These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a neck pain case in the USMLE Step 2 CS exam:
BLUE SHEET Neck pain:
NECK PAIN mnemonic: TIC PHD (you get a tic of getting neck pain due to study too much for your PDH):
T: Tingling, numbness, weakness (always try to ask them together).
T: Trauma to neck or head recently or before symptom start.
T: Travel recently.
I: Ill contacts/Infections recently.
C: Cancer screening (colonoscopy, mammography, PAP test, PSA and prostate exam)
P: Photophobia
H: Heavy lifting (for example, recently moved to another home and lifted a lot of heavy objects) is a risk for disc herniations.
D: Dizziness
PHYSICAL EXAMINATION
1. HEENT:
Neck: Inspection for bruises or masses. Palpation for muscle and bony tenderness. ROM. LHermitte’s and Spurling tests.
2. Extremities: focus in the upper extremities
Inspection
Palpation: for any tender point.
ROM
Peripheral pulses
3. Neurologic:
Motor: Strength
Sensory
DTR’s
Kernig and Brudzinski signs for meningitis
POSSIBLE DIAGNOSTIC STUDIES:
- CBC.
- Electrolytes, calcium, BUN/Cr.
- XR cervical spine.
- MRI cervical spine.
- Nerve conduction studies.
- Serum protein electrophoresis.
DIFFERENTIAL DIAGNOSIS:
- Neck muscle strain.
- Cervical disc herniation.
- Cervical fracture.
- Cervical spondylosis.
- Meningitis.
- Osteoarthritis.
- Metastatic cancer.
- Multiple myeloma.
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