Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med II - Ortho > LSP > Flashcards

LSP Flashcards

1
Q

Common LSP Dx

A 
Spinal stenosis
Lumbar strain
Spondylolistesis / lysis
Herniated nucleus pulposus
Cauda equina syndrome
Pott's dz
Compression fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Spinal stenosis - in general

A

Congenital or acquired narrowing of the spinal canal
Usually worsening with age
>50yo
Distinguish by neurogenic vs. vascular claudication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Spinal stenosis - s/s

A

LBP & leg pain worse with extension
Leg pain with ambulation - dermatomal pattern
Leg weakness
Relief with lumbar flexion
Ask about night pain and bladder / bowel dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Spinal stenosis - exam

A

Increased leg pain with lumbar extension
Diminished reflexes
Decreased leg strength and sensation
SLR +/-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

L4

A

Motor - tibialis anterior
Reflex - patellar
Sensation - medial ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

L5

A

Motor - Extensor hallicus longus
Reflex - none
Sensation - top of foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

S1

A

Motor - Peroneus
Reflex - Achilles
Sensation - lateral ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Spinal stenosis - dx

A

Plain AP & lat x-rays
- DDD, Degenerative scoliosis, osteophyte formation or Degenerative spondylolisthesis
CT/Myelogram vs. MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Spinal stenosis - tx

A 
LESI
NSAIDs
Sx decompression
Refer
- bladder / bowel incontinence
- fail conservative tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Herniated disc - in general

A 
<50yo
Acute onset of leg pain
Pain usually dermatome specific
L4-5 HNP most common
Pain results from direct mechanical compression of nerve root or chemical irritation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Herniated disc - s/s

A 
LBP &amp; leg pain
Worse with
- sitting 
- bending
- coughing / sneezing
- twisting
Difficult to remain in one position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Herniated disc - exam

A 
Difficult to sit
Increased leg pain with lumbar bending
Positive SLR - sitting and supine
Positive "bowstring sign"
L3 femoral N. stretch test
Decreased or absent reflex
Decreased muscle strength
Decrease sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nerve Root - L4

A

Motor - Quads
Reflex - knee jerk
Sensation - anterior thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nerve Root - L5

A

Motor - EHL (big toe)
Reflex - none
Sensation - Shin, top & medial foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nerve Root - S1

A

Motor - Ankle plantar flexion
Reflex - Achilles
Sensation - calf; lateral foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Herniated disc - dx

A

X-rays

MRI scan***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Herniated disc - tx

A 
PT
LESI
Taper dose prednisone
NSAIDs
Muscle relaxers
Analgesics
Nicotine abstinence
Reassurance
Sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Herniated disc - when to refer

A

Cauda equina symptoms
Progressive neuro deficit
Paralysis
Failed conservative tx

19
Q

Lumbar strain - in general

A

Repeated twisting or lifting heavy objects
May last a few days to 4 weeks
Annular tear may cause pain
Tendons, ligaments and muscles may be involved

20
Q

Lumbar strain - s/s

A

LBP, may radiate to buttock

Difficulty standing straight

21
Q

Lumbar strain - RF

A 
Lifting
Twisting
Sitting for prolonged periods
Poor fitness
Smoking
Operating Vibrating equipment
22
Q

Lumbar strain - exam

A

Low back tenderness & spasm
Limited ROM
Normal reflexes and muscle strength
SLR produces LBP

23
Q

Lumbar strain - dx

A

Plain x-rays usually not helpful

Atypical s/s, such as rest or night pain or trauma obtain x-rays

24
Q

Lumbar strain - tx

A 
Short course of NSAIDs
Muscle relaxers
Early PT
No long term bed rest
Avoid narcotics
25
Q

Spondylotisthesis

A

“slip” or “listhesis”
Vertebral body slips in relation to one below
Defect in junction of lamina with pedicle (pars intra-articularis_ - Spondylolysis
Adolescent (L5-S1) vs. Degenerative (no pars defect)
Most likely a fatigue fx that fails to heal
Participation in gymnastics and football, may increase incidence
Degenerative slip secondary to DD found in older adults

26
Q

Spondylotisthesis - s/s

A

May be asymptomatic
LBP with posterior leg radiation
Pain worse with standing and lumbar extension

27
Q

Spondylotisthesis - exam

A

Diminished lumbar lordosis
Palpation - pain and “step-off” with spinous process of slipped vertebra
Lumbar pain with extension
Reflexes and MS usually normal

28
Q

Spondylotisthesis - dx

A

X-ray - AP, lat, oblique view
Pars defect seen on oblique view (scotty dog) absent neck
CT scan
Bone scan

29
Q

Spondylotisthesis - tx

A 
PT
Avoid aggravating activities
Lumbar orthrosis
Sx - degenerative slips
Evaluate every 6 months with x-rays until growth complete
30
Q

Compression Fx - in general

A 
Osteoporosis related
Occurs with or w/o trauma
Acute onset of back pain
May become multiple
All heal in time (2 months)
Feel better with brace (warm-n-foam, camp)
31
Q

Compression Fx - tx

A

Kyphoplasty

Vertebroplasty

32
Q

Kyphoplasty / vertebroplasty

A

1-3% neurologic complication

Reasonable choice for prolonged pain

33
Q

Pott’s Dz

A

TB of the spine
Result in destruction of vertebral bodies
X-ray show vertebral ostolysis or compression fx
Tx - rest and anti-TB meds

34
Q

Cauda Equina Syndrome - in general

A

Compression of causda equina roots
May result from large midline disc herniation
Occurs in only 2%
L4-5 most common

35
Q

Cauda Equina Syndrome - s/s

A

Incontinence
Severe leg pain
Numbness
Difficulty walking

36
Q

Cauda Equina Syndrome - dx

A

Emergent MRI

37
Q

Cauda Equina Syndrome - tx

A

Sx

38
Q

When to order x-rays

A

> 65yo
Hx of trauma
Pain lasting >4weeks
Hx of ca (MRI or bone scan)

39
Q

When to order MRI

A 
Loss of bladder/bowel control
Neurological deficit
Severe leg pain not responding to ESI
Suspected malignancy (ca hx, night pain)
Back pain for 4 months despite tx
40
Q

“Hip pain”

A

Buttock - referred back pain
Groin - true hip joint pain
Lateral - trochanteric bursitis

41
Q

Hx keys

A

What makes pain worse? Better?
Ca - constant, may be worse at night
Pain - increased by activity, relieved by rest
TRUE loss of bladder control

42
Q

Exam keys

A 
Decreased Knee Jerk - L3 or L4
Decreased EHL strentgth - L5
Decreased Ankle Jerk - S1
Beware - "breakaway weakness" or "cogwheeling"
SLR- positive if it produces leg pain
43
Q

Don’t forget other causes

A

Aortic aneurysm
Ca
Fx
DVT

Clin Med II - Ortho (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions