SMT-1 Manual, pgs 66-72

Question 1

181. Who had more cardiovascular risk factors between the controls & dissection in Thomas 2011 study?

Answer 1

Controls

Question 2

182. What were the most common complaints of symptoms for ICA according to Thomas et al 2011 study?

Answer 2

Headache, ptosis, facial palsy, UE/LE weakness

Question 3

183. For UCS integrity, what did Ross & Cheeks 2008 report to use as a screening test?

Answer 3

Canadian C-spine Rules

Question 4

184. What patient presentation was studied by Ross & Cheeks 2008?

Answer 4

MVA –> neck pain with decreased AROM in all planes

Question 5

185. What should Physical Therapists be most alert for when seeing a patient with c/o of neck pain following trauma?

Answer 5

Cervical fracture; even weeks after the trauma occurred.

Question 6

186. What cervical fractures are common in individuals over the age of 65?

Answer 6

Odontoid fracture

Question 7

187. What percent sensitivity is the Canadian C-spine Rules?

Answer 7

100%

Question 8

188. What percent specificity is the Canadian C-spine Rules?

Answer 8

43%

Question 9

189. What are the Canadian C-spine Rules according to Stiell et all 2001?

Answer 9

1. > 65 years old
2. paresthesia in extremities (dermatome changes)
3. dangerous mechanism of injury (MVA/ fall/ trauma)
4. AROM less than 45 degrees rotation bilaterally
5. history of long term steroid use or osteoporosis

Question 10

190. What are the 3 types of odontoid fracture?

Answer 10

1. ) oblique fracture - upper portion
2. ) fracture at base as it attaches to base of C2 (most common
3. ) fracture line extends through the axis of odontoid

Question 11

191. What type of exam needs to be performed when screening for cervical spine fractures?

Answer 11

Neurological (myotome/ dermatome/ DTRs/ bowel & bladder dysfunction/ UMN/ LMN)

Question 12

192. According to Mintken 2008, is there evidence to support the transverse ligament test?

Answer 12

No evidence exists that an anterior shear test is valid.

Question 13

193. When a transverse ligament test was perform in supine in the Mintken 2008 study, what occurred?

Answer 13

Paresthesia in both feet and toes

Question 14

194. What is os odontoideum?

Answer 14

Dens is separated from the body of axis

Question 15

195. What are the signs of craniovertebral instability?

Answer 15

1) . Occipital numbness due to C2 nerve irritation given the anterior translation of C1.
2) . Neck-tongue syndrome (paresthesia of ipsilateral 1/2 tongue with contralateral rotation –> RR = left tongue parsthesia)
3. ) headache with sustained flexion/ lump in throat/ UMN or cord signs

Question 16

196.What are you looking for with open mouth X-ray?

Answer 16

1. ) Is the SP of C2 in midline (off midline = alar rupture)
2. ) Are periodontoid spaces equal? (ipsilateral narrow or lateral shift?)
3. ) Are the articular margins of C1 and C2 lined up?

Question 17

197. Is a craniovertebral instability test valid according to Mintken et al 2008?

Answer 17

No, very little evidence to establish validity

Question 18

198. Is craniovertebral instability testing reliable according to Cattrysse et al 1997?

Answer 18

Inter-examiner reliability of transverse ligament test, alar ligament test, and sharp-purser have all been found to be “poor to unacceptable”

Question 19

199. What percentage of Australian PTs used pre-manipulation stress tests according to Osmotherly & Rivett 2011?

Answer 19

Rarely - 54.5%

Never - 62.4%

Question 20

200. What amount of skin slack was reported in the thoracic fascia interface according to Beneznick et al 2008?

Answer 20

38.75 mm

Question 21

201-205. What movements were visualized in the thoracic spine following prone PA thrust to Rt TP of T10, 11, 12 according to Gal et al 1997?

Answer 21

6-12 mm anterior translation
3-6mm Lt lateral translation
Axial rot of .4-1.2 deg
Sagittal rot of .5-1.8 deg

Question 22

206. What is the purpose of HVLA manipulation according to Herzog et al 1993?

Answer 22

Restore joint integrity/ restore joint motion/ relax hypertonic muscles

Question 23

207. The systematic review by Bronfort et al 2004 concluded what? in relation to exercise, SMT, and medication for the treatment of chronic low back pain?

Answer 23

SMT and exercise > meds for chronic low back pain

Question 24

208. When Dunning et al 2012 directly compared HVLA manipulation with mobilization for patients with mechanical neck pain, what were the changes in disability and pain at 48 hrs?

