Clin Med- Low Back I

Question 1

Spinal malignancy is multiple _________

Answer 1

myeloma

Question 2

Spinal malignancy is a primary malignant tumor in the _______ ________
This is typically in ________ individuals

Answer 2

bone marrow; older

Question 3

Spinal malignancy:

________ metastases is secondary and is the _____ MOST common serious spinal pathology

Answer 3

Spinal; 2nd

Question 4

What are the most common tumors of the spine?

Answer 4

Spinal Mestastases

Question 5

Spinal metastases is MOST often from __________, __________, prostate, _______, GI, and thyroid

Answer 5

breast; lung; kidney

Question 6

__________ is the 3rd MOST common area of metastasis, behind lung and liver

Answer 6

bone

Question 7

With bone metastasis, the ______ ______ is the MOST common structure involved and typically in the _______ portion… this leads to wedging (disc rarely involved)

Answer 7

vertebral body; anterior

Question 8

With spinal malignancy, the _________ region is the MOST area involved (70%)

Answer 8

thoracic

Question 9

With spinal malignancy, _____% created cord compression or myelopathy

Answer 9

20

Question 10

With spinal malignancy risk factor:

97% of spinal tumors are the result of metastases, this means that _______ of _______ is the MOST useful indicator

Answer 10

PMH; cancer

Question 11

With spinal malignancy, _______ bone is replaced by _______

Answer 11

healthy; tumor

Question 12

Which imaging is the GOLD standard for spinal malignancy?

Answer 12

MRI

Question 13

What should you mainly ask in the subjective self/family Hx for ANY patient?

Answer 13

Hx of cancer

Question 14

Cancer S&S the pain is _______ and ________

Answer 14

local; referred

Question 15

With cancer, it worsens as the tumor grows and enroaches on other ________ with more ________

Answer 15

tissue; inflammation

Question 16

With cancer S&S, if someone wakes up at the same time every night it is due to what usually?

Answer 16

metabolic activity

Question 17

As cancer worsens, it is often invariable with ______ or movement and may become constant

Answer 17

position

Question 18

Additional cancer S&S?

Answer 18

N&V

Loss of appetite

unexplained weight loss ≥ 5-10% over a 3-6 month period

fever, chills, night sweats

swollen, non-tender lymph nodes

unusual malaise and fatigue

secondary infections (lowered immunity)

Question 19

What S&S would likely be present due to the involvement of vertebral body? NOT spinal cord yet….

_____ segmental

______ S&S

_____ P!

______reflexive

Answer 19

multi

UMN

Spinal

Hyper

Question 20

With spinal malignancy, the MOST common initial symptom is?

Answer 20

spinal P!

Question 21

With spinal malignancy, there is a ________ and ______ P! that may become progressive and constant

Answer 21

unfamiliar; severe

Question 22

With spinal maligancy, there could be possible bony alterations including ___ and subsequent ______ instability

Answer 22

fxs; joint

Question 23

With spinal malignancy, thay be unable to lie ______ due to P!

Answer 23

flat

Question 24

With spinal malignancy, there will most likely be __________ P! with scan and biomechanical exam components that stress the ______ ________ and lumabr will possibly be +

Answer 24

mechanical; verterbal body

Question 25

With spinal malignancy, there will be a _______ referral to MD unless cord S&S you would want to immobilize for _________ referral

Answer 25

urgent; emergency

Question 26

_______ myelopathy is slow, gradual, and often progressive compression of the cord

Answer 26

Lumbar

Question 27

What level does the spinal cord end?

Answer 27

L1-L2

Question 28

The ______ region is the 2nd MOST common area of spine for compression

Answer 28

lumbar

Question 29

Lumbar myelopathy is ______ due to trauma

Answer 29

NOT

Question 30

What is lumbar myelopathy MOST commonly due to _________ spinal changes

Answer 30

degenerative

Question 31

With lumbar myelopathy and degenerative spinal changes, it has: Lax and buckling _______ ________ Age-related joint _________ with enlarging and enroaching ______ bone aka stenosis Age-related _______ disease with _________ ______ ______ collapse Pathalgical __________ such as spondylolithesis

Answer 31

Ligamentum Flavum disease; athritic disc; herniations vertebral body instability

Question 32

With lumbar myelopathy and malignancy, 20% of the time only well validated RED flag being hx of _________

Answer 32

cancer

Question 33

With lumbar myelopathy, there is rare ______ disc herniation

Answer 33

disc

Question 34

With observation of lumbar myelopathy, it is NOT _____ and NOT likely to ______

Answer 34

acute; splint

Question 35

With lumbar myelopathy and A/PROM- there will be extreme ______ pain with _________ reproduction with scan and biomechanical exam

Answer 35

spinal; mechanical

Question 36

With lumbar myelopathy, A/PROM- there will be extreme spinal pain with mechanical reproduction with scan and biomechanical exam, possibly for: _____-_______ changes _______ body Instability

Answer 36

age-related vertebral

Question 37

With lumbar myelopathy, _____ stress tests will be positive possibly or ______ symptoms

Answer 37

PA; neuro

Question 38

With lumbar myelopathy: DTRs ______reflexive _______ myotomes _______ bowel and bladder Clonus and Babinski ________ Dural mobility _____ Superficial reflexes _______active

Answer 38

hyper fatiguing spastic/retentive + - hypo

Question 39

With lumbar myelopathy, it is a. _______ referral

Answer 39

urgent

Question 40

With lumbar myelopathy, there will be _____ segmental numbness and ______/paralysis of lower extremities and trunk below level of injury likely leading to impaired balance

Answer 40

multi; weakness

Question 41

________ _________ syndrome is compression on some degree of the 20 spinal nn. that originate from the end of spinal cord or conus medularris in the vertebral canal

Answer 41

Cauda Equina

Question 42

Cauda Equina syndrome is ______ or _____ and below what segment?

