Neuromusc diagnosis and management MT

your patient presents with ________, you should take an x-ray before doing a physical exam to assess for cervical spine instability.

Rust sign

What type of reflexes would you expect to see with cervical myelopathy?

Hyperreflexive

Which of the following are characteristic of radiculopathies? (choose all that apply)

Aggravated by coughing, sneezing or straining

Pain is triggered by Phalens

Neck pain is minimal relative to UE pain

Pain has shooting, electrical quality

Pain is worse with typing

Aggravated by coughing, sneezing or straining

Neck pain is minimal relative to UE pain

Pain is shooting, electrical quality

T/F The location of paresthesia is often a more accurate representation of the spinal nerve involved.

True

What are some causes of Cervical Radiculopathy?

HNP

DJD

DDD

Uncovertebral joint arthrosis

Facet arthrosis

All of the above

Which of the following orthopedic test(s) are compression evaluations for the cervical spine?

Valasalva

Soto Hall

Maximum cervical

Jacksons

Modified spurling

Maximum cervical, jacksons, modified spurling

Chelsea (age 27) presents with tiredness and coldness in her left arm with exertion. You determine that she has vascular TOS. How can you tell if the compression is arterial or venous?

Patient reports cold fingers and hand

Positive EAST/Roos test

Positive adsons

Xray

Patient reports cold fingers and hand

Henry (age 59), a BART train operator comes to your office for the first time due to a recent onset of lower neck pain with tingling in both his arms. Which feature of this presentation leads you away from a diagnosis of disc herniation?

Age of patient

T/F Patients undergoing MRI of the cervical spine, regarding cervical myelopathy that demonstrate low intensity signal changes on the T-1 weighted image are thought to represent myelomalacia and necrosis (usually irreversible).

True

A 48 year-old right-hand dominant woman shipping manager presented with a 2-month history of severe left arm pain and weakness to the degree that she could not work. She had tried medications and injections in her neck which provided little relief. She had significant weakness in her left triceps as well as her left wrist flexors (bending the wrist forward). She had dense numbness involving her left index finger and middle finger. X-rays revealed mild arthritis.

HNP C5/6

HNP C6/7

HNP C7/T1

C5/6

Which of the following are known causes of epilepsy

Vascular

Tumor

Head trauma

Metabolic

All of the above

You walk into your adjusting room and you find Mark in a spasmodic episode on the floor. You ensure that he is physically safe and observe that he is not breathing for the few seconds' duration of this episode. He gasps for air once his body relaxes. What did you just witness?

Clonic seizure

Myoclonic seizure

Attack of BPPV

Petit mal seizure

Clonic seizure

In patients with new-onset seizure, emergency EEG should be performed if focal neurological dysfunction unexplainable by a structural lesion is evident. T/F

True

T/F Many patients who experience a first convulsive seizure have already experienced prior spells or stereotypic events that would meet the criteria for diagnosis of epilepsy.

True

If you witness an individual having a seizure that lasts for longer than 5 minutes you should call "911."

True

Which of the following would be classified as a partial seizure?

Absense

Myoclonic

Atonic

Simpe

Simple

What is the most common type of seizure?

Absence seizure

What is the underlying cause of epileptic seizures?

Abnormal electrical activity in the brain

Patients with epilepsy often suffer with ___________ as well.

Depression

Anxiety

Migraines

All of the above

T/F Epilepsy was first discovered in 1950.

FALSE (one of worlds oldest recognized conditions 3000 years old)

T/F A patient with epilepsy may have normal patterns on EEG.

True

T/F A seizure is defined as a brief period of excessive/synchronous neuronal activity in the brain. The outward effect can vary from uncontrolled jerking to as subtle as a momentary loss of awareness.

True

Which of the following sets of features suggests syncope rather than seizure?

preceding aura, experienced as rising gastric sensations

While prone, onset of a confusional episode

Lightheadedness and nausea, then loss of consciousness, collapse, and loss of body tone

Lightheadedness and nausea, then loss of consciousness, collapse, and loss of body tone

You should call an ambulance if you witness a patient having a seizure that lasts for longer than 5 minutes

True

Erno is presenting with dizziness that changes with movement. Which of the following can best help you distinguish between head movement and neck movement as contributing factor?

