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Clinical Management exam I > Low Back Pain > Flashcards

Low Back Pain Flashcards

1
Q

what part of dic tears in a disk tear

A

outer part of disc (annulus) that occurs with aging

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2
Q

Jelly-like nucleus pushes against outer ring and puts pressure on nerves due to wear and tear

Dx?

A

disc herniation

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3
Q

Heel walk checks ___

Toe walk checks ____

A

heel L5

toe S1

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4
Q

what does a positive straight leg raise most likely indicate?

A

disc herniation

+ if pain moving from butt down to leg

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5
Q

disorder where vertebrae have too much mobility – slide on top of one another and compress spinal nerves

surgical tx?

A

Degenerative spondylolisthesis

spinal fusion

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6
Q

Space around spinal cords narrow and puts pressure on cord

Bone spurs grow to provide more support

dx? and most common cause

A

spinal stenosis

arthritis

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7
Q

imaging stude of choice for suspected disc herniation

A

MRI

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8
Q

CC with Degenerative spondylolisthesis

A

“pain and stiffness”

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9
Q

in spinal stenosis what symtpom reflects critical pressure on nerves

A

Weakened leg “foot drop”

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10
Q

pt presents w/ back “pain and stiffness” radiating from butt down to lower leg. he finds relief when leaning forward

dx?

A

spinal stenosis

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11
Q

what condition would require a laminectomy

A

spinal stenosis - removal of bone spurs

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12
Q

pt presents to clinic w/ abck pain. upon exam you notice he has a “round-back appearance” or a “bent over appearance”.

He notes the pain is bad with regular activities such as coughing or sneezing, twisting or reaching.

He reports pain is better when he lies down.

Dx?

surgical tx?

A

vertebral compression fx

kyphoplasty - baloon tamp into affected vertebrae first then cement

vertebroplasty - no baloon just cement into narrowed vertebrae

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13
Q

what condition could you dx w Dual energy x-ray absorptiometry (DEXA)

A

osteoporisis

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14
Q

in order for a pt w/ spinal stenosis to be a canidate for interspinous process devices they MUST:

A

have relief of butt and leg pain when leaning forward to be a candidate

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15
Q

also called “slipped disc”

A

disc herniation

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16
Q

lordosis vs kyphosis

A

lordosis - INWARD curvature at cervical and lumbar regions

kyphosis - OUTWARD curvature of thoracic spine “hump”

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17
Q

what is the cause for the inward curvature seen in hyperlordosis

A

Trunk flexors and hip extensors too weak to balance trunk ext and hip flex

results in lumbar spine overextended

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18
Q

types of kyphosis (3)

A
  • Postural kyphosis à repeated poor posture seen in young F
  • Scheuermann’s Kyphosis à vertebrae become wedged shape assoc. w/ scoliosis (kyphoscoliosis)
  • Congenital kyphosis à vertebrae deformed during fetal development
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19
Q

Spine twisted / side-ways curvature “S” or “C” shape

A

scoliosis

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20
Q

scoliosis could be due to Dec in _______ causing a dec shock absorption resulting in a mis-shapen spine.

A

glycosaminoglycans____

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21
Q

what conditions are assoc w/ scoliosis

A

Neuromuscular disorers

cerebral paslsy

muscular dystrophy

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22
Q

what is a complication of SEVERE kyphosis/ scoliosis

A

Decreased space in thoracic cavity -> compresses heart -> and prevent lungs from fully expanding

  • Shortness of breath
  • Small thoracic cavity
  • Inability to exercise
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23
Q

how can we determine the extent of a spinal deformity

A

measure cobb angle

angle between upper most and lower most vertebrae involved

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24
Q

what conditions are associated w/ lordosis and kyphosis

A

Deformative diseases:

  • Ehlers-Danlos
  • Marfans
  • Osteoporosis

Injury:

  • Compression Fx
  • spondylolisthesis
  • Misaligned vertebrae

Obesity

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25
lordosis or kyphosis or scoliosis
kyphosis
26
lordosis or kyphosis or scoliosis
lordosis
27
lordosis or kyphosis or scoliosis
scoliosis
28
what condition results in the vertebrae become wedged shape
Scheuermann's Kyphosis (kyphoscoliosis)
29
L2-L4 pain
Back radiating to anterior thigh (or medial lower leg)
30
L2-L4 sensory loss
anterior thigh occasional medial lower leg
31
L2-L4 weakness
Hip flexion Hip adduction Knee extension L4 - “squat and rise” •Extension of quad
32
L2-L4 stretch reflex loss
patellar tendon
33
what nerve root is assoc w/ achilles tendon reflex
S1
34
What nerve root is assoc w/ Semitendinosus / semimembranosus (hamstring) tendon reflex
L5
35
L5 pain would be experienced:
Back radiating into * Buttock * lateral thigh * lateral calf * dorsum of foot * Great toe
36
L5 sensory loss would be felt
Lateral calf Dorsum of foot Web space b/w 1st and 2nd toe
37
L5 weakness would be present during
Hip abduction Knee flexion Foot dorsiflexion Toe extension and flexion Foot inversion and eversion “heel walking”
38
S1 would show pain in
Back radiating into * buttock * Lateral or posterior thigh * Posterior calf * Lateral or plantar foot
39
S1 sensory loss would be felt
Posterior calf Lateral or plantar aspect of foot
40
S1 weakness during:
Hip extension Knee flexion Plantar flexion of foot + great toe “toe walking”
41
differentiate S1, L4 and L5
42
L1 pain and sensation would be noticed in the ____ region with weakness during hip \_\_\_\_\_.
Inguinal flexion
43
S2-S4 pain would present as
Sacral or buttock pain radiating into * Posterior aspect of the leg * or perineum
44
S2-S4 would have lack of sensation in
Medial buttock Perineal Perianal
45
S2-S4 would have weakness:
Minimal weakness Urinary/fecal incontinence Sexual dysfunction
46
Bulbocavernosus reflex loss:
S2-S4
47
identify the nerve roots responsible for the reflexes: patellar tendon Semitendinosus / semimembranosus (hamstring) tendon reflex achillies tendon reflex Bulbocavernosus (ankle wink)
patellar L4 hamstring - L5 achillies S1 bulbo S2-S4
48
most common nerve roots affected in disc herniation
L4-5 and L5-S1(90%)
49
in pts with a disc hernaiation they experience pain with prolonged ______ and usually experience more pain during (flexion / extension) in pts w/ spinal stenosis they notice more pain after walking for a few minutes and notably the pain is felt greatest during (flexion / extension) are are relieved of pain when \_\_\_\_\_.
disc hern - prolonged sitting , FLEXION spinal stenosis - EXTEND - lean forward
50
pt comes in complaining of low back pain. they also note perianal numbness along w/ bowel or bladder incontinence. What MUST you rule out
Cauda equina syndrome
51
study of choice to evaluation radicular sx (tingling, numbness, weakness, reflex loss)
MRI
52
is an inflammatory disease that, over time, can cause vertebral fusion
ankylosing spondylitis
53
pt presents to clinic complaining of low back pain: ## Footnote you notice he is in the hunched forward position and says he is unable to breathe deeply, “stiffness when breathing”. Dx? what labs could we order to confirm dx?
HLA -B27 acute phase reactants (ESR, CRP) linked to autoimmune conditions
54
what is usually the 1st presentation of spinal stenosis
•Neurogenic claudication symptoms with walking
55
what you expect to see on x-ray of a person w/ advanced anklyosing spondylitis
BAMBOO
56
You suspect a young male has anklyosing spondylitis - what imaging study could you order to evaluate the first site of inflammation?
MRI SI joint - bone marrow edema
57
a pt comes into clinic w low back pain. He perfers to sit bc of the pain You note limited extension of lumbar spine, which reproduce the sx radiating down the legs. the pain is worse w/ extension and alleviated by sitting/leaning forward. Dx?
spinal stenosis
58
x-rap views when looking at low back pain
AP and lateral views of lumbar spine NO oblique
59
Radiographs with _________ views may be helpful in patients for whom instability is a concern
Flexion-extension
60
MRI should be ordered (with or without) contrast when evaluating low back pain. we should order ____ and ____ views.
w/o contrast sagital and axial
61
Rx to tx low back pain
naproxen 500mg BID flexeril 10mg QHS oxycodone 5mg QHS PRN
62
how is naproxen dosed
naproxen 500mg take 1 tablet BID w/ food for 5 days #10 NRF
63
how is flexeril dosed
flexeril 10mg take 1/2 to 1 tablet PO QHS x 7 days #7 NRF * Counsel pts NO drinking, driving, operative heavy machinery DOCUMENT * Choice for spasm
64
how is oxycodone dosed
oxycodone 5mg take 1 PO QHS PRN for back pain #7

Clinical Management exam I (4 decks)

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