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MSS > 18: Basic Exam for spine > Flashcards

18: Basic Exam for spine Flashcards

1
Q

History of cancer and/or Unexplained weight loss -

A

– r/o malignancy

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2
Q

Loss of bowel or bladder control – r/o

A

r/o myelopathy or stenosis

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3
Q

Significant weakness in spine r/o

A

– r/o myelopathy or radiculopathy

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4
Q

Saddle anesthesia – r/o

A

myelopathy or cauda equina syndrome

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5
Q

Chronic corticosteroid use – r/o

A

compression fracture

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6
Q

Pt that has Immunosuppression and or fever – r/o

A

infection

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7
Q

IV drug use and back pain – r/o

A

infection

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8
Q

Pt with back pain and Prior spine surgery – r/o

A

hardware failure, adjacent segment disease, recurrent disc

herniation

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9
Q

A patient has back Weakness and/or numbness –

we should be suspicious for

A

nerve involvement

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10
Q

Pt has Morning stiffness, improves with activity but not with rest (<40 yo) – suspicious for

A

spondyloarthropathy

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11
Q

fracture of the pars interarticularis

A

Spondylolysis

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12
Q

anterior displacement of one vertebrae on another

A

Spondylolisthesis

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13
Q

a. Hyoid bone –
b. Thyroid cartilage –
c. First cricoid ring –
d. Most prominent spinous process –

A

C3
C4-5
C6
C7

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14
Q

Top of iliac crest located at

A

L4-5

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15
Q

Posterior superior iliac spine located at

A

S2

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16
Q

Expected ROM of Cervicle spine

  1. Rotation:
  2. Flexion:
  3. Extension:
  4. Sidebending:
A

Cervical spine

  1. Rotation – ~70°
  2. Flexion – ~45° (chin to chest)
  3. Extension – ~55°
  4. Sidebending – ~40°
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17
Q

Lumbar spine

  1. Flexion –
  2. Extension –
  3. Lateral bending
  4. Rotation
A

Lumbar spine

  1. Flexion – ~75°
  2. Extension – ~30°
  3. Lateral bending – ~35°
  4. Rotation
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18
Q

passive rapid flexion of middle finger distal phalynx. Positive test is flexion of thumb, index finger

A

Hoffman – signs of Upper Motor Neuron Lesion

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19
Q

stroking sole of foot resulting in great toe extension and toe
spreading

A

Babinski– signs of Upper Motor Neuron Lesion

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20
Q

Straight leg raise (SLR) – lying supine, leg is raised with knee extended. Positive test is

A

reproduction of radicular symptoms with hip flexed between 30-70°

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21
Q

Femoral stretch test – lying prone, knee is flexed to 90° and thigh elevated. Positive test is

A

reproduction of anterior thigh radicular symptoms

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22
Q

Spurling – reproduction of ipsilateral radicular symptoms with cervical spine extension, rotation, lateral sidebending This test suggests

A

cervical nerve root involvement

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23
Q

Lhermitte – electrical shock sensation in limbs with cervical flexion suggests

A

cervical cord involvement

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24
Q

Pt comes in with axial low back pain after acute injury, such as lifting or twisting

A

Lumbar strain

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25
Q

Causes of lumbar strain

A

muscle disruption from excessive stretch or tension

26
Q

During exam, pt experiences localized muscle tenderness, reduced ROM in their spine

A

lumbar strain

27
Q

What imaging would we get for suspected lumbar strain?

A

usually none.

28
Q

Tx for Lumbar Strain

A

Relative rest, NSAIDs, muscle relaxant, physical

therapy

29
Q

Pt complains axial low back pain, gradual onset (cervical: worse with cervical extension;
lumbar: worse standing/walking, better sitting/lying)

A

Osteoarthritis

30
Q

Etiology of osteoarthritis

A

gradual degenerative changes/osteoarthritis to zygoapophyseal (facet)
joints; more common age > 55

31
Q

Expected Exam findings in patient with osteoarthritis
worse with:
better with:

A

nonspecific, pain provoked with active extension, relieved with flexion

32
Q

Treatment for OA–

A 
NSAIDs, mild analgesics. 
Physical therapy (flexion bias), possibly facet joint injections
33
Q

What imaging would we want to order for expected OA?

A

Imaging: none or plain lumbar x-rays.

34
Q

Patient experiences pain and possible numbness/weakness in limb > axial spine
Lumbar: worse sitting/flexion, better standing/extension

A

Radiculopathy

35
Q

most common cause of radiculopathy

A

disc herniation

36
Q

Expected exam findings of patient with radiculopathy?

