Mehlman spinal: Sciatica (UW), meralgia, scolio, kyphosis

Question 1

M. Sciatica. 90 proc due to what?

Answer 1

disc herniation

Question 2

M. Sciatica.
Straight-leg test classically …?

Answer 2

Straight-leg test classically (+) – i.e., reproduces radiating pain.

Question 3

M. Sciatica.
Tx?

Answer 3

same as in herniation

Tx = Light exercise as tolerated + NSAIDs. Bed rest is wrong answer on USMLE

On one of the 2CK CMS forms, ibuprofen straight-up is listed as the answer.

Question 4

UW. Sciatica = lumbosacral radiculopathy.

Etiologies

Answer 4

Etiologies:
a. Compression by herniated disk
b. Lumbar spondylosis (in older patients or those with prior traumatic injury)
c. Infection
d. Inflammatory disorders
e. Mass lesions
f. Vascular disorders
g. Developmental anomalies

Question 5

UW. Sciatica

Patients with uncomplicated lumbar strain can have radiation of pain to the buttocks or posterior thigh, but radiation to calf and foot is more consistent with sciatica.

Answer 5

.

Question 6

UW. Sciatica. Physical exam?

Answer 6

Straight leg test
–> Worsening or reproduction of pain

Question 7

UW. Sciatica. Mx?

Answer 7

Management
a. NSAIDs and acetaminophen (first-line)
i. This is given because acute sciatica resolves spontaneously in most patients. Hence, pain management is the first step to relieve acute pain.

Question 8

M. Meralgia paresthetica.
Due to?

Answer 8

Due to entrapment/compression of lateral femoral cutaneous nerve.

Question 9

M. Meralgia paresthetica.
answer if mentioned what?

Answer 9

patient has pain or paresthesias running down the lateral tight.

Question 10

patient has pain or paresthesias running down the lateral tight?

Answer 10

M. Meralgia paresthetica.

Question 11

M. Meralgia paresthetica.
Often seen as incorrect choice on step, so be aware of it.

Answer 11

.

Question 12

UW. Meralgia paresthetica.
Etiology?

Answer 12

Compression of lateral femoral cutaneous nerve at inguinal ligament due to:

Etiology
* Tight clothing
* Injury during local surgery
* Seat belt injury (eg, motor vehicle collision)

Question 13

UW. Meralgia paresthetica.
Risk factors?

Answer 13

Obesity with heavy panniculus
Diabetes
Pregnancy

Question 14

UW. Meralgia paresthetica.
CP?

Answer 14

Paresthesia & decreased sensation at lateral thigh
No motor deficits

Question 15

UW. Meralgia paresthetica.
Tx?

Answer 15

Avoid tight garments
Weight loss
Anticonvulsants (eg, gabapentin) or nerve block

Question 16

M. Scoliosis. Definition?

Answer 16

Sideways curvature of spine, creating an S- or C-shaped curve.

Question 17

M. Scoliosis. Cause?

Answer 17

Usually idiopathic; affects 3% of population; girls 4:1

Question 18

M. Scoliosis. Can be assoc. with what 3 congenital?

Answer 18

Can be associated with Marfan syndrome, Friedreich ataxia, NF1

Question 19

Can be associated with Marfan syndrome, Friedreich ataxia, NF1?

Answer 19

M. Scoliosis.

Question 20

M. Scoliosis. What test to diagnose?

Answer 20

Adams forward bend test used to diagnose.

Question 21

Adams forward bend test used to diagnose?

Answer 21

M. Scoliosis.

Question 22

M. Scoliosis. In children what Tx?

Answer 22

USMLE wants you to know most children do not need treatment, but that curvatures will remain throughout life

Question 23

M. Scoliosis. when need bracing?

Answer 23

Answer = bracing if curvature is >25 degrees and child is still growing.

Question 24

M. Scoliosis. Whats about surgery?

Answer 24

I’ve never seen surgery as answer for scoliosis on NBME; literature says
recommended only when curvature >40 degrees.

Question 25

M. Kyphosis. definition?

Answer 25

Abnormal convex curvature of thoracic spine.

Question 26

M. Kyphosis. etiology idiopathic in what?

Answer 26

Usually idiopathic due to old age

Question 27

M. Kyphosis. etiology if degenerative?

Answer 27

can be due to degenerative disc disease and compression fractures (osteoporosis).

Question 28

M. Kyphosis. if severe, what about pulmonary?

Answer 28

If severe, can in theory cause restrictive lung disease due to impaired chest wall expansion.