Brainscape's Knowledge GenomeTM

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


See full index

PCMI > 2.1. Approach to Thoracolumbar Spine > Flashcards

2.1. Approach to Thoracolumbar Spine Flashcards

1
Q

7 things you palpate for on the spine

A

1-4: TART

  1. Spinal column
  2. Paraspinal muscles
  3. Muscles of back
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why do you percuss?

A

See most tender points on exam

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

What can percussion on examination identify?

A
  • pain points

- discrete areas of fx (low sensitivity, mod specificity)

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

Differential Diagnosis considerations with thoracic or lumbar spine complaint (5)

A
  1. compression fx
  2. osteomyelitis
  3. muscle spasm
  4. strain (ligaments)/sprain (muscles)
  5. SD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

scoliosis definition

A

abnormal curvature of the spine

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

early onset scoliosis

A

<10 years old

  • kids are still growing so it can affect more than just the spine (malformed ribs affecting lung development)
  • more promise for intervention the earlier its caught
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Adolescent idiopathic scoliosis (AIS)

A
  • most common form
  • affects 4/100 children between 10-18, genders equally affected
  • by 10 yo, spinal growth slows so if you have a significant degree of spinal curvature at this point, curve may continue to progress into adulthood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what spinal curvature defines scoliosis

A

Cobb angle > 10 degrees

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

Epidemiology of AIS

A
  • Only 10% of AIS require treatment (0.3% of population)
  • Genders equally affected
  • Risk of curve progression (and treatment) is 10x higher in female than male
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of adult scoliosis

A
  • de novo degenerative
  • profession of congenital, early onset, or adolescent idiopathic scoliosis
  • secondary to another condition: paralysis, trauma, spinal surgery
  • adult spinal deformity (scoliosis, kyphosis, lordosis, spondylolisthesis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 5 landmarks do you use to screen for scoliosis?

A
  1. Difference in height fo shoulders or scapulae
  2. asymmetry of waistline
  3. asymmetry in distance arms hang from trunk
  4. head shifter to one side and not centered over sacrum, “trunk shift”
  5. A “plum line” dropped from spinous process of C7 (should pass thru gluteal cleft)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you perform a forward bending test for scoliosis?

A
  • pt bends forward with knees extended

- sidebends left and right while physician monitors posteriorly for accentuation or improvement of spinal curvature

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

Spondylolysis

A

stress fracture or detect in vertebral arch

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

spondylolisthesis

A 
displaced fracture (spondylolysis) where vertebral body slips forward over another
-different types: degenerative, isthmus, dysplastic, traumatic, patholgic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Spondylitis

A

inflammation of spinal joint

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

spondylosis

A

painful condition of spine resulting from degeneration of IV disks

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

3 common treatments for scoliosis

A
  1. observation
  2. bracing: dependent on Cobb angle, deformity, progression risk
  3. surgery: usually angle >39-50 degrees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

2 types of braces for scoliosis

A
  1. underarm brace, “Boston brace”

2. under-chin extension, “Milwaukee brace”

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

4 common surgeries for scoliosis

A
  1. posterior spinal fusion, instrumentation, and bone graft
  2. anterior spinal fusion and instrumentation
  3. combination of anterior and posterior
  4. growth modulation techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the curvature, risser scale number, and success rate of the early intervention stage for scoliosis?

A

Curvature: <30 degrees
Risser: 0-2
Success rate: 100%

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

What is the curvature, risser scale number, and success rate of likely to progress intervention stage for scoliosis?

A

Curvature: 30-49 degrees
Risser: 0-3
Success rate: 92%

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

What is the curvature and success rate of above surgical threshold intervention stage for scoliosis?

A

Curvature: >50 degrees

50% success rate

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

What time length is considered acute low back pain?

