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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (neck-pain.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Neck Pain Cheat Sheet)
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Neck Pain Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/22967/}}}
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\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 14th November, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  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}{Anatomy in the neck}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1636926260_neck.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Lymph nodes \newline Thyroid + parathyroid gland \newline Salivary Gland \newline Blood Vessels \newline Muscles, bones, cartilage \newline Nerves \newline Oesophagus + trachea}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Cervical Lymphnodes}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1636926110_lymps.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Non-MSK causes of neck pain}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Oesophagus:}} Indigestion, Difficulty swallowing} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Thyroid:}} Enlargement, Infection/Inflammation, cancer} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Carotid Artery:}} Dissection} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Lymph nodes:}} Infection/inflammation, cancer - Submental, Submandibula, Tonsillar, Parotid, Preauricular, Postauricular, Occupital, Anterior cx, Posterior cx, Supraclavicular} \tn 
% Row Count 8 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Heart:}} MI/IHD - refer to neck and jaw + down left arm} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Lung:}} Apical Tumours - refer to neck, shoulder and arm} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Consider \newline Age, Hx of the lump, Location of the lump, Exam of the lump, Exam of the head/neck}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Questions to ask}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Pain related to exertion, relieved bby rest? Risk factors of IHD/Cardiac issues} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Respiratory symptoms? Smoker?} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Swellings in the neck? (lymphnodes/thyroid?) - How long? Where is it? How was it noticed? Enlarging or changing? Local symptoms? Other symptoms? Other lumps? Hx of cancer? Smoking/alcohol? Travel/trauma?} \tn 
% Row Count 8 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{GI Symptoms?} \tn 
% Row Count 9 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Hx of neck traum/headache/visual \seqsplit{disturbances/neurological} symptoms?} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Recent infections/ hx of cancer?} \tn 
% Row Count 12 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Lumps should reduce within 6 weeks , if not, consider possible malignancy (should be seen within 2 weeks) \newline - Painful nodes = infection \newline - Firm, hard, painless = cancer}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Neck Pain Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pain from superior nuchal line to the tip of T1 , sagittal planes} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Caused by:}} & Myofascial Pain Syndrome \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Intervertebral Joint Hypomobility \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
 & Spondylosis \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Musculoligamentous strain/sprain \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
 & Intervertebral Disc Derangement \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 11 (+ 0)
% Row 7
\SetRowColor{white}
{\bf{Serious Disorders}} & Meningitis/SAH \tn 
% Row Count 13 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & Angina/MI referral \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
 & Metastasis \tn 
% Row Count 15 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Vascular Lesions \tn 
% Row Count 16 (+ 1)
% Row 11
\SetRowColor{white}
 & Oesophageal Disorders \tn 
% Row Count 17 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 17 (+ 0)
% Row 13
\SetRowColor{white}
{\bf{Pitfalls}} & RA \tn 
% Row Count 18 (+ 1)
% Row 14
\SetRowColor{LightBackground}
 & PMR \tn 
% Row Count 19 (+ 1)
% Row 15
\SetRowColor{white}
 & Fibromyalgia \tn 
% Row Count 20 (+ 1)
% Row 16
\SetRowColor{LightBackground}
 & Myelopathy - look for stiffness of the legs \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Lumps:  \newline Children: Reactive lympadenopathy - infections in head/neck/congenital cysts \newline Young adults: Inflammation/infection  - Viral/bacterial adenitis, Thyroid cancer \newline \textgreater{}40s : Malignant until proven otherwise}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{9.1531 cm} x{8.1169 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Refer}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{- Refer to GP when:}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
- Symptoms of Cx radioculopathy persists/not improved with conservative management within 4 weeks & - Clinical Evidence of NR compromise \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Incapacitating Neck/Arm Pain} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Injury Mechnisms}}  \tn
% Row 0
\SetRowColor{LightBackground}
- CT best for fractures, MRI better for soft tissure damage & - F\# commonly @ C1-2, C5-7 \& T12-L2 \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
- Four types of Spinal F\#/Dislocation & 1. Compression 2. Burst 3. Seat Belt Injuries 4. Fracture- Dislocations \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
