cervical myelopathy
cord compression in c-spine
- worse w ext
42
4 risk factors of cervical myelopathy
loosely linked to:
- fam hx (stenosis common in arthritis)
- smoking
- repetitive stress or occupation
- trauma
43
what population is cervical myelopathy more common in
elderly
44
what are 5 s/sx of cervical myelopathy
1. neck/shoulder pain and associated stiffness
2. balance and gait issues related to inc LE tone
3. UE - look at hand - paresis and atrophy dexterity (depending on location)
4. **incontinence**
5. UMN signs
- (+) babinski or (+) clonus
45
triage this patient: suspected cervical myelopathy, not presenting w incontinence or progressive neurological sx
send to PCP
46
triage this patient: suspected cervical myelopathy, PT not working after 4wks
send to PCP
47
triage this patient: suspected cervical myelopathy, aggressive neurological sx and/or incontinence
send to ER for urgent imaging
- may lead to decompression
48
triage pt w suspected cervical myelopathy
if not responding to PT care after 4wks or neurological progression
- need to be referred to PCP
- if new dx referral back to PCP indicated
49
what are ligamentous instability risk factors for the alar and transverse ligament (4)
major trauma/fx - tears or strains
immune insufficiency
os odontoideum - separation of dens from axis
down syndrome
50
what 3 immune system insufficiencies can lead to alar and transverse ligament instability and how
RA or ankylosing spondylitis
psoriatic arthritis
systemic lupus erythematous (SLE)
immune response causes an irritation that eats away at the ligament causing it to loosen
51
what are pediatric specific risk factors for alar and transverse ligamentous instability (2)
retropharyngeal abscess / grisel syndrome
- spontaneous AA dislocation
recurrent upper respiratory track infection
52
what are 7 s/sx of upper cervical ligamentous instability
1. severe limitation during neck AROM (all directions)
2. cervical myelopathy
3. occipital HA and numbness
4. heavy head
5. dizzy
6. brain fog
7. lump in throat difficulty swallowing
53
function of the transverse and alar ligaments and what the danger is to their laxity as a result
hold odontoid process ant against bone
- if not, process moves into spinal cord and compresses at C1 and C2
respiratory centers are right there, if compressed could result in immediate death
54
triage suspected upper cervical ligamentous instability
stabilize neck w hard collar
send to ER
- adequate imaging needed to see relationship of dens to arch of atlas post fx
55
what are risk factors for vertebrobasilar insufficiency
analogous to those that inc risk of atherosclerosis
- age
- obesity
- smoking
- HTN
- DM
- hyperlipidemia
56
what are s/sx of vertebrobasilar insufficiency
5 D's
- dizziness
- diplopia - visual disturbances (nystagmus)
- dysarthria
- dysphagia
- drop attack
nausea, occipital HA, neck pain, facial numbness, ataxic gait
57
triage pt for suspected chronic vertebrobasilar insufficiency
refer to PCP for further investigations
58
triage pt for suspected vertebrobasilar insufficiency w progressive neurological signs
ER - suspecting tear
59
what are the 6 main categories of red flags for the lumbar spine
trauma/fx/stress fx
progressive neurological signs
cancer
infection
vascular
systemic involvement
60
what are risk factors for trauma/fx/stress fx in lumbar spine (4)
osteoporosis
prolonged steroid use
>70yo
trauma
61
what are 3 progressive neurological signs specific to the lumbar spine
1. cauda equina syndrome
2. acute bowel and bladder dysfunction, retention/frequency
3. foot drop / bilateral sciatica
62
what are 2 sx of a lumbar fx
unrelenting pain
significantly limited ROM
63
triage a suspected lumbar fx
send to ER for imaging
64
what are risk factors for cauda equina
any spinal injury that inc risk as well as large disc herniation and spinal stenosis
65
what are 6 s/sx of cauda equina
1. saddle anesthesia
2. acute onset urinary frequency/incontinence
3. global LE weakness in L4-S1 (bilateral)
4. radicular pain (frequently multiple levels)
5. fecal incontinence
6. gait disturbance
66
triage a suspected cauda equina syndrome
ER for urgent imaging and likely surgical decompression if needed
67
