Brainscape's Knowledge GenomeTM

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


See full index

Musculoskeletal, Skin > 091214 anatomy of spine > Flashcards

091214 anatomy of spine Flashcards

1
Q

cervical and lumbar vertebrae are more prone to injury because

A

increased motion of cervical area

increased weight bearing of lumbar area

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

if you have problem going on w/ thoracic area, think..

A

maybe tumor instead of just musculoskeletal, b/c thoracic area has less movement and greater stability with the rib cage

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

exam of musculoskeletal spine

A

observe
palpate

ROM exam
neuromuscular exam (muscle testing, sensory testing, reflex testing)
special tests (spurling’s, Llamette’s)
examine related areas (shoulder for cervical spine, hip for lumbar spine)

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

myotome

A

muscle fibers innervated by motor axons within each segmental nerve root

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

dermatome

A

area of skin innervated by the sensory axons within each segmental nerve root

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

shingles

A

acute neuralgia confined to dermatome distribution of specific spinal or cranial sensory nerve root

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

palpation of hyoid bone-what dermatome level is it at?

A

C3

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

causes of muscle weakness

A 
muscle strain
pain/reflex inhibition
peripheral nerve injury
nerve root lesion (myotome)
upper motor neuron lesion (stroke, MS)
tendon pathology
avulsion
pshychologic (no effort)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lhermitte’s sign

A

passive anterior cervical flexion elicits electric-like sesation down the spine or extremities

implies cervical spinal cord pathology

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

Spurling’s neck compression test

A

with cervical spine extension, rotation, and lateral flexion, you get reproduction of radicular symptoms

implies cervical nerve root pathology

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

Hoffmann’s sign

A

flick the pt’s middle finger distal phalanx
positive test would show that pt’s ipsilateral thumb and index finger would flex-adduct

implies upper motor neuron process affecing cervical spine or brain, but not all who test positive for Hoffmann’s do have UMN process (could be an anxious pt, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

straight leg raise test (or Lasegue sign)

A

patient lies supine while leg is raised passively with the knee extended. examiner stops raising the leg when the pt feels pain

positive test would be leg pain being elicited at 30-70 degrees

implies lumbar nerve root pathology (L5 or S1)

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

femoral nerve stretch test

A

pt placed in prone position while the knee is flexed

positive test is when it reproduces pt’s pain in anterior thigh

implies upper lumbar nerve root pathology

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

what should you think of with regards to upper motor neuron injury? (what types of causes?)

A

spinal cord injury
brain injury or stroke
myelopathy
CNS lesion

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

when you hear lower motor neuron injury, what cuases should you think of?

A

peripheral nerve entrapment

radiculopathy

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

red flags for serious conditions of spine

A

malignancy (hx of cancer, unexplained weight loss, age >50)

spinal fracture (major trauma, minor trauma or strenuous lifting in older or osteoporotic individual, prolonged corticosteroid use, osteoporosis, advanced age >70yo)

infection (constitutional symptoms, recent bacterial infection like UTI or skin or lungs, immunosuppression, IV drug user)

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

lumbar strain hx is usually

A

axial low back pain after acute injury or long time working in yard, etc.

stiffness and limited ROM, localized tenderness in muscle

neuro exam is normal

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

treatment for lumbar strain

A

relative rest
anti-inflam
usually PT is not necessary but if ongoing for more than 1 month, should do PT

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

radiculopathy

A

most commonly from posterolateral herniation

means a pinched nerve root in the spine

in cervical spine: C6, C7 radiculopathies are most common

in lumbar spine: L5, S1 radiculopathies most common

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

dermatomes

A

see dermatome map to review distribution

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

pathophysiology of nerve root compression

A

two things:

mechanical compression– induces neural ischemia and increased intraneural pres, edema or nerve root and dorsal root ganglia. dura is sensitive

biochemical irritation–nucleus pulposis contains cytokines, leukotrienes, cox-2, interleukin-1, TNFalpha. biochemical irritation can cause apoptosis of DRG cells

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

disc herniation hx

A

often picking up something not necessarily even heavy, get pain in the limbs more so than axial

can be acute or also can be insidious

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

what makes lumbar disc herniation worse?

A

sitting
bending
cough, sneeze

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

what makes cervical disc herniation worse?

A

movement, especially towards affected side (like the Spurling’s test)

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

disc herniation exam findings

A

myotomal weakness
dermatomal pain, numbness, tingling
decreased or absent reflex of affected nerve
Spurling or straight leg raise positive

26
Q

treatments for disc herniation

A 
activity modification
pain medication (NSAIDs (for the biochemical effects), neuromodulators like gabapentin and pregabalin, prednisone, limited opioids)

PT

epidural steroid injection for pain control

27
Q

disc herniation indications for discectomy

A

progressive weakness
refractory symptoms
bowel or bladder dysfxn
myelopathy

70-80% improve without surgery

28
Q

ankylosing spondylitis

A

SI joint-sclerotic (inflam eats away)

late-you get thin calcifications in anterior ligament of the spine–get fused entire lumbar spine–limited ROM, bamboo spine. can get SI joint completely fused.

