Neck conditions
Which of the following is INCORRECT about acute torticollis?
The neck is rotated to the non painful side and usually cannot be moved to a neutral position. Simple analgesia, warm compresses and massage may help. There should be no associated neurological symptoms or signs.
What serious condition is recognised to occur in 1:20000 chiropractic spinal manipulations?
All of the answers have been recorded but vertebral artery dissection is well recognised. Patients often present with vertigo, headache, neck pain, ataxia and sometimes long tract signs a variable time after manipulation.
In this video game a man has been stabbed in the neck. Which zone of the neck has he been stabbed in?
There are 3 recognised zones. Zone 1 is from the clavicle to the cricoid. Zone 2 from the cricoid to the angle of the mandible. Zone 3 is up to the superior angle of the mandible. Zone 1 has the highest mortality whilst Zone 2 is the most common site of injury. Each Zone has a slightly different approach to their care.
A 55yr old diabetic lady felt she had a fish bone caught 4 days ago. Now has throat pain, fever, difficulty in swallowing and stridor. What does the xray show?
There is marked retropharyngeal swelling with gas locules. The soft tissue in front of C2 to C4 is only meant to be 1/3 the width of the vertebra, whilst from C4 down to T1 it is meant to be less than 1.1 the width of the vertebra. (image thanks to Radiopaedia).
Whom of the following well known people were NOT beheaded?
Julius Caesar was assasinated by a group of senators in the senate. Stabbed 23 times. Tough meeting.
This man developed a tender neck swelling associated with a fever, difficulty in swallowing and an elevated tongue. What does he most likely have?
Ludwigs angina is a polymicrobial infection of the floor of the mouth that can threaten the airway. It often occurs in patients with poor dental hygeine. Beware and secure the airway in OT. Image thanks to LITFL.
What is Lemierre syndrome?
It occurs in the presence of oropharyngeal infection, like a quinsy. 70% occur in 16 to 25yr olds. Patients usually present unwell with neck pain, trismus and often signs of distal infective emboli especially in the lungs. Fusobacterium necrophorum is the causative organism in up to 80% of cases.
Worldwide, what is the most common cause of a goitre (enlarged thyroid).
When there is dietary iodine deficiency the thyroid enlarges to try to keep up its production of thyroid hormones. Apparently worldwide 2 billion people suffer iodine deficiency of which 50 million are symptomatic.
A 78yr old man slipped and fell in the shower striking his forehead and hyperextending his neck. He has weakness in his arms greater than his legs with his distal muscles affected more than his proximal muscles. What does he most likely have?
The centre of the spinal cord is squished anteriorly by bony spurs or disc material and posteriorly by the ligamentum flavum. Because of the way the parts of the corticospinal tract are layered out those closer to the centre of the cord (the upper limbs) are affected more than those further out (lower limbs). Forced extension in an older person who already has a narrowed spinal canal is usually the mechanism.
Listen to the audio. What condition are you listening to in this infant?
This is the sound of an infant with croup. Note the "barking" cough and some inspiratory stridor.