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South College MSK 3 > Week 1- Medical Screening & Cervicothoracic Region > Flashcards

Week 1- Medical Screening & Cervicothoracic Region Flashcards

1
Q

What is always the first component of the evaluation?

A
  • Medical screening for red/yellow flags
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2
Q

MSK conditions to screen for in the cervical spine

A
  • Cervical fracture
  • Cervical myelopathy
  • Upper cervical ligamentous laxity
  • Spinal infection
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3
Q

Cardiovascular conditions to screen for in the cervical spine

A
  • Cardiovascular event (myocardial infarction)

- Cervical arterial dysfunction

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4
Q

Pulmonary conditions to screen for in the cervical spine

A
  • Pulmonary event
  • Pneumothorax
  • Pulmonary embolism
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5
Q

High-risk factors for cervical fracture

A
  • > /= 65 y
  • Dangerous MOA
  • Upper extremity parasthesia
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6
Q

What is considered a “dangerous MOA”?

A
  • Fall from 3+ ft/5stairs
  • Axial load
  • MVC at 60+ mph, rollover/ejection
  • Motorized rec vehicle accident
  • Bike collosion
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7
Q

What are low-risk factors for cervical fracture?

A
  • Simple rear-end MVC
  • Sitting position in external rotation
  • Ambulatory at any time
  • Delayed-onset neck pain
  • Absence of midline C-spine tenderness
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8
Q

What conditions need to be met to refer for imaging of cervical spine for fracture?

A
  • “Yes” for high-risk factors
  • “No” for low-risk factors
  • Unable to rotate neck 45 degrees L/R
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9
Q

What is cervical myelopathy?

A

-

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10
Q

Mechanical causes of cervical myelopathy

A
  • Trauma (ligament instability, fracture)
  • Spinal cord compression
  • Degenerative changes
  • Bulging disks, thickened ligamentum flavum
  • RA with subsequent atlanto-axial subluxation
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11
Q

Cervical myelopathy systemic causes

A
  • MS, ALS
  • Guillain-Barre
  • Multifocal motor myopathy
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12
Q

5 tests included in cervical myelopathy CPR

A
  • Gait deviation
    • Hoffman’s test
  • Inverted supinator sign
    • Babinski test
  • > 45 years
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13
Q

What is considered a red flag for cervical myelopathy?

A

3/5 positive CPR tests

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14
Q

Signs and symptoms for upper cervical ligamentous laxity

A
  • Occipital headache & numbness
  • Severe limitation during neck
    AROM in all directions
  • Signs of cervical myelopathy
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15
Q

Causes of upper cervical ligamentous laxity

A
  • Trauma
  • RA with atlanto-axial subluxation
  • Down Syndrome
  • Klippel-Feil
  • Os odontoideum
  • Odontoid fracture
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16
Q

Signs and symptoms of a spinal infection

A
  • Unrelenting spine pain
  • Worse/severe pain at night (no change w/ positional changes)
  • Hx of DM, SCI w/ neurogenic bladder, immune suppression
  • Potential fever, chills, fatigue
  • Concurrent infections or IV drug use
  • Possible redness, swelling, warmth
  • Local tenderness over spinous processes
  • Spinal percussion painful
17
Q

What to do in case of a spinal infection

A

Refer for imaging and clinical lab tests

18
Q

Treatment for spinal infection

A
  • Antibiotic therapy

- Surgical decompression

19
Q

Signs and symptoms for cardiovascular event

A
  • Chest pain (gripping, pressure)
  • Abdominal pain
  • Shortness of breath
  • Heart palpitations
  • Irregular heartbeat
  • Dizziness, nausea
  • Peripheral edema
  • Syncope
20
Q

MSK complaints indicating a cardiovascular event

A
  • Jaw, neck, shoulder, arm, & back pain
  • Myalgias, muscular fatigue, & muscle
    atrophy
  • Weakness & fatigue
  • Poor exercise tolerance
21
Q

5 D’s AND 3 N’s indicating arterial dysfunction

A 
- Dizziness or lightheadedness	
related to neck movement
- Drop attacks
- Dysphagia
- Dysarthria
- Diplopia
- Ataxia
- Nausea
- Numbness
- Nystagmus
22
Q

Pain Descriptors for a Pulmonary Event

A
  • Sharp, localized pain
  • Aggravated by breathing,
    coughing, sneezing, laughing, etc.
  • Better in upright/worse recumbent
  • Better with auto splinting
23
Q

