Mehlman spinal: spondylolythesis/disc hern/lumbosacral strain

Question 1

M. Disc herniation.
Radiculopathy down an arm –> herniation?

Answer 1

Cervical disc herniation.

Question 2

M. Disc herniation.
Radiculopathy down a leg –> herniation?

Answer 2

lumbosacral disc herniation.

Question 3

M. 24M lifts a heavy box + gets lower back pain with paraspinal muscle spasm + positive straight-leg raise test + no radiating pain; next best step in Mx (management)?

Answer 3

answer = no further studies indicated;
x-ray is the wrong answer here.

Question 4

M. Straight-leg raise test should ordinarily be positive in ……?

Answer 4

sciatica, but the test is not very reliable and has false-positives

Question 5

M. For simple lumbosacral strain, do not do…?

Answer 5

dont do xray.

Question 6

M. simple lumbosacral strain –> Tx?

Answer 6

Tx is exercise as tolerated + NSAIDs if necessary. Bed rest is the wrong answer for Tx.

Question 7

M. 24M lifts a heavy box + gets lower back pain that radiates down a leg; next best step in Mx?.

Answer 7

x-ray –> in this case, we think about disc herniation.

Although x-ray does not detect the herniation, it’s still the next best step before MRI in order to rule out other things like vertebral mal-alignments

Question 8

M. Nei i spine tema, bet buvo prie lecture.
Bell palsy; next best step in Mx?

Answer 8

“no further studies indicated” –> the wrong answer is “nerve conduction studies.”

Question 9

M. Spondylolithesis. definiton?

Answer 9

,,step-off” of one vertebra relative to other.
arba
,,step-off” between infra/suprajacent vertebrae.

Question 10

,,step-off” of one vertebra relative to other?

Answer 10

M. Spondylolithesis.

Question 11

M. Spondylolithesis. They will say one vertebrae ,,juts out” or ,,step-off” compared to those above/below it.

Answer 11

.

Question 12

M. Spondylolithesis. etiology?

Answer 12

can be due to trauma or idiopathic.

Question 13

M. Disc herniation. definition?

Answer 13

herniation of nucleus pulposus through a tear in annulus fibrosus.

Question 14

M. Disc herniation. Lifting heavy thing/bending over –> occurs shooting pain down the leg = radiculopathy = Dx?

Answer 14

Disc herniation.

answer can be ,,herniated nucleus pulposus”.

Question 15

M. Disc herniation.

Be aware of radiculopathy differences L4, L5, S1.

Answer 15

.

Question 16

M. Disc herniation.
Cervical herniation IS A THING.

Answer 16

.

Question 17

M. Disc herniation.
Patient has shooting pain down an arm = Dx?

Answer 17

Cervical radiculopathy
C8 disc herniation.

Question 18

M. Disc herniation.
Del diagnostikos yra biski consufed.

What to do IF SUSPECTED?

Answer 18

If suspected, newest NBMEs want “no diagnostic studies indicated.

For mere radiculopathy (i.e., radiating pain), no imaging
necessary on new NBME content.

Question 19

M. Disc herniation.
Del diagnostikos yra biski consufed.

What to do IF SUSPECTED + MOTOR/SENSORY Abnormalities?

Answer 19

” X-ray and MRI are not indicated unless there is motor/sensory abnormality (i.e., weakness or numbness)

Question 20

M. Disc herniation. Tipo jeigu tik plinta skausmas, tai nieko, o jeigu jau yra parestezijos hujezijos, tada imaging.

Answer 20

.

Question 21

M. Disc herniation.
Straight leg test?

Answer 21

Straight-leg raise test is not reliable.

Question 22

M. Disc herniation.
Straight leg test when is positive?

Answer 22

Mere pain alone is a negative test.
The test is only positive when they say it reproduces radiculopathy/radiating pain.

Question 23

M. Disc herniation.
There is a 2CK Q where they say straight-leg test causes pain (i.e., negative test) and answer is “no further management indicated” (i.e., Dx is only lumbosacral strain).

Answer 23

.

Question 24

M. Disc herniation. Tx?

Answer 24

Tx is NSAIDs + light exercise as tolerated.

Question 25

M. Disc herniation. Wrong answer on Tx?

Answer 25

Bed rest is wrong answer on USMLE.

Question 26

M. Lumbosacral strain.
Patient has paraspinal muscle spasm following lifting of heavy box without radiculopathy = Dx?

Answer 26

Lumbosacral strain.

Question 27

M. Lumbosacral strain.
Patient has paraspinal muscle spasm following lifting of heavy box with radiculopathy = Dx?

Answer 27

the answer is disc herniation instead

Question 28

M. Lumbosacral strain.
Straight-leg test?

Answer 28

Test can cause pain (i.e., negative test). The test is only positive if
they it reproduces radiating pain

Question 29

M. Lumbosacral strain.
Imaging?

Answer 29

DO NOT DO X RAY.
very HY for 2 CK.

Apparently lumbar spinal x-rays are one of the most frivolously ordered tests, and USMLE wants you to know that you do not order one for simple lumbosacral strain.

Question 30

M. Lumbosacral strain. Tx?

Answer 30

same as in herniation.

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

Question 31

UW. Lumbosacral strain.
Causes?

Answer 31

Strain of paraspinal muscles, tendons, intervertebral ligaments.

Sudden or unbalanced muscle contractions (eg lifting, twirting)

Risk factors: obesity, spinal deformity or degeneration, muscle weakness

Question 32

UW. Lumbosacral strain.
CP?

Answer 32

Pain in lumbar area; may radiate to buttocks, hips, thighs (above knee)

Paraspinal tenderness

No neurologic deficits; negative straight-leg raising test

Question 33

UW. Lumbosacral strain.
Mx??

Answer 33

Moderate activity
NSAIDS
Non-BZD muscle relaxants.