Cervical Artery Dysfunction
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- 1.
What percentage of the cerebral circulation is supplied by the vertebral arteries?
- A.
80%
- B.
50%
- C.
60%
- D.
20%
Correct Answer
D. 20%Explanation
The internal carotid arteries provide the other 80%Rate this question:
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- 2.
At which level does the vertebral artery enter the transverse foramen in the majority (89%) of people?
- A.
C4
- B.
C5
- C.
C6
- D.
C7
Correct Answer
C. C6Explanation
From Thiel (1991)
C4 1%
C5 6%
C6 89%
C7 3%Rate this question:
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- 3.
The origin of the vertebral artery is from the:
- A.
Thoracic aorta
- B.
Subclavian artery
- C.
Internal carotid artery
- D.
External carotid artery
Correct Answer
B. Subclavian arteryExplanation
The right subclavian and common carotid artery originate from the brachiocephalic artery which only exists on the right side (in the neck region).
On the left side, the common carotid and the subclavian artery originate directly off the arch of the aorta (in the thoracic region).
The internal carotid originates from the common carotid artery. The internal carotids provide the other 80% of the cerebral blood supply.Rate this question:
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- 4.
In total, how many cranial nerves are in close anatomical proximity to the internal carotid artery (and could therefore be affected, for example, by an arterial dissection)?
- A.
8
- B.
12
- C.
6
- D.
2
- E.
0
Correct Answer
A. 8Explanation
CN 2 Optic CN 9 Glossopharyngeal
CN 3 Occulomotor CN 10 Vagus
CN 5 Trigeminal CN 11 Accessory
CN 6 Abducens CN 12 HypoglossalRate this question:
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- 5.
Cervical rotation decreases blow flow in (which side) and is maximal at (which level)
- A.
The contralateral vertebral artery
- B.
The ipsilateral vertebral artery
- C.
C0-1
- D.
C1-2
- E.
C2-3
Correct Answer(s)
A. The contralateral vertebral artery
D. C1-2 -
- 6.
At what cervical level do the vertebral arteries turn medially towards the foramen magnum (most torturous section)?
- A.
C0-1
- B.
C1-2
- C.
C2-3
- D.
C3-4
Correct Answer
A. C0-1 -
- 7.
Cranial nerves can be affected by carotid artery dissection. Which these symptoms below can be caused by cranial nerve (CN) dysfunction?
- A.
Asymmetry of shoulder levels
- B.
Decreased sensation over cheek
- C.
Vertigo / dizziness
- D.
Eye ptosis
- E.
Nausea
Correct Answer(s)
A. Asymmetry of shoulder levels
B. Decreased sensation over cheek
C. Vertigo / dizziness
D. Eye ptosisExplanation
CN 11 (Accessory)- trapezius power.
CN 5 (Trigeminal) - facial sensation
CN 8 (Vestibulocochlear) can cause vertigo/dizziness (a reeling sensation; a feeling that you are about to fall).
CN 3 (Occulomotor) can cause ptosis (but make sure to differentiate that it is not from another cause such as sympathetic underactivity).Rate this question:
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- 8.
What is the definition of arterial stenosis?
- A.
Narrowing or occlusion of the arterial lumen
- B.
Hardening of the artery wall
- C.
Smooth muscle spasm of the artery
Correct Answer
A. Narrowing or occlusion of the arterial lumenExplanation
From the Greek "stenos" meaning narrow.Rate this question:
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- 9.
What is the definition of an arterial dissection?
- A.
Distension of arterial wall through weakness
- B.
Atherosclerotic separation of arterial wall layers
- C.
Non-atherosclerotic separation or tear of an arterial wall layer
Correct Answer
C. Non-atherosclerotic separation or tear of an arterial wall layerExplanation
The latin orgin of dissection is to cut or to separate (which is how we also how we use the word in anatomy).Rate this question:
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- 10.
What is the inner most layer of the artery wall called?
- A.
Mesenchyme
- B.
Tunica intima
- C.
Tunica externa
- D.
Pachyderm
Correct Answer
B. Tunica intimaExplanation
The tunica intima is lined with endothelial cells. These are the cells that can become inflammed or damaged by many risk factors, which can then lead to a cascade of events known as the famous 'RESPONSE TO INJURY' hypothesis: Endothelial damage... from the circulation macrophytic white blood cells called monocytes begin to interact with the endothelial cells...the monocytes change into macrophages... some of these macrophytic monocyte cells accumulate lipids and take on a foamy appearance (hence they are now called 'foam cells')... foam cells help to form a swelling in the artery wall called a fatty streak... circulating platelets stick to the foam cells and underlying connective tissue... release of potent growth factors... from the tunica media proliferation and increased thickness of smooth muscle... environment for enhanced lipid accumulation... proliferation and accumulation can lead to blockage or thrombus formation.Rate this question:
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- 11.
Which of these can cause turbulent blood flow?
- A.
Atherosclerotic plaques
- B.
Low platelet count
- C.
Bifurcations
- D.
High blood pressure
Correct Answer(s)
A. Atherosclerotic plaques
C. Bifurcations
D. High blood pressure -
- 12.
The trigeminocervical nucleus is where trigeminal nerve fibres interact with cervical nerve root fibres. This allows painful sensations to the neck, face and head and referral of cervical pain to the head. Where is the trigeminocervical nucleus?
- A.
Reticulo spinal tract
- B.
Grey matter of dorsal horn between C1 - 3
- C.
Brainstem
Correct Answer
B. Grey matter of dorsal horn between C1 - 3 -
- 13.
Using a combination of the surface landmarks below, where would you palpate the carotid artery?
- A.
Lateral to the SCM
- B.
At the level of the hyoid bone
- C.
