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PCM2 Midterm > Scoliosis/Acute Back Pain > Flashcards

Scoliosis/Acute Back Pain Flashcards

1
Q

What is the most common form of scoliosis?

A

adolescent idiopathic scoliosis (AIS)

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2
Q

What are 2 risk factors for developing severe scoliosis?

A
  • females are 5-10x more likely

- kids are 50x more likely if both parents have AIS

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3
Q

Does screening for scoliosis carry any risk?

A
  • screening itself does not carry risks

- if screening is positive, radiographs and referrals can lead to expense and risk of harm

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4
Q

What is the definition of scoliosis?

A

lateral curve of the spine greater than 10 degrees w/ vertebral rotation

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5
Q

Name 4 things you could observe on PE of a pt w/ scoliosis

A
  • shoulder height difference
  • posterior scapula
  • crease at waist
  • leg lengths are usually equal
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6
Q

Describe what would be seen on a positive Adam’s forward bending test

A

lateral bending of spine, but curve will cause rotation and eventually rib hump

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7
Q

What is Risser sign?

A

amount of calcification present on iliac apophysis; measures progressive ossification

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8
Q

Describe the Risser grading scale

A
  • grade 1: up to 25% ossification of iliac apophysis
  • grade 2: 50% ossification
  • grade 3: 75% ossification
  • grade 4: 100% ossification
  • grade 5: iliac apophysis has fused to iliac crest after 100% ossification
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9
Q

Name 5 red flags for scoliosis

A
  • onset before age 8
  • severe pain
  • rapid curve progression > 1 degree per month
  • unusual left thoracic curve (convex to the left)
  • neurological deficits or findings
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10
Q

How do you manage a pt w/ a curve less than 10-15 degrees?

A

monitor unless pt’s bones are immature and progression is likely (Risser sign)

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11
Q

How do you manage a pt w/ a curve between 25-45 degrees

A

bracing

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12
Q

How do you manage a pt w/ a curve greater than 45 degrees in adolescents and greater than 50 in adults?

A

require surgery, rod placement and bone grafting may be necessary

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13
Q

Milwaukee brace vs boston brace vs charleston nighttime brace

A
  • milwaukee: 23 hours/day; used in growing pts
  • boston: apex of curve must be below T10
  • charleston: worn only at night
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14
Q

What is ATR? At what point do you obtain scoliosis radiographs?

A
  • angle of trunk rotation
  • > /= 7 degrees -> obtain radiographs
  • < 7 degrees -> repeat scliometry every 6 months
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15
Q

What is the definition of acute low back?

A

6 to 12 weeks of pain between the costal angles and gluteal folds that may radiate down one or both legs (sciatica)

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16
Q

Give a differential dx of acute low back pain (

A
  • compression fx
  • herniated disc
  • lumbar sprain/strain
  • spinal stenosis
  • spondylosis
  • spondylolysis
  • spondylolisthesis
  • CT disease
  • malignancy
  • AAA
  • GI conditions: pancreatitis, PUD, cholecystitis
  • pelvic conditions: endometriosis, PID
17
Q

What is important to note during the Hx portion of a pt w/ acute back pain?

A
  • whether it is a first episode or recurrent episode
18
Q

What are 8 red flags for back pain?

A
  • TUNA FISH
  • trauma
  • unexplained weight loss
  • neurological sxs
  • age > 50
  • fever
  • IVDU
  • steroid use
  • Hx of cancer
19
Q

How would SD of lumbosacral spine (back strain) present?

A
  • usually starts w/ mild trauma (twisting)
  • muscle ache/spasm
  • strain may become chronic
  • discrete tender points in lumbar tissue
  • no neurological deficits
20
Q

How would flexion contraction of iliopsoas (psoas syndrome) present?

A
  • initiated by positions that shorten psoas (sitting, bending, getting up quickly from squatting position)
  • dull ache in low back (sometimes radiates to groin)
  • tender point at iliacus
  • positive Thomas test
21
Q

How would a herniated nucleus pulposus (herniated disc) present?

A
  • pain will originate in lumbar spine and radiate to leg/foot
  • sharp burning pain - electric quality
  • weakness in affected myotome (decreased reflexes/sensation)
  • usually positive straight leg raise
  • MRI gold standard for dx
22
Q

Where will L1-L3 nerve roots radiate pain to?

A

hip and/or thigh

23
Q

Where will L4-S1 nerve roots radiate pain to?

A

below the knee

24
Q

Which nerve root is impinged at the L4/L5 disc?

A

L5

25
Q

Which nerve root is impinged at the L5/S1 disc?

A

S1

26
Q

What is cauda equina syndrome?

A

large central disc herniation compressing the tail of the lumbar spine

27
Q

How would cued equina syndrome present?

A
  • similar pain to a herniated disc

- impingement of S2-S4 causes bowel/bladder dysfunction, decreased rectal tone, and saddle anesthesia

28
Q

What is spinal stenosis? How would a pt present?

A
  • narrowing of the space around the spinal cord
  • pain originates in low back and radiates down the leg
  • leg numbness and weakness
  • diminished reflexes
29
Q

What is spondylolysis? How is it dx?

A
  • defect in par interarticularis w/o anterior displacement of vertebral body
  • dx made w/ oblique view of lumbar spine (scotty dog present usually at L5/S1)
30
Q

What is spondylolithesis? How would a pt present?

A
  • vetebral body slips in relation to the one below at pars interarticularis (usually between L5/S1)
  • back pain radiating to or below the knee
  • often worse when standing
  • Exam - lumbar spinous process step off
31
Q

What should the pt avoid doing to tx acute low back pain?

A

bed rest not helpful for acute low back pain

32
Q

What is considered an effective tx for acute low back pain?

A

NSAIDs and non-BZD muscle relaxants, stay active and avoid twisting/bending/lifting

PCM2 Midterm (3 decks)

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