Patho E 2 Flashcards
1
Q
What emergent spinal condition does the patient present with sudden onset back pain related to trauma or relative trauma?
A
Vertebral compression fracture
2
Q
Severe osteoporosis & moderate/ mild osteoporosis is relative trauma or trauma?
A
Relative trauma
3
Q
In severe osteoporosis is what is VCF caused by?
A
Simple ADL
4
Q
In mod/mild osteoporosis what is VCF caused from?
A
Activities involving increased trauma (tripping, lifting heavy object)
5
Q
In healthy bone density what is VCF caused by?
A
High impact trauma
6
Q
Risk factors for what include osteoporosis, presenting with osteoporosis risk factors, age >50, hx of vertebral fractures, and bone pathology
A
Vertebral compression syndrome
7
Q
What is the grading for VCF measuring?
A
Loss of height
8
Q
What grade for VCF is 20-25% LOH
A
Grade 1
9
Q
What grade for VCF is 25-40% LOH
A
Grade 2
10
Q
What grade for VCF is >40% LOH
A
Grade 3
11
Q
What is the typical non surgical treatment for VCF
A
Bracing
12
Q
What type of surgery for VCF is cement injected into fracture to stabilize and help reduce pain?
A
Vertebroplasty
13
Q
What type of VCF surgery does a balloon get inserted to restore height and then filled with cement?
A
Kyphoplasty
14
Q
What is a rare emergent condition caused by compression of cauda equina (multiple lumbarsacral nerve roots)
A
Cauda equina syndrome
15
Q
What is the most common cause of CES?
A
Severe disc herniation
16
Q
Your patient presents with urinary and bowel incontinence, saddle parathesia, bilateral leg pain and radiculopathy what is it
A
Cauda equina syndrome
17
Q
T/f cauda equina syndrome develops gradually only
A
False
18
Q
A combination of leg weakness and bladder dysfunction should be assessed for what
A
Cauda equina syndrome
19
Q
T/f cauda equina syndrome is not an emergent referral out
A
False
20
Q
What is the gold standard test for CES?
A
MRI
21
Q
Spinal decompression surgery to removed herniated disk, tumor, etc and antibiotics is treatment for what?
A
Cauda equina syndrome
22
Q
If CES is left untreated what will occur?
A
Irreversible nerve damage = permanent incontinence / paralysis
23
Q
What offers the best outcome for CES?
A
Early surgical intervention
24
Q
What type of spinal tumors originate in the spine, relatively rare and represent a small % of spinal tumors
A
Primary
25
What type of tumors in the spine originate from somewhere else and represent the majority of spinal tumors
Metastatic spinal tumors
26
What is the most common symptom of spinal cancer?
Back/neck pain
27
It is critical for a PT to consider the possibility of what in any pt with a history of cancer and presents with back and neck pain
Spinal tumor
28
What is the initial sign of spinal tumor?
Localized neck and back pain that starts as night pain
29
For a spinal tumors are physical exam findings consistent with postural/orthopedic pathology?
No
30
T/f ROm, strength, and neurological findings are typically normal unless the spinal tumors is very large
True
31
In spinal tumors are pain provoking/ relieving patterns consistent with physical movement?
No
32
Consult/ refer out if a patient has persistent neck/back pain with atleast what other symptoms
Current/recent hx of cancer
Age>50
Unexplained weight loss
Physical exam not consistent with ortho pathology
Failure of conservative treatment for back / neck pain
33
What is the prognosis for spinal cancer?
Less than a year
34
What percent of pt with spinal cancer live up to 2 years?
10-20%
35
What are some treatments for spinal cancer?
Radiation + surgery
36
What is a rare but serious infectious abscess that grows in the epidural space and causes back and neck pain
Epidural spinal abscess
37
Risk factors: IV drug use, diabetes, vascular catheter, recent spinal procedure are for what pathology?
Epidural spinal abscess
38
Where are epidural spinal abscess most common?
Thoracic or lumbar spine
39
T/f progression in epidural spinal abscess are variable
True
40
Your patient presents with back pain, motor weakness, fever, progressive neurological deficits, what is most likely the cause?
