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261. Chest pain: What are the signs and symptoms of other causes of chest pain?

spondylosis, facet joint dysfunction) Symptoms — dull and aching chest pain aggravated by particular movements of the neck. Commonly, exercise makes the pain worse and rest relieves it, but the opposite may also be true. Pain radiates in a non-segmental distribution down the arm, up into the head, into the shoulder, or across the scapulae. May be associated with headache or dizziness, or pain in the spine. Signs — may be associated with paraesthesia or hyperaesthesia, but with no objective loss

2017 NICE Clinical Knowledge Summaries

262. Chest pain: How should I examine a person with chest pain?

for tenderness (gallstones, pancreatitis, or peptic ulceration). Neck — check for localized tenderness and stiffness (cervical spondylosis or osteoarthritis). Legs — check for swelling or tenderness (deep vein thrombosis). Skin — check for rashes (shingles) and bruising (rib fracture). Temperature — check for raised temperature, especially over 38.5ºC (infection, pericarditis, or pancreatitis). Basis for recommendation These recommendations are based on the National Institute for Health and Care Excellence

2017 NICE Clinical Knowledge Summaries

263. Chest pain

, oesophageal rupture, peptic ulcer disease, gastro-oesophageal reflux, oesophageal spasm, or oesophagitis. Musculoskeletal causes, such as rib fracture, costochondritis, spinal disorders (disc prolapse, cervical spondylosis, facet joint dysfunction), osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia or polymyalgia rheumatica. Cancer (for example, lung cancer); herpes zoster; Bornholm's disorder or precordial catch (Texidor twinge); psychogenic or non-specific chest pain. Non-specific chest

2017 NICE Clinical Knowledge Summaries

264. Low Back Pain

POPULATION Adult patients 18 years or older in primary care settings EXCLUSIONS Pregnant women; patients under the age of 18 years; diagnosis or treatment of specific causes of low back pain such as: surgical conditions including instability; referred pain (from abdomen, kidney, ovary, pelvis, bladder); inflammatory conditions (rheumatoid arthritis, ankylosing spondylitis); infections (discitis, osteomyelitis, epidural abscess); degenerative and structural changes (spondylosis, spondylolisthesis, gross

2017 Accelerating Change Transformation Team

265. AIM Clinical Appropriateness Guidelines for Spine Surgery

of the spinal cord from spondylosis, large disc extrusions or OPLL ? Anterior cervical discectomy/fusion/internal fixation (ACDF) - decompression of the nerve roots or spinal cord by disc or osteophyte removal, with or without a fusion ? Posterior cervical foraminotomy - for nerve root decompression in cases of soft posterolateral disc herniation or bony foraminal stenosis ? Posterior laminectomy with or without fusion - for congenital stenosis, multilevel central stenosis from spondylosis, or multiple (...) ., resection or debridement) ? Tumor of the spine or spinal canal ? Infection (osteomyelitis, discitis, or spinal abscess) ? Fracture or dislocation; may be traumatic or pathologic ? Symptomatic, non-traumatic cervical spondylosis as demonstrated by either of the following radiographic findings: o Sagittal plane angulation of greater than 11 degrees between adjacent segments o Subluxation or translation of greater than 3 mm on static lateral views or dynamic radiographs Spondylotic cervical myelopathy when

2017 AIM Specialty Health

267. CIRSE Guidelines on Percutaneous Vertebral Augmentation

) should come to a consensus which patients should undergo this procedure and they should ensure appropriate adjuvant therapy and the follow-up. A detailed clinical history and examination with emphasis on neurological signs and symptoms should be performed to con?rm that the VCF is the cause of debili- tating back pain and to rule out other causes, like degen- erative spondylosis, radiculopathy and neurological compromise. The typical patient suffering from VCF has midline non-radiating back pain

2017 Cardiovascular and Interventional Radiological Society of Europe

268. AIUM Practice Parameter for the Performance of a Transcranial Doppler Ultrasound Examination for Adults and Children

