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Unit 10 > Biomedical Sciences > Flashcards

Biomedical Sciences Flashcards

1
Q

How long does it generally take LBP to resolve on its own?

A

4 weeks

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2
Q

What is the main job of a PT treating LBP?

A

Prevent the transition from acute to chronic pain and the associated disability

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3
Q

Is LBP more prevalent in males or females?

A

Females

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4
Q

What age group has the highest prevalence of LBP?

A

60-69

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5
Q

What are some characteristics that predict which patients become chronic in terms of LBP?

A

Maladaptive pain coping, waddell signs, high functional impairment, poor general health, psychiatric comorbidities

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6
Q

What are Waddell signs?

A

Superficial or nonanatomic tenderness, regional weakness or sensory change, overreaction, pain on axial loading or simulated rotation, non-reproducible pain when pt is distracted

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7
Q

What is a good way to test whether pain is non-reproducible when the pt is distracted?

A

Tell them you’re testing knee strength and then ask them to do an SLR. If they don’t lean back or have tons of pain then this is positive

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8
Q

What is cogwheeling?

A

Resistance then catch, resistance then catch. It is very hard to fake weakness without doing this

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9
Q

Define fear avoidance

A

Purposefully avoiding certain activities because you’re fearful they’ll exacerbate or bring on pain

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10
Q

What are the most important predictors of future cost for a patient with LBP?

A

Severity and depression

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11
Q

If a patient takes a year off work to deal with their LBP, what are the chances they will go back?

A

Less than 25%

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12
Q

How do brief and multidisciplinary approaches to LBP rehab compare in patients with either influence on work planning and no risk of job loss vs patients with no influence and risk of job loss?

A

Pts with influence over work and no risk of job loss do just as well with brief intervention as multidisciplinary. For patients with no influence and risk of job loss they do much better with multidisciplinary

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13
Q

What is the pathoanatomic model?

A

The more pathology you have the more symptoms you will have

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14
Q

How does exercise affect pathology and symptoms in patients with LBP?

A

Exercise dampens symptoms for a given level of pathology. For patients with no symptoms, exercise makes you more resistant to pathology

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15
Q

What type of LBP is the closest to having a 1:1 relationship between pathology and symptoms?

A

Acute trauma

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16
Q

Why doesn’t the pathology model work well for LBP?

A

Psycho-social factors, inflammatory markers, complex relationship between pain, disability, and physical impairment

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17
Q

What are some imaging findings that are often asymptomatic?

A

Herniated discs, bulging discs, degenerative discs, stenosis, annular tear

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18
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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19
Q

What are the dimensions of pain?

A

Sensory and affective

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20
Q

What is a mechanical diagnosis for a patient with LBP based on?

A

Symptomatic response to mechanical forces, clusters of signs and symptoms

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21
Q

Why is it important that we create a relevant classification system for LBP?

A

Currently a single form of treatment is applied to all varieties of non-specific LBP. This yields a non-optimal response

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22
Q

Why does LBP present a significant challenge for meaningful research?

A

Fails to account for existence of potential subgroups of pts, change in pt classification during EOC, and co-interventions

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23
Q

How is chronic LBP defined?

A

> 6 mo

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24
Q

What are some “red flags” that lead to specific LBP?

A

Spinal fractures, cancer, infection, ankylosing spondylitis, cauda equina, other illness

