SPE #1 Flashcards
etiology of cauda equina
primarily mid to lower lumbar age related disc changes
secondarily due to other degenerative spinal changes and malignancy
risk factors for cauda equina
sx
persistent IDD
central stenosis
under 50
obese
what will cauda equina hx include
LBP
bowel bladder incontinence
sexual dysfunction
possible cancer S&S if involved
unilateral or bilateral patchy neuro symptoms
what specific neuro S&S indicate cauda equina
Paresthesias/decreased sensation in multiple derms, especially saddle and groin
multiple myotome weakness/gait abnormality
hypoactive DTRs
+ dural mobility
progressive/alternating findings
questions to ask if you suspect cauda equina
do you have a history of LBP or back surgery?
any bowel/bladder incontinence/sexual dysfunction?
any hx of cancer?
numbness tingling? where?
if numbness and tingling, is it always in the same place or does it vary?
Questions to ask regardless of condition
How does this affect your sleep?
On any medications?
Allergies?
Name and DOB?
etiology of spinal infection
primarily Mycobacterium TB
staphylococcus aureus and brucella also involved
risk factors for spinal infection
immunosupression
sx (especially of spine)
IV drug use
social depravation
Hx of TB or recent infection
if an abcess grows due to a spinal infection, what symtoms might you see
nerve root irritation
vertebral body collapse/fx
cord compression
early S&S of a spinal infection
age related changes with back pain and stiffness is most common
constitutional symptoms NOT common initially
clinical manifestations of a spinal infection
localized/progressive pain
likely mechanical
infection S&S (fatigue, fever since back pain, etc)
weight loss- unexplained
TTP
neuro S&S can eventually influence LE and coordination as well as bowel/bladder dysfunction
loss of lumbar lordosis
referral for spinal infection
urgent unless cord/cauda equina S&S
questions to ask for spinal infection
any fever, fatigue, weight loss, etc?
does movement affect symptoms?
have you experienced any infection in the last few years such as TB?
stiffness?
etiology of AS
genetics = 90%
environment
incidence of AS
usually under 40 (typically 15-30 yrs)
males more than females
usually lumbosacral
symptoms of AS
multi joint inflammation
family hx
extraarticular involvement of eyes, skin, GI, renal, etc
hx of back pain that doesnt change with rest; pain at night from static position
very limited motion
referral for AS
urgent to rheumatologist
criteria for AS
AM stiffness
Pain with rest and relief with exercise
awakening with LBP during 2nd half of night
alternating butt pain
questions for AS
Family hx?
morning stiffness? does it get better with movement?
does the pain wake you up?
does it get better with exercise?
is motion limited?
any other seemingly unrelated issues of eyes, skin, GI, renal, etc?
any pain in your buttock region?
risk factors for kidney stones
disorders that lead to hyperexcretion of calcium (i.e. hyperthyroidism or hypercalciuria)
not primarily drinking water
obesity
high animal protein
clinical S&S of kidney stones
referred pain
intermittent LBP
progresses to acute/severe back, flank, and possibly abdominal pain
radiating pain to groin
bladder dysfunction
eventual unrelenting pain
N&V
possible infection so infection S&S
pain with percussion over kidneys/bladder
referral for kidney stones
urgent but possibly emergency depending on pain
questions to ask for kidney stones
where is your pain?
is it getting worse?
any changes in bladder/urination? pain with that?
any other symptoms? N&V? infection?
any pain with pressure around kidneys or bladder?
risk factors for AAA
males
smokers
over 50
vascular diseases (i.e. atherosclerosis or collagen disorder)
genetics- any family hx ofvascular issues?
etiology of AAA
trauma
vascular disease
infection
S&S for AAA
often asymptomatic
LBP/sometimes abdominal/flank pain
pain worse with activity
searing/ripping/tearing abdominal pain
abdominal heart beat non-tender mass left of midline
referral for AAA
Emergency
questions to ask for AAA
where is your pain?
does it get worse with exertion/activity?
have you noticed any kind of abdominal pulse?
do you smoke?
family hx of vascular?
medical hx of disease?
incidence of osteoporosis
70% undiagnosed
highest in post menopausal women
risk factors for osteoporosis
low hormones = risk factors
family hx
social habits; smoking/drinking/etc
depression
meds; especially corticosteroids > 3 months
any dietary issue that limits vit D
signs that a fracture may occur with osteoporosis
occurs with benign flexion activity
fx S&S
severe back pain (mid thoracic and upper lumbar)
worse pain when bending, compressing, valsalva
could progress to neuro symptoms
ROM/RST limited in flx but possibly all directions
unable to lay flat
referral for osteoporosis
most likely urgent
emergency if neuro or unable to walk
questions to ask for osteoporosis
when did you notice pain?
where is it?
is it worse with bending/pressure?
any numbness/tingling?
does it hurt to lay down flat?
any medical hx of dietary issues, depression, etc?
any recent use of corticosteroids?
any medical hx of low hormones?
any family hx of osteoporosis?
review components cauda equina
neuro MSK scan
findings of multi segment weakness/sensation loss
hypoactive DTRs
+ dural mobility
review components for spinal infection
vitals- looking for fever/increased temp
MSK scan
-mechanical pain from disc compression
-+ compression stress tests
observation of loss of lordosis
TTP at spinous process of involved segment
review components for AS
observation of hyperkyphosis and loss of lordosis
ROM shows loss of motion in multiple directions
consistent block with combined motion
+ stress tests with prolonged hold
review components for nephrolithiasis
vitals - show increased temp/fever
+ murphys percussion
pain with palpation/percussion of bladder
review components of AAA
palpation of swollen, tender mass L of umbillicis
observation of abdominal heart beat
diminished/absent distal pulses (post tib, popliteal, femoral)
bruit with ausculation
review components for osteoporosis
observation of increased kyphosis/FHP
limited/painful ROM mostly with flexion but possibly all directions
RST = weak/painful with all directions
+ compression and PA stress tests
unable to lie flat on back
