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HARRISSONS > Back And Neck Pain > Flashcards

Back And Neck Pain Flashcards

1
Q

Back symptoms are the most common cause of disability in those ____ years old

A
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2
Q

___% of persons will have back pain at some point in their lives

A

70%

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3
Q

Tough cartilaginous ring that surrounds central gelatinous nucleus pulposus which composes the intervertebral disks

A

Annulus fibrosis

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4
Q

Intervertebral Disk are responsible for ___% of spinal length and allow the bony vertebrae to move easily upon each other

A

25%

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5
Q

Intervertebral disk are made of

A

Nucleus pulposus surrounded by a tough cartilaginous ring , the annulus fibrosis

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6
Q

Where the disks are largest and movement is greatest

A

Cervical and lumbar regions

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7
Q

Absorbs the shock of the bodily movements such as walking and running

A

Anterior spine

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8
Q
  • Protects the spinal cord and nerve roots in the spinal canal
  • consists of vertebral arches and processes
A

Posterior spine

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9
Q

Pain sensitive structure of the spine

A
  1. Periosteum of the vertebrae
  2. Dura
  3. Facet joints
  4. annulus fibrosus of the intervertebral disks
  5. Epidural veins and arteries
  6. Longitudinal ligaments
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10
Q

Most frequent causes of back pain

A 
RADICULOPATHY
Fracture
Tumor
Infection 
Referred pain from visceral structures
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11
Q

Is a common cause of neck, arm, low back, buttocks and leg pain

A

Nerve root injury (RADICULOPATHY )

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12
Q

Caused by injury to pain sensitive structures that compress or irritate sensory nerve endings

The site of pain is near the affected part of the back

A

Local pain

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13
Q

Pain that may arise from the abdominal or pelvis visceral primarily accompanied by back pain and usually
UNAFFECTED BY POSTURE

A

Pain referred to the back

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14
Q

Pain may be located in the back or referred to the buttocks or legs

A

Pain of spine origin

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15
Q

Pain tend to refer pain to the lumbar region, groin or anterior thighs

A

Diseases affecting the upper lumbar spine

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16
Q

Diseases that tend to produce pain referred to the buttocks, posterior thighs, calves or feet.

A

Diseases affecting the lower lumbar region

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17
Q

Pain that is typically sharp and radiates from the low back to a leg within the territory of a nerve root

A

RADICULAR PAIN

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18
Q

In radicular pain, pain may increase in postures that stretch out nerves and nerve roots. Sitting with the legs outstretched places traction on the _____ and ____ because the nerve passes to the _____

A
  1. Sciatic nerve, L5 and S1 roots

2. Posterior to the hip

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19
Q

Burning or electric quality of pain favors:

Referred pain or Radiculopathy

A

RADICULOPATHY

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20
Q

Diseases that have referred back pain upon palpating of the abdomen

A

Pancreatitis and abdominal aorta aneurysm

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21
Q

An electrical shock down the spine with neck flexion, suggesting involvement of the spinal cord

A

LHERMITTE’S SIGN

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22
Q

Motor vehicle accidents, violent crimes or falls account for ___% of cervical spinal cord injuries

A

87%

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23
Q

Canadian C spine rule recommends imaging following neck trauma to patients who are

A

> 65 years old
Limb paresthesia
Dangerous mechanism for injury ( diving accident, bicycle collision with tree or parked car, fall from height >3ft or five stairs)

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24
Q

Diagnostic procedure of choice for detection of acute fractures following severe trauma in cervical spine

A

CT SCAN

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25
Q

Preferred diagnostics when traumatic injury to the vertebral arteries or cervical spinal cord is suspected

A

MRI with magnetic resonance angiography

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26
Q

Rapid flexion and extension of the neck usually during automobile accidents

A

Whiplash injury

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27
Q

___% of persons reporting whiplash injury acutely have persistent neck pain 1 year later

A

50%

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28
Q

Imaging of the cervical spine is useful when symptoms persist for

A

> 6 weeks following the injury

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29
Q

Extension and lateral rotation of the neck narrow the ipsilateral intervertebral foramen and may produce radicular symptoms

A

SPURLING’S Sign

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30
Q

Herniated cervical disks are responsible for __% of cervical radiculopaties

A

25%

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31
Q

May produce neck pain that radiates into the back of the head, shoulders or arms or maybe source of headaches in the posterior occipital region supplied by C2-C4 nerve roots

A

Osteoarthritis of the cervical spine / cervical spondylosis

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32
Q

In cervical spondylosis, _____ is the study of choice to define anatomical abnormalities of soft tissues in the cervical regions including the spinal cord.

A

MRI

But CT SCAN is adequate to assess bony Spurs, foraminal narrowing, lateral recess stenosis or OPLL.

