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104 Cards in this Set
- Front
- Back
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How many cervical vertebra - typical and atypical? |
5 typical 2 atypical (C1, C2) |
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What are the typical cervical vertebra composed of? |
body and neural arch |
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Spinous process projects? Transverse process projects? |
dorsally laterally |
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What is the name of C1? C2? |
Atlas - C1 Axis - C2 |
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What separates each vertebra? What 2 parts is this composed of? |
Disc Annulus fibrosus and Nucleus pulposus |
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The nucleus pulpous has a very high content of what? Loss of this content, causes what? |
water abnormal pressure exerted on annulus |
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What is it called if there is a protrusion of the nucleus puposus through the annulus fubrosus? Where does this occur normally? How is this corrected? |
Herniated disc posterio-laterally laminectomy (surgical removal of disc) |
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When assessing the c-spine, what movements in the ROM are necessary? |
Flexion and extension |
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During the PE of the cervical spine, what are special test that can be completed? |
Spurling test and Lhermitte's sign |
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What imaging is the first step used to give a basic assessment of the C-spine? |
Plain C spine XRAY |
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If you wanted to assess C6, C7, and T1, what X-ray view would be ordered? |
Swimmer's view
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If you wanted to assess the dens in the cervical spine, what Xray view would you order? |
Odontoid view - Open mouth |
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If you wanted to assess each of the foramen, what X-ray view would you order? |
Oblique |
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Which test would be used to confirm nerve root dysfunction? |
Electromyography (EMG) testing |
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Which test would be used to distinguish a cervical radiculopathy from other lesions? |
Electromyography (EMG) testing |
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Which test is both diagnostic and therapeutic? How? |
Selective nerve root block (SNRB) local anesthetic on nerve root dorsal root ganglion to find the specific nerve root. Diagnose radiculopathy |
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What presents with aching pain, stiffness in the neck and no radiation, paresthesia, and weakness for up to 6 weeks? |
Mechanical cervical spine pain |
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What are the two main causes of mechanical cervical spine pain? |
Posture and stress |
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What imaging would be necessary for mechanical cervical spine pain without trauma? Which views? |
XRAY cervical AP and lateral (bending) views |
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Why may mechanical cervical spine pain cause loss of normal cervical spine lordosis? |
paravertebral muscle spasms |
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How would you treat a patient with mechanical cervical spine pain? |
Rest Educate on posture correction (PT) NSAIDs, analgesics, muscle relaxants Heat/Ice |
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What is the mechanical cervical spine pain with aching paracervical pain stiffness beginning after injury? |
whiplash |
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What other symptoms may be experienced with whiplash? |
HA, malaise, and fatigue |
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With whiplash, what type of strain would occur from forced hyperextension and hyper flexion? When does occur? |
Musculoligament |
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What causes disc herniation? |
Cervical spine radiculopathy *** young adults trauma or degenrative |
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What is associated with pain the neck with radiation to arm and can cause HA? This may increase with cough. |
Cervical spine radiculopathy |
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What nerve root is most often affected in cervical radiculopathy/ disc herniation? |
C7 |
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What test may be used to assess radiculopathy? |
Spurling test |
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Which nerve root/disc herniation causes paresthesia in index, middle or ring fingers? |
C7 nerve root C6-7 disc herniation |
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Which nerve root/disc herniation causes paresthesia in the thumb or lateral distal foreman? |
C6 nerve root C5-6 nerve herniation |
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Which nerve root/disc herniation causes loss of sensation over the shoulder? |
C5 nerve root C4-C5 disk herniation |
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What is the treatment for radiculopathy? How long does it take to improve, regardless of tx? |
Anti-inflammatories (NASIDS, muscle relaxer, analgesic, oral predinosone) Surgery - only for intractable pain PT, cervical traction, steroid injection 4-8 wks |
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What is caused compression on the cervical spinal cord? What causes this? |
Cervical myelopathy cervical spondylosis, cervical stenosis, tumor, or large disc herniation |
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What are clinical manifestations in cervical myelopathy? |
Leg spasticity, gait change, babinski sign, Lhermitte's sign, upper extremity weakness |
