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\author{bee.f (bee.f)}
\pdfinfo{
  /Title (5002-case-5.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 5 Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 5 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38612/}}}
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\noindent
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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{document}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case Hx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- 62 y.o.\{\{nl\}\}- Neck \& L arm pain\{\{nl\}\}- L pectorals area \& down L posterior arm\{\{nl\}\}- L first 3 fingers} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Onset}}\{\{nl\}\}- Pushing a washing machine 6 weeks ago} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Neck \& shoulder}}\{\{nl\}\}- Deep achy pain\{\{nl\}\}- Hand feels numb \& bit weak\{\{nl\}\}- 7/10} \tn 
% Row Count 7 (+ 2)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{L first 3 fingers}}\{\{nl\}\}- Numb \& sometimes tingly} \tn 
% Row Count 9 (+ 2)
% Row 4
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\mymulticolumn{1}{x{17.67cm}}{{\bf{AF:}} Working overhead, shaving, \& circling head\{\{nl\}\}- {\bf{RF:}} Massaging forearm \& triceps / raising arm / naproxen relieves pain} \tn 
% Row Count 12 (+ 3)
% Row 5
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\mymulticolumn{1}{x{17.67cm}}{{\bf{PMHx}}\{\{nl\}\}- Diagnosed w/ high BP (2004)\{\{nl\}\}- Recent spell of dizziness} \tn 
% Row Count 14 (+ 2)
% Row 6
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Medication}}\{\{nl\}\}- Naproxen\{\{nl\}\}- Atenolol (β blocker)} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Exam Findings}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{ROM Cx}}\{\{nl\}\}- {\bf{AROM:}} pain + restriction\{\{nl\}\}- {\bf{PROM:}} L + R rotation pain + restriction\{\{nl\}\}- {\bf{PROM:}} pain on extension} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical tests}}\{\{nl\}\}- {\bf{Cx maximal compression test:}} arm pain + numbness in L hand\{\{nl\}\}- {\bf{Cx distraction:}} relieves pain (nerve root compression)\{\{nl\}\}- {\bf{Doorbell sign:}} discomfort bilaterally\{\{nl\}\}- {\bf{Shoulder abduction test:}} relieves pain w/ L hand on head\{\{nl\}\}- {\bf{Shoulder depression:}} L pain\{\{nl\}\}- {\bf{TOS:}} negative\{\{nl\}\}- {\bf{Romberg:}} negative\{\{nl\}\}\{\{nl\}\}-  {\bf{Median tension test:}} R uncomfortable, L POC\{\{nl\}\}- {\bf{Ulnar tension test:}} R uncomfortable, L POC\{\{nl\}\}- {\bf{Radial tension test:}} L POC} \tn 
% Row Count 14 (+ 11)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{TTP (tender to palpation) + hypertonic}}\{\{nl\}\}- L traps\{\{nl\}\}- Levator scapluae\{\{nl\}\}- Rhomboids\{\{nl\}\}- Scalenes\{\{nl\}\}- Pecs} \tn 
% Row Count 17 (+ 3)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Spinal palpations:}}\{\{nl\}\}- C5-T1 TTP \& restricted\{\{nl\}\}- T6-T7 restricted extension} \tn 
% Row Count 19 (+ 2)
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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\}\}- C7 radiculopathy (combination of muscle weakness seen) + potential associated degenerative change (based on age) \& potential pre-existing (asymptomatic) disc herniation\{\{nl\}\}- Traumatic sprain / strain event causing the overall symptoms we see now} \tn 
