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Clinical Med - Musculoskeletal > Back & Spine > Flashcards

Back & Spine Flashcards

1
Q

A strain of the back involves the _______ (muscles/ligaments) and a sprain involves the ________ (muscles/ligaments)

A

Muscles

Ligaments

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2
Q

Up to ___ of the population will experience lower back pain

A

70%

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3
Q

Lower back pain is considered acute if the onset is less than __ weeks

A

6 weeks

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4
Q

Why is radiation of pain an important history question when evaluating lower back pain?

A

Sciatica

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5
Q

What systemic (constitutional) symptoms would be ‘red flags’ in the setting of lower back pain?

A

Fever
Chills
Weight Loss

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6
Q

Other than constitutional symptoms….

What are “red flags” associated with lower back pain?

A

Urinary Incontinence
Fecal Incontinence
Neurological Deficits
Unrelenting Pain

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7
Q

Is imaging warranted for diagnosing acute (<6 weeks) lower back pain?

A

No

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8
Q

What are the mainstays of LBP treatment?

A

Rest and modified activity
Physical Therapy (Core strengthening)
NSAIDs (NO Opioids)

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9
Q

_______ is defined as lateral curvature of the spine.

A

Scoliosis

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10
Q

Are teenage females or males more likely to develop scoliosis?

A

Females

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11
Q

What physical Examination findings may alter you to the potential of scoliosis?

A

Off-center head
One hip/shoulder may appear higher
Obvious curvature of the rib cage

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12
Q

What ‘angle’ is measured on an XR with lateral spine curvature?

Between what degrees should a patient be monitored every 4 - 6 months?

A

Cobb’s Angle

Monitor between 10 - 25 degrees

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13
Q

What brace is commonly used in treating scoliosis?

A

Boston Brace

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14
Q

How could scoliosis be managed surgically?

A

Spinal Fusions

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15
Q

What is a medical term for a “slipped disc”?

A

Herniated Nucleus Pulposis (HNP)

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16
Q

What physical examination finding may be present on a patient with HNP?

If this is positive, what nerve roots are likely effected?

A

Straight Leg Raise

L4, L5, S1

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17
Q

What is the diagnostic imaging study of choice when working up HNP?

A

MRI

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18
Q

How can HNP be treated?

A 
Bed Rest
NSAIDs or Prednisone
Muscle Relaxants (Flexeril) 
Narcotics
PT
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19
Q

Steroids can be given by what route to treat HNP?

A

Epidural

20
Q

When would surgical intervention be warranted in treating HNP?

A

Conservative management fails
Severe pain
Neurological deficits

21
Q

______ ______ results from thickening of ligaments and bones in the spine which impinges on nerves and the spinal cord resulting in back pain and numbness.

A

Spinal Stenosis

22
Q

What are THREE examples of spinal stenosis?

A

Central Stenosis
Foraminal Stenosis
Extra-Foraminal Stenosis

23
Q

How would lumbar spinal stenosis present?

A

Dull aching back pain
Numbness (“pins and needles”) in legs, calves, buttocks
Weakness/Loss of balance

24
Q

________ (standing/sitting) exacerbates symptoms in spinal stenosis while ________ (standing/sitting) would relieve the symptoms

A

Standing

Sitting

25
Q

What is the most diagnostic imaging study for working up spinal stenosis?

A

MRI

26
Q

How is mild spinal stenosis manged compared to severe?

A

Mild:

Epidural Injection
PT
NSAIDs
Weight Loss and lifestyle changes

Severe:

Laminectomy +/- Fusion

27
Q

What condition of the lower back is considered a surgical emergency?

A

Cauda Equina Syndrome

28
Q

Where is the most common site of disc herniation that results in Cauda Equina Syndrome?

A

L4-L5

29
Q

A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an “electric shock” radiate down both his posterior legs.

At this point, the presence of what THREE symptoms would arise concern for cauda equina syndrome?

A

Urinary Retention (followed by incontinence)
Fecal Incontinence
Saddle Anesthesia

30
Q

A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an “electric shock” radiate down both his posterior legs. Interestingly, he admits to urinary incontinence on the ride over. On examination, he note decreased rectal sensation and weakness in his lower extremities.

What is the most immediate next step in management of this patient?

A

MRI

31
Q

A 32 y.o. male presents to the ED with complaints of back pain. He noted that about 4 hours ago he was getting up awkwardly from the couch when there was a sudden onset of severe lower back pain. He felt an “electric shock” radiate down both his posterior legs. Interestingly, he admits to urinary incontinence on the ride over. On examination, he note decreased rectal sensation and weakness in his lower extremities. MRI confirms cauda equina syndrome?

How does this patient need to be managed?

A

Surgically! (Laminectomy)

Immediately within 24 hours

32
Q

If surgical intervention does not occur in cauda equina syndrome, what permanent deficit may the patient have?

A

Bladder and Bowel Incontinence

33
Q

Where is the most common site of spondylolysis?

Where is the most symptomatic site of spondylolysis?

A

Common: L5

Symptomatic: L4

34
Q

What is the most common cause of spondylolysis?

A

Overuse (Hyperextension)

35
Q

On XR, how is spondylolysis described?

A

“Scottie Dog with a collar”

36
Q

Other than XR, how is spondylolysis diagnosed?

A

SPECT Scans

37
Q

What imaging modality can be used to classify spondylolysis?

A

CT

38
Q

Focal bone absorption with a hairline deficit would be considered _______ spondylolysis

A

Early

39
Q

Wide defect with small fragments present would be considered _______ spondylolysis

A

Progressive

40
Q

The presence of sclerotic changes would be considered _______ spondylolysis

A

Terminal

41
Q

___________ is the anterior or posterior translation of one vertebral body over another

A

Spondylolisthesis

42
Q

What imaging modality is used to diagnosis Spondylolisthesis?

A

XR

43
Q

T/F: 90% of Ankylosing Spondylitis patients will express the HLA-B27 gene

A

True

44
Q

Which NSAID is the “drug of choice” for treating ankylosing Spondylitis?

A

Indomethacin

45
Q

Which DMARD can be used in ankylosing spondylitis?

A

Sulfasalazine

46
Q

Hyperkyphosis may also be referred to as what?

A

“Dowager’s Hump”

47
Q

Are vertebral fractures common in kyphotic patients?

A

Yes

Clinical Med - Musculoskeletal (6 decks)

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