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33
Q

Synovitis of the atlantoaxial joint c1 and c2, may damage the transverse ligaments of the atlas, producing forward displacement of the atlas on the axis

A

Atlantoaxial subluxation

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34
Q

Radiological evidence of atlantoaxial subluxation occurs in ___% of RA patients

A

30%

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35
Q

Rheumatoid arthritis in atlantoaxial subluxation

imaging modality of choice

A

MRI

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36
Q

Neck pain and less commonly atlantoaxial subluxation

A

Ankylosing spondylosis

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37
Q

Presents as acute posterior occipital or neck pain prior to outbreak of vesicles

A

Acute herpes zoster

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38
Q

Neck pain referred from the heart with coronary artery ischemia

A

CERVICAL ANGINA SYNDROME

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39
Q

Thoracic outlet contains:

A 
Fist rib
The subclavian artery and vein
Brachial plexus
The clavicle 
Lung apex
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40
Q

Is an uncommon disorder resulting from compression of the lower trunk of the brachial plexus or ventral rami of them C8 or T1 nerve roots

A

True neurogenic thoracic outlet syndromes ( TOS)

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41
Q

Cause most often by an anomalous band of tissue connecting an elongate transverse process at c7 with the first rib

A

True neurogenic thoracic outlet syndromes ( TOS)

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42
Q

Signs include weakness and wasting of the intrinsic muscle of the hand and diminished sensation on the palmar aspect of the fifth digit

A

True neurogenic thoracic outlet syndromes ( TOS)

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43
Q

Absence of ankle reflexes can be a normal finding in persons older than age ___ years

A

60 years or a sign of bilateral S1 radiculopathy

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44
Q

The correlation between ct and emg for localization of nerve root injury is between

A

65-73%

45
Q

_____ of asymptomatic patients have a lumbar disk protrusion detected by CT AND MRI scans

A

1/3

46
Q

Signifies injury of multiple lumbosacral nerve roots within the spinal canal distal to the termination of the spinal cord at L1-L2

A

Cauda equina syndrome

47
Q

Low back pain, weakness and are flexor I the legs, saddle anesthesia or loss of bladder function

A

Cauda equina syndrome

48
Q

Due to a ruptured lumbosacral interventebral disk, lumbosacral spine fracture, hematoma within the spinal canal, compressive tumor or other mass lesions

A

Cauda equina syndrome

49
Q

Narrowed lumbar spinal canal and is frequently ASYMPTOMATIC

A

Lumbar spinal stenosis

50
Q

___% of acquired Lumbar spinal stenosis

A

75%

51
Q

Congenital forms of LSS characterized by short and thick pedicels that produce both spinal canal and lateral recess stenosis

A

Achondroplasia and idiopathic

52
Q

Also known as osteoarthritis spine disease, which typically occurs in later life and primarily involves the cervical and lumbosacral spine

A

SPONDYLOSIS

53
Q

Patients often complains of back pain that increases with movement and is associated with stiffness and is better when inactive

A

Spondylosis

54
Q

The anterior slippage of the vertebral body, pedicles and superior articular facets, leaving the posterior elements behind

A

Spondylolithesis

55
Q

Most frequent nerve root injury in Spondylolithesis

A

L5 root

56
Q

In Spondylolithesis, tenderness may be elicited near the segment that has “slipped” forward

A

(most often L4 on L5 or occasionally L5 on S1)

57
Q

Most common neurologic symptom in patients with systemic cancer and is the presenting symptom in ___%

A

Back pain 20% in cancers

58
Q

When is surgery considered for Spondylolithesis

A

Pain symptoms that do not respond o conservative mgt
In cases of progressive neurologic deficit
Postural deformity
Slippage 50%
Scoliosis

59
Q

Most common cause of back pain in cancer

A

Vertebral body metastases

60
Q

Cancer related back pain tends to be

A

Constant
Dull
Unrelieved by rest
Worse at night

61
Q

Once metastasis is found , ____ of patients usually reveals additional tumors

A

1/3

62
Q

Preferred for soft tissue modalities in cancer patients

A

MRI but most rapidly availed imaging modality is best because early diagnosis is crucial

63
Q

Back pain unrelieved by rest, spine tenderness over involved area, elevated ESR

A

Vertebral osteomyelitis

64
Q

Most common cause of vertebral osteomyelitis

A

Staphylococci

Others: Tuberculosis (Potts disease)
Urinary tract, skin and lungs

65
Q

When intervertebral disk is affected by infection

A

Diskitis

66
Q

Presents with back pain, aggravated by movement or palpation, fever, radiculopathy, or signs of spinal cord compression.
Best delineated by MRI

A

Spinal epidural abcess

67
Q

Due to fibrosis following inflammation within the subarachnoid space and due to nerve root adhesions and presents with back and leg pain associated with focal motor, sensory or reflex changes.

A

Lumbar adhesive arachnoiditis

68
Q

Lumbar adhesive arachnoiditis MRI RESULTS

A

MRI shows clumped nerve roots or loculations of CSF within the thecal sac

69
Q

Self limited injury associated with lifting heavy object, a fall or a sudden deceleration. Confined to lower back without radiation to buttocks or legs.

