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Spinal Disorders- LeFebvre > B1. Thoracic Disease > Flashcards

B1. Thoracic Disease Flashcards

1
Q

Is visceral pain referral made worse by coughing or deep respiration?

A

No

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2
Q

About 1 in ___ will have an episode of shingles in their lifetime.

A

4

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3
Q

What is the shingles prodrome?

A

Itching or tingling pain in the area 1-5 days prior to blisters developing

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4
Q

How long does it take for the shingles rash to completely heal?

A

2-4 weeks

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5
Q

When is shingles no longer contagious?

A

After the last blister is scabbed over

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6
Q

What is postherpetic neuralgia?

A

A complication of shingles in which nerves are damaged and can cause pain even after the rash has resolved.

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7
Q

What are two preventions that can decrease the risk of developing post herpetic neuralgia?

A

Acyclovir within 72 hours of onset

Vaccination

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8
Q

Patients who are what age and above are at an increased risk of developing post herpetic neuralgia and therefore should get a vaccine?

A

50+

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9
Q

1 in how many women will develop breast cancer?

A

1 in9

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10
Q

What percentage of breast cancer survivors will develop metastasis?

A

50%

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11
Q

Of the breast cancers that metastasize, what percentage will go to the bone?

A

40-60%

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12
Q

What is the survival rate for breast cancer?

A

> 60%

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13
Q

What percentage of breast cancer deaths are due to recurrence?

A

25%

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14
Q

What are some major risk factors for developing a hematoma (epidural or subdural) that affects the thoracic spine as an SOL?

A
  • over 50
  • taking anticoagulants
  • bleeding disorders
  • recent epidural injections or instrumentation
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15
Q

What is the ancillary study of choice for diagnosing a hematoma in the thoracic spine?

A

MRI

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16
Q

Disease that causes progressive structural thoracic or thoracolumbar
hyperkyphosis (>45 degree) characterized by calcification of vertebral epiphyses, notching of vertebral end plates and wedging of vertebral bodies

A

Scheuermann’s disease

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17
Q

What is the typical onset of Scheuermann’s disease?

A

Puberty (13-17 years)

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18
Q

Who more commonly gets scheuermann’s disease?

A

Males>females around puberty

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19
Q

What are the percentages of scheuermann’s in thoracic and thoracolumbar regions?

A

75% thoracic, 25% thoracolumbar

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20
Q

How common is Scheuermann’s disease?

A

4-8.3% of population is affected

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21
Q

What percentage of Scheuermann’s patients also have an associated scoliosis?

A

30-40%

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22
Q

What is the Heuter-Volkmann principle?

A

One of the etiologic theories for Scheuermann’s disease in which an increased axial load compression affects epiphyseal plate and inhibits growth, while decreased pressure accelerates growth

23
Q

Under what conditions should non-surgical treatment of Scheuerman’s be considered?

A

If the curvature is >40 but <65 degrees and there is > 1 year of spinal growth remaining

24
Q

what are some non surgical treatment options for scheuermann’s disease?

A
  • bracing/casting
  • CMT to promote extension
  • postural training
  • home care to enhance extension and core strength
  • limit weight bearing and contact sports
  • assess nutritional status
  • stretch tight hamstrings
  • reduce myospams
25
Q

Where is the most common location for a compression fracture and where does it refer pain too?

A

TLJ and iliac crest, groin, and greater trochanter

26
Q

What are the 3 common scenarios for patient presenting with compression fracture?

A
  • trauma, sudden pain and audible snapping
  • non-traumatic LBP in patient over 70 could be spontaneous compression fracture
  • low or moderate load trauma in patient over 50, especially post menopausal
27
Q

What effect does corticosteroids have on bone?

A

Rapid bone loss in the first 6 months (10-20% ), especially in hip, spine and forearm

28
Q

Corticosteroids are often prescribed for what conditions?

A
  • asthma
  • IBS
  • MS
  • RA
  • other CT diseases
29
Q

How are compression fractures of the spine affected by activity?