? ?Bull ? ??2008; ? ?24:387–394. 20. Kirsch ? ?JD, ? ?Mathur ? ?M, ? ?Johnson ? ?MH, ? ?Gowthaman ? ?G, ? ?Scoutt ? ?LM. ? ?Advances ? ?in ? ?transcranial Doppler ? ?US: ? ?imaging ? ?ahead. ? ??Radiographics ? ??2013; ? ?33:E1–E14. 21. Machaly ? ?SA, ? ?Senna ? ?MK, ? ?Sadek ? ?AG. ? ?Vertigo ? ?is ? ?associated ? ?with ? ?advanced ? ?degenerative changes ? ?in ? ?patients ? ?with ? ?cervical ? ?spondylosis. ? ??Clin ? ?Rheumatol ? ??2011; ? ?30:1527–1534. 22. de ? ?Oliveira ? ?RS, ? ?Machado ? ?HR

2017 American Institute of Ultrasound in Medicine

270. CRACKCast E103 – Headache Disorders

, lacrimation, rhinorrhea. Injected eye. Nasal congestion. Normal neuro exam. Normal vital signs. The most common disorders mimicking tension headache are migraine, IIH, oromandibular dysfunction, cervical spondylosis, sinus or eye disease, and intracranial masses. Subtle indolent infections (such as, cryptococcal meningitis) should be considered in the immunocompromised. Treatment: ● High flow O2 via NRB at 12 L/min ○ Most resolve in 15 mins ● Sumatriptan 6 mg ● Octreotide 100 mcg SC Prventative therapy

2017 CandiEM

271. Tiny Tip: Back Pain Differential Mnemonic

, and worse at night. Weight loss, night sweats, and history of cancer can also indicate a neoplastic cause. Metastatic disease (ex. prostate cancer) Hematologic (ex. multiple myeloma) P rimary bone tumours O ther Other causes of back pain to consider are: Degenerative: osteoarthritis / spondylosis Chronic pain syndrome Conversion disorder Malingering Developmental – Most of the time this will not present for the first time in the emergency department but it can be a contributing factor to those

2017 CandiEM

272. Cognitive and Mind-Body Therapies for Chronic Low Back and Neck Pain: Effectiveness and Value

. Complement Ther Med 19 Suppl 1: S26–32. doi: 10.1016/j.ctim.2010.11.005 PMID: 21195292 Sahin N, Ozcan E, Sezen K, Karatas O, Issever H (2010) Efficacy of acupunture in patients with chronic neck pain—a randomised, sham controlled trial. Acupunct Electrother Res 35: 17–27. PMID: 20578644 Fu WB, Liang ZH, Zhu XP, Yu P, Zhang JF (2009) Analysis on the effect of acupuncture in treating cervical spondylosis with different syndrome types. Chin J Integr Med 15: 426–430. doi: 10.1007/ s11655-009-0426-z PMID

2017 California Technology Assessment Forum

273. Comparison Outcomes of Discover Total Disk Arthroplasty and Anterior Cervical Discectomy with Fusion in Surgical Treatment of Cervical Disk Degenerative Disease: a Meta-Analysis of Randomized Trials Full Text available with Trip Pro

., Peng Z.Y., Zou Y.G. Cervical disc arthroplasty versus cervical discectomy and fusion for single-level cervical spondylosis: midterm follow-up of a randomized controlled trial. Chin J Tissue Engin Res. 2015;19(9):1358-1364. 10.3969/j.issn.2095-4344.2015.09.008. 9. Rozankovic M., Marasanov S.M., Vukic M. Cervical disc replacement with discover versus fusion in a single level cervical disc disease: a prospective single center randomized trial with a minimum two-year foUow-up. Clin Spine Surg. 2017;30 (...) radiculopathy — a randomized controlled outcome trial with 2-year follow-up. Spine J. 2015;15(6):1284-1294. D01:10.1016/j.spinee.2015.02.039. 12. Sun O., Lei S., Peijia L., Hanping Z., Hongwei H., Junsheng C., Jianmin L. A comparison of zero- profile devices and artificial cervical disks in patients with 2 noncontiguous levels of cervical spondylosis. Clinical spine surgery. 2016;29(2):E61-66. DOI: 10.1097/BSD.0000000000000096. 13. Liberati A., Altman D.G., Tetzlaff J., Muhow C., Gotzsche P.C., loannidis

