Brainscape's Knowledge GenomeTM

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


See full index

Aneesha Flashcards BRS 2 > Back pain > Flashcards

Back pain Flashcards

1
Q

Functions of the spine

A

Locomotor: capable of being both rigid and mobile
Bony armour: protects the spinal cord
Neurological: spinal cord transmission of signals between brain and periphery

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

Key MSK structures of the spine

A
  1. Spinal column consisting of
    A) 24 vetebrae (7 cervical, 12 thoracic, 5 lumbar)
    B) intervertebral discs (act as shock absorbers, allow segmentation and multi-directional movement)
    C) facet joints (small synovial joints at posterior spinal column linking each vertebra)
  2. Muscles- move the spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where do you see normal kyphosis and normal lordosis in the spine

A

Cervical spine, lumbar spine- normal lordosis
Thoracic spine- normal kyphosis

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

Key neurological structures structures of spine

A

Spinal cord- transmission of signals from brain, ends at L2 spinal level
Nerve roots- exit spinal cord bilaterally
Cauda equina- nerve bundle

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

Movements of the spine

A

Flexion (forward bend) vs extension (backwards bend)
Lateral flexion (side bend)
Rotation (twist)

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

How common is back pain

A

Very common, >50% of people will experience an episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is acute back pain self limiting.

A

Usually yes, most better in a few days, 96% better in 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What time duration of back pain qualifies for chronic back pain. How common is it and name a common risk factor

A

12 weeks
Also very common
Caused by sedentary lifestyle

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

Mechanical back pain exacerbating/ relieving factors?

A

Reproduced or worse with movement
Better or not present at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common causes of mechanical back pain

A

Muscular tension (chronic poor posture, weak muscles)
Acute muscle sprain, spasm
Degenerative disc disease
Osteoarthritis of facet joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is sciatica?
What is the typical cause of sciatica?
What determines the location of pain of sciatica?

A

Pain radiating down one leg (may accompany mechanical back pain
Typically caused by disc herniation (nucleus pulposus herniates through annulus fibrosus) contacting the exiting lumbar nerve root
Location of pain is determined by level of herniated disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Serious causes of back pain

A

Tumor- metastatic, myeloma
Infection- discitis, vertebral osteomyelitis, paraspinal abscess (microbiology- staphylococcus, streptococcus, TB)
Inflammatory spondyloarthropathy- ankylosing spondylitis, psoriatic arthritis, IBS-associated
Fracture- traumatic/ atraumatic (osteoarthritis)
Large disc prolapse causing neurological compromise
Referred pain- pancreas, kidneys, aortic aneurysm

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

Red flag symptoms of back pain

A

Pain at night or increased pain when supine
Constant or progressive pain
Thoracic pain
Weight loss
Previous malignancy
Fever/night sweats
Immunosuppressed
Bladder or bowel disturbance (Sphincter dysfunction)
Leg weakness or sensory loss
Age <20 or >55 yrs

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

What syndrome associated with back pain is a neurological emergency and why?

A

Cauda equina syndrome
Untreated, will lead to permanent lower limb paralysis and incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms/ signs of Cauda equina syndrome

A

Saddle parasthesia
Loss of anal tone or PR
Radicular leg pain
Ankle jerks may be absent
Bladder/ bowel incontinence

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

Cauda equina syndrome investigation

A

Urgent MRI lumbar spine

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

Causes of Cauda equina syndrome

A

Large disc herniation
Bony mets/ myeloma
TB
Paraspinal abscess

18
Q

Treatment of Cauda equina syndrome

A

According to cause, may require urgent surgery

19
Q

Back pain: history-taking- what is included?

A

Site & pattern
Character (e.g. aching, throbbing, burning, electricity)
Onset
Prolonged morning stiffness
Exacerbating/relieving factors
Effect of movement vs. inactivity
Radiation (e.g. sciatica)
Buttock pain
Leg weakness
Sensory loss/paraesthesia
Lower limb claudication ((peripheral vascular disease, spinal stenosis))

20
Q

What is involved in examination of the spine?

A

Look
Feel
Move
Straight leg raise (SLR) ((lie flat, lift leg straight up, if sciatica, at some point symptoms reproduced))
Lower limb neurological exam
General exam (signs of malignancy, AAA)

21
Q

What investigations are carried out for back pain?

A

In the absence of red flags, investigation usually not required
Do not routinely arrange a spinal X-ray or other imaging to diagnose non-specific low back pain in primary care
Arrange review if symptoms persist or worsen after 3–4 weeks and reassess for an underlying cause

22
Q

Treatment for low back pain without red flags

A

Time
Analgesia (NSAIDs e.g. ibuprofen, paracetamol, codeine)
AVOID bed rest: keep moving
Physiotherapy
-Soft tissue work
-Corrective exercises esp. core e.g. side plank, bird dog.

23
Q

What types of investigations are used for back pain?

A

Blood tests, radiographs (Xray), CT, MRI

24
Q

What can different blood results indicate with regards to back pain?

