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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
Q

lordosis or kyphosis or scoliosis

A

kyphosis

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26
Q

lordosis or kyphosis or scoliosis

A

lordosis

27
Q

lordosis or kyphosis or scoliosis

A

scoliosis

28
Q

what condition results in the vertebrae become wedged shape

A

Scheuermann’s Kyphosis (kyphoscoliosis)

29
Q

L2-L4 pain

A

Back radiating to anterior thigh (or medial lower leg)

30
Q

L2-L4 sensory loss

A

anterior thigh

occasional medial lower leg

31
Q

L2-L4 weakness

A

Hip flexion

Hip adduction

Knee extension

L4 - “squat and rise”

•Extension of quad

32
Q

L2-L4 stretch reflex loss

A

patellar tendon

33
Q

what nerve root is assoc w/ achilles tendon reflex

A

S1

34
Q

What nerve root is assoc w/ Semitendinosus / semimembranosus (hamstring) tendon reflex

A

L5

35
Q

L5 pain would be experienced:

A

Back radiating into

  • Buttock
  • lateral thigh
  • lateral calf
  • dorsum of foot
  • Great toe
36
Q

L5 sensory loss would be felt

A

Lateral calf

Dorsum of foot

Web space b/w 1st and 2nd toe

37
Q

L5 weakness would be present during

A

Hip abduction

Knee flexion

Foot dorsiflexion

Toe extension and flexion

Foot inversion and eversion

“heel walking”

38
Q

S1 would show pain in

A

Back radiating into

  • buttock
  • Lateral or posterior thigh
  • Posterior calf
  • Lateral or plantar foot
39
Q

S1 sensory loss would be felt

A

Posterior calf

Lateral or plantar aspect of foot

40
Q

S1 weakness during:

A

Hip extension

Knee flexion

Plantar flexion of foot + great toe

“toe walking”

41
Q

differentiate S1, L4 and L5

A
42
Q

L1 pain and sensation would be noticed in the ____ region with weakness during hip _____.

A

Inguinal

flexion

43
Q

S2-S4 pain would present as

A

Sacral or buttock pain radiating into

  • Posterior aspect of the leg
  • or perineum
44
Q

S2-S4 would have lack of sensation in

A

Medial buttock

Perineal

Perianal

45
Q

S2-S4 would have weakness:

A

Minimal weakness

Urinary/fecal incontinence

Sexual dysfunction

46
Q

Bulbocavernosus reflex loss:

A

S2-S4

47
Q

identify the nerve roots responsible for the reflexes:

patellar tendon

Semitendinosus / semimembranosus (hamstring) tendon reflex

achillies tendon reflex

Bulbocavernosus (ankle wink)

A

patellar L4

hamstring - L5

achillies S1

bulbo S2-S4

48
Q

most common nerve roots affected in disc herniation

A

L4-5 and L5-S1(90%)

49
Q

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 _____.

A

disc hern - prolonged sitting , FLEXION

spinal stenosis - EXTEND - lean forward

50
Q

pt comes in complaining of low back pain.

they also note perianal numbness along w/ bowel or bladder incontinence.

What MUST you rule out

A

Cauda equina syndrome

51
Q

study of choice to evaluation radicular sx (tingling, numbness, weakness, reflex loss)

A

MRI

52
Q

is an inflammatory disease that, over time, can cause vertebral fusion

A

ankylosing spondylitis

53
Q

pt presents to clinic complaining of low back pain:

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?

A

HLA -B27

acute phase reactants (ESR, CRP)

linked to autoimmune conditions

54
Q

what is usually the 1st presentation of spinal stenosis

A

•Neurogenic claudication symptoms with walking

55
Q

what you expect to see on x-ray of a person w/ advanced anklyosing spondylitis

A

BAMBOO

56
Q

You suspect a young male has anklyosing spondylitis - what imaging study could you order to evaluate the first site of inflammation?

A

MRI SI joint - bone marrow edema

57
Q

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?

A

spinal stenosis

58
Q

x-rap views when looking at low back pain

A

AP and lateral views of lumbar spine

NO oblique

59
Q

Radiographs with _________ views may be helpful in patients for whom instability is a concern

A

Flexion-extension

60
Q

MRI should be ordered (with or without) contrast when evaluating low back pain.

we should order ____ and ____ views.

A

w/o contrast

sagital and axial

61
Q

Rx to tx low back pain

A

naproxen 500mg BID

flexeril 10mg QHS

oxycodone 5mg QHS PRN

62
Q

how is naproxen dosed

A

10 NRF

naproxen 500mg

take 1 tablet BID w/ food for 5 days

63
Q

how is flexeril dosed

A

7 NRF

flexeril 10mg

take 1/2 to 1 tablet PO QHS x 7 days

  • Counsel pts NO drinking, driving, operative heavy machinery DOCUMENT
  • Choice for spasm
64
Q

how is oxycodone dosed

A

7

oxycodone 5mg

take 1 PO QHS PRN for back pain

Clinical Management exam I (4 decks)

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