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What causes neck flexion with resulting sensation of electrical shock radiating down the spine? |
Lhermitte's sign |
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What is seen at 2? |
Cervical myelopathy -- disk herniation |
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What is the treatment for many patients with cervical myelopathy, especially if neurological deficit for < 6 months with a patient younger than 70? |
Surgical decompression |
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What are the 3 degenerative diseases of the cervical spine? |
Osteoarthritis, spondylosis, degenerative disk disease |
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In degenerative diseases of the cervical spine, which vertebra are comely affected? Which roots? |
C4-C7 vertebra C5,C6, and C7 roots |
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By what age do most adults have DDD? |
40 y/o |
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When does pain increase with extension and decrease with flexion of the neck? |
Cervical osteoarthritis, spondylosis, DDD |
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What causes disc space narrowing, vertebral end plate sclerosis, and osteophyte development? By what age does this commonly occur? |
Degenerative Disease of the C-spine 60 |
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If they have advance degenerative disease of the C-spine with radiculopathy/ myelopathy, what imaging is necessary? |
MRI or CT |
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What is the conservative treatment for Degenerative disease of the C-spine? |
PT, traction, cervical collar, and analgesics |
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What is the surgical treatment for Degenerative disease of the C-spine? |
laminectomy, foraminotomy, cervical spine infusion |
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What presents with chronic pain for at least 6 months and affect predominately woman as age increases? |
fibromyalgia |
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What has multi system involvement? |
Fibromyalgia |
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If a patient has fibromyalgia, the pain is at least how many paired tender points? |
11/18 |
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Tender points of fibromyalgia |
Freebie |
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What is the non-pharmalogical Tx for fibromyalgia? |
-education - PT, OT - Mental health - stress reduction, coping |
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Which step in management for fibromyalgia confirms diagnosis, explain condign, and treat comorbities (mood/ sleep disturbances)? |
1st |
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Which step in management for fibromyalgia uses a low-dose TCA/ cyclobenzaprine, exercise program, and cognitive-behavioral therapy? |
2nd |
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Which step in management of fibromyalgia may require a specialty referral, rheumatology, pain management, physiatry, and combination therapy? |
3rd |
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What is another name for thoracic outlet syndrome? |
Cervical rib syndrome |
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What has hereditary elongation of C7 transverse processes, with fibrous bands of the accessory ribs and bone fusion on variant ribs? |
Cervical rib syndrome (neurogenic) |
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What is caused by overhead work or posturing of the neck? Who is more likely to have this -- males or females? |
Thoracic outlet syndrome aka Cervical rib syndrome females |
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What is the most common clinical presentation of Thoracic outlet syndrome? Which plexus is it compressing? What would confirm this? |
Neurogenic (90%) brachial EMG/ NCS |
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In thoracic outlet syndrome, if there is a vascular clinical manifestation, what is being compressed? What would confirm this? |
Subclavian artery or vein Arteriogram/venogram |
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A patient with Thoracic outlet syndrome, will complain pain, numbness and tingling, what nerve is normally affected? |
Ulnar nerve |
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Which thoracic outlet syndrome presents with atrophy of intrinsic muscles, and decreased ulnar sensation? |
Nuerogenic |
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Which thoracic outlet syndrome presents with pallor/coolness o upper extremities, weak or absent pulses, and decreased BP in affected arm? |
Arterial |
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Which thoracic outlet syndrome presents with edema and cyanosis of the upper extremities and distended shoulder and chest veins? |
Venous |
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This image shows what SE of thoracic outlet syndrome? |
Postural decomposition |
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Which proactive maneuvers are used to assess Thoracic Outlet Syndrome (Cervical Rib Syndrome)? What is considered a positive test? |
Adson's maneuver - reduction in the radial pulse Wright test - diminished pulse orparesthesias Roos Test - reproduce symptoms or claudication |
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Which proactive maneuver do you hyper abduct and externally rotate the affected arm? |
Wright Test |
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Which proactive maneuver has both shoulders abduct and externally rotate 90 with elbows flexed90, opening and closing hands for 3 minutes? |
Roos test |
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What may show you an additional rib to "clue" you into diagnosing the patient with thoracic outlet syndrome? |
