SMT-1 Manual, pgs 56-66

Question 1

What did Fernandez-de-las-Penas 2005 measure?

Answer 1

The validity of the lateral shift test, confirming that the distance between subjacent transverse processes of the dysfunctional joint would be reduced.

Question 2

What was the difference in mm between subjacent transverse processes in the Fernandez-de-las-Penas 2005?

Answer 2

3.44 mm less at hypomobile side

Question 3

How did Smedmark et al 2000 test PPIVMs?

Answer 3

2 PTs assess C2-3 lateral flexion, 1st rib depression, C7-T1 flex/ext, and C1-C2 rotation for 61 patients = 244 tests.

Question 4

What was the percent of agreement in Smedmark et al 2000 study?

Answer 4

77%

Question 5

What was inter-rater reliability of the Smedmark et al 2000 study?

Answer 5

70-87% (Fair to moderate).

Question 6

What is the Kappa Co-Efficient of Smedmark et al 2000 study?

Answer 6

.28 and .43

Question 7

Did Jull et al 1994 find that pain was needed to identify a dysfunctional joint?

Answer 7

No-pain is not needed

Question 8

How will an symptomatic joint present

Answer 8

Abnormal displacement, abnormal tissue resistance, and pain.

Question 9

How did Jull et al 1994 examine and label joints?

Answer 9

PAIVM and PPIVM C0-C1 to C6-C7 manual rated 0-6 (Gonnella et all 1982)

Question 10

The percent agreement of normal joint as painless in Jull et al 1994?

Answer 10

98%

Question 11

What did Jull et al 1997 find with pain?

Answer 11

Pain provocation and joint dysfunction was used.

Question 12

How was the inter-examiner agreement with Jull et al 1997?

Answer 12

Excellent to complete.

Question 13

What area was examined in Jull et al 1997?

Answer 13

C0-C1, C1-C2, C2-C3

Question 14

What was the most common dysfunctional segment in Jull et al 1997?

Answer 14

C1-C2

Question 15

What was the second most common dysfunctional segment in Jull et al 1997?

Answer 15

C2-C3 > C0-C1

Question 16

According to Ernst 2010, how man Chiropractic SMTs have resulted in death?

Answer 16

26

Question 17

According to Dvorak & Orelli, what was the estimated rate of overall, “slight neurological complications”?

Answer 17

1 in 40,000

Question 18

Estimated rate of “important complication”?

Answer 18

1 in 400,000

Question 19

According to Lee et al 1995, what % of neurologists reported at least one case of stroke?

Answer 19

21%

Question 20

What was the reported estimate of CVAs from Danish Chiro’s?

Answer 20

1 per 1.3 million Cx treatments / 1 in 362 tx

Question 21

In cadavers, Symons et al 2002 found what % of strain from cervical ROM testing of vertebral artery?

Answer 21

1.2-12.5% greater than at rest

Question 22

During cervical HVLAT, what % of strain is found on vertebral artery?

Answer 22

6.2% greater than at rest

Question 23

When did mechanical failure of vertebral artery occur?

Answer 23

139-162% greater than at rest

Question 24

According to Rothwell et al 2001, what was the relationship of age, chiro, and VBA stroke?

Answer 24

For those aged <45 years, cases were 5 x more likely than controls to have visited a chiro within 1 week of VBA stroke

Question 25

Did Smith et al 2003 find a significant association between neck HVLAT and ischemic stroke or TIA.

Answer 25

NO

Question 26

What did sub group show in the Smith et al 2003 study?

Answer 26

The 25 cases with VBA dissection were 6x more likely to have consulted a chiro within 30 days before their stroke compared to the control.

Question 27

Did Dittrich et al 2007 find an association between CAD and HVLAT to Cervical spine.

Answer 27

No

Question 28

Murphy 2010 found what two explanations related to screening for CAD?

Answer 28

1. No way to predict or screen for @ risk post manip/stroke. | 2. Pts sought chirocare but still stroked out independent of cervical manipulation, meaning VA was already in progress.

Question 29

What did Murphy 2010 conclude regarding the relationship between chiros, PCPs, and CADs.

Answer 29

No strong claim that there is causal relationship between cervical HVLAT and VADs, a VAD is already in progress, but seek chiro or PCP care for neck pain and HA. The dissection takes its natural course independent of cervical HVLAT.

Question 30

Does Murphy 2010 feel it is the PTs job to screen for an "at risk" patient.

Answer 30

No it is for PTs to determine a differential diagnosis and refer because current evidence indicates that VADs is no a complication to cervical HVLAT.

Question 31

151. What did Cassidy et al 2008 find regarding the association between chiropractic care, primary care practitioners, and stroke?