A

SLR or Spurling positive, neurologic deficits (myotomal weakness, decreased reflex, dermatomal reduced sensation)

37
Q

Imaging ordered for suspected radiculopathy:

A

MRI, possible EMG.

38
Q

Tx for patient with radiculopathy

A

Relative rest, physical therapy, surgical
discectomy if progressive/severe weakness or unresponsive to conservative care. For
pain, NSAIDs, oral or epidural corticosteroids, limited opioids, neuromodulators

39
Q

Pt comes in with slowly progressive back and unilateral or bilateral leg pain. It is worse when standing, and better when sitting. Positive for shopping cart sign (bc flexes spinal canal)

A

Lumbar stenosis

40
Q

You suspect your patient to have lumbar stenosis, what are the key DDx?

A

Differentiate from vascular claudication (must sit

or bend to relieve symptoms)

41
Q

Causes of Lumbar Stenosis

A

narrowing of the spinal canal (due to disc herniation/ protrusion, ligamentum flavum thickening, osseous thickening of bone/facet joint, spondylolisthesis)

42
Q

Imaging ordered for suspected Lumbar Stenosis

A

Imaging: MRI, possibly CT or EMG.

43
Q

Treatment for Lumbar Stenosis

A

NSAIDs, neuromodulators, physical therapy (flexion bias), use of walker, epidural steroids, surgery for lumbar decompression

44
Q

Patient comes in with back pain, numbness, weakness in arms and/or legs; balance and gait difficulties;
bowel/bladder dysfunction

A

cervical myelopathy

45
Q

Etiology for suspected cervical myelopathy

A

cervical canal stenosis with spinal cord compression

46
Q

On exam, patient has arm and/or leg weakness, upper motor neuron signs– hyperreflexia, Hoffman/Babinski, ataxia, and increased tone

A

Cervical myelopathy

47
Q

Treatment options for Cervical Myelopathy

A

Surgical decompression. No role for nonoperative

treatment

48
Q

What imaging would you order for suspected cervical myelopathy?

A

MRI

49
Q

Old patient comes in with sudden thoracic (or lumbar) pain with no history of trauma. On exam they are tender over spinous processes, paraspinals. Worse: lumbar flexion. Better: lumbar extension.
Normal neuro exam (unless nerve root affected)

A

Compression fracture

50
Q

Causes of Compression fracture in spine

A

ii. Etiology – majority related to osteoporosis, older patients; anterior vertebral body
wedge fracture. T10, T11, T12, L1 most commonly. In younger patients w/o clear
etiology, consider malignancy, multiple myeloma. 1/3 are asymptomatic

51
Q

Patient comes in with suspected comression fracture of spine. What imaging do you order?

A

plain x-rays, possibly MRI or CT; DEXA scan to eval for
osteoporosis.
If malignancy considered: CBC, SPEP, alkaline phosphatase, sed rate (malignancy for our younger pts)

52
Q

Tx options for

A

NSAIDs, acetaminophen, calcitonin, mild opioids. Consider bracing for 6 weeks.
Physical therapy. Symptoms usually improve in 3 months.
Vertebroplasty/kyphoplasty a consideration, evidence of efficacy limited

53
Q

Pt comes in with onset of low back pain < age 40, insidious, better with exercise, pain at
night and on waking, not improved with rest

A

Ankylosing spondylitis

54
Q

Suspected etiology of Ankylosing spondylitis

A

inflammatory spondyloarthropathy, usually sacroiliitis initially. Can be associated with uveitis, inflammatory bowel disease, psoriasis among other features

55
Q

On exam, patient i has reduced

A

Reduced lumbar ROM, often tender to palpation over sacroiliac joints with
positive joint provocative tests (FABER, Gaenslen).

56
Q

You suspect a patient of having ankylosing spondylitis. What imaging would you order?
Early?
Late?
Labs?

A

plain x-rays – earliest finding sacroiliitis.

Later syndesmophytes can progress to “bamboo spine”. Labs: HLAB27, C-reactive protein, sed rate.

57
Q

Tx options for patient with ankylosing spondylitis?

A

NSAIDs – typically marked relief. Consider anti-TNF agents.

Physical therapy, emphasis on spine extension

58
Q

Pt comes in and complains of leg pain, numbness, weakness; saddle anesthesia; bowel/bladder
dysfunction (urinary retention most common; urinary or stool incontinence). Dx?

A

Cauda equina syndrome

59
Q

Etiology of patient with cauda equina syndrome

A

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

60
Q

What exam findings would you expect to see in someone with cauda equina syndrome?

A

reduced or absent reflexes, weakness, decreased rectal tone

61
Q

Tx for cauda equina syndrome?

A

Surgical emergency

MSS (26 decks)

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