A
25
Q

Pros and cons of radiography, CT, MRI

A

Radiographs (X-rays)
-poor sensitivity, radiation
-cheap, widely available

Computed tomography (CT) scans:
-good for bony pathology, larger radiation dose

Magnetic resonance imaging (MRI):
-Best visualization of soft tissue structures like tendons and ligaments
-Best for spinal imaging: can see spinal cord and exiting nerve roots
-Expensive and time-consuming

26
Q

What does this image show?
Possible cause?

A

“Wedge fracture”/ vertebral collapse
Can be caused by osteoporotic weakening

27
Q

25 year old man originally from Nepal
Worsening low back pain for 8 weeks
Worse in the morning but present at all times
Weight loss
Night sweats

Differential?

A

TB! (cancer less likely because young)
Nepal is an indicator

28
Q

In what age groups are herniated discs most common

A

30-50

29
Q

Natural history for herniated disc

A

Good outlook

Normally spontaneous improvement, although typically slower than for low back pain alone

30
Q

Treatment of herniated disc

A
  1. Conservative as for LBP without sciatica
    -Analgesia especially NSAIDs
    -Physiotherapy to improve core strength and treat associated muscle spasm
  2. Nerve root injection (local anaesthetic and glucocorticoid)
  3. Surgery if neurological compromise or symptoms persist (Trials of surgery vs conservative Rx show no long term advance for surgery)
31
Q

Can slipped discs resolve spontaneously

A

Yes, sequential MRI studies show that herniated portion of the disc tends to regress with time with partial or complete resolution in two thirds of cases after six months.

32
Q

What is inflammatory spondyloarthropathy? Give examples

A

Group of immune-mediated inflammatory diseases
Ankylosing spondylitis (AS)((loss of spinal movements, severe spinal deformity)), psoriatic arthritis and inflammatory bowel disease (IBD)

33
Q

What joins are affected in inflammatory spondyloarthropathy?

A

Primarily inflammation of the spine (spondylitis) and sacro-iliac joints (sacro-iliitis)
Peripheral joints, esp. tendon insertions (entheses), can also be affected- this can cause dactylitis/ sauasage fingers

34
Q

Extra-articular manifestations of inflammatory spondyloarthropathy?

A

Anterior uveitis (iritis) – ocular inflammation
Apical lung fibrosis
Aortitis/aortic regurgitation
Amyloidosis – due to chronically serum amyloid A (SAA) depositing in organs

35
Q

Pathophysiology of ankylosing spondylitis

A

Characterised by enthesitis (inflammation of the entheses- sites where tendon and ligaments join to bone)

Large genetic component
Many genetic variants associated with the disease (polygenic)
HLA-B27 is the strongest genetic risk factor
HLA = a region on chromosome 6 encoding MHC molecules
HLA-B27 is a class 1 MHC molecule
Cells present peptides to CD8 T cells in association with MHC class 1 molecules

HLA-B27 +ve in 90% of AS patients versus ~10% in general population
Used as a diagnostic biomarker but HLA-B27 +ve alone does not equal AS

Cytokines play important roles in pathogenesis
tumour necrosis factor alpha (TNF-alpha)
interleukin-17 (IL-17)
interleukin-23 (IL23)

Aberrant peptide processing pathways (aminopeptidases) in the endoplasmic reticulum

36
Q

What can you see in imaging of sacroiliac joint in ankylosing spondylitis

A

Irregular SI joint, increased whitening on either side

37
Q

Imaging in ankylosing spondylitis:
Sacro-iliitis on MRI

A
38
Q

Natural history of untreated Ankylosing Spondylitis

A

Spinal enthesitis
->
Bridging syndesmophytes
(new bone growth between adjacent vertebra)
->
Spinal fusion

39
Q

Spinal MRI in Ankylosing Spondylitis-Advantage over Xray?
What is an MRI sign of AS on MRI?

A

MRI can detect spinal inflammation before X-rays changes develop

In image we see “Shiny corners” sign at L4, L5 and S1

40
Q

Management of ankylosing spondylitis

A

1) Physiotherapy and a life-long regular exercise programme

2) Pharmacological
1st line: non-steroidal anti-inflammatory drugs (NSAIDs)
-e.g. ibuprofen, naproxen, diclofenac
-Mechanism: NSAIDs inhibit cyclooxygenase 1 and 2 (COX1 and 2)
-Risks: peptic ulcer, renal, asthma exacerbation, ↑ atherothrombosis risk
-Selective COX2 inhibitors (e.g. celecoxib) reduce GI ulcer risk

2nd line: ‘Biological’ therapies
Therapeutic monoclonal antibodies (mAbs) targeting specific molecules
Use if inadequate disease control after trying 2 NSAIDs
Anti-TNF-alpha (e.g. adalimumab, certolizumab, infliximab, golimumab)
Anti-IL17 (e.g. secukinumab)

Aneesha Flashcards BRS 2 (47 decks)

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