Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheum > 02a: Low Back Pain/Spondyloarthropathies > Flashcards

02a: Low Back Pain/Spondyloarthropathies Flashcards

1
Q

Low back pain in first trimester pregnancy likely due to (X). And in later pregnancy?

A

X = sacroiliac hypermobility

Large uterus compressing SC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F: pre-existing disc disease is required for a disc to herniate.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Disc herniation occurs at the (X) disc the majority of the time and in the (Y) disc approx 1/3 of the time.

A 
X = L4-5
Y = L5-S1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Disc herniations cause pain that is (better/worse) when sitting, (exacerbated/relieved) by lying, and is often (uni/bi)-lateral.

A

Worse;
Relieved;
Unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

(Referred/Radicular) pain is sclerotomal, meaning it presents as (stinging/aching).

A

Referred; aching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

(Radicular/referred) pain can be exacerbated by Valsalva maneuvers, such as:

A

Radicular

Cough, sneeze, straining at stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Low back pain resulting from (X) is worse with activity and at the end of the day. It is characterized by pain being relieved when patient in the supine position.

A

X = Mechanical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T/F: mechanical low back pain can cause referred pain to other locations.

A

True (hip/leg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

(X) is the term referring to degeneration of the intervertebral disc and/or the joint.

A

X = Spondylosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

(X) is a defect in the pars interarticularis of the vertebral column.

A

X = Spondylolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patient with large disc herniation affecting sacral roots will likely present with which symptoms.

A
  1. Urinary retention (most common finding)
  2. Loss of rectal tone/constipation
  3. Saddle anesthesia and leg pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The “Cauda Equina” syndrome refers to which medical problem?

A

Large disc herniation affecting sacral roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F: Most (over 50%) of disc herniations require surgery.

A

False - resolve over time (disk shrinks/regresses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Osteoporotic fracture of spine produces (slow/fast) onset, (mild/severe) back pain and is (aggravated/relieved) by lying or sitting and (aggravated/relieved) by standing. The pain is (uni/bi)-lateral and (does/doesn’t) radiate into legs.

A

Fast (sudden), severe;
Aggravated by any movement and all positions;
Bilateral, no radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Patient comes in complaining of low back pain. He appears to be bending to one side and cannot fully extend or stand erect. You suspect (X) as the cause and tell him to (sit/lay) down for relief.

A

X = muscle spasm

Lay down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

(X) is a slippage of one vertebral body on another.

A

X= Spondylolisthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In (spondylosis/spondylolysis/spondylolisthesis), disc narrowing increases pressure across the facet joint, leading to (Y) of that joint.

A

Spondylosis

Y = osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Degenerative disc disease is aggravated by (sit/stand/sleep) position and can eventually lead to degenerative (X) disease, which is aggravated by (sit/stand/sleep) position.

A

Sitting
X = joint
Standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

(spondylosis/spondylolysis/spondylolisthesis) can result in scoliosis if (X) is uneven. How does this differ from congenital/idiopathic scoliosis?

A

Spondylosis
X = Disc degeneration

Only in lumbar spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Degenerative spinal stenosis is due to degenerative (disc/joint) disease with disc bulging. This as well as thickening of the (X) ligament causes narrowing of the spinal canal.

A

Combo of disc and joint disease;

X = ligamentum flavum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In spinal stenosis, (walking/standing/sitting) is painful and pain can be relieved by (walking/standing/sitting). Bending and squatting causes (relief/pain) because:

A

Walking worse than standing still;
Sitting relieves pain
Relief
spinal canal volume is increased when we flex and is decreased when we fully extend

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Claudication in spinal stenosis is (vascular/neurogenic) and pain starts (proximally/dismally). It can be relieved when patient does what?

A

Neurogenic; proximally (unlike vascular claudication);

Sits down/bends forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Walking uphill would be more painful for patient with (vascular/neurogenic) claudication.

A

Vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

(X) is an inflammatory systemic polyarthritis that predilects to the spine.

A

X= Systemic seronegative spondyloarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T/F: Systemic seronegative spondyloarthritis often involves peripheral joints.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

T/F: Systemic seronegative spondyloarthritis is typically relieved by rest.

A

False - rest makes it worse; relieved by exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Patient with throbbing low back pain that is much more pronounced in the supine position. What’s toward the top of your differential?

