(Some) Clinical boxes weeks 2-3

Question 1

What does a back sprain involve?

Answer 1

Only ligaments

Question 2

What does a back strain involve?

Answer 2

Some degree of muscle fibers tearing; it’s the most common cause of lower back pain

Question 3

What two things can back spasms result from?

Answer 3

Muscle or ligament injury (both can be caused by heavy lifting)

Question 4

How you do properly lift something to avoid strain on IV discs?

Answer 4

Hold object close to your body, don’t bend back

Question 5

What test is used to determine if a patient with low back pain has a herniated IV disc? Explain it

Answer 5

Straight leg test; provider lifts pt’s leg with the pt’s leg fully straight, causing traction on the nerve root forming the sciatic nerve, which would replicate herniated disc pain

Question 6

What part of an IV disc can be responsible for herniations? Where?

Answer 6

Nucleus pulposis can herniate posterolaterally (where anulus is thinner) and compress spinal nerve roots

Question 7

The localized back pain of a herniated disc results from what?

Answer 7

Pressure on the longitudinal ligaments, periphery of anulus pulposis, and inflammation from chemical irritation from nucleus pulposis rupture

Question 8

Chronic pain resulting from a herniated disc is likely of what origin?

Answer 8

Dermatomal (from the compressed spinal nerve root)

Question 9

Where does most herniation occur?

Answer 9

L4-L5 or L5-S1

Question 10

Sciatica is often caused by what?

Answer 10

Herniated lumbar IV disc or osteophytes that compress L5 or S1 component of sciatic nerve

Question 11

In what region do symptom-inducing disc herniations occur almost as much as the lumbar region? What is compressed?

Answer 11

Cervical, compresses nerve exiting at that level

Question 12

Rupture of an alar ligament of the atlas results in what?

Answer 12

A 30% increase in ROM to the opposite side

Question 13

True or false: It has been shown that IV discs increase in size with age despite losing their turgor.

Answer 13

True; they become more convex and diameter increases between ages 20-70.

Question 14

What causes osteophytes (bone spurs) to develop around the edges of the vertebral bodies?

Answer 14

Aging of IV discs combined with changing [increasingly concave] shape of vertebral bodies increase compressive forces on the peripheral part of the bodies, causing osteophytes

Question 15

Obstructive arterial disease particularly affects what artery that supplies the spine?

Answer 15

Great segmental medullary artery

Question 16

When a patient has their back flexed for a lumbar puncture, what ligament is stretched?

Answer 16

Ligament flava

Question 17

1) What do radiographs of early to moderate osteoporosis show?
2) What about of advanced osteoporosis?

Answer 17

1) Demineralization (lower radiodensity of spongy bone of VBs, vertical striping b/c of loss of horizontal trabeculae)
2) Vertebral body collapse and increased thoracic kyphosis

Question 18

What are the 5 categories of back pain causes?

Answer 18

1) Fibroskeletal structures
-like periosteum, ligaments, IV discs
2) Meninges
3) Synovial joints
4) Muscles
5) Nervous tissue

Question 19

1) What are fibroskeletal structures and meninges of the spine innervated by?
2) What innervates the synovial joints and muscles of the back?

Answer 19

1) Recurrent (meningeal) branches of spinal nerves
2) Posterior rami (articular and muscular branches)

Question 20

What are the 3 main causes of localized lower back pain?

Answer 20

Muscular, joint, or fibroskeletal

Question 21

What is muscular lower back pain (LBP) usually caused by?

Answer 21

Reflexive cramping causing ischemia

Question 22

Pain from vertebral fractures is often _____________ in nature, whereas pain from discs slipping is normally caused by ______________ (and disrupted posterolateral anullus fibrosis)

Answer 22

periosteal; ligaments

Question 23

What minimizes blows to the calvaria?

Answer 23

Its convex nature

Question 24

1) Hard blows to the head in thin areas are likely to cause what?
2) What are comminuted fractures?
3) What is the most frequent type of skull fracture? Describe.
4) What can happen if the calvaria is thick at point of impact?

Answer 24

1) Depressed fractures
2) Bone broken into several pieces
3) Linear calvarial fractures; fractures radiate away from point of impact in 2+ directions
4) Can bend inward without fracturing

Question 25

1) What do basilar fractures involve? What can happen here?
2) Why can pterion fractures be life threatening?

Answer 25

1) Bones forming the cranial base (occipital around foramen magnum, temporal, or sphenoid); CSF can leak into nose or ear
2) Anterior branches of MMA are right below it, can cause epidural hematoma, which can put pressure on the cerebral cortex below it. Can kill within several hours

Question 26

1) What is the dangerous part of the scalp?
2) How can things spread from this layer to the cranial cavity?
3) The epicranial aponeurosis is continuous with what?
4) What does the frontal belly of the occipitofrontals muscle insert into?

Answer 26

1) Loose connective tissue (below epicranial aponeurosis)
2) Emissary veins (pass through calvaria to meninges)
3) Temporal fascia attached to zygomatic arches
4) Skin

Question 27

1) Why do facial lacerations tend to gape?
2) What does this property also enable?

Answer 27

1) Because the face doesn’t have a distinct layer of deep fascia and the SQ tissue is loose between facial muscle attachments
2) Fluid to collect/ facial swelling

Question 28

What is trigeminal neuralgia (tic douloureux)? Why does it happen?

Answer 28

Sharp pains caused by touching the face; cause is unknown but could be due to a blood vessel compressing CNV’s sensory root

Question 29

1) Anesthesiologists often use what pulse?
2) What is another pulse that can be palpated on the face?

Answer 29

1) Temporal artery pulse
2) Facial artery

Question 30

1) When can the facial artery be occluded?
2) True or false: compression of the facial artery on one side stops all bleeding
3) What lacerations require pressure on both sides to stop bleeding?

Answer 30

1) B/c of pressure against the mandible where it crosses it
2) False, because it has so many anastomoses
3) Lip lacerations