Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP II - Beck > Week 3 > Flashcards

Week 3 Flashcards

1
Q

When would you do a low neuro exam?

A

For patients with neck pain and (5)

  • no radiating P into extremity or head
  • no numbness, tingling, weakness in arms or legs
  • no HA or CN sx
  • no recent sig trauma
  • patient under 50 yo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the Pathoanatomical ddx for Acute Traumatic Neck pain? (5)

A 
Sprain
Strain
Facet syndrome
Disc derangement
Fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the Pathoanatomical ddx for NON-Traumatic Neck pain? (4)

A

Facet syndrome *1/3-2/3 of pts with persistent (chronic) neck pain
Disc derangement
Sprain
Strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percent of chronic neck pain patients have facet syndrome?

A

36 - 67%

Aka 1/3-2/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the natural history/prognosis for patients with neck and arm sx?

A

80-90% will resolve w/in 8 weeks

40% will relapse w/in 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 5 main clues for nerve root lesion

A 
Arm Pain (3 things: Quality *sharp, electrical, burning, stabbing; Location: known dermatomal; Arm > neck P)
Arm Paresthesia
SMR deficits
Big 5 cervical ortho tests
Spinal loading procedures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the “big 5” cervical ortho tests?

A 
Cervical compression
Cervical distraction
Shoulder ABD
Valsalva
ULTT - median nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A list for radicular pain syndromes in the neck

A list for cord compression

A

NR:
1 - Osteophyte
2 - Disc herniation
3 - Stenosis

Cord:
1 - Disc hern
2 - Stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

B list for radicular pain syndromes in the neck

B list for cord compression

A 
NR:
1 - Structural instab
2 - Tumor/SOL
3 - Infection
4 - NR adhesion
5 - Trauma to NR
Cord:
1 - Tumors/SOL
2 - Structural instab
3 - Cord trauma
4 - Fx/dislocation
5 - Cord adhesions
6 - Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What MOI can cause Trauma to NR directly?

A 
Compression
Hyperextension
Lateral flexion with shoulder depression
Hyperflexion
Arm traction * brachial plexus only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

C list for radicular pain syndromes in the neck

A

Disc derangement
Facet syndrome
Joint dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the 1st thing you do with a patient?

What is the 2nd thing?

3rd thing?

A

Disease or injury?

Is there nerve damage? (with the 5 things list)

Find the pathoanatomical dx (use the A, B, C lists), then biomechanical dx, and complicators or contributors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Indications for radiographs? (4)

A

1 - Trauma
2 - Red flags
3 - Neuro Sx (cord/radicular)
4 - Nonresponsive >1 month failed conservative care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HIGHEST Indications for cervical MRI in disc cases after radiographs have been taken?

A

1 - Myelopathy
2 - Progressive MOTOR deficit
3 - Non-responsive to conservative care
4 - Presurgical exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What blood tests in blood chem panel may point to bone cancer?

A

Alk phos = bone building disease
Ca2+ levels = bone breakdown disease
Proteins = MM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does syringomyelia present?

A

Diffuse “cape-like” distribution of pain/temp loss over 1 or 2 shoulders

17
Q

What cervical conditions do oral corticosteroids put the patient at risk for? (2)

A

Osteoporosis

Ligamentous instability especially the upper cervicals

18
Q

How do you perform arm squeeze test? How do you interpret it?

A

When there is NR compression, 1+ nerves of the arm are sensitive to moderate compression of the biceps and triceps area and should be more painful than other areas of the shoulder and upper arm.

Positive test hurts 3+ more or during the pressure on the middle 1/3 of the upper arm, compared with compressing the AC and anterolateral-subacromial areas.

E.g. if the shoulder hurt 1/10 but arm hurt 4/10 that suggests it may not be a shoulder problem but a nerve problem from the neck.

19
Q

Atypical presentations of cardiac distress are usually found in people who are (3)

A
  • Older patients
  • Non smokers
  • no previous Hx of angina
20
Q

If you take your hands away form the neck when performing Kemps, what do you chart that as?

A

Quadrant test

21
Q

What is the clinical decision rule for facet syndrome?

What is the +LR?

A
  • positive ER test
  • P with static palp over facet
  • restriction to PA joint glide

+LR 4.95

22
Q

What 2 types of clues to focus on when you think there are nerve root problems?

A

1 - Deficits and

2 - Paresthesia distribution (NOT pain) is more predictive than pain distribution

23
Q

What are the 3 top indicators of a C8 radiculopathy in order?

A
  • Sensory loss in the little finger
  • Diminished triceps reflex
  • Weak finger flexion
24
Q

Which of the 5 big cervical ortho tests are sensitive?

A

ULTT—median n. is sensitive

The other 4 are not.

25
Q

What does it mean when e.g. valsalva is not sensitive?

A

If valsalva is negative, it isn’t very useful.

Useful when it’s positive, not useful as an individual test when it is negative

26
Q

Age range for cervical disc herniation?

A

40-60
Peak age 50-54

Rare <30 but not impossible

27
Q

What pattern of physical exam procedures and their findings would suggest a nerve root that was most susceptible to compressive forces? (4)

A

AROM: extension, ips-rotation/lateral flexion

AROM: flexion, contra-rotation/lateral flexion

Cervical compression

Cervical distraction

28
Q

What pattern of PE procedures and their findings would suggest a nerve root that is more sensitive to tension forces? (2)

A

ULTTs

Shoulder abd test/ Bakody’s sign

29
Q

What are the key indicators to order a cervical radiographic series?

A
  • Moderate to high load trauma
  • Red flag for disease
  • Cord/Radicular sign/sx
  • Non responsive cases
30
Q

What are the HIGHEST indicators for when to order an MRI in a patient with a cervical disc herniation? (AKA standard of care)

A

◦ suspicion of myelopathy
◦ progressive deficit
◦ non responsive to conservative care
◦ pre-surgical exam

31
Q

What is standard of care?

A

When you practice and do what any reasonable doctor would do

32
Q

What is medical necessity?

A

You have enough evidence to justify a particular Tx or study

You need to prove that the study is a reasonable step

33
Q

What are things to do in office for disc herniation?

A

McKenzie evaluation - can try for acute pt

Neuromobilization - NOT acute pt: wait a few weeks

Manipulation

34
Q

What does a manipulation schedule look like for a cervical disc herniation patient?

A

Manipulation 3-5x/week for 2-4 weeks then 1-3x/week

35
Q

What is the prognosis for cervical disc herniation patient?

A

50% better in 2-4 weeks
70% better in 1 month
86% better in 3 months

36
Q

If your patient has pain or paresthesia along the Medial side of the hand (little finger), where in the nervous system might the lesion be?

A
  • Lower brachial plexus injury e.g. TOS, tumor, stretch trauma “plexitis or plexopathy”
  • Ulnar nerve entrapment or nerve root “neuritis or neuropathy”
  • MFTPs
  • Nerve root “radiculitis or radiculopathy”
37
Q

What specific muscles with MFTPs might project pain into the medial hand (little finger)?

A
  • Latissimus dorsi
  • Serratus anterior
  • Pectoralis Major or Minor

CP II - Beck (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions