Clin med back

Question 1

Emergency
compression of lumbar roots

p/w saddle anesthesia, urine retention, fecal incontinence, sexual dysfunction

Name condition, diagnostic, mgmt:

Answer 1

Cauda equina syndrome

CT myelogram, MRI w/ contrast

Dexamethasone

Question 2

MC myelopathy in elderly

progressive spondylosis c spurs, herniation, lig. hypertrophy

pain in neck, radiate to arms

gait disturbance

weakness, sonsory deficit

Name condition, diagnostic, mgmt:

Answer 2

cervical spinal stenosis

AP, Lat xray
MRI
CT myelogram
EMG/NCS

Tx: 
Nsaids
bracing
epidural
PT

Question 3

MC cause of spondylosis

MC cause of neuro pain in elderly

neuro claudication

relief laying supine or leaning forward.

radicular sx, no LBP

Name condition, diagnostic, mgmt:

Answer 3

lumbar spinal stenosis

PE: wide gate, diminished DTRs

Imaging:
AP, Lat X Ray
MRI
CT Myelogram
EMG/NCS

MGMT:
nsaids, bracing, epidural, PT

Question 4

acute LBP c radicular pain

radiation to foot, or anterior thigh

relief laying supine c elevated knees

Name condition, diagnostic, mgmt:

Answer 4

lumbar radiculopathy

PE: gait evaluation r/o myelopathy
+ straight leg raise or reverse straight leg raise
LBP and spasm

MGMT:
nsaids, CS, PT

epidural

surgery if myelopathy

Question 5

abrupt onset of neck pain, worse over time

follows dermatome

radiate to upper extremity

Answer 5

cervical radiculopathy

MRI if sx > 4 weeks
Gait evaluation
decreased ROM
loss of cervical lordosis

MGMT:
Nsaids, CS, PT

epidural

surgery if myelopathy

Question 6

pain radiating to shoulders, occurs c ROM

occipital HA

defect of pars interarticularis 2ry facet arthritis

Answer 6

cervical spondylolisthesis

lateral, oblique cervical radiograph

refer to orthospine/neurosurg

Question 7

LBP radiating to buttocks

relief of pain c laying down, aggravated by bending

caused by osteoarthritis

Answer 7

lumbar spondylosis

AP, Lat x ray for disc narrowing, osteophyts

NSAIDs, PT

Question 8

osteoarthritis of spine, +/- other arthropathy

decreased cervical ROM

> 3 mo neck pain

worse c upright standing

Answer 8

cervical spondylosis

+spurling test
AP, Lat cervical x ray
MRI s contrast

nsaids, PT, surgery

Question 9

LBP radiating to buttocks

hx of lifting, twisting c acute onset

difficulty standing erect

Answer 9

lumbar sprain/strain

PE: TTP low back, SI
limited flexion, +/- spasm
normal NV exam

rest, NSAIDs, PT, trigger point

Question 10

Sx: dermatomal pattern
hypotonia, reflexia
weakness, loss of sensation
atrophy, fasciculation

Causes:
foraminal narrowing, herniation, spondylosis, lig hypertrophy

Answer 10

radiculopathy

Question 11

sx: weakness, loss of sensation
spacisity
hyperreflexia
\+ babinski
\+ lhermitte

causes:
compression of spinal cord
spinal stenosis

Answer 11

myelopathy