Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine II > disorders of the spine > Flashcards

disorders of the spine Flashcards

1
Q

three most common reason people visit their pcp

A

skin
joint
back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MC cause of back pain

A

mechanical

lumbar strain 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ddx for back pain

A 
"	Degenerative disk disease
"	Spinal stenosis
"	Disk herniation
"	Spondylolisthesis
"	Compression fracture
"	Severe deformity (scoliosis, kyphosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Visceral or Non-Mechanical ddx for back pain

A 
"	Neoplasm
"	Infection (diskitis, osteomyelitis)
"	Ankylosing spondylitis
"	Paget's disease
"	Prostatitis
"	Dissecting aortic aneurysm
"	Pancreatitis
"	Cholecystitis
"	Gastric ulcer
"	Nephrolithiasis
"	PID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

most common etiologies of back pain

A

Muscle strain
Degenerative disk disease
Fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

etiology of back pain that is self limiting, often associated with heavy lifting or sudden deceleration injuries; pain usually non-radiating

A

Muscle strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what does degenerative disk disease look like

A

develops slowly over time but acute event triggers disk rupture, tear, or herniation resulting discogenic back pain, may also have sciatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fxs associated with back pain

A

most result from compression or flexion injuries and consist of anterior wedging; more severe injury may cause a “burst” fracture with involvement of vertebral body and posterior elements; vertebral chip fracture caused by fall from a height (L5 most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

questions to ask for back pain

A 
how did the pain start 
was it sudden or gradual
where 
the pattern
the intensity
the duration
what makes it worse or better 
rest?
leg/arm pain, weakness, neumbness, problems walking
bowel or bladder problems 
Hx of pain
work or sports history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what specific hx questions might you want to ask a person with back pain

A

: congenital spine problems, previous episodes of low back pain, previous back injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what type of work related qwuestions would you want to ask

A

any legal action taken related to the pain if this is a work related injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

general medical hx needed for back pain

A

h. General medical hx, including smoking, drinking, drug use, arthritis, cancer, malabsorption, arthritis, weight loss, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PE for back pain

A

inspection of habitus affect posture gait and active ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

palpation for back pain

A

push your thumb on the spinous process and note any tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

strength exam for back pain

A

do a full strength exam and document any abnormal findings

also have them do a straight leg raise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

sensation

A

do a quick sensory exam and document any abnormal findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

reflexes

A

check patellar and Achilles reflexes and for clonus.

Then check biceps, brachioradialis, and Hoffman’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hoffman’s test

A

relax their hand and lift their hand from their middle finger and you flick their middle finger - if positive all the other fingers will move like a jelly fish)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

scale for grading strength

A
  1. 0/5 - no movement/flaccid
  2. 1/5 - barest flicker of movement/tone
  3. 2/5 - can’t overcome force of gravity
    can drag across but not up
  4. 3/5 - can overcome gravity, but not any applied resistance
  5. 4/5 - weaker than normal, but can overcome resistance
    ( if you can come in and walk but you are
    weak )
    a. Ex - if you can walk
  6. 5/5 - normal strength
  7. For strength grading, you may chart with - or + to give a more nuanced pictture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

scale for grading reflexes

A
  1. 0 - absent
  2. 1+ - diminished but present
  3. 2+ - average
  4. 3+ - brisker but average
  5. 4+ - very brisk/hyperreflexive
    a. Ominous sign
    V. Scoliosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

scoliosis workup

A

hx-usually a-sxs and noticed in school

PE-rib hump with pt bent forward and waist asymmetry and shoulder asymmetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

dx test for scoliosis

A

Get a 36 inch anterior/posterior XR

Scoliosis is diagnosed as a lateral curve greater than 10 degrees on Cobb angle. It is important to also get a lateral view to check for any associated kyphosis. XRs should be done
annually through puberty until the patient becomes skeletally mature (when the risk of progression is much lower)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

tx for scoliosis

A

i. Regular physical exams by a spine surgeon or neurosurgeon to watch for progression. Bracing may be indicated for aggressively changing curves or curves over 25 degrees

Surgery is indicated for any curve over 50 degrees or rapidly changing curves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lumbar disk problems causes

A

This is a common cause of chronic and recurrent low back and leg pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

areas of the spine where we most commonly see disc problems

A

Most often at L4-L5 or L5-S1, but can involve any level of the lumbar spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what population do we normally see disc issues in

A

c. Worse in those who have a history of heavy repetitive lifting, smoking (dries the discs out faster), or driving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is central stenosis

A

d. Degeneration of the nucleus pulposus and the annulus fibrosus; the disk may protrude posteriorly, causing central stenosis. This can push on the dura and compress nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is foraminal stenosis

A

e. The intervertebral space may decrease as the disk degenerates, which can cause foraminal stenosis and may compress one or both of the exiting nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

two components of the intervertebral disc

A

annulus is the OUTER

inner is the nucleus pulposa

30
Q

Hx of an individual with suspected disc issues

A

pain-sudden or insidious w/ or w/o associated even

acute disc herniations generall cause MORE LEG PAIN (i.i nerve root pain) while degeneration gernally causes more back pain

leg pain is dermatomal with paresthesias and tingling may also have weakness in specific muscle group

herniations are usually self-limited >90% of the time while degeneration will worsen

31
Q

exam for suspected disc disorder

A

mechanical back pain wiht motion in ddd

may have blunted achilles reflex or patellar reflex

32
Q

achilles reflex is assoicated with which nerve roots

A

L5-S1

33
Q

patellar reflex is assocaited with which spinal roots

A

L3-4

34
Q

what is another reason you may not have a good reflex exam in a pt

A

DM

35
Q

other specific exam findings of ddd

A

may have weakness in specific myotome -For example, weak dorsiflexion (tibialis anterior) for L4-5 disk, or weak plantar flexion (gastrocnemius/soleus) for L5-S1 disk (if L5-S1 neuropathy - then they can’t flex their great toe)

36
Q

what is saddle anesthesia

A

reduced rectal tone and bowel/bladder incontinence in cases of cauda equina (a surgical emergency)

37
Q

dx studies of ddd

when would we use MRI

A

i. XR may show loss of disk space height in degenerative disk disease

MRI is the study of choice for disc herniation

38
Q

disc herniation is most common at

what would we see on a MRI

A

L4-L5 OR L5-S1

39
Q

what would we see on a MRI of disc herniation

A

, can be central or lateral, may look like a bulge in the disk or may be an extruded disk fragment

degeneration can sometimes be seen as modic changes at the vertebral endplates (inflammation associated with arthritis)

40
Q

iv. For people who can’t get MRI what is the study of choice for disc herniation

A

CT MYELOGRAM

41
Q

Treatment for disc herniation

A

Approximately 80% of disk herniation pain will resolve within six weeks

During that time, advise your patient to avoid heavy lifting and repetitive bending

NSAIDS, oral prednisone, narcotics, muscle relaxants

Nerve membrane stabilizers for nerve pain: gabapentin, pregabalin

Physical therapy can increase ROM and strengthen core muscles. Acupuncture may help with pain

Corticosteroid epidural injections may provide relief of neurogenic pain (sciatica)

42
Q

when should you refer to a surgeon

A

Refer to spine surgeon for new onset or progressive weakness or incapacitating pain beyond 6 weeks (microdiskectomy for disk herniations or lumbar fusion for degenerative disk disease)

43
Q

when would we need a emergent surgeon referral

A

vii. If cauda equina is suspected, get a surgical evaluation right away

44
Q

what are some unique problem with cervical disc

A

more mobile and therefore more prone to generation but does not bear weight

45
Q

hx of cervical spine issue

A

neck pain w or w/o HA
shooting arm pain radiating or tingling down arm
numbness paresthesia in fingers
progressice weakness unilaterally in specific muscles (deltoid triceps ) or loss of grip strength

MAY have probelms with balance walking or muscle spasms in legs

46
Q

PE for cervical spine pain

A

look for loss of sensation in a specific dermatome
KNOW THE FINGERS

try to r/o carpal tunnel with tinnels

brachial plecopathy or ulnar neuropathy

an electromyogram may be indicated

47
Q

Spurling’s test

A

ii. Positive Spurling’s test for cervical radiculopathy. May also have neurogenic-type pain just medial to scapula