{\bf{Compression:}} & Hyperflexion + Axial Compression - usually posterior height is maintained \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{Burst Fractures}} & Axial loading of the spine \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{Seat-Belt}} & Rapid Deceleration - Axis, middle + posterior structures affected \tn 
% Row Count 17 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Investigations}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Canadian C-Spine Rules} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{For Alert (GCS = 15) pts over 16 after trauma} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{High Risk Factor}} & - \textgreater{}65 yo or Dangerous Mechanism of injury/Paresthesia in Extremities \tn 
% Row Count 6 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{Low Risk Factor - allows safe assessment of ROM}} & - Simple Rear End Collision \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & - Sitting Position in Emergency Department \tn 
% Row Count 12 (+ 3)
% Row 5
\SetRowColor{white}
 & - Walking at any time \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & - Delayed onset of Neck Pain \tn 
% Row Count 16 (+ 2)
% Row 7
\SetRowColor{white}
 & - Absence of Midline Cx tenderness \tn 
% Row Count 18 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Are they able to turn their heads Left and Right 45 degrees}}} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{N/A}} for \textless{}16, GCS \textless{}15, Acute Paralysis, Known Vertebral Disease/ previous surgery \newline {\bf{Dangerous Mechanism of Injury}} = Fall from elevation \textgreater{}3 ft/five stairs, axial load to head, high speed vehicle accidents (\textgreater{}100km/h), rollover, ejection, motorised recreational vehicles, bicycle/collisions}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.1169 cm} x{9.1531 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Features in the history}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Location}} & - Localised/Radiating \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & - Localised = Muscle strain, ligament sprains, manipulable lesions, facet joint/disc degeneration - Radiation into the arm = nerve/MTrps \tn 
% Row Count 8 (+ 7)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 8 (+ 0)
% Row 3
\SetRowColor{white}
{\bf{Characteristics of pain}} & Sharp (acute) Dull/aching (Chronic) = Muscle/ligament/disc \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & Deep/Boring pain = Bone/joint \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
 & Electrical, numbing, tingling, shooting = neurogenic \tn 
% Row Count 16 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 16 (+ 0)
% Row 7
\SetRowColor{white}
{\bf{Onset}} & Trauma? Anything that set it off? Life/Activity changes prior to the onset? \tn 
% Row Count 20 (+ 4)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 20 (+ 0)
% Row 9
\SetRowColor{white}
{\bf{Aggravating \& Relieving Factors}} & Pain during neck extension - compression of posterior elements - Usually the Facet Joints, consider NR if pain radiates down Arm \tn 
% Row Count 27 (+ 7)
% Row 10
\SetRowColor{LightBackground}
 & - Pain with overhead Activities Consider TOS \tn 
% Row Count 30 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.1169 cm} x{9.1531 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Features in the history (cont)}}  \tn
% Row 11
\SetRowColor{LightBackground}
 & - Pain at the end of the day = chronic overuse, mechanical disorder, degeneration \tn 
% Row Count 4 (+ 4)
% Row 12
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 4 (+ 0)
% Row 13
\SetRowColor{LightBackground}
{\bf{Pain duration}} & Muscle strains = Recover in a few days to a couple of weeks \tn 
% Row Count 7 (+ 3)
% Row 14
\SetRowColor{white}
 & Ligament Sprains = Up to a couple of months \tn 
% Row Count 10 (+ 3)
% Row 15
\SetRowColor{LightBackground}
 & Disc Injuries/herniation = 3-6 months \tn 
% Row Count 12 (+ 2)
% Row 16
\SetRowColor{white}
 & Chronic Pain = \textgreater{}6 months - degenerative, mechanical instability, chronic \seqsplit{inflammatory/neuropathic} process \tn 
% Row Count 17 (+ 5)
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 17 (+ 0)
% Row 18
\SetRowColor{white}
{\bf{Associated symptoms}} & Arm symptoms (pain, paraesthesia, weakness, clumsiness) \tn 
% Row Count 20 (+ 3)
% Row 19
\SetRowColor{LightBackground}
 & Headaches, dizziness, nausea \tn 
% Row Count 22 (+ 2)
% Row 20
\SetRowColor{white}
 & Difficulty Walking - scuffing of toes, feeling unbalanced (CSM) \tn 
% Row Count 25 (+ 3)
% Row 21
\SetRowColor{LightBackground}
 & - Did they come on the same time as your complaint? \tn 
% Row Count 28 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.5988 cm} x{9.6712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Red Flags}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Condition}} & {\bf{Red Flags}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{F\#}} & Trauma, Loss of consciousness, Thrown from a vehicle, inability to move neck due to pain, Rust's sign, use of high does Steroids, Pain on Percussion \tn 
% Row Count 8 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\bf{Tumour}} & \textgreater{}50 yo, Pain at rest, Unexplained weight loss, Hx of cancer, Failure to improve with previous treatments, Dysphagia, Headache, Vomiting, Pain on Percussion \tn 
% Row Count 16 (+ 8)
% Row 3
\SetRowColor{white}
{\bf{Infection}} & Systemic S\&S, Risk factors ( immunosuppresion, underlying disease, penetrating wound, exposure to infectious disease), Intravenous Drug use, Pain at rest, Nuchal rigidity, Pain on Percussion \tn 
% Row Count 25 (+ 9)
% Row 4
\SetRowColor{LightBackground}
{\bf{Spinal Cord Compression}} & Trauma to the neck, Paraesthesias of upper and or lower extremities, Difficulty walking/stiff gait, Babinski + Hoffman +ve, Hyperactive Reflexes, Ankle Clonus \tn 
% Row Count 33 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.5988 cm} x{9.6712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Red Flags (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
{\bf{Cerebral/Spinal Haemorrhage}} & Cerebrovascular symptoms/signs, Anticoagulant Use \tn 
% Row Count 3 (+ 3)
% Row 6
\SetRowColor{white}
{\bf{Vertebral/Carotid Aneurysm}} & Cardiovascular Risk Factors, TIA \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.3175 cm} x{12.9525 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Neck Pain in Children}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Consider:}} & Infection, inflammation of cx lymphnodes - tonsilities/pharyngitis. Meningitis, acute torticollis - Chronic Junvenile Arthritis \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.3175 cm} x{12.9525 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Neck Pain in the Elderly}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Consider:}} & - Cx spondylosis with radiculopathy/myelopathy \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & - Atlantoaxial Subluxation - RA \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & - PMR \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
 & - Metastatic Cancer \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & - Pancoast Tumour \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
 & - Angina/MI \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & - Pharyngeal \& Retropharyngeal infection/tumour \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Lumps Where?}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Midline: Thyroid swellings, Thyroglossal cyst, Submental lymph nodes} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Lateral (anterior triangle): Thyroid swellings, Submandibular gland swelling, Lymph nodes, Parotid swellings} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Lateral (posterior) : Lymph nodes, Carotid artery aneurysm, Cx ribs} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Neck Lumps}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1636926381_neck lumps.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Exam}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Site, Size, Shape, Surface (4 S's)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Consistency, Colour, Compressible/fluctuant (3 C's)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Transillumination, Tenderness, Tethered (3 T's)} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Autoimmune}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Diabetes} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{RA} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Pernicious Anaemia} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Hashimotos} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{MS} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{SLE} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Vitiligo} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Thyroid Anatomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1636926487_thyroid.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Thyroid Physiology}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1620467179_tp.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Palpating the thyroid}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1636926585_palp.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hypothyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- If goitre = Hashimotos, if no goitre = Atrophic primary hypothyroidism} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{Caused by}}: Hashimotos, Surgery/radioactive treatment to the thyroid ,Side effect of medications (Amiodarone, Lithium), Iodine deficiency, Pituitary Tumour} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Symptoms:}} Tiredness, Lethary, Xathomas, Constipiation, Intolerance to cold, Muscle stiffness, Cramps, CTS, Menorrhagia, Slowing of intellectual activity, Reduced motor activity, decreased appetite, weight gain, Dry skin + hair loss, Deep, hoarse voice} \tn 
% Row Count 12 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Signs:}} Expressionless, dull face with perorbital + tongue swelling, Sparse hair, Pale cool skin with rough, doughy texture, Coarse dry brittle hair, Goitre, Bradycardia, Obesity, Prolonged relaxation phase of DTR, Peripheral neuropathy} \tn 
% Row Count 17 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Thyroxine} \tn 
% Row Count 18 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hyperthyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Grave's disease} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Symptoms:}} Restless, nervous, emotional irritable, sleeping poorly, Tremour of the hands, Losing weight, Palpitations, Sweating and dislike of heat, Diarrhoea, SOB, Menstrual changes (light/infrequent), SKin problems - hair thinning, itching. Increased thirst, Tiredness + muscle weakness} \tn 
% Row Count 7 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Signs:}} Sinus Tachycardia (can be atrial fib), Fine tremour, Warm, moist skin, Goitre, Hyperreflexia, Proximal Myopathy, muscles weakness and wasting, exopthalmus} \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{Medication:}}: Beta blockers, Carbimazole , Surgery: Thyroidectomy, Radio Iodine (kills iodine producing cells)} \tn 
% Row Count 14 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Exam:}} Observe + Palpate Thyroid gland with two hands standing behind the patient, get patient to swallow {\bf{Normally, gland is not palpable unless enlarged!}}} \tn 
% Row Count 18 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}