29
Q

early stage of ankylosing spondylitis

A

widening of SI joint, adjacent sclerosis

posterior longitudinal ligament sclerosis

30
Q

late stage of ankylosing spondylitis

A

fusion of both SI joints
symmetric syndesmophytes bridging all vertebral bodies–get bamboo spine

ossification of anterior, posterior, and interspinous longitudinal ligaments

31
Q

ankylosing spondylitis involves inflam of?

A

SI joints
axial skeletal joints

enthesitis
chondritis
osteitis

32
Q

systemic effects of ankylosing spondylitis

A

lung fibrosis
iritis
CV

33
Q

what lab marker is positive for ankylosing spondylitis

A

90% HLA-B27 positive (but if positive, doesn’t mean you have it)

ESR, sed rate

34
Q

spondylolisthesis can be very bad b/c

A

this bilateral defect causes slippage of the vertebrae, causing neuro problems

35
Q

arthropathy

A

disease of a joint

36
Q

60 yo degenerative changes of spine

A

degenerative disc

facet arthropathy

37
Q

facet joint arthropathy hx

A

gradual onset
low back pain

lumbar: worse w/ standing, walking and extension. better with sitting and lying
cervical: worse with cervical extension

38
Q

etiology of facet joint arthropathy

A

gradual degenerative changes or osteoarthritis to the facet joints

39
Q

exam findings of facet joint arthropathy

A

non specific

pain worse w/ active extension, relieved by flexion

40
Q

lumbar stenosis hx

A

slowly progressive
pain in back and one or both legs

worse with standing and walking
better with lumbar flexion and sitting (biomechanically, when we extend our spine, it actually narrows the spinal canal)

41
Q

diff btwn lumbar stenosis and peripheral vascular disease symptoms

A

person with PVD can just stop and stand (they don’t need to bend or change spinal condition, as long as there’s enough oxygen to muscles their pain will go away)

spinal stenosis-need to lean over something

42
Q

lumbar stenosis exam findings

A

check pulse - if pulse is good, they don’t have peripheral vascular disease (can rule this out of differential)

no focal findings

neuro exam is normal

43
Q

etiology of lumbar stenosis

A

disc disease
osseous thickening of bone, facet joints, spondylolisthesis

thickening of ligamentum flavum

all of the above can contribute to the disease

44
Q

lumbar stenosis

A 
PT
gait aid-facilitate flexion
NSAIDs, neuromodulators
epidural steroids
surgical treatment if reallyk intolerable
45
Q

in older pts, compression fracture in spine usually occurs where

A

in L1-L4

46
Q

compression fractures of vertebrae tend to occur where in the veretebrae?

A

anterior wedge

47
Q

compression fractures-majority of them occur in whom?

A

people with osteoporosis

48
Q

hx of compression fracture

A

usually sudden onset of thoracic or lumbar pain

can be related to trauma or often, little or no trauma

worse with flexion and movement
better with rest

usually no leg pain unless there’s retropulsion and nerve is affected

49
Q

exam findings for compression fracture

A

local tenderness

painful lumbar ROM (especially flexion)

50
Q

imaging for compression frac

A

get plain XR

consider MRI or CT if you think it’s pathologic fracture

51
Q

treatment for compression frac

A 
acetaminophen, calcitonin, mild opioids
consider bracing (if lot of pain)
52
Q

hx of cauda equina syndrome

A

back pain
leg pain, numbness, weakness
saddle anesthesia
bowel and bladder dysfunction

53
Q

etiology of cauda equina syndrome

A

large disc herniation compressing cauda equina most common (also could be epidural tumor, abscess, or hematoma)

54
Q

exam findings for cauda equina syndrome

A

reduced or absent reflexes, weakness, decreased rectal tone

55
Q

treatment for cauda equina syndrome

A

emergency surgery

56
Q

cervical myelopathy can be from acute or chronic condition-true or false?

A

true

57
Q

key difference btwn cervical and lumbar stenosis?

A

cervical-can affect upper motor neurons

lumbar-past L1 and L2, is just lower motor neuron problem

58
Q

hx of cervical myelopathy

A

usually over 50 yrs old
varied presentation
often loss of fine motor skills and hand clumsiness
gait disturbance
may or may not have bowel or bladder effects
motor weakness
lower extremity numbeness, weakness, pain

59
Q

exam findings of cervical myelopathy

A

upper and lower extremities with predominantly upper motor neuron finds and weakness below level of cord involvement

positive Babinski, ankle clonus, Hoffmann’s sign

Llhermitte sign

Romberg sign (close eyes and stand)-may be positive due to loss of proprioception

wide based gait b/c of the risk of fall

60
Q

treatment for cervical myelopathy

A

usually surgical (cervical decompression-laminectomy)

Musculoskeletal, Skin (33 decks)

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