2018 Traumatology and Orthopedics of Russia

274. Assessing Fitness to Drive

addiction • ageing-related changes in motor, cognitive and sensory abilities together with degenerative disease. Although these medical standards are designed principally around individual conditions, clinical judgement is needed to integrate and consider the effects on safe driving of any medical conditions and disabilities that a patient may present with. For example, glaucoma may cause a slight loss of peripheral vision. If combined with cervical spondylosis and low insight, there is likely

2016 Cardiac Society of Australia and New Zealand

275. Cerebral palsy: Scenario: Adult with confirmed cerebral palsy

or joint disorder is suspected and causing pain or affecting posture or function. These may include osteoarthritis, cervical instability or spondylosis (including athetosis), spinal deformity (including scoliosis, kyphosis and lordosis), subluxation of the hips, wrist and shoulders, biomechanical knee problems, and abnormalities of the foot structure. Be aware that low bone mineral density is common in adults with CP, particularly in people with reduced mobility or reduced weight bearing, taking

2016 NICE Clinical Knowledge Summaries

276. Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

for genetic damage, malformation, or neurodevelopmental effects based on current knowledge [79]. Furthermore, MRI may also demonstrate other reasons for occult pelvic pain, such as soft-tissue abnormalities or the subchondral hip or supra-acetabular stress fractures described in some osteoporotic patients [63]. The clinical differential diagnosis includes sacroiliitis from inflammatory or infectious causes, osteitis condensans ilii, and lumbosacral degenerative spondylosis [60]. Variant 12: Suspect stress

2016 American College of Radiology

277. Osteoporosis and Bone Mineral Density

. The NOF recommends treatment in patients with a 10-year probability of a hip fracture =3% or a 10-year probability of a major osteoporosis-related fracture =20% based on FRAX [16]. Two sites are routinely evaluated with DXA: the lumbar spine and hip. Up to 4 vertebral levels, L1-L4, are measured and reported in addition to 2 regions of the hip: the total and the neck [12]. In the event of artifactually elevated lumbar spine BMD due to fracture, facet joint osteoarthritis, or spondylosis, up to 2 (...) with spondylosis and degenerative facet osteoarthritis. Such findings may involve 1 or more of the L1 ACR Appropriateness Criteria ® 12 Osteoporosis and Bone Mineral Density through L4 levels scanned. The International Society of Clinical Densitometry recommends that no more than 2 levels may be excluded from the overall calculation of lumbar spine BMD [55]. If more than 2 levels are involved, then the entire spine should be excluded from evaluation [55]. In this circumstance the recommendation is to scan

2016 American College of Radiology

279. CRACKCast E043 – Spinal Injuries

Extension x 3 Posterior neural arch fracture – fracture of neural arch of c1 (just look it up…) from compression of posterior elements of c2 Unstable secondary to location Hangman’s fracture – classically described as forced extension against a noose, this traumatic spondylosis of both pedicles of c2, now more commonly seen in MVC Technically unstable, but often without cord damage secondary to the very large neural canal diameter here Extension teardrop – abrupt extension results in ALL pulling off

2016 CandiEM

280. CRACKCast E001 – Airway

is the presence of an underbite: if the patient CANNOT bite their upper lip with their lower teeth (buck teeth boy) they will be a very difficult tube!!*** Evaluate the 3-3-2 rule Mouth opening, length of mandible, and thyromental distance A high riding larynx and receding mandible = impossible tube Mallampati score : Mallampati I = easy; Mallampati IV = challenging Use a Laryngoscope to visualize in obtunded pts. Obstruction or obesity Epiglottitis, ludwig’s angina, etc. Neck mobility Spondylosis, Rheumatoid

2016 CandiEM

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