% Row Count 6 (+ 6)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{NICE guidance}}\{\{nl\}\}- Refer for MRI \& consideration of invasive management options (most pts w/ Cx radiculopathy don't need surgery)\{\{nl\}\}- {\bf{Conservative management:}}\{\{nl\}\}-  Can be considered while pt is waiting for further investigation\{\{nl\}\}- Need to closely monitor neurological status\{\{nl\}\}- Main concern: weakness \& long-term impact on pt's ADLs\{\{nl\}\}- Pt should contact GP again to discuss pharmacological options} \tn 
% Row Count 15 (+ 9)
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Less likely Dx}}\{\{nl\}\}- {\bf{TOS:}} possible from Hx but less likely as no reproduced symptoms in physical examination\{\{nl\}\}- {\bf{Peripheral nerve entrapment (median / radial):}} depending on the location of the entrapment, less likely to explain the whole presentation \& the symptoms being aggravated by max. Cx compression \& relieved by Cx distraction suggest root involvement\{\{nl\}\}- {\bf{Sub-acute Cx spine sprain / strain:}} may be initial onset of symptoms, it doesn't explain the current neurological picture\{\{nl\}\}- Non-specific neck pain w/ associated myofascial involvement:{\emph{* could account for part of the presentation but doesn't explain the objective neurological deficit }}(comment have mechanical \& myofascial involvement in pts w/ radiculopathy)*} \tn 
% Row Count 31 (+ 16)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Important not to miss}}\{\{nl\}\}- {\bf{Cardiac causes \& apical lung tumour:}} unlikely given the whole clinical picture, including all Hx \& physical examination findings\{\{nl\}\}- {\bf{Cx radiculomyelopathy:}} should be considered in any pt w/ neck \& arm pain, especially older pts} \tn 
% Row Count 6 (+ 6)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Separate complaint of momentary dizziness:}} after getting up quickly from a stooped position\{\{nl\}\}- Most likely due to postural hypotension (aka. orthostatic hypotension)\{\{nl\}\}- Could be cervicogenic \& important not to miss {\emph{(causes would be vascular)}}} \tn 
% Row Count 12 (+ 6)
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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{Presentations of C6, C7 \& C8 radiculopathy}} (nerve root)\{\{nl\}\}⏺ {\bf{{\emph{C6:}}}}\{\{nl\}\}- Radiating pain down the arm to the thumb \& index finger\{\{nl\}\}- Weakness in the biceps \& wrist extensors\{\{nl\}\}- Tingling or burning sensations in the fingers\{\{nl\}\}- Difficulty w/ fine motor skills (buttoning a shirt or holding small objects)\{\{nl\}\}⏺ {\bf{{\emph{C7:}}}}\{\{nl\}\}- Radiating pain down therm to the middle finger\{\{nl\}\}- Weakness in the triceps \& wrist flexors\{\{nl\}\}- Tingling or burning sensations in the middle finger\{\{nl\}\}- Difficulty with grip strength \& hand dexterity\{\{nl\}\}⏺ {\bf{{\emph{C8:}}}}\{\{nl\}\}- Radiating pain down the arm to the ring \& little finger\{\{nl\}\}- Weakness in the hand intrinsic muscles\{\{nl\}\}- Tingling burning sensations in the ring \& little fingers\{\{nl\}\}- Difficulty w/ fine motor skills (typing or writing)} \tn 
% Row Count 17 (+ 17)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Presentation of median \& radial nerve entrapment}}\{\{nl\}\}⏺ {\bf{{\emph{Median nerve:}}}} (aka. carpal tunnel syndrome)\{\{nl\}\}- Numbness, tingling, or burning sensation in the thumb, index, middle, \& half of the ring finger\{\{nl\}\}- Weakness in the hand, especially the thumb, making it difficult to grasp objects or hold into things\{\{nl\}\}- Pain in the wrist \&/or forearm, which can be worse at night or during repetitive tasks\{\{nl\}\}- Feeling of clumsiness or a tendency to drop things\{\{nl\}\}⏺ {\bf{{\emph{Radial nerve:}}}}(aka. radial tunnel syndrome)\{\{nl\}\}- Pain or tenderness in the forearm or elbow, which can be worse when bending the wrist or fingers back or rotating the forearm\{\{nl\}\}- Weakness in the wrist or fingers, making it difficult to grip or hold onto things\{\{nl\}\}- Numbness or tingling sensation in the back of the hand, or the thumb, index, \& middle finger\{\{nl\}\}- Feeling of weakness or inability to extend the wrist or fingers} \tn 
% Row Count 36 (+ 19)
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentiate between radiculopathy \& peripheral nerve entrapment presentations}}\{\{nl\}\}⏺ {\bf{{\emph{Location of symptoms:}}}}\{\{nl\}\}- {\bf{Radiculopathy:}} usually causes symptoms in specific area of the arm or hand that corresponds to the location of affected nerve root (e.g. C6 causes Sx in neck, shoulders, \& arms, while C8 causes Sx in the ring \& little fingers)\{\{nl\}\}- {\bf{Peripheral nerve entrapment:}} causes Sx in specific nerve distribution in the arm or hand (e.g. carpal tunnel syndrome causes Sx in the thumb, index, middle, \& half of the ring finger)\{\{nl\}\}⏺ {\bf{{\emph{Pattern of Sx:}}}}\{\{nl\}\}- {\bf{Radiculopathy:}} usually causes Sx that radiate along a specific nerve pathway (herniated disc causing C6 radiculopathy can cause pain that radiates down the arm to the thumb \& index finger)\{\{nl\}\}- {\bf{Peripheral nerve entrapment:}} Usually causes Sx in a more localised area (carpal tunnel syndrome usually causes pain, numbness, \& tingling in the thumb, index, middle, \& half of ring finger)\{\{nl\}\}⏺ {\bf{{\emph{Onset of Sx:}}}}\{\{nl\}\}- {\bf{Radiculopathy:}} usually develops gradually over time (herniated disc may take weeks or months to cause noticeable Sx)\{\{nl\}\}- {\bf{Peripheral nerve entrapment:}} can develop suddenly or gradually (carpal tunnel syndrome can develop suddenly due to repetitive hand movements or wrist injury)\{\{nl\}\}⏺ {\bf{{\emph{Association w/ other conditions:}}}}\{\{nl\}\}- {\bf{Radiculopathy:}} often associated w/ other spinal conditions (e.g. herniated discs, spinal stenosis, or degenerative disc disease)\{\{nl\}\}- {\bf{Peripheral nerve entrapment:}} can be associated w/ activities or conditions that put pressure on the nerves (e.g. repetitive hand movements, wrist injuries, or certain medical conditions like diabetes)} \tn 
% Row Count 35 (+ 35)
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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{Management of pts w/ radiculopathy}}\{\{nl\}\}⏺ {\bf{Conservative management:}}\{\{nl\}\}- Rest\{\{nl\}\}- Manual therapy\{\{nl\}\}- Medications\{\{nl\}\}- Heat \& ice therapy\{\{nl\}\}⏺ {\bf{Invasive management:}}\{\{nl\}\}- Epidural steroid injections\{\{nl\}\}- Surgery\{\{nl\}\}⏺ {\bf{Lifestyle changes:}}\{\{nl\}\}- Maintaining good posture \& body mechanisms\{\{nl\}\}- Exercise\{\{nl\}\}- Maintaining a healthy weight} \tn 
% Row Count 8 (+ 8)
% Row 4
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Different types of TOS, how it's diagnosed \& managed}}\{\{nl\}\}⏺ {\bf{{\emph{Neurogenic TOS:}}}}\{\{nl\}\}- Compression of {\bf{brachial plexus}}\{\{nl\}\}- Shoulder, arm, \& hand\{\{nl\}\}⏺ {\bf{{\emph{Venous TOS:}}}}\{\{nl\}\}- Compression of subclavian {\bf{vein}}\{\{nl\}\}- Blood vessel that carries blood {\emph{from arm to heart}}\{\{nl\}\}⏺ {\bf{{\emph{Arterial TOS:}}}}\{\{nl\}\}- Compression of the subclavian {\bf{artery}}\{\{nl\}\}- Blood vessel that carries blood {\emph{from heart to arm}}\{\{nl\}\}⏺ {\bf{{\emph{Diagnosis:}}}}\{\{nl\}\}- Combination of medical Hx, physical examination, \& diagnostic tests\{\{nl\}\}- Tests: x-rays, MRI or CT scans, EMG, or nerve conduction studies\{\{nl\}\}⏺ {\bf{{\emph{Management:}}}}\{\{nl\}\}- {\bf{Conservative management:}} manual therapy, medications, lifestyle modifications\{\{nl\}\}- {\bf{Invasive management:}} surgery, vascular procedures {\emph{(angioplasty or stenting)}}} \tn 
% Row Count 24 (+ 16)
% Row 5
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Presentations for MI, angina \& apical lung tumours}}\{\{nl\}\}⏺ {\bf{{\emph{MI}}}} (blood flow to heart is blocked, damage or death of heart muscle):\{\{nl\}\}- Chest pain or discomfort (pressure / tightness in the chest)\{\{nl\}\}- Pain or discomfort in the arms, neck, jaw, back, or stomach\{\{nl\}\}- SOB\{\{nl\}\}- Nausea / vomiting\{\{nl\}\}- Sweating\{\{nl\}\}- Feeling lightheaded or dizzy\{\{nl\}\}⏺ {\bf{{\emph{Angina}}}} (chest pain that occurs when heart muscle don't get enough blood flow / oxygen):\{\{nl\}\}- Pressure or squeezing sensation in chest\{\{nl\}\}- Pain or discomfort in the arms, neck, jaw, shoulder, or back\{\{nl\}\}- SOB\{\{nl\}\}- Nausea / vomiting\{\{nl\}\}- Sweating\{\{nl\}\}- Feeling lightheaded or dizzy\{\{nl\}\}⏺ {\bf{{\emph{Apical lung tumours}}}} (lung tumour that grows in the apex of lung):\{\{nl\}\}- Chest pain\{\{nl\}\}- Coughing up blood\{\{nl\}\}- SOB\{\{nl\}\}- Hoarseness or difficulty speaking\{\{nl\}\}- Fatigue or weakness\{\{nl\}\}- Loss of appetite or weight loss\{\{nl\}\}- Swelling of the face, neck, or arms} \tn 
% Row Count 44 (+ 20)
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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{Postural hypotension}} (aka. orthostatic hypotension)\{\{nl\}\}⏺ {\bf{{\emph{Definition:}}}}\{\{nl\}\}- Drop in BP (≥20 mm Hg systolic and/or ≥10 mm Hg diastolic) that occurs within 3 minutes of standing\{\{nl\}\}⏺ {\bf{{\emph{Mechanism:}}}}\{\{nl\}\}- Normally, when person stands up, body compensates by increasing HR \& constricting blood vessels to maintain BP → if postural hypotension, compensatory response is inadequate, leading to drop in BP \& reduced blood flow to brain\{\{nl\}\}⏺ {\bf{Symptoms:}}{\emph{\{\{nl\}\}- Dizziness or lightheadedness\{\{nl\}\}- Fainting or near-fainting\{\{nl\}\}- Blurred vision or tunnel vision\{\{nl\}\}- Nausea\{\{nl\}\}- Fatigue\{\{nl\}\}- Headache\{\{nl\}\}⏺ {\bf{}}Causes:}}{\emph{\{\{nl\}\}- Dehydration\{\{nl\}\}- Medication side effect\{\{nl\}\}- Diabetes\{\{nl\}\}- Nervous system disorder\{\{nl\}\}- Aging\{\{nl\}\}⏺ {\bf{}}Treatment}}* (depends on underlying cause):\{\{nl\}\}- Lifestyle changes: staying hydrated, standing up slowly, wearing compression socks\{\{nl\}\}- In some cases, medication adjustments} \tn 
% Row Count 20 (+ 20)
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\end{document}