A

An aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patient with chronic low back pain, percussion tenseness over lumbar spine (L4-5), and anorexia/weight loss. What’s toward the top of your differential?

A

Tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patient with generalized, chronic low back pain that isn’t relieved by any position and doesn’t feel much different throughout the day. Multiple tender points found along spine. What’s toward the top of differential?

A

Fibromyalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A flank crease is found on the (concave/convex) side of a scoliosis.

A

Concave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

On forward flexion, fingers should reach (X) inches from the floor. People with low back problems average (Y) inches.

A 
X = 4
Y = 10+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

FABER test involves (X) and will produce pain in (Y) if the problem involves (Z).

A 
X = Flexion, ABduction, Extension of hip
Y = back/hip 
Z = lumbar spine or sacroiliac joint
33
Q

Positive straight leg raise means pain is experienced when leg raised (X) degrees.

A

X= between 30 and 60

34
Q

Positive straight leg raise seen in 95% of patients with which low back problem?

A

Radiculopathy (second to disc herniation)

35
Q

The femoral stretch test (Ely’s test) performed by:

A

Patient lies prone with knee flexed; doc extends hip with patient knee still flexed at 90°

36
Q

Positive femoral stretch test involves:

A

Anterior thigh or back pain (L2-4 nerve root involvement)

37
Q

“Seronegative” spondyloarthropathies means (X) is negative.

A

X = RF/ACPA serum levels

38
Q

List some common clinical features among spondyloarthropathies

A
  1. Inflammatory back pain
  2. Asymmetric peripheral oligoarthritis
  3. Other specific organ involvement (uveitis, psoriasis, IBD)
39
Q

List the five types of seronegative spondyloarthropathies

A

Mnemonic: PAIR + undifferentiated

  1. Psoriatic arthritis
  2. Ankylosing Spondylitis
  3. IBD-related
  4. Reactive arthritis
  5. Undifferentiated
40
Q

Which patients are genetically predisposed to ALL spondyloarthropathies?

A

HLA-B27 positive

41
Q

Initial and most common presentation of ankylosing spondylitis. It’s defined by presence of 4 out of which 5 characteristics?

A

Inflammatory back pain;

  1. Age of onset over 40
  2. Insidious symptom onset
  3. 3 months of symptoms
  4. Morning stiffness (over hour)
  5. Better with X. Worse with rest
42
Q

Describe the various parts of spine affected in ankylosing spondylitis and the actions limited at these regions.

A
  1. Thoracolumbar junction (axial rotation)
  2. Lumbar (flexion/extension and lateral flexion)
  3. Thoracic (chest expansion)
  4. Cervical (general ROM)
43
Q

List some physical exam tests used to assess patient for ankylosing spondylitis

A
  1. Schober test
  2. Finger to fibula test; finger to floor test
  3. Thoracic rotation
  4. Chest wall expansion
  5. Cervical spine tests
44
Q

Chest wall expansion test: fingers placed at (X) position and difference in distance between inhalation and exhalation should be (Y).

A 
X = T4 (below nipple)
Y = at least 5 cm
45
Q

Patient with lower back pain expresses that it’s especially painful when she does figure 4 stretch after her runs. This is a positive (X) physical exam test, indicating involvement of (Y).

A 
X = FABER
Y = sacroiliac joint
46
Q

What does ankylosis even mean?

A

Bone fusion

47
Q

An early radiologic sign of (X) is squaring of the vertebral bodies, aka (Y). What’s the best way to detect this?

A 
X = spondyloarthropathies 
Y = Romanus lesions

MRI

48
Q

List some potential skin findings in patient with spondyloarthropathies.

A

Erythema nodosum, psoriasis, pyoderma gangrenosum

49
Q

List some potential musculoskeletal findings in patient with spondyloarthropathies.

A

Dactylitis, enthesitis, osteopenia

50
Q

List some common sites of enthesitis

A

Achilles tendon-calcaneal junction, insertion of the plantar fascia on the calcaneus, insertion at the ischial tuberosity, insertion of the patellar tendon at the tibial tuberosity

51
Q

T/F: over 50% of patients with mechanical back pain will find improvement with NSAIDs.

A

False - 15%

52
Q

Patients with over (X) months of back pain that started at (Y) age are evaluated for spondyloarthropathies. Only one classic SpA feature is needed to support diagnosis IF (Z) is present.