Chest (apical lordotic) and C-spine xray MRI |
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What tests will show if there is stenosis of the vessels in a patient with Thoarcic outlet syndrome? |
Doppler and non-invasive BF Angiography |
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How would you tx Thoracic outlet syndrome? |
- PT!! - NSAIDs - Mobilization and manipulation (Myofascial release) |
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If the patient has a cervical spine fracture, what is the X-ray protocol? |
AP/lateral/ oblique and Odontoid |
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What is absolutely necessary for cervical sone stabilization even if there is a potential for a cervical spine fracture? |
Hard cervicl collar |
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In a cervical spine fracture which radiographic view will allow you to see the cervical thoracic junction? |
Lateral swimmer's view |
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C1(Atlas) Fracture |
Jefferson's fracture |
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What is the name of the bilateral fracture affecting both the anterior and posterior arches of C1? How often will a C2 fracture be involved as well? |
Jefferson Fracture 1/3 |
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When would you see a Jefferson fracture? |
Diving, MVA, falling on head |
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Which fracture is shown in this CT scan? |
Jefferson fracture |
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What is the TX for a Jefferson fracture? |
Collar or brace X3 month w/ cervical traction |
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What is 20% of all cervical spin fractures? What is another name for this fracture? |
C2(Axis) Fracture ir Hangman's fracture |
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Which fracture is a bilateral fracture of the pedicles to pars interarticularis of the axis? ** |
C2(Axis) Fracture/ Hangman's fracture |
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What causes a C2(Axis) Fracture/Hangman's fracture? |
severe extension injury |
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In this XRAY, which fracture is shown? |
C2(Axis) Fracture/ Hangman's fracture |
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In this CT scan, which fracture is shown? |
C2(Axis) Fracture/ Hangman's fracture |
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Which type of collar/ vest can be worn with a CT fracture? |
Philadelphia collar and Halo vest |
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What is the fracture of the dens called? ** |
Odontoid fracture (C2 fracture) |
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*** If there is a hyperflexion injury causing a Odontoid fracture (C2 fracture), which direction is the dens displaced? |
anteriorly |
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*** If there is a hyperextension injury causing a Odontoid fracture (C2 fracture), which direction is the dens displaced? |
posteriorly |
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Which type of odontoid fracture: tip fracture (stable) |
Type 1 |
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Which type of odontoid fracture: Body fracture |
Type II |
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Which type of odontoid fracture: Basilar fracture , with fracture line into body of the axis (unstable) |
Type III |
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Name all the fractures. |
Top: Jefferson fracture Middle: Odontoid fracture (1,2,3) Bottom 2: Hangman's fracture |
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What is the treatment for an odontoid fracture? |
Halo vest |
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Which fracture commonly affects the middle or lower cervical spine? |
Vertical compression fracture (stable fractures) |
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A vertical compression fracture 3 (VCS 3) is also known as a... |
Burst fracture (Jefferson fracture C1 -least common) |
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What is treatment normally for a VCF - operative or nonoperative? |
nonoperative |
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What fracture is caused by forceful flexion with compression (most commonly seen with diving) ? |
Flexion compression fracture |
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Name the two types of flexion compression fractures. |
1) wedge compression fracture 2) ** Flexion Teardrop Fracture |
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Which flexion compression fracture is unstable that has subluxation of the vertebral body posteriorly? Does this have neurologic defects? |
** Flexion Teardrop fracture yes |
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What radiographic imaging would be done for a flexion teardrop fracture? |
Table lateral film |
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Which type of flexion compression fracture? |
Wedge |
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Which type of flexion compression fracture? |
Teardrop |
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What causes complete anterior dislocation of the vertebral body causing cord damage? |
Bilateral Facet Dislocation |
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What is the fracture of the spinal process? Which vertebra are normally affected? |
Clay shoveler's fracture (C6-T1) |
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What is hyper flexion with paraspinous contraction on the spinous process caused by heavy lifting (shoveling)? |
Clay shoveler's Fracture |
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What is the name of the fracture? What is the tx? |
Clay shoveler's fracture Hard collar 10 days followed by a soft collar |