A

< 4-6 weeks

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

Symptoms of cauda equina

A
  • progressive motor or sensory defect
  • saddle anesthesia (buttocks, perineum and inner surfaces of the thighs)
  • bilateral sciatica or leg weakness
  • difficulty urinating, including retention
  • bowel or bladder incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What time length is considered subacute low back pain?

A

6 weeks to 3 months

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

What are red flag findings for spinal pathology for onset <20 years or > 55 years?

A
  • unrelenting thoracic pain at night, unrelated to time or activity
  • widespread neuro symptoms
  • unexplained weight loss
  • feeling unwell, fever, chills
  • significant trauma
  • penetrating wound near spine
  • structural spinal deformity
  • Hx: osteoporosis cancer or strong suspicion of current cancer, recurrent infection (UTI), HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is IV drug use pertinent with low back pain complaints?

A

highly associated with acute bacterial endocarditis –> osteomyelitis

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

Why is steroid use pertinent with low back pain complaints?

A

decrease immune response, could lead to things like osteoporosis which would make bones weaker

29
Q

What is the sensitivity and specificity for diagnosis of compression fractures >50 years of age?

A

sensitivity: 84%
specificity: 61%

30
Q

pseudoclaudication

A

painful cramps that are not caused by PAD but rather by spinal, neurological or orthopedic disorders such as spinal stenosis, diabetic neuropathy, or arthritis

31
Q

Ankylosing spondylitis

A
  • typical onset <40 years (sens: 100%, specificity: 7%)
  • pain was not relieved laying supine (sens: 80%)
  • morning back stiffness (sens: 64%)
  • pain duration >3 months (sens: 71%)
32
Q

Sensitivity vs specificity

A
  • sensitivity: ability of a test to correctly identify those with the disease (true positive rate)
  • specificity: ability of the test to correctly identify those without the disease (true negative rate)
33
Q

vascular vs spinal claudication

A

arterial circulatory insufficiency (known as vascular claudication) or spinal stenosis (known as neurogenic or pseudo-claudication).

Patients with either condition will generally see the leg pain go away with rest, but spinal stenosis patients usually must sit for a few minutes to ease the leg pain and often the accompanying low back pain. Vascular claudication will dissipate simply if the patient stops walking.

34
Q

common symptoms of lumbar spinal stenosis

A
  • gradual development over time
  • non-continuous pain that comes and goes
  • occurring during specific activities like walking) and/or in positions like standing upright
  • relieved by rest, whether sitting or lying down and/or getting into any flexed forward position
35
Q

Sciatic nerve pain or Sciatica symptoms

A

sharp, burning nerve pain that runs from lower back or hip, down back of leg, to foot
-from injury or compression of sciatic nerve

36
Q

When evaluating for low back pain, what 4 structures will you feel for in the palpation part of the exam?

A
  1. spinous processes of thoracic and lumbar spines
  2. transverse processes “ “
  3. paraspinal muscles
  4. Sacroiliac joint
    * evaluate for TART in each of these areas
37
Q

What type of pathology would one find “step-offs”?

A

spondylolisthesis - forward slippage of one vertebra, which may compress spinal cord

38
Q

What could tenderness over the sacroiliac joint be an indication of?

A

sacroilitis and ankylosing spondylitis

39
Q

What reflexes and their associated nerve root would you be testing for during a low back complaint evaluation?

A
  1. patella, L4

2. achilles tendon, S1

40
Q

What would the straight leg raise (Laseque) test be evaluating for?

A

lumbosacral radiculopathy (usually from a herniated disc) and/or sciatic neuropathy

41
Q

How would one perform the straight leg raise (Laseque) test?

A
  • patient supine
  • passively flex patients ipsilateral hip with knee extended
  • add dorsiflexion to increase dural tension in low lumbar and high sacral levels
42
Q

What would be considered a positive test for the straight leg raise (Laseque) test?

A

presence of worsening radicular pain radiating to ipsilateral leg, especially between 30-60 degrees and worse with dorsiflexion
tightness is common so don’t associate it as radiating pain for a positive test

43
Q

What could a positive sign at >70 degrees during a straight leg raise test specifically indicate?

