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

Question 1

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

Answer 1

osteoporosis (compression fracture).

Question 2

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

Answer 2

osteoporosis (compression fracture).

Question 3

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

Answer 3

osteoporosis (compression fracture).

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

epidural abscess.

Question 7

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

Answer 7

spondylolisthesis.

Question 8

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

Answer 8

lumbar spinal stenosis

Question 9

Cervical spondylosis. definition?

Answer 9

Degeneration of pars interarticularis component of vertebral body.

Question 10

Cervical spondylosis. where can occur?

Answer 10

Spondylosis can occur in lumbar spine, but usmle like cervical

Question 11

Cervical spondylosis. what case?

Answer 11

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

Question 12

M. Atlantoaxial subluxation. definition?

Answer 12

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

Question 13

M. Atlantoaxial subluxation. really HY for what patients?

Answer 13

who have RA.

Question 14

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

Answer 14

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

been both of these answers on surg.

Question 15

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

Answer 15

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

Question 16

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

Answer 16

cervical spine

Question 17

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

Answer 17

.

Question 18

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

Answer 18

This can cause spinal cord compression and difficulties with intubation

Question 19

UW. Atlantoaxial subluxation CP?

Answer 19

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

Question 20

M. Lumbar spine stenosis. Definition?

Answer 20

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

Question 21

M. Lumbar spine stenosis. what case?

Answer 21

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

Question 22

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

Answer 22

M. Lumbar spine stenosis.

Question 23

M. Lumbar spine stenosis. pain relieved…

Answer 23

when leaning forward

Question 24

UW. Lumbar spine stenosis. Etiologies?

Answer 24

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

Question 25

UW. Lumbar spine stenosis. CP?

Answer 25

Low back pain:
–> Increased with lumbar extension (eg, walking downhill)
–> Decreased with lumbar flexion (eg, walking uphill, leaning)

Question 26

UW. Lumbar spine stenosis. Shopping cart sign?

Answer 26

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

Question 27

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

Answer 27

lumbar spinal stenosis.

Question 28

M. Back pain worse when walking down a hill –> Dx?

Answer 28

lumbar spinal stenosis

Question 29

M. Bilateral paresthesias in the arms in rheumatoid arthritis patient –> Dx?

Answer 29

atlantoaxial subluxation.

Question 30

M. Bilateral paresthesias in the arms in rheumatoid arthritis patient –>Dx imaging?

Answer 30

MRI of spine to Dx atlantoaxial subluxation.

Question 31

M. Prior to surgery in rheumatoid arthritis patient –> imaging?

Answer 31

cervical CT or flexion/extension x-rays of cervical spine to check for atlantoaxial subluxation.

Question 32

M. Cervical foraminal stenosis. Definition?

Answer 32

Not stenosis of cervical spinal canal, but STENOSIS of FORAMEN WHERE NERVE EXITS.

Question 33

Not stenosis of cervical spinal canal, but STENOSIS of FORAMEN WHERE NERVE EXITS.?

Answer 33

Cervical foraminal stenosis.

Question 34

M. Cervical foraminal stenosis. what case?

Answer 34

Old women + difficulty fasting buttons + weakness of hand muscles + loss of sensation of little finger –> Answer C7-T1 foraminal stenosis.

Question 35

M. Cervical foraminal stenosis.
Old women + difficulty fasting buttons + weakness of hand muscles + loss of sensation of little finger –> what C level?

Answer 35

Answer C7-T1 foraminal stenosis.

Question 36

M. lumbar spinal stenosis. can be ,,neurogenic claudication”. what vignette?

Answer 36

Symptoms sounds like intermitent claudication, but normal pulses, no cardiovascular disease.

Question 37

M. lumbar spinal stenosis. why increased in obesity?

Answer 37

technically, its and osteoarthritic change of the spine -> therefore incr. in obesity