Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spinal Disorders - Me > Midterm - New week 1 > Flashcards

Midterm - New week 1 Flashcards

1
Q

First step in differential diagnosis of NMS condition

A

Injury or diease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 spinal causes of musculoskeletal pain from disease

A
  1. Metastatic/primary tumor
  2. Infection
  3. Inflammatory disease (AS, RA, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2 non-spinal causes of musculoskeletal pain from disease

A
  1. Viscerosomatic

2. Other: AAA, endocrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

___% of LBP is due to serious disease. ___% due to local cancer or spinal infection. ___% due to referred pain from GI, reproductive or urinary

A

3%
1
2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

History is ___% of diagnosis

A

90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Excruciating pain when lying supine, relived by sitting up, hunched over a table suggests

A

Malignant retroperitoneal lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

spinal percussion is exquisite and lingers with what three conditions. Give sensitivity and specificity of each

A
  • cancer (poor Sn and sp)
  • fracture (poor Sn and sp)
  • spinal infection (86% Sn, 60% sp)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

At least __/__ of bone cancers are metastatic. Usually from (4 things)

A

2/3

- breast, lung, prostate, kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most metastatic bone cancers are osteo______. A few are osteo______ like _____

A

Osteolytic

Osteoblastic (like prostate cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Lefebvre’s 20-50 rule. What is normal range

A

If <20mm/hr abnormal but probably not clinically meaningful
If >50m/hr probably significant disease process requiring further testing and advanced imaging

Normal range is 0-18 mm/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ESR>100 think what 3 thing

A
  • multiple myeloma
  • temporal arteritis
  • polymyalgia rheumatica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Increased white count (>11,500) can suggest ________immature white cells can suggest _______.
Depressed suggest _______

A
  • spinal infection, cancer or inflammatory disease
  • Leukemia
  • Multiple myeloma or other cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Two most common causes of elevated calcium

A
  • Metastatic cancer

- hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AP increases in osteo_____ cancer to >____. Normal = ______.

What should you think when you see >AP

A

Osteoblastic
>150
0-50

Paget’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What three places do viscerosomatic and LBP originate

A

Reproductive
Urinary
Gastrointestinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a pathognomic sign

A

Strongly indicates a certain disease

Ex: thoracolumbar pain relieved by knees drawn up and forward flexion is pathognomic of a pancreas issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where does the colon (except sigmoid) refer

A

Mid-lumbar spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where do gynecological disorders refer

A

Above L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where do sigmoid colon, rectum and pelvic refer

A

Sacral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 5 diagnostic possibilities of leg and back pain?

A 
Nerve involvement 
- myelopathy 
- radiculopathy 
- neuropathy 
No nerve involvement 
- deep referred pain
- Separate lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are characteristics of sclerotogenous pain

A
  • deep-aching, diffuse pain
  • sclerotomal segmetnal patterns
  • Often more proximal than distal (does not go beyond the knee)
  • pain often radiates over time (referral territory grows)
  • field may skip regions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common type of spine related extremity pain seen in practice?

A

Sclerotogenous pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When the patient has leg or arm symptoms with spinal pain, one of the top priorities is to

A

Decide with if symptoms are neuropathic or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 5 steps of neuropathic assessment

A

History

  • leg pain (location? quality? Severity? Spine position)
  • paresthesia

Physical exam

  • nerve tension tests
  • sensory, motor, reflex tests
  • spinal loading
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Once you find there is nerve damage, what is the next step

A

Find out what part of the nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 4 main leg pain qualities of radicular syndrome?

A 
1. Location
may be past the knee, may be dermatomal, feels superficial (skin deep) 
2. Quality 
Sharp, stabbing, electrical, painful cold, lancinating 
3. Severity 
leg pain often worse than back pain 
4. Spinal position 
Sometimes affected by spine position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the paresthesia of radicular syndrome

A

Often present and more likely to follow a dermatomal distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the sensory, motor, reflex of radicular syndrome?

A

Ma be one or more deficits usually corresponding to the same nerve root (may be hypersensitivity instead)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What two things may cause nerve root compression

A

Herniated disc

Spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the results of nerve tension tests in radicular syndrome

A

often reproduce leg symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Nerve tension tests (SLR, XSLR, Braggard, Bowstring, Bonnet, Slump, Dreyerle) provoke and inflamed peripheral nerve (aka ________) or it’s nerve roots (aka ________)

A

Neuritis

Radiculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SLR tensions what nerve roots and peripheral nerve?

what is a hard and soft positive test?

A

L4, L5, S1
Sciatic nerve

Hard- create or aggravates lower extremity pain below knee
Soft - above knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SLR is good at testing for patients with ______ but has a poorer sensitivity for What additional 3?

A

Posterolateral disc herniations

  • spinal stenosis
  • spondylolisthesis (sensitivity 14%)
  • midline and medial disc herniations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is braggard test?

A

Patient supine, leg raised, dorsiflex foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is bowstring test

A

Patient supine, knee flexed, apply pressure to tibial nerve in popliteal fossa

36
Q

What is bonnet test

A

Patient supine, leg raised, internally rotate and adduct hip

37
Q

What is maximum SLR test

A

Dorsiflex, internally rotate, chin on chest, bear down

38
Q

What is the Bechetrew test

A

Seated SLR

39
Q

What is slump test

A

Seated maximum SLR

Seated SLR, foot dorsiflexed, leg internally rotated, with spine “slumped”, bearing down

40
Q

What nerve roots and peripheral nerve is the femoral stretch test.

A

L2, L3, L4

Femoral nerve

41
Q

What are spinal loading (kemps, valsalva, flexion) results of radicular syndrome

A

Rapid reproduction of leg symptoms

42
Q

If there are neuropathic findings what is the next step

A
  • find which nerve root is involved
  • is it irritated, soft neurologic sign, hard sign
  • what is the cause
43
Q

Once you have enough clues a nerve root is damaged, call it a radicular finding. If it has no defects, call it _______. If it has even one defect, call it _______

A

Radiculitis

Radiculopathy

44
Q

what is Alcock’s syndrome

A

Pudendal nerve lesion

*the back probably will not hurt.

45
Q

What are three reasons of peripheral nerve entrapment and compression?

A
  • piriformis syndrome
  • perineal nerve compression
  • femoral neuropathy secondary to pelvic tumor
46
Q

What are three peripheral nervous system diseases

A
  • diabetes
    -alcohol neuropathy
    Vitamin B12 deficiency
47
Q

What is the leg pain neuropathic tool for peripheral nerve

A

Follow a peripheral nerve territory (stocking distribution)
- often burning, may be stabbing, electrical, sharp
Not likely to be affected by spine position

48
Q

What is the leg paresthesia neuropathic tool of peripheral nerve?

A

Usually present and in a peripheral nerve territory (stocking distribution)

49
Q

What is the SMR neuropathic tool of peripheral nerve

A

May be one or more deficits usually corresponding to the same peripheral nerve

50
Q

What is the nerve tension test neuropathic tool of peripheral nerve?

A

Often reproduce leg symptoms

51
Q

What is the spinal loading procedure of neuropathic tool of peripheral nerve

A

Usually do not reproduce leg symptoms

52
Q

What nerve roots make the femoral nerve

A

L2-4

53
Q

What are three causes of femoral neuropathy

A
  • diabetic mononeuropathy
  • Tumor
  • Psoas or iliacus hematoma
54
Q

What motor symptoms might be seen with femoral nerve damage

A

Hip flexors and knee extensors affected first. First sign may be knee buckling

  • week iliopsoas and quadratus muscle testing. Single leg raise form chair
  • if there is also adductor weakness, the lesion is NOT the femoral nerve but more proximal (lumbosacral plexus or L2-4)
55
Q

Which reflex is associated with femoral nerve? Which stretch test?

A

Patellar reflex

Femoral stretch test - creates sharp anterior thigh pain

56
Q

T/F there is motor involvement with Meralgia Paresthetica

A

FALSE

57
Q

What age tends to get Meralgia paresthetica?

A

40-60

58
Q

What is one of the most common neuropathies

A

Peroneal nerve entrapment from crossing legs while sitting

59
Q

What might be characteristic of perineal nerve entrapment

A
  • foot drop may be partial or complete (often primary presentation)
  • weak ankle dorsiflexion, great toe extension or eversion
  • numbness/paresthesia over lateral aspect of lower leg and dorsum of foot
    Forced ankle inversion may increase pain because it stretches the nerve
60
Q

T/F cord problems are not commonly associated with low back pain

A

T

61
Q

What are three injuries that could cause cord compression? What disease?

A
  • TLJ compression fracture
  • upper lumbar disc lesion
  • spinal canal stenosis
  • diabetes
62
Q

T/F both CES and spinal cord compression symptoms include urinary incontinence, constipation and impotence

A

T

63
Q

What are 5 pathologies associated with a positive Romberg’s test?

A

1 - myelopathy
2- peripheral nerve lesion (eg. diabetic neuropathy)
3- multiple nerve lesions (eg. due to spinal stenosis)
4- cerebellar disease
5 - vestibular disorders

64
Q

What is the leg pain neuropathic tool for lumbar myelopathy?

A
  • May or may not be present
  • Location: Generalized, sometimes soles of feet (not dermatomal)
  • Quality: Often described as burning
  • Severity: Usually back pain is worse than leg pain
65
Q

What is the leg paresthesia neuropathic tool of myelopathy?

A

May be present but not dermatomal, often a sense of numbness

66
Q

What is the SMR neuropathic tool of myelopathy?

A

May have some sensory loss (contralateral pain, ipsilateral position sense/vibration/two point discrimination), may have UMNL signs, may have +Romberg/balance tests)

67
Q

What would the nerve tension test neuropathic tool show for myelopathy

A

Negative

68
Q

What would spinal loading neuropathic tool for myelopathy show

A

Symptoms not affected by spinal loading

69
Q

How do you make a diagnosis of deep referred pain?

A

Exclude neuropathic pain. This is based primarily on negative results

70
Q

What is the leg pain neuropathic tool of deep referred pain

A

Usually not past the knee (but definitely can be)
Location: More general, non-dermatomal
Quality: achy, crampy, grabbing (many possible descriptors)
Severity: Back pain usually > than leg pain Sometimes affected by prolonged spine position

71
Q

What is the leg paresthesia neuropathic tool of deep referred pain

A

Not usually present, but when present it is non dermatomal

72
Q

What is the SMR neuropathic tool for deep referred pain show

A

Usually no deficits

73
Q

What does the nerve tension tests neuropathic tool for deep referred pain show

A

Usually negative (may aggravate LBP)

74
Q

What does spinal loading neuropathic tool for deep referred pain show?

A

Usually do not reproduce leg symptoms

75
Q

Burning pain and dynamic tactile allodynia is associated with ______

A

Peripheral neuropathic pain, not radicular

76
Q

esthesia

A

Perception of sensation

77
Q

Paresthesia

A

Sense on pins and needles, tingling, itching

Odd sensations not needed to be provoked by physical exam

78
Q

Dysesthesia

A

Distorted unpleasant sensations perceived in response to normally non-noxious stimuli

79
Q

Allodynia

A

Nonnoxious stimuli perceived as painful

80
Q

Hypesthesia

A

(Hypoesthesia) decreased sensitivity to touch

81
Q

Hyperesthesia

A

Increased sensitivity to touch

82
Q

Anesthesia

A

Absence of touch sensation

83
Q

Analgesia

A

Absence of pain sensation

84
Q

Hypoalgesia

A

Decreased sensitivity to pain

85
Q

Hyperalgesia

A

Increased sensitivity to pain

Spinal Disorders - Me (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions