3.1 Flashcards
Which is more infectious, chickenpox or shingles?
chickenpox
what cells do we see in shingles?
multinucleated giant cells
when shingles is reactivated, which way does it travel (anterogradely or retrogradely)
anterogradely
Does shingles rash cross the midline
no
Which roots are most commonly affected in shingles
thoracic
lumbar
when is a patient with shingles no longer infectious
7-10 days; after rash has healed over
What ganglion are activated in Ramsay Hunt
geniculate ganglion or dorsal root ganglion
What nerves are affected in Ramsay Hunt
CN7
Possible CN8
Will facial paralysis be contralateral or ipsilateral for shingles
Ipsilateral
what nerve roots are involved in herpes zoster ophthalmicus
trigeminal ganglion or dorsal root ganglion
what nerve is affected in herpes zoster ophthalmicus
ophthalmic division of trigeminal nerve
What sign is commonly seen in herpes zoster ophthalmicus
hutchinson’s sign
eye involvement in shingles indicates what other nerve could be involved
nasociliary nerve
sciatic nerve controls what dermatomes?
L4-S2
what is the most common cause of lower back pain
lumbar strain
what is lumbar strain
acute tear or stretch of paraspinal muscles
muscle spasms in lumbar strain are related to
activity; pain worsens with activity
do most herniations occur posteriorly or anteriorly? why?
posteriorly; posterior longitudinal ligament is much narrower
At what level is herniated disc most common
L5-S1
what is the most common organism is osteomyelitis
staph aureus
what bacteria is associated with osteomyelitis in someone after prosthetic joint placement
staph epidermis
what bacteria is associated with osteomyelitis in someone with SCD
salmonella
what bacteria is associated with osteomyelitis in neonates
Group B strep
what bacteria is associated with osteomyelitis in someone with puncture wounds through tennis shoes
pseudomonas
very common symptom of osteomyelitis
refusal to bear weight
Gold standard of diagnosis for osteomyelitis
bone aspiration (biopsy)
does spinal epidural abscess most commonly occur anteriorly or posteriorly
posteriorly
class triad in spinal epidural abscess
fever
spinal pain
progressive neurologic deficit
test of choice for spinal epidural abscess
MRI with contrast (gadolinium)
what type of lesion will you see in MRI with spinal epidural abscess
ring enhancing lesion
what is the most common presenting symptom in amyotrophic lateral sclerosis
asymmetric limb weakness
what is usually spared in ALS
sensation
voluntary eye movement
sphincter function (bowel and bladder)
sexual function
sensory exam is usually normal
treatment option for ALS
Riluzone
what is the most common cause of death in ALS
respiratory failure
when is ALS typically fatal
usually 3-5 years after symptom onset
what imaging method is best for herniated disc
MRI
spinal column cancers are most commonly due to
metastases (70%)
what is the most common primary bone malignancy in children and young adults
osteosarcoma
Appearance on radiographs for osteosarcoma
sunburst or hair on end appearance
is cauda equina a lower motor neuron issue or upper? why?
Lower motor neuron issue; spinal cord ends at conus medullaris
most common cause of cauda equina syndrome
massive lumbar disc herniation
will anal wink test be increased or decreased for cauda equina syndrome
decreased
Imaging for cauda equina syndrome
immediate MRI
treatment for cauda equina syndrome
emergent decompression
corticosteroids to reduce inflammation
primary infection in adults with HSV1
tonsillopharyngitis
primary infection in kids with HSV1
gingivostomatitis
What type of smear used for HSV and varicella
Tzanck
where do most cases of spondylolysis occur
L5-S1
spondylolysis is due to what defect
pars articularis defect
what will you see on radiographs for spondylolysis
scotty dog appearance
at what grade do you do interventions for spondylolisthesis
Grade 3 and above (50%-75% for grade 3)
what kind of gait do kids with spondylolisthesis tend to have
phalen-dickson gait
burst (Jefferson) fracture of the atlas (C1)
bilateral fractures of both the anterior and posterior arches of C1
odontoid process (dens) fractures
fracture of the dens (odontoid process) of the axis (C2)
How is odontoid process fracture best seen on imaging
AP odontoid (open mouth) view
hangman’s fracture (C2/axis pedicle)
traumatic bilateral fractures of the pedicles or pars interarticularis of the axis vertebra (C2)
clay-shoveler’s fracture
spinous process avulsion fracture most common at the lower cervical vertebrae
where does clay shoveler’s fracture most commonly occur
C7
flexion teardrop fracture
anterior displacement of a wedge-shaped fracture fragment
extension teardrop fracture
triangular shaped avulsion fracture of the antero-inferior corner of the vertebral body as a result of rupture of the anterior longitudinal ligament
where are extension teardrop fractures most common
C2
what type of fracture can result in anterior cervical cord syndrome
flexion teardrop fractures
what type of fracture can result in central cord syndrome
extension teardrop fracture
Burst fracture
due to nucleus pulpous of the intervertebral disc being forced into the vertebral body, causing it to burst outwards