Above the SCJ
- D.
Medial to the SCM
- E.
2cm from the midline of the trachea
Correct Answer(s)
B. At the level of the hyoid bone
D. Medial to the SCM
E. 2cm from the midline of the tracheaExplanation
Palpate anterior neck, at level of C3/4 medial to SCM muscle. Looking for obvious asymmetries, noticeable pulsatile masses (indicative of aneurysm). Kerry / MACP 2009Rate this question:
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- 14.
What is the estimated risk of an adverse event from manual therapy to the cervical spine?
- A.
1 in 1000
- B.
1 in 100 000
- C.
1 in 1 000 000
- D.
Risk impossible to predict from available evidence
Correct Answer
D. Risk impossible to predict from available evidenceExplanation
The incidence and percentage risk of an adverse event from cervical manipulation is impossible to predict from the available evidence (Kerry, et al 2007), but the risks involved should not prevent you from applying potentially beneficial treatments to appropriate patients with minimal or no vascular risk factors.
If you have weighed up the risks and have clinically reasoned that it would be appropriate to apply a cervical spine treatment, you could explain to the patient “although cerebrovascular symptoms (such as stroke or death) can be unpredictable and that there inherent risks with the procedure, complications are very rare (Halderman, et al, 2002) and that according to your assessment the risk of an adverse event is likely to be very minimal”.
As an aside - re: Cervical Artery Dissection not related to cervical manipulation - from Graziano et al (2007) - in the general population the incidence of cervical artery dissection = 2.6 per 100,000 (0.0026%).Rate this question:
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- 15.
Do all CAD adverse events following physiotherapy intervention lead to permanent symptoms?
- A.
Yes
- B.
No
- C.
Not sure
Correct Answer
B. No -
- 16.
In managing cervical spine pain and dysfunction, what is most clinically effective?
- A.
Acupuncture
- B.
Exercise and advice
- C.
GP management
- D.
Manual therapy, exercise and advice
- E.
Medication
Correct Answer
D. Manual therapy, exercise and adviceExplanation
Systematic review has shown Manual Therapy, exercise and advice are most clinically effective in cervical spine pain and dysfunction.Rate this question:
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- 17.
Which of these are potential benefits of cervical mobilisation or manipulation? (more than one answer)
- A.
Increased range of movement
- B.
Decreased headaches
- C.
Decreased pain
Correct Answer(s)
A. Increased range of movement
B. Decreased headaches
C. Decreased pain -
- 18.
Which of these are potential risks of cervical mobilisation or manipulation?
- A.
Dizziness
- B.
Cerebrovascular accident (CVA) / stroke
- C.
Increased pain
- D.
Death
Correct Answer(s)
A. Dizziness
B. Cerebrovascular accident (CVA) / stroke
C. Increased pain
D. Death -
- 19.
Of the answers below, which two subjective markers are considered ‘key’ indicators for identifying cervical artery dysfunction?
- A.
The 5 D's (dizziness, diplopia, dysphagia, dysarthria, drop attacks, and 3 N's (nausea, nystagmus, numbess)
- B.
Limb weakness
- C.
Loss of short-term memory
- D.
Type and location of pain (headache, neck pain)
Correct Answer(s)
A. The 5 D's (dizziness, diplopia, dysphagia, dysarthria, drop attacks, and 3 N's (nausea, nystagmus, numbess)
D. Type and location of pain (headache, neck pain) -
- 20.
Which of these medical conditions are high risk factors for vascular disease and therefore increase the risk of CAD?
- A.
Regular smoker
- B.
Poor diet
- C.
Diabetes
- D.
Erectile dysfunction (ED)
- E.
Severe obesity
Correct Answer(s)
A. Regular smoker
C. Diabetes
E. Severe obesityExplanation
There are major and minor vascular risk factors. Poor diet and ED are minor risk factors.
For example, ischaemic heart disease:
3 major risk factors present = X 7 increased risk of IHD
2 major risk factors present = X 4 risk
1 major risk factors present = X 2 riskRate this question:
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- 21.
Which drugs might raise your index of suspicion that vascular risk factors might be present?
- A.
Anticoagulants
- B.
Statins / anti-cholesterol
- C.
Steroids
- D.
Antihypertensives
- E.
HRT
Correct Answer(s)
A. Anticoagulants
B. Statins / anti-cholesterol
D. Antihypertensives
E. HRT -
- 22.
If you think the blood vessels (CAD) are the structure producing the patients symptoms, what would be the next steps in your management?
- A.
Urgent onward referral for medical review
- B.
Do a full objective assessment
- C.
Blood pressure testing
- D.
Further subjective questioning
- E.
Functional positional testing (VBI test)
Correct Answer(s)
A. Urgent onward referral for medical review
C. Blood pressure testing
D. Further subjective questioning -
- 23.
If CAD risk factors are present, what would you not include in an objective assessment?
- A.
Passive accessory joint palpation
- B.
Active ROM
- C.
Measurement of waist-hip-ratio (WHR)
- D.
Neurological testing
- E.
VBI / functional positional test
Correct Answer
E. VBI / functional positional test -
- 24.
Which of the following subjective signs may indicate an arterial dissection?
- A.
Dizziness, diplopia, dysphagia and nausea
- B.
Unilateral head and neck pain unlike any other previous pain
- C.
Intermittent longstanding neck pain
- D.
Just dizziness
- E.
Age >65
Correct Answer(s)
A. Dizziness, diplopia, dysphagia and nausea
B. Unilateral head and neck pain unlike any other previous pain
D. Just dizziness -
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Current Version
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Jan 15, 2013Quiz Edited by
ProProfs Editorial Team -
Jun 01, 2010Quiz Created by
Cadysfunction
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