Answer 42

acute; chronic; L1-L2

Question 43

Cauda Equina syndrome is ____ with 2% of lumbar age-related ____ changes

Answer 43

rare; disc

Question 44

Cauda Equina syndrome is PRIMARILY due to ____ to ______ lumbar age-related disc changes

Answer 44

mid; lower

Question 45

Cauda Equina syndrome is SECONDARILY due to other _______ spinal changes and ________

Answer 45

degenerative; malignancy

Question 46

What are the risk factors for Cauda Equina syndrome? Mid to lower lumbar - _______ IDD, central> postlat IDD - ________ stenosis - surgery - < ______ years - Obesity

Answer 46

Persistent central 50

Question 47

Cauda Equina syndrome clinical manifestations S&S Hx including (LMN): ____ _____ P! Bowel and blader _________ _________ dysfunction Possible _____ S&S if malignancy contributing

Answer 47

Low back incontinence sexual cancer

Question 48

With Cauda Equina syndrome, limited and worse with _____ and better with ______ activities

Answer 48

EXT; FLX

Question 49

With Cauda Equina syndrome, there are progressive or even alternating LE/_______ findings due to movement of ______ ______

Answer 49

patchy; spinal nerves

Question 50

With Cauda Equina syndrome, there are paresthesia's and decreased sensation in multiple dermatomes in what areas?

Answer 50

saddle or groin area

Question 51

With Cauda Equina syndrome, there a multiple ______ weaknesses and _____ abnormality

Answer 51

myotomial; gait

Question 52

With Cauda Equina syndrome, there are ______active DTRs

Answer 52

hypo

Question 53

Is dural moblity + for cauda equina syndrome?

Answer 53

yes

Question 54

What kind of referral is Cauda Equina syndrome?

Answer 54

emergency

Question 55

What imaging is the GOLD standard for Cauda Equina syndrome?

Answer 55

MRI

Question 56

______ __________ is the infectious disease of spinal structures

Answer 56

spinal infections

Question 57

Osteomyelitis is associated with _______ infections nad affects the ______

Answer 57

spinal; bone

Question 58

Discitis means what?

Answer 58

disc infection

Question 59

Spinal infections is uncommon in ________ countires but resurgence with longevity and IV drug use

Answer 59

wealthier

Question 60

Discitis is more common in ______ spine

Answer 60

lumbar

Question 61

Spinal infections etiology: Primarily from _____ _______ bacteria What is the secondary?

Answer 61

air born staph bacteria

Question 62

What are risk factors for spinal infection?: ________ suppression _________ particularly of the spine and repeated procedures _____ drug use ________ depravation Hx of _____ or other recent infections

Answer 62

Immuno Surgery TB

Question 63

With spinal infection, it may take days, _____ or ______ to spread to the spine

Answer 63

months years

Question 64

With spinal infections, it spreads to the disc MORE commonly in the ______ spine

Answer 64

lumbar

Question 65

With spinal infection, it is NOT common but as abscess grows the following may occur: ____ ______ irritation _______ ______ collapse/fx ______ compressionmay develop

Answer 65

nere root vertebral body cord

Question 66

What is the MOST common presenting symptom for spinal infection?

Answer 66

age-related changes with back P!/stiffness

Question 67

With spinal infections, there are __________ and ________ symptoms NOT common initially

Answer 67

constitutional; infection

Question 68

What are the infection S&S? _______ (MOST common early symptom) Fever, _____, ______ N&V Enlarged and likely ________ lymph nodes _________ (maybe lymphangitis or streaks toward lymph nodes) abcess, _____, and or swelling

Answer 68

Malaise chills; sweats tender Redness; heat

Question 69

Spinal infection is usually ______ and ______ spinal P! that limits motion

Answer 69

localized; progressive

Question 70

With spinal infections, it is likely _______ pain for disc > ______ _______ involvement with scan and biomechanical exam

Answer 70

mechanical; vertebral body

Question 71

Spinal infection, infection S&S particuraly they would experience ______ fatigue and have a _____ since onset of back P!

Answer 71

abnormal; fever

Question 72

If spinal infection is left untreated, it could lead to: ______ weight loss of ≥ 5-10% over a 3-6 month period with loss of appetite _______ S&S influence LE and coordination as well with bowel and bladder ________ Loss of lumbar ______

Answer 72

unexplained neurological; dysfunction lordosis

Question 73

Spinal infection is a _______ referral unless cord or Cauda equina S&S then _______ referral to MD

Answer 73

urgent; emergency