A

SPAINS AND STRAINS

70
Q

Most traumatic fractures of the lumbar vertebral bodies result from the injuries producing ____
*burst fracture

A

Anterior wedging or compression

71
Q

____ of compression fractures seen in radiology are asymptomatic

A

Two thirds 2/3

72
Q

Most common non traumatic vertebral body fractures are due to

A

postmenopausal or senile osteoporosis

73
Q

___% risk of additional vertebral fracture at 1 year following fist vertebral fracture is

A

20%

74
Q

Abnormally increased bone density often due to Paget’s disease is readily identifiable on routine X-ray and assoc with increase ALKALINE PHOSPHATASE in an otherwise healthy older person.

A

OSTEOSCLEROSIS

75
Q

Shown to reduce the incidence or risk of osteoporotic fractures and are the preferred treatment to prevent additional fractures

A

ANTIRESORPTIVE DRUGS
esp BIPHOSPHONATES
example ALENDRONATE)

76
Q

Urgent SURGERY is recommended for px with

A

CES or spinal cord compression

77
Q

CES or spinal cord compression symptoms

A

Bowel or bladder dysfunction
Diminished sensation in a saddle distribution
Sensory level on the trunk
Bilateral weakness and spasticity

78
Q

Most common reason for recommending surgery

A

SCIATICA

79
Q

Is a bony defect in the vertebral pars interarticularis caused by a stress microfracture in a congenital abnormal segment

A

SPONDYLOLYSIS

80
Q

Most common cause of persistent low back pain in adolescents and often associated with sports related activities
Occurs up to ____% in adolescents

A

SPONDYLOLYSIS 6%

81
Q

Refers to the abnormal curvature in the coronal (lateral) plane of the spine

A

Scoliosis

82
Q

Scoliosis plus an additional forward curvature of the spine

A

Kyphoscoliosis

83
Q

A failure of closure of one or several vertebral arches posteriorly

A

Spina bifida occulta

84
Q
  • Progressive cauda equina disorder
  • Myelopathy may be the initial manifestation
  • often in a young adult who complains of perineal or perianal pain
A

Tethered cord syndrome

85
Q

In Tethered cord syndrome, MRI studies reveals

A
  • Low lying conus below L1 and L2

* Short and thickened filum terminale

86
Q

The sudden appearance of lumbar pain in a patient receiving anticoagulants suggests

A

Retroperitoneal HEMORRRHAGE

87
Q

Classic clinical train of abdominal pain, shock and back pain occurs in ___% of AAA

A

20%

88
Q

In AAA, abdominal Examination Reveals a pulsating mass ___%

A

50-75%

89
Q

Upper abdominal diseases

A

T8 to L1-L2

90
Q

Lower abdominal diseases

A

L2-L4

91
Q

ALBP risk factors history

A 
Pain worse at rest or at night
Prior history of cancer
History of chronic infection
History of trauma
Incontinence
Age>70 years
IV DRUG Use
Glucocorticoid use
History of rapidly progressive neurological deficit
92
Q

Acute lumbar back pain of ____________
___% expect full recovery with ALBP w/o leg pain
2/3 improved after___ weeks

A
93
Q

First line treatment options for ALBP

A

Acetaminophen and NSAIDs

94
Q

Chronic LBP defined as pain lasting for _____

Accounts for ___% of total back pain cost

A

> 12 weeks

50%

95
Q

Mainstay treatment of CLBP

A

Exercise therapy

96
Q

Medication for CLBP

A

Acetaminophen
NSAIDs
Tricyclic antidepressants

97
Q

Osteoarthritis of the cervical spine that may produce neck pain that radiates into the back of the head, shoulders or arms,
May be the source of headache in the posterior occipital region
Supplied by c2-c4 nerve roots

A

Cervical spondylosis

98
Q

Roots most commonly affected in cervical spondylosis

A

C7 and C6

99
Q

Coffin the diagnosis of TOS

A

EMG and nerve conduction studies

100
Q

Compression of the subclavian artery by a cervical rib

A

Arterial Thoracic outlet syndrome

101
Q

BP IS REDUCED ON THE AFFECTED LIMB

A

Arterial Thoracic outlet syndrome

102
Q

Confirms the diagnosis of Arterial Thoracic outlet syndrome

A

Ultrasound

103
Q

Treatment of Arterial Thoracic outlet syndrome

A

Thrombolysis or anticoagulation (non-invasive)

And surgical excision of the cervical rib compressing the the subclavian artery

104
Q

Due to subclavian vein thrombosis resulting in the swelling of the arm and pain
VENOGRAPHY diagnostic test of choice

A

VENOUS TOS

105
Q

Disputed TOS ___%

A

95%

106
Q

In disputed TOS most prominent pain

A

Chronic arm and shoulder pain

107
Q

Severe shoulder pain, wasting and weakness of the supraspinatus and infraspinatus muscles

A

Supra scapular neuropathy

108
Q

Acute onset of severe shoulder pain or scapular pain followed typically by weakness of proximal arm and shoulder girdle muscles

A

Acute brachial neuritis

HARRISSONS (62 decks)

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