A
  • aggravated by standing or walking

- relieved by rest or lying down

30
Q

What is paralytic ileum and when does it occur?

A

A temporary stoppage of intestinal peristalsis for 2-3 days (acute phase) following a compression fracture.

31
Q

What are some findings on physical exam for a compression fracture?

A
  • painful and limited AROM, especially in flexion
  • muscles guarding and splinting
  • sharp lingering pain with percussion
  • Neuro abnormalities possible if there is NR or cord involvement
  • need to rule out underlying cause of pathological fracture (MM or metastatic cancer, hyperparathyroid)
32
Q

When should joint plays and orthopedic tests be performed if a compression fracture is suspected?

A

Although most compression fractures are stable and will heal on their own, joint plays and orthopedic tests should not be performed until after radiographs have been obtained

33
Q

If an acute compression fracture is seen on radiograph, what is your next step?

A

Refer to orthopedist for medicolegal reasons, although management is primarily conservative

34
Q

according to McNab, what is the % collapse cut off point for a surgical compression fracture?

A

50% collapse is considered surgical and under responds to conservative care

35
Q

What is the surgical intervention for compression fractures?

A

MIFR - minimally invasive fracture reduction

36
Q

What is the management plan for a compression fracture during the acute phase?

A
  • restrict food intake for 2-3 days
  • reduce inflammation
  • control pain
  • reduce myospasms (unless helping to stabilize)
  • rest
37
Q

When a patient is instructed to rest during the acute phase management of a compression fracture, what are their typical instructions?

A
  • no weight bearing for 2 weeks
  • another month of conservative treatment
  • no lifting for 3 months
38
Q

How long does it take a compression fracture to consolidate?

A

90 days

39
Q

At what point should a compression fracture be re-Xrayed?

A

3 months

40
Q

What is the most common metabolic disorder?

A

Osteoporosis

41
Q

What is osteoporosis?

A

A reduction in bone mass per unit volume to a level below what is required for normal mechanical support and function. Both cortical thickness and #/size of trabeculae is lost

42
Q

If you suspect your patient is at risk of osteoporosis, what test should you order?

A
  • densitometry (DXA or DEXA) or quantitative computerized tomography (QCT)

NOTE: radiographic assessment is not recommended as a screen

43
Q

What are radiographs not recommended for screening for osteoporosis?

A

X-rays will not detect bone loss until it has reached 30-50%

44
Q

What is a T-score?

A

Score that is based on how many standard deviations the patient is away from average, healthy bone density

Normal > -1
Osteopenia < -1 and > -2.5
Osteoporosis < -2.5 (w/o fracture)
Established osteoporosis < -2.5 (w/ fracture)

45
Q

What are the management goals and interventions for patients with established osteoporosis?

A
  • manage predisposing medical conditions (meds, hormone therapy, etc.)
  • reduce fall risk (vision, home safety, supportive shoes, etc.)
  • optimize strength, balance and flexibility
  • improve nutrition
46
Q

What is the affect of Vitamin D and calcium supplementation in osteoporosis?

A

there was no significant
association of calcium or vitamin D with risk of hip fracture compared with placebo or no
treatment.

47
Q

What exercises should be given to a scheuermann’s patient?

A

Ones that promote extension this can either be through distraction or traction exercises

48
Q

What is the biggest clue a patient is having visceral pain referral?

A

NMS exam is relatively normal

  • usually associated with chest or abdominal pain
  • usually will have other symptoms of involved organ
49
Q

What is the referral pattern for the esophagus?

A

Between the shoulder blades, narrowly

50
Q

What is the referral pattern for the heart?

A

Between the shoulder blades, wide,

Left shoulder, below the xiphoid process

51
Q

What is the referral pattern for the gallbladder?

A

Under the right scapula, can expand to the armpit or the top of the shoulder

52
Q

What is the referral pattern for the pancreas?

A

TL junction across the entire flank area

53
Q

What is the referral pattern for the stomach?

A

Wide across the mid back, more on the left, around T7-T9

Spinal Disorders- LeFebvre (25 decks)

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