Answer 24

HVLA = decreased --> 50.5% disability and 58.3% pain
Mobs = decreased --> 12.8% disability and 12.6% pain

Question 25

209. How does joint manipulation effect the alpha motor neurons?

Answer 25

The quick stretch to a joint capsule and surrounding tissues stimulate GABA release which actives interneurons that inhibits the alpha motor neuron.

Question 26

210. What is the definition of cervicogenic headache according to Braud 2005 and Xiasbin et al 2005?

Answer 26

Benign recurrent headache presenting with pain in the trigeminal nerve distribution, cervical pain, and biomechanical provocation features of varying proportions.

Question 27

211. According to Nilsson 1995 & Pfaffenrath & Kaubel 1990, what is the prevalence of CGH?

Answer 27

15-20% of all chronic & recurrent HAs

Question 28

212. What did Jull 1997 list regarding CGHs?

Answer 28

CGHs are those which arise from musculoskeletal impairments in the neck, aggravated by neck movements and posture and patients cannot recognize relieving factor

Question 29

213. What year did the International HA Society diagnose CGH?

Answer 29

1988, 2004

Question 30

214. How many diagnostic criteria for CGH for IHS? 215. What is #1? 216. #2 Where is pressure reproduced? 217. #3 Other assoc pain? Does it make sense neuroanatomically? 218. #4 Does the pain shirf to other regions? 219. #5 Starting and referring point? Reflecting what branch? 220. #6 Do head pain characteristic add value? 221. #7 what confirms a CGA?

Answer 30

214=7 215. Jull 1997 aggravated by neck movements or sustained posture, pt cannot recognized aggravating factors or relieving factors 216. reproduced pressure over upper cervical spine 217. ipsilateral neck and arm pain and does not make sense neuroanatomically 218. No seems to be unilateral during attack unlike migraine and it may shift between episodes 219. Starts occipital region, spreads to occiput and commonly to front, retro-orbital or temporal aspect reflecting trigeminal nerve opthalmic branch 220. Not really intensity can be mild, moderate, severe, but there is not a "build up" like with migraine 221. Diagnostic block but many UK neurologist will not do this because it can trigger additional problems.

Question 31

222. What population is most likely to get CGH?

Answer 31

Females 4 to 1

Question 32

223. Is there a familiar tendency with CGH?

Answer 32

No

Question 33

224. Is thereGenerally trauma related with CGH?

Answer 33

Not all patient can identify a specific onset, Jull 1997 feels increased sedentary nature of modern day work contributes

Question 34

225. Do migraine medications help for CGH?

Answer 34

No

Question 35

226. What did Jull & Niene 2004 list as other side effects to CGH?

Answer 35

226. nausea, phono-phobia, dizziness, blurred vision, swallowing difficulty, periocular edema

Question 36

227. Does Jull 1997 agree with Jull & Niene 2004?

Answer 36

Jull 1997 feels they are not a dominant feature as migraine with aura of cluster HAs

Question 37

228. What did Bogduck 2005 find as a source of CGH?

Answer 37

C0-C3 joints and discs, C0-C3 ligament, muscle, dura,

Question 38

229. Can the thoracic spine cause a CGH?

Answer 38

Yes Paris & Vitti 2001 found T2 HA in case study

Question 39

230. What does T1-T4 supply?

Answer 39

230. T1-T4 supplies sympathetic efferents out flow for head and neck and face region

Question 40

231. Migraine HA acupuncture point?

Answer 40

GB-20 superior oblique

Question 41

232. Fernandez-de-la-penas et al 2005 found what referred pain pattern? 233. Did Travell & Simmons document this?

Answer 41

232. Multiple TrPs in superior oblique muscle evoked typical referred pattern 233. No fernandez-de-la-penas 2005 was the 1st

Question 42

234. What does the SOM refer to?

Answer 42

deep within the eye retro-orbital (inter-cranial) Supra-orbital (extra-cranial) Homo-lateral forehead (extra-cranial)

Question 43

235. According to Bogdak 2005 what segment is most likely the source of CGH?

Answer 43

C2-C3 facet joint but evidence is inconclusive

Question 44

236. According to Hall & Robinson 2004 and Jull et al 1997 what was the most likely source for CGH?

Answer 44

C1-C2, 24/28 had and was unilateral restricted and reproduced pain

Question 45

237. According to Crossman & Neary 2000 what CN is most inferred? 238. Main sensory to what areas? 239. For what proprioceptive pathways? 240. Via what branch? 241. Affecting what muscles of mastication?

Answer 45

237. CN V, trigeminal nerve 238. Scalp, face, cornea, oral and nasal cavity, cranial dura matter 239. muscle of mastication and TMJ 240. Auriculltemporal branch from mandibular branch of CN5 241. masseter, temporalis, medial & lateral pterygoids