Epidural spinal abscess
41
Your physical exam reveals tenderness of thoracic spine, hyper reflexia, spasticity/paresis below T6, and saddle parethesia, what is likely the cause?
Epidural spinal abscess
42
What is the best imaging for epidural spinal abscess?
MRI
43
What is the treatment for epidural spinal abscess
Antibiotic and urgent surgery with neurological symptoms
44
T/f irreversible paralysis is likely when an epidural spinal abscess is diagnosed early
False
45
What is an acute/chronic infection of bone (usually staph A)
Vertebral osteomyelitis
46
Risk factors : immunocompromised state, iv drug use, endocarditis, age are for what pathology?
Vertebral Osteomyelitis
47
Your pt presents with new/ worsening back pain with fever, with symptoms developing over 2 weeks
Vertebral osteomyelitis
48
You examine your pt and find localized tenderness of t4-t7 (vertebrae random), redness and warmth, painful ROM, and negative neuro screen. What is likely
Vertebral osteomyelitis
49
What is used to diagnose vertebral osteomyelitis?
MRI
50
What is used to rule out other pathologies but NOT a diagnostic tool for vertebral osteomyelitis?
x ray
51
How do you treat osteomyelitis
Antibiotics and surgical debridement
52
What is the prognosis of osteomyelitis if caught early
Good prognosis
53
What is the prognosis of osteomyelitis involving prosthetic devices?
Difficult to treat and reduces chances of favorable outcome
54
How likely is chronic osteomyelitis likely to reoccur(percent)
30-50%
55
What are Bone spurs along facet joint and loss of disc height and function?
Osteoarthritis (spondylosis)
56
Your >50 yrs old pt presents with gradual onset and repeated episodes of back and neck pain for months with a provoking event (prolonged standing). Symptoms are worse in the morning and better with moving around. What is likely
Osteoarthritis
57
When you examine your patient you see minor postural deviations, trunk extension provokes pain, trunk flexion feels good to stretch and radicular tests (SLR and PKB) are negative what is likely?
Osteoarthritis (spondylosis)
58
What is common diagnostic tool for osteoarthritis?
X-ray - if greater than 50 and symptoms 4-6 weeks
59
What are goals for pt intervention for spondylosis
Mimimize acute symptoms
Optimize ROM but may NOT be possible to get it fully back
Therapeutic exercise focused on ADL and ergonomics
Identify / minimize provoking activity
60
What is a bony narrowing of vertebral canal or intervertebral foramen at multiple levels
Spinal stenosis
61
What type of spinal stenosis is osteoarthritis (acquired or congenital)
Acquired
62
What type of spinal stenosis is abnormal vertebral growth/development (acquired/congenital)
Congenital
63
Your patient presents with back pain, leg pain and limping (claudication). They say their pain is provoked by walking, prolonged standing or trunk extension activity. It is relieved with trunk flexing. What is likely
Spinal stenosis
64
When you examine your patient they have leg pain, limping with walking that is relieved by leaning forward. They have some lumbrosacral tenderness,extension provokes leg symptoms. They have neurological claudication and peripheral arterial disease and flexion and rest relieved symptoms.
Spinal stenosis
65
What are some goals for spinal stenosis in pt
Mimimize acute symptoms, realistic ROM expectations, optimize function, patient education
66
True/ false injections for spinal stenosis are supported by literature
False
67
What are positive predictors for a laminectomy for spinal stenosis
Male, younger, better walking, self rated health good, less comorbidities, pronounced canal stenosis
68
What are negative predictors for surgery for spinal stenosis
Depression, decrease walking capacity, cardiovascular comorbidities, scoliosis
69
Does interspinous spacer implantation prevent extension or flexion in spinal stenosis?
Extension
70
What is spondylosis?
Stiffening or fusion of joint - degenerative changes - osteoarthritis
71
What is spondylolysis
Pars interarticularis defect of vertebral canal
72
What is spondylolisthesis
Pars interarticularis defect with anterior displacement of the vertebra
73
What is grade 1 spondylolistheis?
