Mehlman spinal: spondylo, atlantis, lumbar/cervical stenosis/osteoporosis cases 04-08 (3) Flashcards
Point tenderness over a vertebra in older woman –> Dx?
osteoporosis (compression fracture).
Point tenderness over a vertebra in younger patient on steroids –> Dx
osteoporosis (compression fracture).
Point tenderness over a vertebra in patient with autoimmune disease –> recognize patient is on steroids –> Dx?
osteoporosis (compression fracture).
34F + Hx of SLE (or IBD, or RA, etc.) managed with multiple medications + point tenderness over vertebra; Dx?
osteoporosis (compression fracture) –> need to be able to infer she’s on prednisone since autoimmune disease.
Point tenderness over vertebra + patient who has pituitary adenoma. Dx?
Dx for adenoma? –> ACTH (Cushing disease) –> osteoporosis (compression fracture).
Point tenderness over a vertebra in IV drug user –> Dx?
epidural abscess.
,,Step-off” of one vertebra relative to another –> Dx?
spondylolisthesis.
Back pain worse when standing or walking for long periods of time –> Dx?
lumbar spinal stenosis
Cervical spondylosis. definition?
Degeneration of pars interarticularis component of vertebral body.
Cervical spondylosis. where can occur?
Spondylosis can occur in lumbar spine, but usmle like cervical
Cervical spondylosis. what case?
> 50 y/o + neck pain + MRI shows degenerative changes of cervical spine.
M. Atlantoaxial subluxation. definition?
increased mobility between first (atlas) and second (axis) vertebrae.
M. Atlantoaxial subluxation. really HY for what patients?
who have RA.
M. Atlantoaxial subluxation. Pacient is under anesthesia for surgey. what must to do?
CT or flexion/extension xray of cervical spine prior surgery when intubated.
been both of these answers on surg.
M. Atlantoaxial subluxation. one case:
Pt with RA + no surgery + has paresthesias in upper limb –> Dx?
MRI of cervical spine (implying a. subluxation has already occured).
UW. Atlantoaxial subluxation.
RA does not involve the axial skeleton, but it does involve …..
cervical spine
UW. Atlantoaxial subluxation.
RA does involves spine –> leads to life-threatening complication – Atlantoaxial subluxation.
.
UW. Atlantoaxial subluxation in the backgroung of RA. It can cause what?
This can cause spinal cord compression and difficulties with intubation
UW. Atlantoaxial subluxation CP?
a. Neck pain
b. Progressive spastic quadriparesis
c. Sensory deficits in the hands and feet
M. Lumbar spine stenosis. Definition?
Narrowing of the spinal canal –> compression of lumbar nerve roots
M. Lumbar spine stenosis. what case?
> 50 y.o + lower back pain, that worsens when walking down a hill OR when standin/walking for extended periods of time.
> 50 y.o + lower back pain, that worsens when walking down a hill OR when standin/walking for extended periods of time.
M. Lumbar spine stenosis.
M. Lumbar spine stenosis. pain relieved…
when leaning forward
UW. Lumbar spine stenosis. Etiologies?
a. Degenerative arthritis (spondylosis)
b. Degenerative disk disease
c. Thickening of ligamentum flavum
d. Displacement of one vertebral body relative to another (spondylolisthesis)