Mehlman spinal: spondylo, atlantis, lumbar/cervical stenosis/osteoporosis cases 04-08 (3) Flashcards

1
Q

Point tenderness over a vertebra in older woman –> Dx?

A

osteoporosis (compression fracture).

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2
Q

Point tenderness over a vertebra in younger patient on steroids –> Dx

A

osteoporosis (compression fracture).

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3
Q

Point tenderness over a vertebra in patient with autoimmune disease –> recognize patient is on steroids –> Dx?

A

osteoporosis (compression fracture).

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4
Q

34F + Hx of SLE (or IBD, or RA, etc.) managed with multiple medications + point tenderness over vertebra; Dx?

A

osteoporosis (compression fracture) –> need to be able to infer she’s on prednisone since autoimmune disease.

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5
Q

Point tenderness over vertebra + patient who has pituitary adenoma. Dx?

A

Dx for adenoma? –> ACTH (Cushing disease) –> osteoporosis (compression fracture).

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6
Q

Point tenderness over a vertebra in IV drug user –> Dx?

A

epidural abscess.

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7
Q

,,Step-off” of one vertebra relative to another –> Dx?

A

spondylolisthesis.

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8
Q

Back pain worse when standing or walking for long periods of time –> Dx?

A

lumbar spinal stenosis

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9
Q

Cervical spondylosis. definition?

A

Degeneration of pars interarticularis component of vertebral body.

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10
Q

Cervical spondylosis. where can occur?

A

Spondylosis can occur in lumbar spine, but usmle like cervical

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11
Q

Cervical spondylosis. what case?

A

> 50 y/o + neck pain + MRI shows degenerative changes of cervical spine.

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12
Q

M. Atlantoaxial subluxation. definition?

A

increased mobility between first (atlas) and second (axis) vertebrae.

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13
Q

M. Atlantoaxial subluxation. really HY for what patients?

A

who have RA.

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14
Q

M. Atlantoaxial subluxation. Pacient is under anesthesia for surgey. what must to do?

A

CT or flexion/extension xray of cervical spine prior surgery when intubated.

been both of these answers on surg.

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15
Q

M. Atlantoaxial subluxation. one case:
Pt with RA + no surgery + has paresthesias in upper limb –> Dx?

A

MRI of cervical spine (implying a. subluxation has already occured).

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16
Q

UW. Atlantoaxial subluxation.
RA does not involve the axial skeleton, but it does involve …..

A

cervical spine

17
Q

UW. Atlantoaxial subluxation.
RA does involves spine –> leads to life-threatening complication – Atlantoaxial subluxation.

18
Q

UW. Atlantoaxial subluxation in the backgroung of RA. It can cause what?

A

This can cause spinal cord compression and difficulties with intubation

19
Q

UW. Atlantoaxial subluxation CP?

A

a. Neck pain
b. Progressive spastic quadriparesis
c. Sensory deficits in the hands and feet

20
Q

M. Lumbar spine stenosis. Definition?

A

Narrowing of the spinal canal –> compression of lumbar nerve roots

21
Q

M. Lumbar spine stenosis. what case?

A

> 50 y.o + lower back pain, that worsens when walking down a hill OR when standin/walking for extended periods of time.

22
Q

> 50 y.o + lower back pain, that worsens when walking down a hill OR when standin/walking for extended periods of time.

A

M. Lumbar spine stenosis.

23
Q

M. Lumbar spine stenosis. pain relieved…

A

when leaning forward

24
Q

UW. Lumbar spine stenosis. Etiologies?

A

a. Degenerative arthritis (spondylosis)
b. Degenerative disk disease
c. Thickening of ligamentum flavum
d. Displacement of one vertebral body relative to another (spondylolisthesis)

25
UW. Lumbar spine stenosis. CP?
Low back pain: --> Increased with lumbar extension (eg, walking downhill) --> Decreased with lumbar flexion (eg, walking uphill, leaning)
26
UW. Lumbar spine stenosis. Shopping cart sign?
Leaning forward relieves pressue -> relieved symptoms. Buvo fotke su pardes vezimeliu, nes kai pasilenki ji stumti --> palengveja simtomai Kai issitiesi, aka lumbar extension --> symptoms worsens
27
M. Back pain worse when standing or walking for long periods of time –> Dx?
lumbar spinal stenosis.
28
M. Back pain worse when walking down a hill –> Dx?
lumbar spinal stenosis
29
M. Bilateral paresthesias in the arms in rheumatoid arthritis patient –> Dx?
atlantoaxial subluxation.
30
M. Bilateral paresthesias in the arms in rheumatoid arthritis patient –>Dx imaging?
MRI of spine to Dx atlantoaxial subluxation.
31
M. Prior to surgery in rheumatoid arthritis patient –> imaging?
cervical CT or flexion/extension x-rays of cervical spine to check for atlantoaxial subluxation.
32
M. Cervical foraminal stenosis. Definition?
Not stenosis of cervical spinal canal, but STENOSIS of FORAMEN WHERE NERVE EXITS.
33
Not stenosis of cervical spinal canal, but STENOSIS of FORAMEN WHERE NERVE EXITS.?
Cervical foraminal stenosis.
34
M. Cervical foraminal stenosis. what case?
Old women + difficulty fasting buttons + weakness of hand muscles + loss of sensation of little finger --> Answer C7-T1 foraminal stenosis.
35
M. Cervical foraminal stenosis. Old women + difficulty fasting buttons + weakness of hand muscles + loss of sensation of little finger --> what C level?
Answer C7-T1 foraminal stenosis.
36
M. lumbar spinal stenosis. can be ,,neurogenic claudication". what vignette?
Symptoms sounds like intermitent claudication, but normal pulses, no cardiovascular disease.
37
M. lumbar spinal stenosis. why increased in obesity?
technically, its and osteoarthritic change of the spine -> therefore incr. in obesity