Signs and Symptoms for Pulmonary Event

A
  • Dyspnea/shortness of breath (at rest or exertional)
  • Persistent cough
  • Fevers, chills, general malaise
  • Weak, rapid pulse with fall in BP (pneumothorax)
  • Cyanosis
24
Q

Signs and Symptoms of a Pneumothorax

A
  • Shortness of breath, dry cough
  • Acute onset sharp pain in the chest (upper & lateral chest wall)
  • Can refer to ipsilateral shoulder/upper trapezius region, across chest, to the scapular region, and to the abdomen
  • Change in respiratory movements
  • Drop in blood pressure, increased venous distension in neck
  • More pain in recumbent positions/better in sitting
25
Q

Predictor variables for pulmonary embolism

A
  • Clinical signs and symptoms of DVT (3.0)
  • No alternative diagnosis (3.0)
  • Heart rate >100 bpm (1.5)
  • Immobilization following surgery in the past 4 weeks (1.5)
  • Previous DVT/PE (1.5)
  • Hemoptysis (1.0)
  • Malignancy (treated currently, in the last 6 months, or palliative) (1.0)
26
Q

Levels of risk and probability of pulmonary embolism

A
  • > 2.0 pts = Low Risk = 3.6% probability
  • 2.0 - 6.0 pts = Moderate Risk = 20.5% probability
  • > 6.0 pts = High Risk = 66.7% probability
27
Q

Where will pancreas issues refer to?

A
  • Left shoulder
  • Anterior central abdomen
  • Posterior thoracic region
28
Q

Where are issues if there is pain in the posterior thoracic region?

A

Issues in the esophagus, liver, gallbladder, common bile duct, and pancreas

29
Q

Where are issues if there is pain in the right shoulder region?

A

Issues in the stomach, duodenum, liver, gallbladder, and common bile duct

30
Q

Signs and symptoms for stomach, duodenal, or pancreatic conditions

A
  • Gnawing, cramping, burning, “heartburn”, aching
  • Constant or sudden onset, weight loss, nausea, vomiting, fever, malaise
  • May have pain in waves or may be related to eating or drinking in timing
  • Early satiety, black “tarry” or light colored stools (pancreatic cancer)
31
Q

Causes of stomach, duodenal, and pancreatic conditions

A
  • Gastric, pyloric, or duodenal ulcers

- Stomach cancer

32
Q

Where will kidney/renal issues refer to?

A
  • Left inguinal region
  • Posterior QL region
  • Left shoulder
33
Q

Where is the common site of metastases?

A

Skeleton

  • 60% thoracic
  • 40% lumbosacral
  • Rare in C-spine
34
Q

What is the “lead kettle” mnemonic?

A

PB KTLL

  • Prostate
  • Breast
  • Kidney
  • Thyroid
  • Lung
  • Lymphoma
35
Q

Cancers most commonly affecting the cervico-thoracic spine

A
  • Thyroid & esophageal cancer
  • Hodgkin’s lymphoma
  • Pancoast’s tumor
  • Multiple myeloma
  • Breast cancer
  • Other organ cancers that can refer to the T-spine
36
Q

What predicts cancer in patients?

A
  • Age >/= 50
  • Unexplaiined weight loss
  • Previous Hx of cancer
  • Failure to improve over 1 month
  • 100% sensitive
37
Q

Common Risk Factors for Depression

A
  • Current/past hx of major depression
  • Family hx of major depressions (first degree relative)
  • Hx of MI, CA, CVA, substance abuse/dependency, obesity, CHF, dementia, or DM
  • Currently suffering from significant loss or change in social status
  • Pregnant or post-partum
  • Fatigue or sleep disturbance, fatigue, weight change
  • Women > men
  • Chronic pain or 2+ chronic diseases
38
Q

Depression screen questions?

A
  • Over past 2 weeks, have you felt down, depressed, or hopeless?
  • Over past 2 weeks, have you felt little interest or pleasure in doing things?
  • Do you want help?
39
Q

Suicide risk factors

A
  • Family hx of suicide attempts
  • Sense of hopelessness
  • Previous attempt or plan
  • Hx of chronic progressive illness
  • Recent significant loss
  • Unemployment
  • Widowed, divorced, or living alone
  • Hx of psychiatric illness
  • Sex (males higher rate of completion; females higher attempt rate)
  • Recent interpersonal struggle
  • Presence of firearms in home (for teens)

South College MSK 3 (22 decks)

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