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(chapter 1 - chapter 250) Questions, answers with rationales_ A+ solutions
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(chapter 1 - chapter 250) Questions, answers with rationales_ A+ solutions
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8/22/24, 3:16 AMprimary care interpersonal collaborative practice Final
DANIEL
Practice questions for this set
Terms in this set (115)
Sources of neck pain
Bone, disks, joints, ligaments, fascia, muscles, and nerve roots
Neck Pain
Pain can effect the neck or can move into the head, shoulders, or arms
Can start without an inciting event
Manual labor occupations
Female gender
Headaches
risk factors of neck pain
Smoking
Poor job satisfaction
Poor biomechanics
Chronic pain neck pain > 12 weeks
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Obtain a thorough Hx and P.E. including past medical, social, occupational, and family
history
neck pain clinical presentation
ROS
Sx PQRST
Careful observation of the patient
Note: cervical alignment, discomfort, frequent position change and evaluating the
patient's affect
Observe: Gait
physical exam for neck pain The skin and vascular system should be appraised for medical causes of neck pain,
including meningitis, dental or jaw pain, and malignant neoplasm
Spinal palpation
Neuro testing, provocative testing
Neck Pain: Cervical Compression Test (axial load test)
X-rays
CT scan/MRI
diagnostic for neck pain Labs (Dependent on systemic symptoms or if anything else is going on)
ESR, CBC, alkaline phosphatase, and calcium levels
EMG (rare diagnostic)
It is imperative to R/O serious sources of neck pain, including
Infection, fracture, inflammatory diseases, neoplasm, and other medical causes, with a
thorough Hx and P.E.
differential diagnosis neck pain
Metastatic disease or infection, diabetic neuropathy, Lyme disease, herpes zoster,
thoracic outlet syndrome, and brachial plexopathy
Cervical dystonia/torticollis
age >65 years
Paresthesia in extremities
Altered mental status
Multiple fractures
Drowning or diving accident
traumatic neck pain risk factors
Significant head or facial injury
Rigid spinal disease (e.g. ankylosing spondylitis)
"Dangerous mechanism" defined as: a fall from an elevation of 3 feet or more, or 5
stairs; axial load to the head (e.g. diving), MVC at high speed > 60mph or with rollover
or ejection, collision involving a motorized recreational vehicle or a bicycle collision.
C-spine must be immobilized in these situations. C-spine CT is the study of choice to
evaluated for injury - screening imaging MUST be done before any neck movement
exam **
NEXUS clinical decision tool for adults: 5 criteria must be met in order for the patient to
be classified as low risk for C-spine injury
No tenderness at the posterior midline of the C-spine
C-spine injury
No focal neuro deficit (e.g. facial asymmetry, speech abnormalities, vision/hearing
problems)
Normal level of alertness
No evidence of intoxication
No clinically apparent, painful injury that might distract the patient from the pain of a C-
spine injury
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Red Flag Signs/Symptoms:
Fever in a patient with new neck pain (meningitis, sepsis, cervical osteomyelitis, and
cervical epidural abscess)
A history of cancer
Exam Approach
General Appearance of neck, ROM, C-spine palpation for tenderness, nuchal rigidity
(Kernig and Brudzinski signs), examination of the upper extremities, neuro exam
(sensation, strength, reflexes, tone spasticity). Make sure to examine skin as well. Apply
the Spurling test (but not in patients with RA, cancer, infection, or possible neck injury)
Hallmark clinical manifestations of cervical radiculopathies:
Pain, sensory loss, motor weakness in the distribution of the affected nerve root
nontraumatic neck pain Management
Progressive weakness/neurologic changes - refer to spine surgeon or neurosurgeon
Associated trauma or if diagnostic workup reveals fracture or instability of the cervical
spine - send to ED immediately
For nonemergent causes of neck pain (torticollis, radiculopathy)
Heat, ice, and massage
Appropriate posture and body mechanics
Avoid lifting more than 10 lbs, exaggerated movements, repetitive bending or upper
extremity twisting
Manual/mechanical traction
Multimodality PT
Pain control
Classified by Sx duration as acute, subacute, or chronic
Risk factors
Age >65 years
Genetic disposition
Obesity
Smoking has also been linked to accelerated degenerative disk disease
Chronic LBP risk factors
Preexisting psychological conditions (e.g., anxiety, depression, or somatization
disorder)
low back pain Maladaptive coping strategies
Lower socioeconomic status (end up on disability)
Poor general health
Low back pain has been classified based on pathophysiology
Mechanical
Systemic medical illness
Clinical Presentation
LBP is classified as axial or radicular pain
Axial: isolated to the low back
Radicular: radiating to the leg/thigh that can be more severe than the back pain
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