BACKPAIN

Question 1

The posterior parts of the vertebrae articulate with
one another at the diarthrodial facet join ts also called
____________

Answer 1

apophysial or zygapophysial joints),

Question 2

The stability of the spine depends on the integrity

of the ________

Answer 2

vertebral bodies, pedicles and intervertebral discs
and on two types of supporting structures, ligamentous
(passive) and muscular (active)

Question 3

The vertebral and paravertebral structures derive
their innervation from the ________________ (also known as recurrent meningeal or
sinuvertebral nerves).

Answer 3

meningeal branches of the

spinal nerves

Question 4

The __________ is a common
site of entrapment of the traversing root by posterolaterally
herniated disc material and bony overgrowth

Answer 4

lateral recess

Question 5

Deposition of________ and alterations of glycosarninoglycans combine
to decrease the water content of the nucleus pulposus;
concomitantly, the cartilaginous endplate becomes less
vascular

Answer 5

collagen and

elastin

Question 6

increasing frequency of lumbar disc degeneration

and bulging, approaching 70 percent by the________

Answer 6

fiftieth year.

Question 7

Four types of BACK pain may be distinguished:

Answer 7

local, referred,
radicular, and that arising from secondary muscular
spasm.

Question 8

________ is caused by any pathologic process that
impinges on structures containing sensory endings,
including the periosteum of the vertebral body, capsule
of apophysial joints, annulus fibrosus, and ligaments.

Answer 8

Local pain

Question 9

Referred pain in reference to the spine is of two types:
one that is projected from the __________and other
structures lying within the territory of the lumbar and
upper sacral dermatomes, and another that is projected
from ________ to the spine.

Answer 9

spine to viscera

pelvic and abdontinal viscera

Question 10

Pain
caused by disease of the upper part of the lumbar spine
may be referred to the ________.

This has been
attributed to irritation of the_________
which are derived from the posterior divisions of the first three lumbar spinal nerves and innervate the superior portions of the buttocks.

Answer 10

medial flank, lateral hip, groin, and
anterior thigh

superior cluneal nerves,

Question 11

Pain from the lower part of the
lumbar spine is usually referred to the lower buttocks
and posterior thighs and is a result of irritation of lower
___________which activate the same pool of intraspinal neurons as the nerves that innervate the posterior thighs

Answer 11

spinal nerves,

Question 12

The mechanism is stretching, irritation,
or compression of a spinal root within or central
to the intervertebral foramen

Answer 12

RADICULAR

Question 13

Any maneuver that stretches the nerve roote.

g., ___________

Answer 13

“straight-leg raising” in cases of sciatica-evokes

radicular pain.

Question 14

pain thitt originates in the
buttock and is projected along the posterior or posterolateral
thigh. It results from irritation of the L5 or Sl nerve root

Answer 14

SCIATICA

Question 15

In patients with severe circumferential constriction of
the ________ because of spondylosis ( lumbar stenosis),
sensorimotor impairment and referred pain are elicited
by standing and walking

Answer 15

cauda equina

Question 16

Pain resu lting
from ________ usually occurs in relation to local
spinal irritation and may be thought of as a nocifensive
reflex for the protection of the diseased parts against
injurious motion.

Answer 16

m uscular spasm

Question 17

A sagging gluteal fold suggests involvement of the

_____

Answer 17

Sl root.

Question 18

Lateral bending is usually less revealing than forward
bending but, in ______________bending to the opposite side aggravates the
pain by stretching the damaged tissues

Answer 18

unilateral ligamentous or muscular

strain,

Question 19

With ________
passive lumbar flexion causes little pain and is not
limited as long as the hamstrings are relaxed

Answer 19

umbosacral disc lesions and sciatica,

Question 20

with the knees
flexed to 90 degrees, sitting up from the reclining position
is unimpeded and not painful; with knees extended,
there is pain and limited motion ________

Answer 20

(Kraus-Weber test)

Question 21

Among the most helpful signs in detecting nerve
root compression is __________ (possible up to almost 90 degrees in normal individuals) with the
patient supine.

Answer 21

passive straight-leg raising

Question 22

diseased. Straight raising of the opposite leg
(“crossed straight-leg raising,” Fajersztajn sign) may
cause sciatica on the opposite side and is a more specific sign of _________ than is the Lasegue sign

Answer 22

prolapsed disc

Question 23

Asking
the seated patient to extend the leg so that the sole of the
foot can be inspected is a way of checking for a _______

Answer 23

feigned

Lasegue sign.

Question 24

Maneuvers in the lateral decubitus position yield less

information but are useful in eliciting ________

Answer 24

joint disease.

Question 25

In cases of _________, abduction of the upside leg against resistance reproduces pain in the sacroiliac region, sometimes with radiation of the pain to the buttock, posterior thigh, and symphysis pubis

Answer 25

sacroiliac joint disease

Question 26

A helpful indicator of hip disease is the ___________: with the patient supine, the heel of the offending leg is placed on the opposite knee, and pain is evoked by depressing the flexed leg and externally rotating the hip.

Answer 26

Patrick test

Question 27

T2-weighted MRI performed with elimination of the hyperintense signal of fat __________allows inflammation and edema to be visualized in the bone marrow and paravertebral soft tissues that normally contain fat

Answer 27

("fat suppression", i.e., the short Tl inversion recovery or | "STIR" sequence),

Question 28

A common anomaly is fusion of the fifth lumbar vertebral body to the sacrum__________or, conversely, separation of the first sacral segment, giving rise to 6, rather than the usual 5 lumbar vertebrae _________

Answer 28

("sacralization") | "lumbarization"

Question 29

_________ consists of a congenital and probably genetic bony defect in the pars interarticularis (the segment at the junction of pedicle and lamina) of the lower lumbar vertebrae

Answer 29

Spondylolysis

Question 30

These constitute b y far the most frequent causes o f low | back pain

Answer 30

tra u m at i c D i s o rd e rs of t h e Low B a c k

Question 31

The term __________ may be preferable for minor, self-limiting injuries that are usually associated with lifting heavy loads when the back is in a mechanically disadvantaged position, or there may have been a fall, prolonged uncomfortable postures such as in air travel or car rides, or sudden unexpected motion, as may occur in an auto accident.

Answer 31

acute low back strain

Question 32

__________ is the most likely diagnosis when there is tenderness over the sacroiliac joint and pain radiating to the buttock and posterior thigh, but this always needs to be distinguished from the sciatica of a herniated intervertebral disc

Answer 32

Sacroiliac joint and ligamentous strain

Question 33

Recurrent attacks are typical of ________ that affects the vertebrae and facet joints

Answer 33

degenerative | spine disease

Question 34

A fractured transverse process, which is almost always associated with________ of the spine and causes tearing of the paravertebral muscles and a local hematoma, produces deep tenderness at the site of the injury

Answer 34

high-impact rotary injury

Question 35

In some circumstances, tears of the paravertebral musculature may be associated with extensive bleeding into the retroperitoneal space. There may be a delayed subcutaneous hematoma in the flanks __________

Answer 35

(Grey-Turner sign

Question 36

These benign tumors characteristically cause severe nocturnal pain located in one region of the parasagittal spine that awakens the patientfrom a peaceful sleep; The typical appearance is a _____________ surrounded by a rim of bony sclerosis

Answer 36

osteoid osteoma well-demarcated lytic lesion

Question 37

TREATMENT OF VERTE BRAL COMPRESSION FRACTURE For the mundane thoracic and lumbar fracture associated with osteoporosis, _________ are usually adequate.

Answer 37

bed rest, and analgesics

Question 38

This condition i s a major cause o f severe and chronic or recurrent low back and leg pain. It occurs mainly during the third and fourth decades of life when the nucleus pulposus is still gelatinous

Answer 38

H e r n i at i o n of L u m b a r I nte rve rte b ra l D i scs

Question 39

in HNP, The disc between the_________ is most often involved, and, with decreasing frequency, that between the fourth and fifth (lA-LS), third and fourth (L3-lA), second and third (L2-L3), and-quite infrequently-the_________

Answer 39

fifth lumbar or first sacral vertebrae (L5-S1 ) ``` first and second (Ll-L2) lumbar vertebrae ```

Question 40

In more severe cases of disc disease, a small piece of the nucleus may be entirely extruded as a "free fragment", sometimes called a___________ and be mobile enough to affect a root at an adjacent level or to give rise to unusual precipitating features of radicular pain

Answer 40

sequestered disc fragment,

Question 41

The fully developed syndrome of the common prolapsed intervertebral lower lumbar disc consists of _____, ________ and________

Answer 41

(1) pain in the sacroiliac region, radiating into the buttock, thigh, and the calf, a symptom broadly termed sciatica; (2) a stiff or unnatural spinal posture; and often (3) some combination of paresthesia, weakness, and reflex impairment.

Question 42

In HNP, The most comfortable position may be lying on the back with legs flexed at the knees and hips and the shoulders raised on pillows to obliterate the _________

Answer 42

lumbar | lordosis.

Question 43

In cases of root compression, pain is also characteristically provoked by pressure along the course of the sciatic nerve at the _____________ (sciatic notch, retrotrochanteric gutter, posterior surface of thigh, and head of the fibula)

Answer 43

classic points of Valleix

Question 44

Many variations of the Lasegue maneuver have been described (with numerous eponyms), the most useful of which is accentuation of the pain by dorsiflexion of the foot ___________ or of the great toe _________

Answer 44

(Bragard sign) (Sicard sign).

Question 45

Lasegue maneuver | with the healthy leg may evoke sciatic pain on the contralateral side), but usually of lesser degree ______

Answer 45

(Fajersztajn | sign)

Question 46

Sciatica may be provoked by forced flexion of the head and neck, coughing, or pressure on both jugular veins, all of which increase intraspinal pressure __________

Answer 46

(Naffziger sign).

Question 47

Lesions of the fifth lumbar root (LS) produce pain in the region of the hip and ___________(to the lateral malleolus), and less often, the dorsal surface of the foot and the first or second and third toes

Answer 47

posterolateral thigh (i.e., sciatica) and, in more than half such cases, lateral calf

Question 48

With lesions of the ____________), the pain is felt in the midgluteal region, mid-posterior part of the thigh, posterior region of the calf to the heel, outer plantar surface of the foot, and fourth and fifth toes

Answer 48

first sacral root S1

Question 49

The less-frequent lesions of the ______________ give rise to pain in the anterior part of the thigh and knee and anteromedial part of the leg (fourth lumbar), with corresponding sensory impairment in these dermatomal distributions

Answer 49

third (L3) and fourth | (L4) lumbar roots

Question 50

Very large __________ may compress the entire cauda equina with a dramatic syndrome that includes intense low back and bilateral sciatic pain, incomplete paraparesis, loss of both ankle jerks, and, most characteristic, varying degrees of urinary retention and incontinence

Answer 50

central disc protrusions

Question 51

In herniated disc, The needle EMG study is abnormal, showing fibrillation potentials in denervated muscles after 1 or 2 weeks, but it may remain normal in ______

Answer 51

10 percent of cases

Question 52

Loss or marked asymmetry of the H reflex is another useful indication of S1 radiculopathy, but this simply corroborates the ______

Answer 52

loss of an Achilles | reflex.

Question 53

types of disc herniation 1. extension of a disc (or discs) beyond the margins of the interspace _________. 2. asymmetrical extension of the disc beyond the margin of the interspace ________ 3. and in only 1 percent was there more extreme extension of the disc _______

Answer 53

(bulging) (protrusion), (extrusion or sequestration).

Question 54

a general constellation of bone, joint and ligamentous changes that narrow the spinal canal and neural foramina

Answer 54

Lu m ba r S p i n a l Ca n a l Ste n osis ( " Lu m b a r Ste n osis" and N e u ro g e n i c C l a u d icati o n )

Question 55

A prominent feature of many cases of the degenerative spinal disorder is displacement and malalignment of one vertebral body in relation to the adjacent one, or ________

Answer 55

spondylolisthesis

Question 56

There is burning leg pain and continuous and complex rhythmic movements of the toes, as the name implies. Symptoms may begin on one side but become bilateral. Lumbar nerve root compression, most often from lumbar stenosis, or other types of peripheral damage underlie most cases.

Answer 56

painful legs-moving toes

Question 57

Atherosclerosis of large and medium-sized arteries often leads to symptoms that are induced by exercise ________ but may also occur at rest ________

Answer 57

(intermittent claudication) | ischemic rest pain

Question 58

If the atherosclerotic narrowing or occlusion implicates the aorta and iliac arteries, it may also cause hip and buttock claudication and impotence in the male __________

Answer 58

(Leriche syndrome).

Question 59

The pain is described as a stiffness that is centered in the affected part of the spine. It is increased initially by movement and is associated with limitation of motion but is often worse on arising in the morning

Answer 59

DOA

Question 60

In contrast to the spinal claudicatory syndrome, ____________ make the pain better in DOA

Answer 60

warming up and progressive mobilization

Question 61

osteoarthritic degeneration of the facet joint gives rise to a focal parasagittal lumbar back pain, with tenderness over the joint but without signs of root compression.

Answer 61

F acet Sy n d ro m e

Question 62

In Facet syndrome, If the diagnosis is established by local injection, pain centers offer radiofrequency ablation of the ______ nerves that innervate the joint as a means of permanent relief

Answer 62

small recurrent | sensory

Question 63

Approximately 95 percent of patients with ankylosing spondylitis are marked by the histocompatibility antigen __________

Answer 63

HLA-B27

Question 64

In advanced stages of AS, a __________ syndrome may complicate ankylosing spondylitis, the result apparently of an inflammatory reaction and proliferation of connective tissue

Answer 64

cauda equina compression

Question 65

A fracture of a vertebral body in an otherwise healthy young or middle-aged person should alert the physician to the possibility of an underlying ______

Answer 65

metastasis

Question 66

Sudden, excruciating midline back pain (le coup de poignard or "the strike of the dagger")-often with rapidly evolving paraparesis, urinary retention, and numbness of the legs-may armounce the occurrence of

Answer 66

intraspinal hemorrhage

Question 67

Diseases of the pancreas are apt to cause pain in the | back, being more to the right of the spine if the_______ is involved and to the left if the _________

Answer 67

head of the pancreas body and tail are implicated

Question 68

may evoke pain in the lower thoracic or lumbar spine with a tendency to radiate to the lower part of the abdomen, groins, anterior thighs, or flank.

Answer 68

Retroperitoneal neoplasms

Question 69

A tumor in the ________ region often produces a urillateral lumbar ache with radiation toward the groin and labia or testicle; there may also be signs of involvement of the upper lumbar 􀂚pinal roo􀅚

Answer 69

iliopsoas

Question 70

Inflammatory diseases and neoplasms of the _______ cause pain that may be felt in the lower abdomen, the midlumbar region, or both.

Answer 70

colon

Question 71

Pain from a lesion in the trariSverse colon or first part of the descending colon may be _______; its level of reference is to the _______

Answer 71

central or left-sided second and third lumbar vertebrae

Question 72

Retroperitoneal appendicitis may have an odd referral of pain to the_______

Answer 72

low flarlk and back.

Question 73

The pain of neoplastic infiltration of______ | may be projected to the low back and is continuous, becoming progressively more severe

Answer 73

pelvic nerve plexuses

Question 74

among the most difficult patients t o manage are those with chronic low back pain who have already had one or more laminectomies and sometimes a fusion without substantial relief

Answer 74

Fa i l ed Back Synd ro m e

Question 75

Pain of brachial plexus origin is experienced in the ______, or in the axilla and around the shoulder; it may be worsened by certain maneuvers and positions of the arm and neck __________

Answer 75

supraclavicular region | extreme rotation

Question 76

Pain localized to the shoulder region, worsened by motion, and associated with tenderness and limitation of movement, especially internal and external rotation and abduction, points to a ______

Answer 76

tendonitis, subacromial bursitis, | or tear of the rotator cuff or labrum of the shoulder joint

Question 77

With a laterally situated disc herniation between the fifth and sixth cervical vertebrae, the symptoms and signs are referred to the___________ The full syndrome is characterized by pain at the trapezius ridge and tip

Answer 77

sixth cervical root

Question 78

Compression of the eighth cervical root at (C7-Tl disc) may mimic _________. The pain is along the medial side of the forearm and the sensory loss is in the distribution of the medial cutaneous nerve of the forearm and of the ulnar nerve in the hand

Answer 78

ulnar nerve palsy

Question 79

The centrally situated disc is often painless, and the cord syndrome may simulate______ and ________. Bilateral hand numbness, paresthesia, or similar altered sensation is common

Answer 79

multiple sclerosis or a | degenerative neurologic disease

Question 80

In the case o f cervical disc with radicular pain, a _________ is sometimes beneficial

Answer 80

closefitting foam collar

Question 81

_________ alone is not recognized as an indication for surgery in cervical spondylosis. sx approach is________

Answer 81

Mild weakness ``` anterior approach (transdiscally), which leaves the posterior elements intact and allows for retained stability of the spine. ```