low back

Question 1

Lumbar nerve roots exit above or below the vertebra

Answer 1

below

Transition zone at C8 is where it changes from above to below

Question 2

what cancers are most likely to met to the spine?

Answer 2

lung, breast, GI, prostate

Question 3

DDx for back pain that has nothing to do with the spine or it’s structures

Answer 3

UTI, gallstone/kidney stone, pregnancy, AAA

Question 4

Physical Exam:

Answer 4

inspection, palpation, ROM, strength, sensation, reflexes, special tests

Question 5

what nerve: hip flexion

Answer 5

L2

Question 6

what nerve: knee extension

Answer 6

L4

Question 7

ankle dorsiflexion

Answer 7

L5

Question 8

great toe flexion

Answer 8

L5, S1

Question 9

great toe extensor

Answer 9

L5

Question 10

knee flexor

Answer 10

L5, S1

Question 11

plantar flexors

Answer 11

S1, S2

Question 12

dermatome for medial malleolus

Answer 12

L4

Question 13

dermatome for base of 2nd toe

Answer 13

L5

Question 14

dermatome for base of 5th toe

Answer 14

S1

Question 15

patellar reflex

Answer 15

L4

Question 16

Achilles reflex

Answer 16

S1

Question 17

Hamstring contraction

Answer 17

L5

Question 18

This special test elicits low back pain when a leg is flexed by 30-70 degrees, often pain is worse when foot is passively dorsiflexed

Answer 18

strait leg raise

Question 19

what would a positive strait leg raise test indicate?

Answer 19

sciatic nerve impingement, typically from disc herniation at L5

Question 20

Pathological state of the spine (ex: arthritis)

Answer 20

Spondylosis

Question 21

Fracture of the pars interarticularis

Answer 21

spondylolysis

Question 22

slipping of one vertebrae over another

Answer 22

spondylolisthesis

Question 23

What are the possible causes of “lumbar strain”

Answer 23

muscle, ligament, arthritic joint, disc problem

Question 24

How long should a patient expect to wait before lumbar strain symptoms start to resolve?

Answer 24

2 weeks

Question 25

5 ways to treat back pain

Answer 25

SLIME

sx, lifestyle, injections, meds, exercise

Question 26

The _______test is done by having pt hyperextend the spine and rotate. If this reproduces pain, the pt likely has a problem with __________

Answer 26

Stork test, problem with facet joint or posterior spine

Question 27

spondylolysis is most common in young (developing) athletes who repetitively hyperextend the spine, causing a fatigue fracture of the __________

Answer 27

pars interarticularis

Question 28

What are you worried about in patients with spondylolisthesis?

Answer 28

nerve compression

Question 29

what is one of the most common signs of disc herniation that is impinging on L5?

Answer 29

foot drop

Question 30

Your patient has fallen and comes in complaining of feeling wobbly on her legs. She has not been able to urinate since the fall. What is the first thing you should do?

Answer 30

Perform DRE, anal sphincter will be lax (S1-S3) if there is compression of the cauda equina. Surgical decompression emergency. Do this prior to MRI

Question 31

What does a positive grocery cart sign indicate?

Answer 31

Neurogenic claudication = spinal stenosis

Question 32

What position exacerbates spinal stenosis?

Answer 32

spinal extension

Question 33

When would you consider treating SS surgically? And what is the sx option?

Answer 33

If red flag s/s develop, consider decompression with laminectomy