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ClinMed II > SPE #1 > Flashcards

SPE #1 Flashcards

1
Q

etiology of cauda equina

A

primarily mid to lower lumbar age related disc changes

secondarily due to other degenerative spinal changes and malignancy

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2
Q

risk factors for cauda equina

A

sx

persistent IDD

central stenosis

under 50

obese

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3
Q

what will cauda equina hx include

A

LBP
bowel bladder incontinence
sexual dysfunction
possible cancer S&S if involved
unilateral or bilateral patchy neuro symptoms

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4
Q

what specific neuro S&S indicate cauda equina

A

Paresthesias/decreased sensation in multiple derms, especially saddle and groin

multiple myotome weakness/gait abnormality

hypoactive DTRs

+ dural mobility

progressive/alternating findings

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5
Q

questions to ask if you suspect cauda equina

A

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?

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6
Q

Questions to ask regardless of condition

A

How does this affect your sleep?

On any medications?

Allergies?

Name and DOB?

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7
Q

etiology of spinal infection

A

primarily Mycobacterium TB

staphylococcus aureus and brucella also involved

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8
Q

risk factors for spinal infection

A

immunosupression

sx (especially of spine)

IV drug use

social depravation

Hx of TB or recent infection

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9
Q

if an abcess grows due to a spinal infection, what symtoms might you see

A

nerve root irritation

vertebral body collapse/fx

cord compression

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10
Q

early S&S of a spinal infection

A

age related changes with back pain and stiffness is most common

constitutional symptoms NOT common initially

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11
Q

clinical manifestations of a spinal infection

A

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

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12
Q

referral for spinal infection

A

urgent unless cord/cauda equina S&S

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13
Q

questions to ask for spinal infection

A

any fever, fatigue, weight loss, etc?

does movement affect symptoms?

have you experienced any infection in the last few years such as TB?

stiffness?

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14
Q

etiology of AS

A

genetics = 90%

environment

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15
Q

incidence of AS

A

usually under 40 (typically 15-30 yrs)

males more than females

usually lumbosacral

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16
Q

symptoms of AS

A

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

17
Q

referral for AS

A

urgent to rheumatologist

18
Q

criteria for AS

A

AM stiffness

Pain with rest and relief with exercise

awakening with LBP during 2nd half of night

alternating butt pain

19
Q

questions for AS

A

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?

20
Q

risk factors for kidney stones

A

disorders that lead to hyperexcretion of calcium (i.e. hyperthyroidism or hypercalciuria)

not primarily drinking water

obesity

high animal protein

21
Q

clinical S&S of kidney stones

A

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

22
Q

referral for kidney stones

A

urgent but possibly emergency depending on pain

23
Q

questions to ask for kidney stones

A

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?

24
Q

risk factors for AAA

A

males
smokers
over 50
vascular diseases (i.e. atherosclerosis or collagen disorder)
genetics- any family hx ofvascular issues?

25
Q

etiology of AAA

A

trauma
vascular disease
infection

26
Q

S&S for AAA

A

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

27
Q

referral for AAA

A

Emergency

28
Q

questions to ask for AAA

A

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?

29
Q

incidence of osteoporosis

A

70% undiagnosed

highest in post menopausal women

30
Q

risk factors for osteoporosis

A

low hormones = risk factors

family hx

social habits; smoking/drinking/etc

depression

meds; especially corticosteroids > 3 months

any dietary issue that limits vit D

31
Q

signs that a fracture may occur with osteoporosis

A

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

32
Q

referral for osteoporosis

A

most likely urgent

emergency if neuro or unable to walk

33
Q

questions to ask for osteoporosis

A

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?

34
Q

review components cauda equina

A

neuro MSK scan

findings of multi segment weakness/sensation loss
hypoactive DTRs
+ dural mobility

35
Q

review components for spinal infection

A

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

36
Q

review components for AS

A

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

37
Q

review components for nephrolithiasis

A

vitals - show increased temp/fever

+ murphys percussion

pain with palpation/percussion of bladder

38
Q

review components of AAA

A

palpation of swollen, tender mass L of umbillicis

observation of abdominal heart beat

diminished/absent distal pulses (post tib, popliteal, femoral)

bruit with ausculation

39
Q

review components for osteoporosis

A

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

ClinMed II (12 decks)

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