Question 1

A patient comes to a provider with reports of unilateral arm pain and weakness with mild neck pain. The provider notes that the patient prefers holding the affected arm crossed in front of the throat. A history reveals a recent onset of sexual dysfunction. What does the provider suspect based on this history?

A) Axial neck pain
B) Cervical myelopathy
C) Diabetic neuropathy
D) Facet joint pain

B

Accepted Answer

The patient's presentation suggests cervical myelopathy, which is a compression of the spinal cord in the neck region. The unilateral arm pain and weakness are likely due to nerve root compression, while the mild neck pain and the patient's preference for holding the arm crossed in front of the throat suggest compression of the spinal cord in the neck region. The recent onset of sexual dysfunction may also be related to cervical myelopathy, as it can affect the nerves that control sexual function. Axial neck pain is typically more generalized and does not involve nerve root or spinal cord compression. Diabetic neuropathy typically affects the feet and hands bilaterally and does not usually present with arm weakness or sexual dysfunction. Facet joint pain can cause unilateral arm pain, but it would not explain the patient's preference for holding the arm crossed in front of the throat or the recent onset of sexual dysfunction.

Question 2

A provider suspects degenerative disk disease in a patient with chronic neck pain. Which diagnostic test will be performed?&#10;A) Computerized tomography (CT)&#10;B) Magnetic resonance imaging (MRI)&#10;C) Plain radiograph&#10;D) Radionuclide bone scintigraphy

Accepted Answer

Magnetic resonance imaging (MRI) is the best diagnostic test to evaluate degenerative disk disease. It allows for better visualization of soft tissue structures such as intervertebral disks and spinal cord than CT or plain radiograph. Radionuclide bone scintigraphy is used to detect bone abnormalities and is not specific for degenerative disk disease.

Question 3

A patient has chronic radicular neck pain that no longer responds to over-the-counter NSAIDs and physical therapy measures and reports having difficulty sleeping. Which medication will the provider order?

A) A skeletal muscle relaxant
B) A tricyclic antidepressant
C) An opioid analgesic
D) Gabapentin

D

Accepted Answer

Gabapentin is commonly used for the treatment of chronic pain of neuropathic origin and can also improve sleep. Skeletal muscle relaxants and tricyclic antidepressants may provide some pain relief, but they do not address the underlying neuropathic component of this patient's pain. Opioid analgesics are generally not recommended for the treatment of chronic non-cancer pain due to the risk of dependence, addiction, and adverse side effects.

Deck 164: Neck Pain