48
Q

iii. Always watch for signs of spinal cord comp ression as seen in cervical spinal stenosis

what do these look like

A

myelopathic gait, ankle clonus, hyperreflexia, Hoffman’s sign)

49
Q

tx for cervical spine issues

A

i. NSAIDs, oral prednisone, narcotics, muscle relaxants. Gabapentin or pregabalin may be indicated for severe pain
ii. Physical therapy to improve range of motion
iii. Short term use of soft cervical collar

50
Q

when would we refer to a surgeon for cervical spine issues

A

iv. Refer to spine surgeon for incapacitating pain, declining motor function, or severe central stenosis

51
Q

Ankylosing Spondylitis

A

onset insidious
low back and butt pain associated with morning stiffness and nocturnal back pain unrelieved by rest but improved with exercise

52
Q

what diagnostic test would we use for AK

A

elevated ESR presence of histocompatability antigen HLA-B27

53
Q

Ankylosing Spondylitis is characterized by what back morphology

A

Loss of lumbar lordosis w/ exaggeration of thoracic kyphosis

54
Q

what is the pathophys of AS

A

Inflammation and erosion of the annulus fibrosis at the point of contact w/ the vertebral body are followed by bony growth; this causes bridging of vertebral bodies and eventual reduction of spinal mobility (“bamboo spine”)

55
Q

inflammation of spine

A

Spondylitis

56
Q

refers to general degenerative process of spine (presence of bony spurs, disk degeneration, etc)

A

Spondylosis

57
Q

most common where?

what does it look like on xray

A

i. Weakened or cracked pars articularis. On oblique XR, the “scottie dog” looks like it has a collar
ii. Most common site is L4-5

58
Q

Spondylolisthesis

A

= fracture through the pars articularis w/ displacement (Grades 1-4)
pedicles, and superior articular facets gradually slip anteriorly and leave the posterior elements behind. “Scottie dog” will look decapitated - head separate from body on oblique XR. Vertebral bodies will not line up on lateral views. Graded I-4

59
Q

pain most commonly associated with herniated disc

A

increased pain with coughing sitting standing strain

60
Q

which deep tendon reflex is affected in cauda equina syndrome?

A

Achilles (ankle) reflex.

61
Q

What critical diagnoses should be considered in patients with syncope and back pain?

A

Ruptured abdominal aortic aneurysm, aortic dissection, pulmonary embolism and ruptured gastric/duodenal ulcer.

62
Q

signs of spinal cord compression in pts with neck pain

A

mylopathic gait
ankel clonus
hyper reflexia
hoffman’s

63
Q

pt after car accident has 4+ patellar reflex clonus and bilateral hoofman’s

what do you suspect

A

disc herniation with spinal cord compression

64
Q

back pain that worsens with walking

what else do you want to ask to confirm spinal stenosis

A

lumbar stenosis 7.4 times more likely if pain doesn’t occur when sitting

better with bending

pain in both legs

neurogenic claudication

65
Q

external portion of the spine

A

arthritis in the lower spine

66
Q

What is first line therapy for spinal stenosis?

A

Adequate pain management, physical therapy, exercise, and weight loss.

67
Q

spinal fxs arise from

A

may be from trauma
or may be a chronic degenerative process (usually due to loss of bone density as in osteopenia and osteoporosis)

Associated with focal tenderness

68
Q

c. New compression fractures from osteopenia may be treated with

A

vertebroplasty or kypoplasty, where cement is squirted into the bone

69
Q

which type of fxs are suggestive of malignancy

A

d. Compression fractures above the mid thoracic region are suggestive of malignancy

70
Q

Traumatic fractures w/o listhesis (i.e., intact pars articularis) or retropulsion of bony fragments can be treated

A

w/ external bracing (TLSO), or internal bracing (fusion). Otherwise, surgery is indicated

71
Q

Pt is a 44 yo woman who jumped from a 2-story window in escaping a fire. She landed on her feet and immediately felt excruciating back pain, worse with movement. She has no weakness and no sensory deficits. Her reflexes are intact

A

found with compression fx of the spine

needs surgert meow

Medicine II (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions