Mehlman spinal: Sciatica (UW), meralgia, scolio, kyphosis 03-10 (2) Flashcards
M. Sciatica. 90 proc due to what?
disc herniation
M. Sciatica.
Straight-leg test classically …?
Straight-leg test classically (+) – i.e., reproduces radiating pain.
M. Sciatica.
Tx?
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.
UW. Sciatica = lumbosacral radiculopathy.
Etiologies
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
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.
.
UW. Sciatica. Physical exam?
Straight leg test
–> Worsening or reproduction of pain
UW. Sciatica. Mx?
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.
M. Meralgia paresthetica.
Due to?
Due to entrapment/compression of lateral femoral cutaneous nerve.
M. Meralgia paresthetica.
answer if mentioned what?
patient has pain or paresthesias running down the lateral tight.
patient has pain or paresthesias running down the lateral tight?
M. Meralgia paresthetica.
M. Meralgia paresthetica.
Often seen as incorrect choice on step, so be aware of it.
.
UW. Meralgia paresthetica.
Etiology?
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)
UW. Meralgia paresthetica.
Risk factors?
Obesity with heavy panniculus
Diabetes
Pregnancy
UW. Meralgia paresthetica.
CP?
Paresthesia & decreased sensation at lateral thigh
No motor deficits
UW. Meralgia paresthetica.
Tx?
Avoid tight garments
Weight loss
Anticonvulsants (eg, gabapentin) or nerve block
M. Scoliosis. Definition?
Sideways curvature of spine, creating an S- or C-shaped curve.
M. Scoliosis. Cause?
Usually idiopathic; affects 3% of population; girls 4:1
M. Scoliosis. Can be assoc. with what 3 congenital?
Can be associated with Marfan syndrome, Friedreich ataxia, NF1
Can be associated with Marfan syndrome, Friedreich ataxia, NF1?
M. Scoliosis.
M. Scoliosis. What test to diagnose?
Adams forward bend test used to diagnose.
Adams forward bend test used to diagnose?
M. Scoliosis.
M. Scoliosis. In children what Tx?
USMLE wants you to know most children do not need treatment, but that curvatures will remain throughout life
M. Scoliosis. when need bracing?
Answer = bracing if curvature is >25 degrees and child is still growing.
M. Scoliosis. Whats about surgery?
I’ve never seen surgery as answer for scoliosis on NBME; literature says
recommended only when curvature >40 degrees.
M. Kyphosis. definition?
Abnormal convex curvature of thoracic spine.
M. Kyphosis. etiology idiopathic in what?
Usually idiopathic due to old age
M. Kyphosis. etiology if degenerative?
can be due to degenerative disc disease and compression fractures (osteoporosis).
M. Kyphosis. if severe, what about pulmonary?
If severe, can in theory cause restrictive lung disease due to impaired chest wall expansion.
