Lecture 113

Question 1

Localized spine pain can indicate:

Answer 1

Possible tumor or infection

Question 2

Mechanical spine pain can indicate:

Answer 2

Commonly a fracture, or discogenic disease

Question 3

Radicular spine pain can indicate:

Answer 3

Herniated disc or stenosis

Question 4

rNighttime spine pain can raise concern for:

Answer 4

Tumor or serious pathology

Question 5

What imaging modality is key for diagnosing herniated disc, stenosis, spinal cord lesions?

Answer 5

MRI

Question 6

Bone scans can detect:

Answer 6

Areas of increased metabolic activity (metastatic disease, infection, stress fractures)

Question 7

A lateral cervical X-ray that shows loss of lordosis can indicate:

Answer 7

Whiplash/cervical strain

Question 8

Chronic disc degeneration and facet arthropathy due to “wear and tear” with age can cause:

Answer 8

Cervical spondylosis

Question 9

What are the first signs of cervical spondylosis?

Answer 9

Discogenic neck pain (insidious onset, worsened by motion)

Question 10

Cervical spondylosis can develop into:

Answer 10

Radiculopathy

Question 11

Severe or chronic cases of cervical spondylosis can result in:

Answer 11

Myelopathy (bilateral weakness, impaired fine motor skills, gait disturbances, bowel/bladder dysfunction)

Question 12

Surgical intervation for severe radiculopathy or myelopathy caused by cervical spondylosis involves:

Answer 12

Anterior cervical discectomy and fusion

Question 13

Degenerative spondylosis and potential disc herniation is known as:

Answer 13

Cervical disc disease

Question 14

In cervical disc disease, the herniated disc compresses the nerve root above/below the disc level

Answer 14

Below

Question 15

Clinical presentation of cervical disc disease

Answer 15

Neck pain, radicular symptoms, possible UMN signs

Question 16

Best imaging modality for cervical disc disease

Answer 16

MRI

Question 17

A posterior foraminotomy or anterior cervical discectomy and fusion is used to treate

Answer 17

Severe cervical disc disease

Question 18

Rheumatoid arthritis has ____ involvement in 90% of patients

Answer 18

Cervical spine

Question 19

Atlantoaxial subluxation (C1-C2) in rheumatoid cervical spondylitis can be caused by:

Answer 19

Pannus formation

Question 20

Atlantoaxial subluxation (C1-C2) in rheumatoid cervical spondylitis can cause:

Answer 20

Destruction of the transverse ligament

Question 21

An incompetent transverse ligament can compress the spinal cord and risk:

Answer 21

Quadriplegia or brainstem compression

Question 22

Any cervical manipulation in a patient with Rheumatoid cervical spondylitis can risk:

Answer 22

Sudden cord compression

Question 23

Decreased bone mass caused by low bone mineral density can cause what condition, commonly in the thoracic spine

Answer 23

Vertebral compression fracture

Question 24

Point tenderness over spinous processes and possible kyphosis can indicate

Answer 24

Vertebral compression fracture

Question 25

Surgical treatment for vertebral compression fracture involves:

Answer 25

Kyphoplasty or vertebroplasty

Question 26

Lumbar herniated disc, AKA

Answer 26

Herniated nucleus pulposus (HNP)

Question 27

What is the most common level for a herniated disc?

Answer 27

L4-L5

Question 28

Decreased patellar reflex and weakness in knee extension can indicate herniated disc at what spinal root?

Answer 28

L4 involvement

Question 29

Weakness in dorsiflexion of foot (heel walk) can indicate herniated disc at what spinal root?

Answer 29

L5 involvement

Question 30

Weakness in plantar flexion (toe walk), decreased Achilles reflex can indicate herniated disc at what spinal root?

Answer 30

S1 involvement

Question 31

Most common treatments for herniated disc

Answer 31

NSAIDs, PT, epidural steroid injections

Question 32

Indications for herniated disc surgical intervention

Answer 32

Progressive nerological deficits, cauda equina syndrome, or failure of conservative measures

Question 33

Degenerative disc disease without focal herniation diagnosis

Answer 33

Discogenic back pain

Question 34

Discogenic back pain worsens with:

Answer 34

Bending, sitting, axial loading

Question 35

Discogenic back pain has a ____ straight leg raise

Answer 35

Negative

Question 36

Diagnosis for a stress fracture in pars interarticularis

Answer 36

Spondylolysis

Question 37

Cause of spondylolysis

Answer 37

Overuse injury with repetitive lumbar extension

Question 38

Positive "scotty dog" sign on radiographs can indicate

Answer 38

Spondylolysis

Question 39

Anterior slipping of one vertebra relative to another

Answer 39

Spondylolisthesis

Question 40

Types of spondylolisthisis

Answer 40

Dysplastic, isthmic (pars defect), degenerative, traumatic, pathologic

Question 41

Grading system for spondylolisthesis

Answer 41

Grade 1 (<25% slip)- grade 5 (100% slip)

Question 42

Seronegative spondyloarthropathy that primarily affects the axial skeleton

Answer 42

Ankylosing spondylitis

Question 43

HLA-B27 is strongly associated with:

Answer 43

Ankylosing spondylitis

Question 44

Gradual onset of chronic low back pain and morning stiffness (<1 hour), reduced spinal ROM are manifestations of:

Answer 44

Ankylosing spondylitis

Question 45

Classic radiographical findings of ankylosing spondylitis

Answer 45

Bamboo spine - syndesmophytes bridging vertebral bodies

Question 46

Labs for ankylosing spondylitis

Answer 46

Elevated ESR/CRP, negative RF/anti-CCP

Question 47

Narrowing of the spinal canal or intervertebral foramina leading to compression of nerve roots or thecal sac

Answer 47

Spinal stenosis

Question 48

Pain in low back, buttocks, or legs while standing/walking that is relieved by flexion is a classic presentation of:

Answer 48

Spinal stenosis

Question 49

How is neurogenic claudication differentiated from vascular claudication?

Answer 49

Pain does not improve with flexion in vascular claudification

Question 50

Compression of lumbosacral nerve roots leading to peripheral nerve dysfunction

Answer 50

Cauda Equina syndrome

Question 51

Saddle anesthesia, bowel/bladder dysfunction, and flaccid lower extremities are signs of

Answer 51

Cauda equina syndrome

Question 52

Cauda equina requires surgical decompression within ____

Answer 52

48 hours