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25
What are the 3 broad categories of back pain?
Non-specific, specific, LBP with spinal stenosis or radiculopathy
26
What is radiculopathy and how will pt present?
Problem with the nerve root. Will have pain into extremity and neurologic compromise (generally hyporeflexia)
27
What is the general patient presentation for an individual with ankylosing spondylitis?
Younger, arm stiffness, alternating buttock sxs, awake due to sxs, better with exercise
28
What LR indicates no change in the likelihood of a disease?
1
29
What does a LR of 0.09 indicate?
Large and often conclusive decrease in likelihood of disease
30
What does a LR of >10 indicate?
Large and often conclusive increase in likelihood of a disease
31
How should a low risk LBP patient be treated?
Advice, reassurance, medication (NSAIDs, tylenol)
32
How should a medium risk LBP patient be treated?
PT
33
How should a high risk LBP patient be treated?
Enhanced package of care including PT + counseling
34
What is the Keele STarT back screening tool?
Puts patients into risk categories to help direct management of LBP
35
Briefly describe the items on the Keele STarT back screening tool
first 4 relate to physical impairments, last 4 are psychological (fear, anxiety, catastrophizing, depression)
36
What are the PT approaches to LBP classification?
McKenzie method, treatment based classification, others
37
What does McKenzie think are the main predisposing factors for LBP?
Poor sitting posture, frequency of flexion in ADLs
38
What type of LBP patients are PTs most effective for?
Medium to high psycho-social risk status, or low psycho-social risk status with predominantly leg pain
39
What types of interventions would you do for a high irritability LBP patient?
Directional preference exercise, mobs, traction, active rest
40
What types of interventions would you do for a moderate irritability LBP patient?
Sensorimotor, stabilization, flexibility
41
What are some common LBP outcome scales?
Oswestry and Roland-Morris
42
Briefly describe the Oswestry
Self-report scale of 10 categories of functional tasks scored 0-5 for a max pos score of 50 (higher score = more disabled)
43
What Oswestry score makes a pt considered high disability
>40
44
What are yellow flags?
Things about the person that might be an obstacle to recovery
45
What are blue flags?
Things about work that might be an obstacle to recovery
46
What are black flags?
Things about the context that might be an obstacle to recovery
47
If you are exhibiting passive coping strategies, what is your locus of control?
External
48
What are some things to look for as a follow-up to the depression screen?
Sig weight change, sleeping habits, fatigue, difficulty concentrating, thoughts of suicide
49
What questions make up the depression screen?
Over the past 2 weeks have you felt down, depressed, or hopeless? Over the past 2 weeks have you felt little interest or pleasure in doing things?
50
What is the LR of the depression screen
good negative (smoke detector - good at ruling out)
51
What are Waddell's signs?
Tenderness, simulation tests (axial loading, rotation), distraction test, regional disturbances (weakness, sensory), overreaction
52
How many of Waddell's signs are you looking for to be positive?
3/5
53
According to the fear avoidance model, what are the types of response to pain
Adaptive (confrontation) and non-adaptive (avoidance)
54
What are the subscales of the FABQ (fear avoidance questionnaire)?
Physical activity and work
55
How might we modify patient education for a pt who has fear avoidance tenancies?
Unambiguous education so that pt views pain as a common condition rather than a serious disease
56
What are some approaches to patient education for a pt who has fear avoidance tendencies?
Pain neuroscience education, motivational interviewing
57
What is the central message of pain neuroscience education?
Pain does not equal harm
58
What is the goal of motivational interviewing?
Elicit and strengthen motivation for change
59
What are the 4 tenants of motivational interviewing?
Acceptance collaboration, evocation/understanding, partnership
60
What are the 3 different communication styles in motivational interviewing?
Directing, guiding, following
61
When might one use a directing or following style of communication?
Directing - ER | Following - palliative care
62
What are the stages of a conversation according to motivational interviewing?
Open ended questions, affirmations, reflections, summary
63
Is it more effective to respond to a reflective statement with a question or a statement?
Statement
64
What are the graded exercise principles?
Reward patient for meeting exercise goal, no reward for limitation due to pain, exercise progression based on meeting quota, focus on behavior and achievement rather than sxs
65
What is graded exposure?
Gradual exposure to specific activities that produce fear
66
What type of patients do best following the back book? (graded exercise based on quota)
People who have high fear avoidance (acute LBP)
67
With respect to disability, which patient stratification did best when receiving stratified care
High-risk patients
68
How much of the variance in pain-related disability does pain explain?
10%
69
List 4 disability-related psychosocial risk factors?
Catastrophizing, injustice, beliefs/expectations, fear
70
What are some solutions to catastrophizing?
Education, disclosure, activity participation
71
What are some solutions to fear?
Graded exposure, pre-determined activity involvement
72
What are some solutions for disability beliefs?
Engage pts in behavior that is inconsistent with their beliefs
73
What are some solutions for perceived injustice?
Validation of distress, empathetic reflection, increase awareness of negative consequences of behavior motivated by anger
74
What portion of the vertebrae are we pressing on when we do PA pressures? What about cross hand technique?
PA - spinous process | Cross-hand - articular pillars
75
How much flexion/extension do we get in the L-spine per motion segment?
10-15 degrees
76
Why do we often use rotation for manipulation maneuvers in L-spine
Very little rotation ROM so it's easy to tighten up quickly
77
How are loads distributed in an IV disc?
Evenly. Converted from compression --> tensile stress
78
What portion of the IV disc is resistant to tension?
Annulus
79
How is collagen oriented in the annular layers?
Lamellar fashion obliquely and perpendicularly
80
What is the consequence of lamellar oblique/perpendicular orientation of the collagen fibers in the annulus?
Resists tension well, only half the fibers are resisting a stress at a given time
81
What are the functions of an IV disc?
Load transfer, motion, stabilizer, spacer
82
What portion of the IV disc functions like a stabilzer?
Annulus (like short, thick, ligament)
83
What portion of the disc allows motion at a segment?
Nucleus
84
Why does the spacer function of the disc contribute to stability?
Puts other tissues of the segment on tension
85
What changes does the IV disc undergo with aging?
Less water (GAGs), nucleus less distinct, less stiff, increased creep response
86
What is the first thing that occurs as IV discs start to degenerate?
Loss of proteoglycans
87
How does an IV disc get nourishment?
Intermittent pressure
88
What are some positions that generate very low IV disc pressure?
Supine, side lying, hook lying
89
What are some positions/activities that generate very high IV disc pressure?
Slumped sitting, flexion in standing
90
What are the phases of degeneration of a disc?
Dysfunction - disc injury, biochemical changes, inflammatory changes Instability - disc thinning, laxity of spinal lig Restablization - fibrosis and osteophyte formation
91
What are some examples of degenerative disc conditions?
DDD, spondylosis, spondylolysis, spondylolisthesis, spinal stenosis
92
In spondylolysis diagnosis, you look for the scotty dog sign on an xray. What portiosn of the vertebrae make up the portions of the dog?
Ear - superior facet Head - transverse process Paw - inferior facet
93
What view is best for viewing scotty dog?
Oblique
94
Define anterolosthesis and retrololisthesis
Antero - top disc slips forward | Retro-top disc slips back
95
What motions should you avoid with a patient who has spondylolisthesis?
Extension, end range flexion (emphasize stabilization)
96
Compare and contrast central and lateral lumbar spinal stenosis
Central - around nerve roots of cauda equina | Lateral - around spinal nerve
97
What type of exercise program is given to spinal stenosis patients?
Flexion-based stabilization program
98
Why is extension detrimental for stenosis patients?
Degenerated discs and thickened ligamentum flavum protrude posteriorly into lumbar canal causing compression of cauda equina
99
What is the most common age range to get LBP during?
30-60
100
What are some ways that muscles can generate pain?
Strain, myofascial pain, spasms
101
What are some ways that vertebrae can generate pain?
Fractures, trauma, osteoporosis, tumors
102
What are some ways that facet joints can generate pain?
Arthritis, bone spurs
103
What are some ways that IV discs can generate pain?
Herniation, tears/rupture
104
What is the mechanism for whiplash
Hit from behind, neck goes into extreme extension and then snaps forward
105
What are some things that can cause LBP?
Advanced age leading to arthritis, falls, auto accidents, poor mechanics/posture, high impact sports, poor nutrition, obesity, and pregnancy, smoking
106
Why does obesity or pregnancy often cause LBP?
Leads to increased lordotic curve on the spine
107
Why do smokers have a hard time healing from back injury?
Affects blood flow to the spine leading to delayed healing
108
What are some side effects of anti-inflammatory medications
Upset stomach, risk for patients with ulcers and kidney problems
109
What are some side effects of muscle relaxants?
Drowsiness
110
What are some side effects of medication used for nerve pain?
Drowsiness, swelling in legs, dry mouth
111
What are some side effects of pain medications?
Tolerance, addiction, abuse potential, street value
112
What are some elements of a comprehensive pain program?
Urine testing, PT, acupuncture, massage therapy, mind-body therapies, nutritional support, natural medicines, trigger point therapy, psychotherapy
113
What is MRI good for visualizing?
Organs, soft tissues, bone, disc, ligaments, and nerves
114
When might a patient receive nerve conduction studies/EMG?
If they have radiating pain
115
What are some ways to treat muscle strain, spasms, and myofascial pain?
Antiinflammatories, muscle relaxants, PT
116
What are trigger point injections?
Local injections of anesthetic and sometoimes steroid into the muscle
117
What types of medications are generally used to treat compression fractures?
Narcotics
118
What types of PT exercise will patients with compression fractures generally be given?
Extension-based
119
What type of imaging do we use to tell the age of a fracture?
MRI (cell turnover will appear bright)
120
What are kyphoplasty and vertebroplasty procedures?
Introduce cement into bone via needle to treat compression fractures
121
How are facet joint strains and arthritis treated?
Antiinflammatories, facet joint injection (block medial branch), ablation,
122
What types of patients generally receive ablation?
>60yo since facet joints are susceptible to arthritic change
123
How are SI joint strains and arthritis generally treated?
Antiinflammatories, PT SI joint injections
124
How are disc herniations and spinal stenosis generally treated?
Antiinflammatories, nerve medications, pain medications, PT with traction, epidural steroid injection
125
What are the different approaches for epidural steroid injection?
Interlaminar approach, transforaminal, caudal approach
126
What is the transformainal approach for epidural steroid injections?
Follow nerve root into the transverse foramen (coming in from side)
127
Compare and contrast transforaminal, caudal, and interlaminar approaches for epidural steroid injections
Transforaminal is most precise, interlaminar a little less, caudal is shotgun approach but useful if someone has had a laminectomy
128
What are the benefits to steroid injection over oral streroids?
Concentration of steroid delivered to pathology site is proportional to effectiveness, injected steroid isn't dependent on local blood flow which is compromised with compressive lesions

Unit 10 (7 decks)

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