Fitz-ritson test

HX of trauma

Comorbid autoimmune

Dix-hallpike maneuver

Fitz ritson

T/F BPPV is an example of central vertigo

False

T/F The direction of nystagmus can help us differentiate between central and peripheral causes of vertigo

True

Which of the following is NOT an associated risk factor for BPPV?

HX of trauma

Orthostatic hypertension

Age

Vit D low levels

Orthostatic hypertension

The most common cause of vertigo with no hearing loss is?

BPPV

T/F Central vertigo may present with vertical nystagmus.

True

Chiropractic treatment for a migraine sufferer should include which of the following:

Upper cervical manipulation

Cervico-thoraco jct. manipulation

Applications of ice to mitigate the acute severity

Biofeedback

Diet recommendations

All of the above

Which of these characteristics is included in the diagnosis of migraine without aura, according to the International Headache Society?

A) Headache duration of a minimum 2 hours and a minimum of 3 attacks

B) associated neck pain and stiffness

C) dull pain that spreads to forehead

D) photophobia

Photophobia

A 35 y/o male presents to your office complaining of a right sided HA that travels from the subocciput to the frontal region of the skull. He relates that the pain is a level 7 and is noticed greater in the temporal and frontal region; almost like a band of tightness. It occasionally goes to the left side of the head. The pain is greater at the end of the day and may last 30 minutes to several days. The HA is aggravated with exercise, mental stress and certain smells. The application of ice along with rest and analgesics provides relief. What type of HA is this patient suffering from?

Tension type

headache lasting between 4 to 72 hours, presenting with nausea and photophobia, and aggravated by or inhibiting physical activity may be due to which type of headache?

Migraine

As a common pain syndrome, what percentage of the population suffers from migraine?

10-13%

T/F The severity of hypertensive HA may increase with an acute decrease in blood pressure

False

Which form of headaches often present the greatest diagnostic challenge to practicing clinicians?

Secondary headache

All of the following are signs/symptoms of a patient with a Hypertension HA except:

Unlike any other HA

Blurry vision

Chest pain

Dizziness

Nausea

Unlike any other HA

Which of the following are risk factors in patient's suffering from cervicogenic headache:

Prev neck trauma

Cervical subluxation

Poor head carriage

Repetitive head and neck motion

Normal C-curve

Prev neck trauma

Cervical subluxation

Poor head carriage

Repetitive head and neck motion

Attacks of Migraine HA can be provoked by which of the following;

Dec intracranial compliance

Unclear mechanism

High humidity

Low pressure

Thunderstorms

All of above

The perception of innocuous stimulus as painful is known as

Allodynia

T/F Chronic pain only occurs following tissue or nerve injury.

False

Which cranial nerve transmits pain and temperature sensation from the face?

CN V

With acute pain _____

A) often associated with nerve damage

B) relief is proportional to tissue healing

C) usually deep and aching

D) all of above

Relief is proportional to tissue healing

Which of the following is NOT involved in the pain/temperature pathway

a) spinothalmic tract

B) primary somatosensory cortex

C) nucleus gracilis

D) substantia gelatinosa

Nucleus gracilis

Which of the following is NOT associated with chronic pain?

Long term pathology

Nerve damage

More prone to depression

All of above

T/F The substantia gelatinosa in the dorsal horn of the spinal cord is involved in the modulation of pain.

True

Which of the following are examples of neuropathic pain?

A) deep aching pain worse in evening

B) postherpetic neuralgia

C) trigeminal neuralgia

D) complex regional pain syndrome

E) myalgia

B) postherpetic neuralgia

C) trigeminal neuralgia

D) complex regional pain syndrome

The following statement describes a type of abnormality in pain sensation; "pain due to a stimulus that does not usually provoke pain."

Allodynia

Minnie (48 years of age) presents with gradual onset of fatigue, weight gain, and dry skin. After your history and physical exams are complete, your clinical impression is that of thyroid imbalance. Which of the following choices would be the most appropriate diagnostic step to take next?

Lab tests

The following statement describes what type of diagnosis; " A vague diagnosis often used for non-medical reasons (like reassuring the patient or appeasing bureaucracy).

Trashcan diagnosis