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PCMII Exam 1 > Scoliosis and Acute Low Back Pain > Flashcards

Scoliosis and Acute Low Back Pain Flashcards

1
Q

Scoliosis is lateral curvature of the spine greater than ___ degrees with vertebral rotation

A

10

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2
Q

What form is scoliosis most commonly found in?

A

Idiopathic (85%)

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3
Q

Risk factors for progressive scoliosis

A

Female

Both parents have adolescent idiopathic scoliosis

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4
Q

What population is recommended for screening for scoliosis?

A

Children and adolescents 10-18

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5
Q

What is a positive Adam’s forward bend test?

A

Pt stands and bends at the waist, with a rib hump unilaterally because of spine rotation

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6
Q

Why is screening for scoliosis a controversial topic?

A

Radiographs and referrals for scoliosis can lead to significant expense and risk of harm to patient and most scoliosis cases do not progress to clinically significant state

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7
Q

What classifies as rapid curve progression in a patient with scoliosis?

A

Curve progression >1 degree per month

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8
Q

What are the red flags associated with scoliosis?

A

Onset before age 8

Severe pain

Rapid curve progression > 1 degree per month

Unusual Left thoracic curve

Neurological defects (midline hairy patch, cafe au lait spots)

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9
Q

Angle of trunk rotation greater than ___ degrees and Cobb angle of greater or equal to ___ degrees will determine if a pt needs radiography for scoliosis

A

ATR >7 degrees

Cobb > or equal to 10 degrees

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10
Q

What is Risser sign?

A

Amount of ossification present in the iliac apophysis

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11
Q

What grade would a Risser sign be if a scoliotic patient is more likely to progress in severity?

A

Grades 1-3

The less ossified bones are, the more likely a case will progress

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12
Q

What is the curve angle for scoliosis that requires no active treatment?

A

Less than 10-15 degrees

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13
Q

What is the curve angle for scoliosis in patients that may need a brace?

A

25-45 degrees

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14
Q

What is the curve angle for scoliosis that needs surgery?

A

50 degrees

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15
Q

When would a scoliotic curve cause pulmonary compromise?

A

>50 degrees

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16
Q

When would a scoliotic curve cause cardiac compromise?

A

>75 degrees

17
Q

How is acute back pain classified?

A

6-12 weeks of pain between costal angles and gluteal folds

May radiate down one or both legs (sciatica)

Nonspecific

18
Q

What are the differential diagnoses for acute back pain of the intrinsic spine?

A

Compression fracture

Herniated nucleus pulposus

Lumbar sprain/strain

Spinal stenosis

Spondylolisthesis

Spondylolysis

Spondylosis

19
Q

What are the differential diagnoses for acute back pain that has spread systemically?

A

Connective tissue disease

Inflammatory spondyloarthropathy

Malignancy (pain in prone position)

Vertebral diskitis/Osteomyelitis

20
Q

What are the differential diagnoses for acute back pain that are referred?

A

Abdominal aortic aneurysm

GI conditions (retroperitoneal, peptic ulcer, and cholecystitis)

Herpes zoster

Pelvic conditions

21
Q

What are the 4 main red flags for serious etiology of acute low back pain?

A

Hx of Cancer

Hx of Cauda Equina

Fracture

Infection

22
Q

What are the red flags to look for in a patient’s history when they present with low back pain?

A

T - Trauma

U - Unexplained weight loss

N - Neurologic sx

A - Age >50 y/o

F - fever

I - IVDU (intravenous drug use)

S - Steroid use

H - History of CA

23
Q

Steps of a physical exam for acute low back pain?

A

Inspection

Palpation

Percussion (Lloyd’s punch)

ROM

Strength/sensation

Specialty testing

24
Q

What is the motor, sensory, and reflex innervation of L3?

A

Motor: Hip flexion

Sensory: Anterior/Medial thigh

Reflex: Patella

25
Q

What is the motor, sensory, and reflex innervation of L4?

A

Motor: Knee extension

Sensory: Ant leg/Medial foot

Reflex: Patella

26
Q

What is the motor, sensory, and reflex innervation of L5?

A

Motor: Dorsiflexion/Great toe

Sensory: Lateral leg/Dorsal foot

Reflex: Medial hamstring

27
Q

What is the motor, sensory, and reflex innervation of S1?

A

Motor: Plantar flex

Sensory: Posterior leg/lateral foot

Reflex: Achilles

28
Q

How does back strain present?

A

Onset with mild trauma (twisting)

Muscle ache or spasm

May become chronic

Discrete tender points in lumbar tissue on exam

No neurological defects

29
Q

How does Psoas Syndrome Present?

A

Shortening/spasm of iliopsoas muscle

Dull ache in low back, sometimes refers to groin

30
Q

What is the main risk factor for psoas syndrome?

A

Desk jobs

31
Q

A herniated disc in the lumbar region will compress the nerve root of which vertebrae?

A

The vertebrae below

32
Q

How will herniated nucleus pulposus present?

A

Pain radiating down the leg (sciatica)

Sharp burning pain - like electricity

Weakness in affected myotome

33
Q

What is cauda equina syndrome?

A

Large, central disc herniation compressing tail of lumbar spine, compressing sacral nerve roots

34
Q

Impingement of what nerve roots in Cauda Equina syndrome cause bowel/bladder dysfunction, decreased rectal tone, and saddle anesthesia?

A

S2-S4

35
Q

A delay in surgery to treat cauda equina can result in what?

A

Irreversible paralysis

36
Q

Spondylolysis is caused by a defect in what?

A

Defect in par interarticularis without anterior displacement

37
Q

Spondylolisthesis is caused by what?

A

Vertebral body slips in relation to the one below at the pars interarticularis

38
Q

What is the management of low back pain for the first two visits?

A

1st visit: Patient education, avoid exacerbating movement, stay active, NSAIDs, muscle relaxant

2nd visit: Different NSAIDs, refer to PT, refer to spine subspecialist

PCMII Exam 1 (7 decks)

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