Answer 31

There is a strong association between primary care visits and stroke in those >45yo compared to chiro visits.

Question 32

152. What did Cassidy et al 2008 find regarding those patients <45 years old with sxs (HA and neck pain)?

Answer 32

They are 3x more likely to see a chiro or PCP before their stroke compared to controls.

Question 33

153. Is the VBI test validated according to Kerry &Taylor 2006?

Answer 33

No. There is little evidence that a neg test predicts the absence of an arterial pathology or identifies those at risk.

Question 34

154. According to Kerry & Taylor is the VBI test sensitive or specific?

Answer 34

It is neither Sn or Sp.

Question 35

155. What were the results of Carlesso et al 2010 systematic review of adverse events after cervical manipulation or mobilization?

Answer 35

Thiel et al 2007 reported no major or catastrophic outcomes in 50,276 Cx HVLATs. Average 16.3% of minor events across all studies.

Question 36

156. What did the 16.4% minor events consist of according to Thiel et al 2007?

Answer 36

An increase in neck pain and headaches.

Question 37

157. Why did Carlesso et all 2010 systematic review say no definitive conclusions can be made by the existing research?

Answer 37

- small number of studies - weak association - moderate study quality - ascertainment bias

Question 38

158. What is the gold standard for measuring blood flow?

Answer 38

MRA - Magnetic Resonance Angiography

Question 39

159. According to Kerry et al 2008 what is a better term than VBI?

Answer 39

Cervical Artery Dysfunction

Question 40

160. How do Kerry & Taylor 2006 screen for CAD in patients presenting with neck pain and headache sxs?

Answer 40

- Cranial Nerve and eye exam - Blood Pressure - Signs of ICA or VA dissection - Past medical history related to atherosclerosis - hand held Doppler - Functional CAD positional tests: ROT for VA, EXT for ICA

Question 41

What should the PT recognize as a clue related to carotid artery dissection (CAD)?

Answer 41

A Headache that is like no other that the patient has had before.

Question 42

Does Kerry et al 2008 feel there is an increase risk of upper cervical HVLAT?

Answer 42

No studies have focused on that question

Question 43

Why is the upper cervical so taboo?

Answer 43

because of the course of the vertebral artery between C2 and occiput

Question 44

Where are most plaques found in the vertebral artery?

Answer 44

At the bifurcation of the internal and external vessels found in the mid to lower cervical spine.

Question 45

According to Kerry et at 2008, is HVLAT as risky as joint mobilizations?

Answer 45

No, a gentler, repeated movement could cause potential dissection

Question 46

Have Mckenzie or other non-thrust manual therapies been subject to the same degree of study?

Answer 46

No

Question 47

According to Kerry & Taylor 2010 what signs and symptoms should a PT be aware of during a potential CAD screening?

Answer 47

CN Palsies and Horner's syndrome (ICA pathology)

Question 48

What nerve is most commonly affected in ICA pathology?

Answer 48

Hypoglossal (12)- Tongue out

Question 49

What are 3 other nerves that could be affected besides the most common (hypoglossal)?

Answer 49

Glosspharyngeal, Vagus, Accessory

Question 50

What % of ICA dissection patients is Horner's syndrome present in?

Answer 50

82%

Question 51

Signs & Symptoms of Horner's syndrome:

Answer 51

``` Head, Neck or Facial pain Drooping eyelid (ptosis) Sunken eye (enophthalmia) Constricted pupil (miosis)Facial dryness (anhidrosis) Retina & Cerebral Ischemia signs ```

Question 52

What is Horner's syndrome an interruption of?

Answer 52

Sympathetic nerve fibers supplying the eye

Question 53

Where does the superior cervical ganglion lie

Answer 53

In the posterior wall of the carotid artyery

Question 54

What does the ICA supply in terms of the eye?

Answer 54

Supplies the retina via the opthalmic artery

Question 55

What can an emboli from an ICA cause?

Answer 55

Retinal ischemic dysfunction

Question 56

What are the signs and symptoms of retinal ischemic dysfunction?

Answer 56

Painless episodic loss of vision blackout localize/patchy blurring of vision Amaurosis Fugax - loss of vision to one eye

Question 57

What should the PT be aware of in terms of Headache?

Answer 57

A headache like never before

Question 58

According to Thomas et al 2011 are general cardiovascular risk factors enough to determine risk of CADS?

Answer 58

No, a neurological/neurovascular is better gauge

Question 59

#1 complaint of symptoms in Thomas et al 2011 for VBA

Answer 59

HA, Neck pain, diziness

Question 60

What % of dissections had a history of minor mechanical neck trauma 3 weeks prior?

Answer 60

64%