A 
X = 3 
Y = under 45 
Z = sacroiliitis on imaging
53
Q

Patients with over (X) months of back pain that started at (Y) age are evaluated for spondyloarthropathies. Two or more classic SpA feature is needed to support diagnosis IF (Z) is present.

A 
X = 3
Y = under 45
Z = HLA-B27 positive
54
Q

T/F: the structural changes seen in ankylosing spondylitis primarily involve bone destruction.

A

False - osteoproliferative (new bone)

Syndesmophytes, ankylosis

55
Q

Some of the features of SpA include (improvement/no change) with NSAIDs and serum elevation of (X) protein.

A

Improvement;

X = C-reactive

56
Q

T/F: nearly 90% of the genetic risk of ankylosing spondylitis is attributed to HLA-B27 gene.

A

False - only 20-30%; other genes involved too

57
Q

Ankylosing spondylitis: which pharmacologic and/or non-pharmacologic treatment would you initially recommend?

A

Non-pharm: ESSENTIAL (PT, posture training, ROM exercises)

Pharm: NSAIDs to start (first-line)

58
Q

Ankylosing spondylitis: Role of DMARDs is (crucial/limited). In peripheral arthritis, (X) has been shown to be effective.

A

Limited;

X = sulfasalazine

59
Q

Ankylosing spondylitis: The mainstay of treatment is (X) therapy, which has dramatically changed the prognosis for this disease.

A

X = anti-TNFα

60
Q

T/F: only anti-TNFa therapy has proven effective in prevention of radiographic progression for Ankylosing Spondylitis.

A

True, if started early (which also has its adverse effects)

61
Q

T/F patients with axial SpA do not received DMARDs at all (only NSAIDs or anti-TNFa).

A

True

62
Q

SpA therapy: move on to anti-TNFa after active disease has been treated with (X) for at least (Y) period of time.

A 
X = NSAIDs
Y = 4 weeks
63
Q

Secukinumab has recently been FDA approved for treatment of (X). What does it target?

A

X = spondyloarthropathies

IL-17

64
Q

T/F: male to female ratio of psoriatic arthritis is 1:1

A

True

65
Q

T/F: 5% of psoriasis patients will develop psoriatic arthritis

A

False - 20-30%

66
Q

(X) is the biggest risk factor for psoriasis (skin disease).

A

X = HLA-Cw6

67
Q

Psoriatic arthritis is also one of very few types of arthritis to frequently involve the (X) joints.

A

X = distal interphalageal

68
Q

Radiographic feature: pencil in cup deformity makes you think of which disease?

A

Psoriatic arthritis

69
Q

Psoriatic arthritis articular patterns: polyarticular (symmeteric/asymmetric) or oligoarticular (symmetric/asymmetric). Star the one like RA.

A

Symmetric*

Asymmetric

70
Q

T/F: Enthesitis and Dactylitis are features of psoriatic arthritis.

A

True

71
Q

Peripheral psoriatic arthritis first treated with (X), then (Y). If severe, (Z) is used.

A 
X = NSAID
Y = DMARD
Z = Biologics (anti-TNFa)
72
Q

(X) is a(n) (septic/aseptic) arthritis accompanied by extra-articular manifestations and following certain GU/GI infections.

A

X = reactive arthritis

Aseptic

73
Q

T/F: Male to female ratio for reactive arthritis is 9:1.

A

False - 9:1 for venereally acquired, 1:1 for GI acquired

74
Q

List some bacterial species that trigger Reactive Arthritis:

A
  1. Chlamydia
  2. Shigella
  3. Salmonella
  4. Yersinia
  5. Campylobacter
  6. Clostridium
75
Q

Classic triad of Reactive Arthritis.

A
  1. Conjunctivitis
  2. Urethritis
  3. Arthritis
76
Q

Reactive arthritis: (X)% develop chronic course, (Y)% resolve completely, and (Z)% have relapses.

A

X = Y = Z = 33.33

77
Q

Reactive arthritis: acute treatment includes (X). Which other agents are used?

A

X = NSAIDs

Corticosteroids, Sulfasalazine, Antibiotics (if infection)

78
Q

IBD-associated spondyloarthropathy may be associated with (X) IBDs. (Y)% of individuals with IBD develop peripheral arthritis.

A 
X = UC or Crohn's
Y = 10-20

Rheum (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions