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\author{bee.f (bee.f)}
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  /Title (5002-case-3.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 3 Cheat Sheet)
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 3 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38491/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 11th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{- 37 y.o. SE carpenter\{\{nl\}\}- R neck, upper traps \& arm pain following RTA (road traffic accident) 3 weeks ago\{\{nl\}\}- 20mph, rear ended by a car going 30mph, airbags went off} \tn 
% Row Count 4 (+ 4)
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\mymulticolumn{1}{x{17.67cm}}{- Neck ache 5/10\{\{nl\}\}- Sharp arm pain (when present) 7/10\{\{nl\}\}- Neck pain hasn't changed\{\{nl\}\}- Arm pain becoming more frequent} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{AF:}} Changing position, trying to stretch neck\{\{nl\}\}- {\bf{RF:}} Painkillers (ibuprofen 1-2 200mg / day)\{\{nl\}\}- {\bf{AA:}} neck movement, work, cannot go gym (normally does cardio\& weights 3x / week)\{\{nl\}\}- {\bf{Associated:}} numbness in lateral forearm +thumb; diminished grip strength} \tn 
% Row Count 13 (+ 6)
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\mymulticolumn{1}{x{17.67cm}}{- Wakes 4-5x / night due to pain\{\{nl\}\}- Usually sleeps on front but now has to sleep on side} \tn 
% Row Count 15 (+ 2)
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\mymulticolumn{1}{x{17.67cm}}{- Saw GP 3 days after accident - Dx w/ whiplash (predicted 2-3 month recovery time)} \tn 
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Working diagnosis:}}\{\{nl\}\}- Whiplash associated disorder (WAD) \& C6 radiculopathy\{\{nl\}\}→ Initially would classify as WAD grade II, but w/ later onset of neurological symptoms it could be classified as WAD grade III, but more likely as a C6 radiculopathy} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Considering age:}}\{\{nl\}\}- Most likely cause of {\bf{C6 radiculopathy}} is a {\bf{{\emph{disc herniation}}}}\{\{nl\}\}- IVD's are very {\bf{strong when healthy}} \& need major force to be damaged ∴ although there's a temporal association between the onset of these symptoms \& the whiplash injury it's likely that the trauma worsened some pre-existing asymptomatic disc derangement\{\{nl\}\}→ Don't make casual link between the RTA \& the onset if the C6 radiculopathy; it's best to say "there appears to be an association between the RTA \& onset of the C6 radicular symptoms", without MRI before \& after RTA we cannot assess the damage caused to the disc} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Suggestive Cx disc herniation:}}\{\{nl\}\}- Pts with suggestive of this should also be assessed for signs of {\bf{Cx myelopathy}} {\emph{(fine motor skills, pain / stiffness in the neck, loss of balance, trouble walking)}}} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{"Easter egg":}}\{\{nl\}\}- The "easter egg" in this case were the urinary symptoms which were {\emph{unrelated}} to the presenting complaint but {\bf{not normal}} \& ∴ should be included conditions list} \tn 
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{WAD diagnosis \& management:}}\{\{nl\}\}⏺ {\bf{{\emph{Signs \& symptoms:}}}}\{\{nl\}\}- Neck pain \& stiffness: pain may be localised / spread to shoulders, upper back, or arms\{\{nl\}\}- Headache: may be dull or throbbing in nature\{\{nl\}\}- Dizziness: even lightheadedness / vertigo\{\{nl\}\}- Fatigue: may be due to disrupted sleep or increased stress\{\{nl\}\}- Cognitive dysfunction: problems w/ concentration, memory, \& other cognitive functions\{\{nl\}\}- Blurred vision: (or difficulty focusing)\{\{nl\}\}- Tinnitus: ringing in ears\{\{nl\}\}- Anxiety \& depression\{\{nl\}\}- Numbness or tingling: (or weakness) in arms or hands\{\{nl\}\}⏺ {\bf{{\emph{Imaging:}}}}\{\{nl\}\}- X-rays: rule out fractures or dislocations\{\{nl\}\}- CT scans: more accurate at detecting fractures, dislocations, \& other injuries\{\{nl\}\}- MRI: more detailed for soft tissue in the neck, discs, ligaments, \& nerves {\emph{(most sensitive imaging modality for detecting soft tissue injuries)}}\{\{nl\}\}- Ultrasound: detects tears or other injuries in the muscles\{\{nl\}\}⏺ {\bf{{\emph{Management:}}}}\{\{nl\}\}- Acute stage: pain management (NSAIDS), rest, \& gentle ROM exercises, ice therapy (reduce inflammation \& pain)\{\{nl\}\}- Sub-acute: manual therapy to help restore ROM, strengthen the neck muscles, \& reducing pain; cognitive-behavioural therapy to help pts cope w/ emotional \& psychological impact of the injury\{\{nl\}\}- Chronic stage: managing long-term effects of the injury, manual therapy, exercise (maintain muscle strength) \& pain management strategies} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Cx radiculopathy diagnosis \& management:}}\{\{nl\}\}⏺ {\bf{{\emph{Signs \& symptoms:}}}}\{\{nl\}\}- Neck pain: may be sharp or dull, \& may radiate to the shoulder, arm or hand\{\{nl\}\}- Numbness \& tingling: "pins \& needles" sensation in neck, shoulder, arm, or hand\{\{nl\}\}- Muscle weakness: neck, shoulder, arm, or hand, may make it difficult to grip objects or perform other daily activities\{\{nl\}\}- Reflex changes: diminished or absent\{\{nl\}\}- Reduced ROM: neck, shoulder, arm, or hand\{\{nl\}\}- Headaches: often located in the back of the head or neck\{\{nl\}\}- Loss of coordination: particularly in the hands or fingers, may make it difficult to perform fine motor tasks\{\{nl\}\}⏺ {\bf{{\emph{Imaging:}}}}\{\{nl\}\}- X-rays: initial assessment, rule out fractures or spinal instability\{\{nl\}\}- MRI: most commonly used, detailed images of soft tissues, spinal cord, nerve roots, \& IVDs; can help identify the location \& severity of nerve compression or irritation\{\{nl\}\}- CT: useful in identifying bony abnormalities that may be contributing nerve compression or irritation\{\{nl\}\}- EMG: measures electrical activity in muscles \&nerves, used to confirm diagnosis of Cx radiculopathy \& determines the severity of nerve damage\{\{nl\}\}⏺ {\bf{{\emph{Management:}}}}\{\{nl\}\}- Mild to moderate: rest \& activity modification, manual therapy, medications, steroid injections\{\{nl\}\}- Severe symptoms: in this case conservative treatment failed \& surgery is needed} \tn 
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Cx myelopathy diagnosis \& management:}}\{\{nl\}\}⏺ {\bf{{\emph{Signs \& symptoms:}}}}\{\{nl\}\}- Weakness: arms \& legs\{\{nl\}\}- Numbness \& tingling: arms, legs, hands, \& feet\{\{nl\}\}- Loss of balance \& coordination\{\{nl\}\}- Changes in reflexes: hyperreflexia or diminished reflexes\{\{nl\}\}- Bowel or bladder dysfunction: in severe cases\{\{nl\}\}- Neck pain: result of compression or damaged spinal cord\{\{nl\}\}⏺ {\bf{{\emph{Imaging:}}}}\{\{nl\}\}- MRI: most commonly used, detailed images of spinal cord, etc; also show areas of compression or damage to the spinal cord\{\{nl\}\}- CT: bony structures \& any abnormalities that may be compressing the spinal cord\{\{nl\}\}- X-ray: identify bone abnormalities that may be compressing the spinal cord\{\{nl\}\}- Myelography: injecting a contrast material into the spinal canal to help visualise there spinal cord \& nerves; used if MRI not available or contraindicative\{\{nl\}\}- EMG: confirms diagnosis \& helps determine location \& severity of nerve damage\{\{nl\}\}⏺ {\bf{{\emph{Management:}}}}\{\{nl\}\}- Mild to moderate: rest \& activity modification, manual therapy, medications\{\{nl\}\}- Severe symptoms: in this case conservative treatment failed \& surgery is needed} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Most common causes of increased frequency of urination in a 37 y.o. female:}}\{\{nl\}\}- UTI\{\{nl\}\}- Overactive bladder: muscles contract involuntary, causing sudden urge to urinate \& frequent urination\{\{nl\}\}- Pregnancy: hormonal changes that increase the frequency (especially 1st \& 3rd trimester)\{\{nl\}\}- Interstitial cystitis (IC): chronic condition that causes pain \& discomfort in the bladder \& pelvic region\{\{nl\}\}- Diabetes: result of high blood sugar levels, which can lead to increases urine production\{\{nl\}\}- Bladder or kidney stones: increased urination along w/ pain during, blood in urine, \& lower abdominal or back pain\{\{nl\}\}- Medications: (e.g. diuretics) can increase urine production} \tn 
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Examination Findings}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Sensation}}\{\{nl\}\}- C6 dermatome: reduced sharp sensation} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Cx AROM + PROM}}\{\{nl\}\}- RR, RLF, \& ext, all increase neck \& shoulder / upper traps pain, movement guarded} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{TTP}}\{\{nl\}\}- Locally over the upper traps \& middle-lower Cx} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical tests}}\{\{nl\}\}- {\bf{R maximal foraminal compression:}}\{\{nl\}\}- {\bf{Purpose:}} diagnosis Cx nerve root compression causing Cx radiculopathy\{\{nl\}\}- {\bf{Findings:}} reproduces sharp arm pain as well as neck pain\{\{nl\}\}- {\bf{Cx distraction:}}\{\{nl\}\}- {\bf{Purpose:}} joint space increased to relieve pressure on nerve root\{\{nl\}\}- {\bf{Findings:}} relieving\{\{nl\}\}- {\bf{Arm squeeze test:}}\{\{nl\}\}- {\bf{Purpose:}} distinguish Cx nerve root compression from shoulder disease\{\{nl\}\}- {\bf{Findings:}} R 5/10 mid. upper traps, 2/10 in upper \& lower upper arm\{\{nl\}\}- {\bf{Lhermitte's sign:}}\{\{nl\}\}- {\bf{Purpose:}} looking for electric like shock\{\{nl\}\}- {\bf{Findings:}} local neck pain but no pain into arms or legs} \tn 
% Row Count 21 (+ 14)
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