14 Jan 24

Question 1

Spinal epidural abscess causes ?

Answer 1

💩Staph aureus
💩Distant infection (cellulitis ,joint/bone)
💩Spinal procedure(epidural catheter)
Direct inoculation
💩Injection drug use
💩 immunocompromised state DM , alcoholic
💩trauma and epidural hematoma (that gets infected )

Question 2

Spinal Epidural abscess CF

Answer 2

➡️Fever (50%)
➡️Focal/severe back pain
➡️Neurologic findings (motor/sensory change, bowel bladder dysfunction,paralysis)

Question 3

SEA dx

Answer 3

🖍⤴️ ESR
🖍Blood and aspirate cultures
🖍MRI OF SPINE with contrast (to see presence and extent of infection that cannot be seen on CT or Xray)

Question 4

Ttt of SEA

Answer 4

🛞Broad spectrum antibiotics (vancomycin plus ceftriaxone)
🛞Aspiration/ surgical decompression

Question 5

SEA progression ……

Answer 5

Progressive symptoms due to compression of spinal cord

Focal back pain
➡️ nerve root pain (shooting , electric-shock sensation)
➡️ motor weakness , sensory changes, bowel / bladder dysregulation
➡️ paralysis

Question 6

SEA and trauma

Answer 6

Trauma can lead to dev of epidural hematoma that may expand and become infected. Leading to abscess.

Question 7

Cervical spine injury management

Answer 7

High risk injury
High mechanism
Trauma causing concomitant closed head injury

Do CT with contrast

Low risk injury
Do NEXUS low risk criteria for cervical spine imaging

Question 8

NEXUS low risk criteria for cervical spine imaging

Answer 8

Any of the following NSAID

🤡Neurologic deficit. N
🤡spinal tenderness S
🤡Altered mental status A
🤡intoxication I
🤡distracting injury D

If none present NO CT scan indicated

Question 9

Transverse myelitis mechanism

Answer 9

Immune mediated infiltration of inflammatory cells in a segment of spinal cord causing oligodendrocyte cell death and demyelination.

Trigger: recent infection
Bimodal peak

Question 10

Transverse myelitis CF

Answer 10

> or equals 1 contiguous spinal cord segment inflammation (mostly thoracic cord) causing rapid progressive myelopathy

➡️ motor weakness progresses from flaccid to spastic paraparesis (UMNS)
➡️autonomic dysfunction
Bowel/bladder incontinence or retention sexual dysfunction
➡️ sensory dysfunction
Pain , paresthesia , numbness with distinct sensory level

Question 11

Dx of transverse myelitis

Answer 11

MRI
Enhaced affected cord segments

Question 12

Ttt of TM

Answer 12

High dose IV steroids

Question 13

Spinal cord injury managament

Answer 13

ABC
Catheterisation (disruption of autonomic fibers)

Question 14

Tethered cord (spinal dysraphism) CF

Answer 14

▶️Back/leg pain worse with activity
▶️Neurologic findings eg weakness , hyporeflexia
▶️New onset scoliosis
▶️Lumbosacral cutaneous abnormailty
(Lipoma)

Question 15

Tethered cord dx

Answer 15

MRI

Question 16

Tethered cord mechanism

Answer 16

Stretch induced dysfunction of spinal cord

In closed spinal dysraphism the posterior arches fail to fuse while overlying skin remains intact
The spinal cord abnormally attaches to surrounding tissues (lipoma) extending from spinal canal to subcut tissues.

As the child grows inferior end of spinal cord remains fixed and stretches rather than rising in spinal canal.
Stretching due to repetitive movements exacerbates cord dysfunction leading to progressive back buttock leg pain.

Question 17

Cervical myelopathy (compression)
Cause :

Answer 17

Degenerative changes in vertebral bodies discs joints due to age

Question 18

Cervical myelopathy CF:

Answer 18

Radiculomyelopathy with

Compression at spinal cord;
UMN signs below lesion (hyperreflexia , spasticity)

Compression at spinal nerve roots ;
LMN findings (atrophy,hyporeflexia) at the same level.

Urinary symptoms
Sensory deficits
Lhermitte sign

Question 19

Radiculopathy
Neck arm pain with 4th 5th digit sensory deficit

Answer 19

C8 radiculopathy (nerve root compression)

Neck movements worsen the impingement causing radiation down the arm.

Question 20

Mechanism of radiculopathy

Answer 20

Compression of nerve root ;

Disc herniation
Osteophytes (spondylosis is degeneration of disc and bones in neck)

Question 21

Radiculopathy dx and ttt

Answer 21

Clinical

Ttt: Gradual resolution
NSAIDS and avoidance of provocative maneuvers.
Moderate physical activity
Oral steroids for severe pain

Indications for MRI:

MRI only when malignancy or abscess is suspected , progressive symptoms , B/L symptoms.
Xray has limited use

Question 22

Patient with right arm pain , loss of biceps reflex on rt side and loss of elbow flexion. Pain improved with shoulder abduction.

Answer 22

C6 radiculopathy

Reflexes : biceps brachioradialis
Sensory : thumb , index finger
Weaknes :
Elbow flexion(biceps)
Forearm supination pronation (brachioradialis)
Wrist extension

Question 23

Radiculopathy pain pattern

Answer 23

Shoulder abduction reduces tension on impinged nerve and improves pain when hand is placed on top of head
Shoulder abduction relief test

Lateral flexion and rotation of neck (cradling phone between head and shoulder) narrows neural foramina worsening compression on nerve root.

Question 24

C6 radiculopathy vs median nerve injury

Answer 24

Median nerve would not cause neck pain

Question 25

C5 radiculopathy

Answer 25

Reflex. Biceps
Sensory. Lateral arm

Weakness: Shoulder abduction (deltoid)
Elbow flexion (biceps)

Vs rotator cuff injury; weakness of shoulder abduction but biceps reflex unaffected

Question 26

Cervical facet dislocation mechanism

Answer 26

Forced flexion of cervical spine (falling onto flexed neck )
Usually single facet dislocated hence UL symptoms

Question 27

Cervical facet dislocation common affected vertebral bodies

Answer 27

C5/6 : C6 radiculopathy
Weakness of wrist extension
Sensory at forearm and thumb

C6/7: C7 radiculopathy
Weakness triceps extension
Wrist flexion
Sensory index and middle finger

Question 28

Fetal alcohol sundrome

Answer 28

Microcephaly
Small palpebral fissures
Midface hypoplasia
Smooth philtrum
Thin vermillion border

Question 29

Fetal hydantoin syndrome

Answer 29

In utero phenytoin exposure
Midface hypoplasia
Cardiac defects
Microcephaly
Hypoplastic digits / nails
Cleft lip palate

Question 30

Digeorge 22q11

Answer 30

Ocular hypertelorism
Low set posteriorly rotated ears
Interrupted aortic arch
Craniofacial anomalies
Dev delay

Question 31

Symtoms of IVH

Answer 31

Acute neurologic changes

  Lethargy 
  Hypotonia 
  Seizures 

Anemia
Bulging fontanelle
Rapidly inc head circumference
Bradycardia (cushing reflex)
Apnea

Question 32

Apnea of prematurity cause

Answer 32

Immature central resp centers in pons and medulla