Brainscape's Knowledge GenomeTM

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


See full index

PCM2 Midterm > Scoliosis and Low Back Pain > Flashcards

Scoliosis and Low Back Pain Flashcards

1
Q

Scoliosis

A

lateral curve of the spine great than 10 degrees with vertebral rotation

classified as congenital, neuromuscular, or idiopathic
*most are idiopathic

adolescent idiopathic scoliosis is the most prevalent

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

Risk factors of Scoliosis

A

female more likely to progress to sever scoliosis

hereditary: if both parents have AIS: kids are more likely to require tx than general population

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

Screenings

A

Negligible risk to patients

-radiographs and referrals: increase expense and risk of harm

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

Adolescent Idiopathic Scoliosis: Screening

A

Children aged 10-18

Treatment is determined by the degree of spinal curvature

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

Clinical Presentation of Scoliosis

A 
diastematomyelia: congenital splitting of the spinal cord
Syringomyelia: cavity in the spinal cord
Tethered cord
Spinal tumors--cause spinal curvature
neurofibromatosis
unilateral cavus food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physical Exam for Scoliosis

A

body tires to keep eyes level
shoulder height difference
posterior scapula
crease at waist

Adam forward bend test
*leg lengths are usually equal

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

Adam’s Forward Bend Test

A

bends forward at the waist with examiner assessing from symmetry

-possible scoliosis-lateral bending of the spine, curve will cause spinal rotation and rib hump will be visible on examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Scoliometer

A

quantify the spinal curve and rotation…does the spine need radiography?

Radiography: Cobb angle greater than 10 degrees

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

Risser Sign-Progression Prediction

A

defined by the amount of calcification present in the iliac apophysis and measures the progressive ossification from anterolaterally to posteromedially

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

Red Flags for scoliosis

A
  1. onset before age 8
  2. severe pain
  3. unusual left thoracic curve
  4. neurologic deficits or findings (midline hairy patch)
  5. rapid curve progression: 1 degree per month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ROS for Scoliosis Important

A

left curve associated with additional pathology

-spinal cord tumors, neuromuscular disorders, chiari malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Scoliosis Exam

A
  • lateral curve of spine greater than 10 degrees with vertebral rotation
  • adams forward bend or scoliometer
  • right or left curve
  • neuroexam, skin exam, imaging when necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of a curve less than 10-15 degrees

A

no active treatment and can be monitored

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

management of a curve between 25-45 degrees in patients lacking skeletal maturity

A

used to be treated with bracing, but this tx hasn’t been proven to prevent curve progression

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

management of a curve more than 45 degrees

A

rod placement and bone grafting

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

Treatment for Scoliosis

A

Bracing

  • halt progression of curve that is between 20 and 45 degrees
  • not effective for large curves

Milwaukee brace
Boston brace–apex of curve must be below T10
Charleston Nighttime brace

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

Milwaukee Brace

A

used for scoliosis
20-40 degree curves
used with growing patients

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

Boston Brace

A

works on a multitude of deformities (lordosis, rotation, soliosis)

**apex of curve must be below T10

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

Charleston Nighttime Brace

A

worn only at night….sB patient into the curve

“as effective as 24 hour brace”

20
Q

Surgical Option for Scoliosis

A

adolescents with curve greater than 40 degrees require definitive tx
pulmonary compromise starts at curves greater than 50 degrees
cardiac compromise with 75+degrees

  • -posterior spinal fusion
  • -Harrington Rods
21
Q

What is concerning for PE for scoliosis?

A

LEFT CURVE IS WORSE THAN RIGHT

22
Q

left curve scoliosis

A

don’t tx as conservatively

23
Q

Evaluation of Low Back Pain

A

5th most common reason for dr visits

most are self limiting and resolve with little intervention

24
Q

Acute Low Back Pain

A

defined as 6-12 weeks of pain between the costal angles and gluteal folds that may or may not radiate

25
Q

Differential Dx for acute low back pain

A 
compression fracture
herniated disc
lumbar sprain/strain
spinal stenosis
spondys
CT disease: multiple joint arthralgias
Inflammatoy spondyloarthropathy
Malignancy: pain worsens in the prone position
AAA
GI conditions (pancreatitis)
Herpes Zoster
Pelvic Conditions: discomfort in lower abdomen
26
Q

Red Flags with Low Back Pain

A
  • Cancer
  • Cauda Equina Syndrome: bowel and bladder incontinence
  • Fracture
  • Infection: severe pain and lumbar spine surgery within past year, IV drug use

Trauma, unexplained weight loss, neurologic symptoms, age above 50, fever, IVDU, Steroid Use, History of Cancer

27
Q

Back Strain: SD of Lumbosacral Spine

A 
mild trauma
--usually twisting 
described as muscle ache or spasm
strain may become chronic
discrete TP of lumbar tissue
no neurological deficits
28
Q

Psoas Syndrome

A

Flexion Contracture
initiated by psoas, sitting, bending, getting up quickly from squatting position, desk jobs

may refer to the groin
+thomas test
TP medial to ASIS

29
Q

Herniated Nucleus Pulpous

A

herniated disc in lumbar region that will exert pressure on the nerve root of the vertebrae below

  • pain in lumbar radiates to foot
  • sharp burning pain
  • weakness in affected myotome (decreased reflexes)
  • most treated conservatively
30
Q

How to Dx Herniated Nucleus Pulpous

A

MRI

31
Q

Radiation Patterns

A

spine structures: thigh region
SI joint: thigh and below the knee
Lumbar root: more leg pain than back pain
L1-L3 nerve roots: radiate to hip/knee thigh
L4-S1: pain radiates below the knee

32
Q

Where do most herniations occur?

A

L4/L5

L5/S1

33
Q

L1-L3

A

radiates to hip and or thigh

34
Q

L4-S1

A

radiates below the knee

35
Q

Cauda Equina Syndrome

A

lateral central disc herniation compressing the tail of the lumbar spine causing compression of sacral nerve roots

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

**Emergent, surgery is imperative

36
Q

Spinal Stenosis

A

narrowing of the space around the spinal cord
pain originates in lower back and radiates down the leg
pain worsened w/ standing, walking, laying supine

37
Q

Spondylolysis

A

“Collar of Scotty Dog”

fracture of pars interartcilaris

38
Q

Spondylolisthesis

A

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

L5 and S1
pain worse with standing
+ step off sign with lumbar palapation

39
Q

L5/S1

A

plantar flex
sensory to posterior leg and lateral foot
achilles reflex
Toe Walk

40
Q

L4/L5

A

Dorsiflex the great toe
lateral leg and dorsal foot
reflex: medial hamstring
Heel walk

41
Q

L3

A

Hip Flexors
Sensory: anterior/medial thigh
patella

42
Q

L4

A

knee extension
sensory: anterior leg with medial foot
patella reflex

43
Q

Imaging for Low Back Pain

A

dont image within the first 6 weeks unless red flags are present (neurological deficit or osteomyelitis)

44
Q

Treatment for Nonspecific Acute Low Back Pain

A

Bed rest is not helpful
NSAIDS and muscle relaxants
patient education: Stay active
PT

45
Q

History/ Risk Factors

A 
age
level of trauma
job/hobby
IVDU
Steroid Use
HX of Cancer
46
Q

ROS for Back Pain

A

fever?
weight loss?
Neuro symptoms–bowel and bladder dsfxn?

PCM2 Midterm (8 decks)

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