0-25%
74
What is grade 2 spondylolistheis
25-50%
75
What is grade 3 spondylolistheis
50-75%
76
What is grade 4 spondylolistheis
75-100%
77
What is grade 5 spondylolistheis
100+%
78
What are the two different kinds of spondylolistheis
Isthmic and degenerative
79
What kind of spondylolistheis affects younger adults/kids, is excess extension forces on pars interarticularis during adolescence causes the break and acute pain
Isthmic spondylolistheis (type II)
80
Where does Isthmic spondylolistheis usually occur?
L5/S1
81
What type of spondylolistheis affects older pt with osteoarthritis which causes small anterior displacement but does NOT break
Degenerative spondylolistheis (type III)
82
True / false in degenerative spondylolistheis the pars interarticularis breaks
False
83
What type of spondylolistheis does a pt have an onset of LBP following repetitive extension activity; severe cases may have LBP and radiating leg pain
Isthmic spondylolistheis
84
Your young pt presents with limited AND PAINFUL TRUNK EXTENSION that provokes symptoms, tenderness of vertebrae and step off sign, negative neuro screen, and SLR demonstrates TIGHT HAMSTRINGS. What is likely
Isthmic spondylolistheis
85
In Isthmic spondylolisthesis what view lateral or oblique reveals anterior displacement?
Lateral
86
In Isthmic spondylolisthesis what view reveals the Scotty dog defect
Oblique
87
What are the PT goals of Isthmic spondylolistheis?
Remove provoking activity (parents and coaches)
Manage acute symptoms
Restore trunk extension after symptoms resolve
Restore hamstring flexibility
Safely return to sport
88
True / false if gross instability and neuro symptoms sometimes a spinal fusion is required for Isthmic spondylolistheis
True
89
What type of spondylolisthesis occurs in patients with osteoarthritis so the pt presentation is similar to osteoarthritis?
Degenerative spondylolisthesis
90
You complete your physical exam and your patient presents with osteoarthritis symptoms, a step off sign, and positive straight leg test. What is likely
Degenerative spondylolisthesis
91
True / false degenerative spondylolisthesis is diagnosed on X-ray
True
92
What is the most common spine deformity?
Scoliosis
93
What is a lateral curvature (atleast 10 degrees) with a rotation deformity
Scoliosis
94
Dextroscoliosis is left or right curve
Right
95
Levoscoliosis is a left or right curve?
Left
96
What three types of scoliosis are there?
Infantile, juvenile, adolescent
97
What type of scoliosis is least common and is <3yrs which will normally resolve
Infantile
98
What type of scoliosis is not least common or most common and onsets ages 3-9 with rapid progression and severe deformity
Juvenile
99
What type of scoliosis is the most common type of scoliosis with onset age 10-13, female>male
Adolescent
100
Your patient presents with lateral curvature in upright position, limited lateral flexion, rib hump when flex trunk, and trunk angle of 10 degrees or greater
Adolescent idiopathic scoliosis
101
What is the gold standard for measuring scoliosis
Cobb angle
102
What degree of Cobb angle needs to be present to diagnose scoliosis
10 degrees
103
True / false Cobb angle is measured to monitor progression of scoliosis
True
104
What two things are critical for scoliosis
Early detection
Monitoring progression
105
Your patient presents with a 26 degree Cobb angle in your clinic. What is the imaging, referral status and treatment for this pt?
Radiograph every 6 months
Refer out
Brace
106
True/ false PT can reduce spinal curve in scoliosis
False
107
What are PT goals for scoliosis
Reduce symptoms
Optimize function and ADL
108
What can be used for scoliosis to minimize / slow progression of curve
Bracing
109
What is the only treatment for scoliosis that can correct the curve
Surgery
110
What is a spinal nerve root impingement due to space occupying lesion in vertebral canal or intervertebral foramen
Radiculopathy
111
Where is radiculopathy common?
Lumbar and cervical
112
Your patient presents with radiating pain down arm or leg and may or may not be accompanied with back/neck pain
Radiculopathy
113
Where is lumbar radiculopathy most common?
