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Advanced Spine > Final Scraps for Exam 1 > Flashcards

Final Scraps for Exam 1 Flashcards

1
Q

Current recommendations suggest clinicians conduct a focused hx and physical exam to classify pts into 1 of 3 categories:

Diagnostic triage!

A
  1. Non-specific LBP
  2. LBP with potential radiculopathy or spinal stenosis
  3. LBP potentially due to serious spinal pathology (i.e. Tumor, infection, AS)
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2
Q

What are the things you’d want to rule out for serious spinal pathology?

A
  1. Cancer
  2. Spinal fx
  3. Infection
  4. Abdominal aortic aneurysm
  5. Kidney or urinary disorders
  6. Cauda equina
  7. Vascular claudication
  8. Ankylosing spondylitis
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3
Q

Absence of these 4 essentially rules out cancer

A
  1. Previous hx of non-skin cancer
  2. Failure of conservative tx in last month
  3. Age over 50
  4. Significant unexplained WL in the past 6 months
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4
Q

These lab values might indicate high likelihood of cancer

A
  • ESR
  • hematocrit under 30%
  • anemia
  • WBC over 12000
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5
Q

What are 5 characteristics that make spinal fx more likely?

A
  • age over 50
  • female
  • major trauma
  • pain and tenderness
  • a distracting painful injury
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6
Q

What is the cause of spinal fx in gymnasts typically?

A

Microfracture

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7
Q

Corticosteroid use and spinal fx

A
  • decreased bone density

- increased risk for OP related fx

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8
Q

In the absence of major trauma, vertebral fx present so similarly to these that only 30% are identified in clinical practice

A

Acute nonspecific LBP

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9
Q

Infection: Does lack of fever rule this out?

A

No: lack of fever does not significantly decrease the odds of infection

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10
Q

Risk factors for AAA

A
  • family hx
  • heart stuff
  • cerebrovascular disease
  • increased height
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11
Q

Decreased risk for AAA

A
  • female
  • DM
  • African American
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12
Q

Presentation of AAA

A
  • highly variable
  • 75% are asymptomatic
  • may report low t-spine, lumbar, abdominal, hip, or buttock pain
  • not usu a cause of LBP
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13
Q

What would clue you in to kidney or urinary issues as a source of LBP?

A
  • unilateral flank pain
  • low ab pain above pubic bone
  • may have pain radiating to groin
  • difficuly initiating urination (or pain)
  • blood in urine
  • UTI hx
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14
Q

CES onset

A
  • sudden OR
  • progress quickly over a few hours or 1-2 days

Requires surgery within 48 hours

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15
Q

Most common cause of CES

A
  • Large, midline posterior disc herniation, commonly at L4-5 or L5/S1
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16
Q

Other causes of CES

A
  • spinal stenosis
  • spinal tumor
  • infection
  • fx
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17
Q

S/s of CES

A
  • changes in b/b
  • saddle paresthesia/anesthesia
  • unilateral or bilateral sciatica
  • hard neuro signs (most common over butt, post/sup thighs, perineal)
  • abn passive SLR
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18
Q

Vascular claudication is usually a symptom of:

A

PVD

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19
Q

Vascular claudication is caused by:

A

Insufficient blood flow to the LE

20
Q

Vascular claudication can mimic

A

Neurogenic claudication

21
Q

When do sx increase with vascular claudication?

A
  • same distance each time

- walking uphill or up stairs

22
Q

What decreases sx of neurogenic claudication?

A
  • walking uphill
  • sitting
  • flexed spinal position
23
Q

What things may make you suspect PVD?

A
  • cool skin
  • presence of at least one bruit
  • palpable pulse abnormality
24
Q

With AS, when does back pain improve?

A

Improves with exercise, but not with rest

25
Q

What are some other key features of AS aside form improving with exercise?

A
  • alternating buttock pain
  • morning stiffness
  • waking up during the last half of the night
26
Q

What is the definition of radiculopathy?

A

s/s associated with nerve root pathology including

  • paresthesia
  • hypoesthesia
  • anesthesia
  • motor loss
  • pain
27
Q

What is the definition of symptomatic spinal stenosis?

A
  • Narrowing of the spinal canal or lateral recess

- usually result of degenerative, developmental, or congenital disorders

28
Q

This outcome measure is really only appropriate for pts with acute LBP who have had it less than 30 days

A

RMDQ

29
Q

RMDQ

A

Roland Morris Disability Questionnaire

30
Q

PSFS

A

Patient Specific Functional Scale

31
Q

What age group are you most likely to see LBP?

A

30-60

32
Q

Occupations most likely to be associated with LBP

A
  • sales
  • clerical work
  • repair
  • transportation
33
Q

What are the physical stresses most commonly associated with back pain? (4)

A
  1. Heavy or frequent lifting
  2. Whole body vibration (driving)
  3. Prolonged or frequent bending or twisting
  4. Postural stresses (high spinal loads or awkward postures)
34
Q

Which areas need to be cleared with LBP pts?

A
  • lower t-spine and lumbosacral spine
  • bilateral butt/LE (circumferentially)
  • abdomen/groin
  • N/T anywhere
35
Q

When should you start looking for red flags?

A

When the pt reports worsening of sx

36
Q

Morning stiffness: When would you think MSK?

A

Better in the morning

Eased by rest

37
Q

Morning stiffness: When would you think DJD?

A
  • better or less painful in morning

- eased with movement within 30-60 mins

38
Q

Morning stiffness: When would you think systemic inflammatory?

A
  • better with rest, but present with greatest stiffness in morning
  • usu longer than 60 mins
39
Q

Morning stiffness: When would you think non-MSK?

A

Sx unchanged in morning

40
Q

Common side effects for LBP meds: NSAIDs

A

back and/or shoulder pain for

  • retroperitoneal bleeding
  • GI sx
  • kidney/liver problems
  • MI
41
Q

Common side effects for LBP meds: corticosteroids

A
  • AVN femoral head
  • OP
  • immunosuppression
  • steroid-induced myopathy
42
Q

Common side effects for LBP meds: antidepressants

A

Movement disorders

43
Q

Common side effects for LBP meds: skeletal muscle relaxants

A

Sedation

44
Q

Common side effects for LBP meds: statin-related drugs

A

MSK pain

45
Q

Common side effects for LBP meds: opioids

A
  • nausea
  • constipation
  • dry mouth
  • dizziness
  • addiction
46
Q

What is the strongest predictor of future LBP?

A

Presence of leg pain

47
Q

Failure to centralize sx is considered a strong predictor for

A

Chronicity

Advanced Spine (50 decks)

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