what are 2 specific sx to colon cancer
change in bowel sx
bloody stool
68
incidence of colon cancer and the course of dz
3rd most common
common metastasis site
thoracic spine and rib mets common
69
triage a suspected colon cancer
refer to PCP - that day and w follow up phone call
70
what are 3 risk factors of infection or osteomyelitis
recent infection - UTI, pneumonia, cellulitis
recent surgery/procedure
IV drug use
immunosuppression
71
s/sx specific to infection/osteomyelitis
no relief w rest
72
triage a suspected osteomyelitis/infection
ER for emergent imaging
- cluster of findings w risk factors
73
what is a common vascular red flag in the lumbar area
AAA
74
2 risk factors for AAA
hx of vascular dz
>50yo
75
s/sx of AAA (4)
LBP
pulsating mass
throbbing pulsing at rest or recumbent
>3cm
76
what is a key part of the PT exam for objective data on AAA
abdominal exam
77
triage a suspected AAA
ER today
- consider location and pt scenario of ambulance or not
78
what are 4 systemic involvement flags relating to the lumbar spine
gynecologic reasons
urological
referred pain from abdominal
referred pain from lungs
ankylosing spondylosis
79
what are 3 gynecological causes of LBP
endometriosis
ovarian cysts
ectopic pregnancy
80
what are s/sx of gynecologic disorders (11 - just think to be familiar)
irregular periods
breast tenderness
n/v
chronic constipation
pain w defecation
fever, night sweats
drop in BP - bleeding
vaginal discharge
abnormal bleeding (spotting, heavy)
postmenopausal bleeding
urinary sx (dysuria, freq, urgency)
81
what are male reproductive causes of LBP (3)
prostate path
- BPH
- prostate cancer
testicular cancer
82
triage suspected gynecologic, prostate path, or testicular cancer
refer to PCP or urologist/gynecologist w/i week
- follow up w phone call
83
what 5 sx are emergent referrals of gynecologic, prostate, or testicular path
unable to urinate
blood in urine or stool
unrelenting pain
progressive neurological signs
constitutional s/sx
84
what is a risk factor for pancreatitis
alcohol abuse
85
what is a risk factor for appendicitis
younger
86
what are 6 s/sx of appendicitis and pancreatitis
rebound tenderness
- at McBurney's point for appy
RLQ pain
abdominal exam reproduced back pain
constitutional signs
GI signs
possible temp
87
triage a suspected appendicitis
ER today
88
triage a suspected pancreatitis
ER today
89
what are 4 types of abdominal hernias
umbilical
incisional
epigastric
diastis recti
90
risk factors for abdominal hernias (3)
men
obesity
heavy lifting
91
s/sx of abdominal hernia
pain or discomfort
- in groin
- when bending over
- w coughing
- w lifting
92
PT exam for abdominal hernia
palpate - mass or hernia?
- have them do a sit up or bear down and see if it gets bigger (d/t intra abdominal pressure)
93
triage suspected abdominal hernia
refer to PCP if undiagnosed
94
what is a lung path that can refer to back pain
pneumonia
95
3 s/sx of pneumonia to sus out if that is what is referring to back pain
s/sx associated w pulm sx
fever
auscultate
96
triage a suspected ankylosing spondylosis
needs a medical diagnosis
- if suspect send to PCP
97
what is a sx of ankylosing spondylosis
lot of stiffness
- >30min every morning for >3mo
98
2 risk factors of ankylosing spondylosis
males > females
younger (20s)
99
why does ankylosing spondylosis need a medical diagnosis
goes into active phases
- body attacks ligaments and lays down scar tissue
then goes into remission and get more stiff
- this is when we treat them, not when in active phase
100
what is systemic involvement at the lumbar spine that can come from urologic system (3)
urolithiasis
renal tumors
perinephric abscesses
101
what are red flag urgent situations in cases of sciatica
acute radiculopathy w urinary retention, saddle anesthesia, or bilateral neurological findings
102
what are yellow flag complicated cases of back pain
age > 50
systemic s/sx
risk factors: fever, wt loss, hx of cancer, hematuria, adenopathy, IV drug use
103
in cases of suspected stenosis (back/leg pain relieved by sitting) what are reasons that lead you to want imaging as opposed to just treating the sx? what flag is this considered?
intolerable sx or neurologic deficits
yellow flag