L5-S1-L4
114
Your patient reports radiating leg pain / sensory loss / parathesia provoked by back movement what is likely
Lumbar radiculopathy
115
You observe your patient has an antalgic posture and gait, limited trunk flexion that provokes leg symptoms, decreased dermatome and myotome sensation, and decreased DTR, positive SLR test, positive well leg raise sign, and positive PKB test; what is likely
Lumbar radiculopathy
116
In lumbar radiculopathy a positive SLR indicated which nerve roots impacted
L5 S1
117
If a patient has a positive PKB test what nerve root is affected
L4
118
In the SLR test how do you confirm neuro symptoms
Lowering leg slightly and dorsiflexing foot if they feel symptoms stop if they don’t raise until stretch
119
A positive SLR test is indicated by
Radicular pain in S1 or L5 dematomes
120
A negative SLR test is indicated by
Hamstring tightness, SI hip or back pain
121
What are the four steps in a S1 radiculopathy
Sensation, strength, reflex, SLR
122
What are the four steps of neuro screen in L5 radiculopathy
Sensation, strength, reflexes, SLR
123
What are the four steps of neuro screen in L4 radiculopathy?
Sensation, strength, reflex, PKB
124
Where is light touch applied to sensory test L4
Medial knee leg foot
125
Where is light touch to sensory test L5
Dorsum of foot
126
Where is light touch to sensory test S1
Lateral foot
127
Where is L4 strength tested?
Knee extension
128
Where is L5 strength tested?
Great toe extension
129
Where is S1 strength tested?
Plantar flexion
130
Where is DTR for L4
Patella
131
Where is DTR for L5
Hamstrings (not typical)
132
Where is S1 DTR
Achilles
133
When is MRI indicated for lumbar radiculopathy
Signs of CES, progressive neuro loss, failure to improve 4-6 wks
134
What are goals for lumbar radiculopathy
Reduce acute symptoms (McKenzie) treatment
Optimize trunk stability
ADL
Pt education
135
True / false if pt does not improve with PT you should refer out for surgical management
True
136
Your pt reports radiating pain paresthesia sensory loss provoked with neck movement and down arm
Cervical radiculopathy
137
What are the common nerve roots in cervical radiculopathy
C7 C6 C5
138
Your patient had antalgic gait and posture of head and neck, ipsilateral flexion & rotation & extension provoke UE symptoms, vertebral tenderness, positive spurling and compression test, positive distraction, ipsilateral rotation of less than 60 degrees
Cervical radiculopathy
139
T/f you should apply compression if pt has pain turning head ipsilateral during spurling test
False
140
T/f c5 c6 c7 all have positive spurling test and compression
True
141
Where do you test C5 dermatome
Light touch along lateral upper arm
142
Where do you test C6 dermatome
Light touch along lateral forearm and thumb + index finger
143
Where do you test C7 dermatome
Light touch middle finger
144
Where do you test C8 dermatome
Light touch along pinky finger (5th) and middle forearm
145
Where do you test DTR C5
Biceps
146
Where do you DTR C6
Brachioradialis
147
Where do you DTR C7
Triceps
148
Where do you test C5 myotome
Shoulder abduction and elbow flexion
149
Where do you test C6 myotome
Elbow flexion wrist extension
150
Where do you test C7 myotome?
Elbow extension wrist flexion
151
Where do you test C8 myotome
Finger flexion
152
Where do you test T1 mytome
Finger abduction
153
When is MRI indicated for cervical radiculopathy
Myelopathy, progressive neuro loss, failure to improve 4 -6 weeks
154
What are cervical radiculopathy goals?
Reduce acute symptoms
Optimize trunk stability
ADL
Pt education
155
What is the more common cervical radiculopathy procedure - anterior cervical discectomy and fusion or posterior cervical discecrtomy
Anterior
156
What general terms are used for non specific back pain
Back pain neck pain postural pain
157
Your patient presents with back pain from a specific activity or event, they dont have any risk factors, systemic pathology, emergent spinal pathology or orthepedic pathology what is it
Nonspecific back pain
158
Are neuro screens and special tests negative or positive with non specific back pain
Negative
159
What are some PT goals for non specific back pain?
Reduce symptoms
Optimize arthrokinematics
Improve trunk ROM
Core stability
ADL
Pt education
160
If non specific back pain does not resolve in 4-6 wks what is indicated X-ray or MRI
X-ray
161
If non specific back pain with radicular pain than what is indicated X-ray or MRI
MRI
162