A

mechanical low back pain due to muscle strain or joint disease

44
Q

What could a positive sign at >15 degrees during a straight leg raise test specifically indicate?

A

IT band contracture

45
Q

What physical findings would make sciatica diagnosis 5x more likely?

A

ipsilateral calf wasting and weak dorsiflexion

46
Q

How would one perform a contralateral (crossed) straight leg raise test?

A
  • patient supine

- passively flex pt’s contralateral hip with knee extended

47
Q

what would be considered a positive test while performing the contralateral (crossed) straight leg raise test?

A

presence or worsening radicular pain, radiating into contralateral leg, especially between 30-60 degrees

48
Q

What would a positive contralateral (crossed) straight leg raise test possibly indicate?

A

lumbosacral radiculopathy (usually from herniated disc) and/or sciatic neuropathy

49
Q

What spinal curvature increases with age?

A

thoracic kyphosis

50
Q

What helps bring the head back to midline in patients with scoliosis?

A

lateral and rotatory curvatures of the spine

51
Q

What patients/conditions present with unequal shoulder height?

A
  1. scoliosis
  2. sprengel deformity of scapula from attachment of extra bone or band
  3. “winging” of scapula from loss of long thoracic nerve innervating serrates anterior and contralateral weakness of trapezius
52
Q

What patients/conditions present with unequal height of iliac crest or pelvic tilt?

A
  1. unequal leg length
  2. scoliosis
  3. abduction or adduction of hip
  4. herniated lumbar disc
53
Q

What would deformity of theca on forward bending, especially when height of scapula is unequal suggest?

A

scoliosis

54
Q

What would persistence of lumbar lordosis suggest?

A

muscle spasm or ankylosing spondylitis

55
Q

What conditions is decreased spinal mobility common in?

A

osteoarthritis and ankylosing spondylitis

56
Q

What is caudal equine syndrome?

A

condition of spinal nerve root compression usually by massive disc protrusion, fracture/trauma, or tumor that results in bowel/bladder dysfunction

*requires EMERGENT management and surgical decompression within 48 hours, or permanent nerve damage can remain

57
Q

Meningocele

A

meninges forced out between vertebra

-surgically repaired with usually no neurological damage

58
Q

Myelomeningocele

A
  • most common
  • unfused portion of spinal cord protrudes through opening
  • very severe (permanent) neurological complications
59
Q

Ferguson’s angle

A

Normal: 30-40 degrees
-used to evaluate stability of lumbosacral region by equating angle between: lumbosacral angle and the lumbar gravity line

60
Q

what muscles are involved in flexion at hips?

A
  • psoas major
  • psoas minor
  • quadratus lumborum
  • abdominal muscles attaching to anterior vertebrae (internal or external obliques or rectus abdominis)
61
Q

what muscles are involved in extension at hips?

A

-deep intrinsic back muscles (erector spina and transversospinalis)

62
Q

what conditions would spinal “step-offs” occur?

A

spondylolisthesis

63
Q

what is tenderness over the sacroiliac joint common in?

A

sacroilitis and ankylosing spondylitis

64
Q

what is radiculopathy commonly called?

A

pinched nerve

65
Q

where do >95% of disc herniations occur and why?

A

L5-S1 because the spinal angles are sharply posterior

66
Q

what would signs of ipsilateral calf wasting and weak dorsiflexion highly suggest?

A

sciatica

67
Q

why is diagnostic accuracy of the straight leg test limited for dx radiculopathy?

A

low specificity (high sensitivity)

68
Q

What are classic presentations of caudal equina?

A
  • low back pain
  • bowel/bladder dysfunction
  • sensory loss of perineum “saddle anesthesia” and decreased anal sphincter tone
  • bilateral sciatica and leg weakness

PCMI (15 decks)

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