Exam 2

Question 1

prognostic indicators of recurrent pain

Answer 1

Hx previous episodes
Excessive spine mobility
Excessive mobility in other joints

Question 2

prognostic indicators of chronic LBP

Answer 2

Presence of symptoms below the knee
Psychosocial distress or depression**
Fear of pain, movement, and re-injury or low expectations of recovery
Pain of high intensity
A passive coping style

Question 3

lumbar spine pain is classified as

Answer 3

Area bordered by transverse line from T12 – S1

Question 4

sacral spine pain is classified as

Answer 4

Area bordered by vertical lines through PSISs and horizontal lines through S1 and sacrococcygeal joints

Question 5

common sites of neoplasm metastasis

Answer 5

breast
lung
prostate
kidney

Question 6

main pain complaints with neoplasms

Answer 6

Persistent
Not alleviated with “bed rest”
Worse at night
Neurologic symptoms

Question 7

physical exam findings for neoplasms

Answer 7

Non-mechanical presentation
Age > 50 years
Anemia
Neurologic Signs
Lab tests for confirmation

Question 8

epidural abcess– what is it and what can it be associated with

Answer 8

Haematogenous spread of bacteria into epidural space

Associated with DM, chronic renal failure, IV drug misuse, alcoholism, cancer

Question 9

vertebral osteomyelitis

Answer 9

infection of the vertebrae themselves

Question 10

what is the most common thing to see in pt’s history with vertebral osteomyelitis

Answer 10

bladder infection

Question 11

who is at an increased risk for vertebral osteomyelitis

Answer 11

Immunocompromised patients
DM

Question 12

pain complaints with vertebral osteomyelitis

Answer 12

Local, focal back pain
Worse with mechanical loading, improves with recumbent position

Question 13

physical exam findings with vertebral osteomyelitis

Answer 13

Fever
Local tenderness
Aggravated with local percussion
Neurologic Signs (cord/ root)
Lab tests important for diagnosis

Question 14

progression of epidural abscess

Answer 14

Local, focal back pain
Radicular signs/ symptoms
Paralysis

Question 15

henschke cluster for vertebral fracture

Answer 15

Age > 70 years
Significant trauma
Prolonged corticoid steroid use
Sensory alterations from the trunk down

Question 16

red flags for vertebral fracture

Answer 16

Older age
Significant trauma
Corticosteroid use
Contusion/ abrasion

Question 17

roman cluster for vertebral COMPRESSION fracture

Answer 17

Age > 52 years
No presence of leg pain
Body mass index </= 22
Does not exercise regularly
Female gender

Question 18

if serious health conditions are so uncommon, why do we need to still screen for them?

Answer 18

they are commonly misdiagnosed
better to be safe than sorry
likelihood is low but effects are significant if you find something serious
severity can prioritize unlikely conditions

Question 19

spondylolysis

Answer 19

Fatigue fracture of pars interarticularis

MOI: Repetitive microtrauma with extension/ extension with side-bending activities

Question 20

where do most spondylolysis typically occur

Answer 20

L5 level

Question 21

spondylolysthesis

Answer 21

Anterior slip of the vertebra following bilateral spondylolysis

graded by amount of slippage

Question 22

iatrogenic discitis

Answer 22

Most commonly from discography
Bacterial infection from needle during discography
Extremely painful
May lead to sepsis or epidural abscess

Question 23

internal disc disruption

Answer 23

interrupts interior layers of the lamina
bulging (more give in areas that are weaker)

Question 24

what is possible with discogenic pain and what is it

Answer 24

Schmorl’s nodes

Blood extruded from intraosseous veins in the marrow spaces
*Nucleus infiltrates vertebral body