Spinal

Question 1

typical presentation of simple backache

Answer 1

age 20-55
lumbosacral, buttocks, thighs
mechanical pain

Question 2

describe sciatica

Answer 2

nerve root pain 
shooting pain radiating down leg and toes 
unilateral 
paraesthesia 
numbness

Question 3

desbribe the hallmark of cauda equina

Answer 3

saddle anaesthesia
difficulty micturition
lost anal tone/faecal continence
progressive motor weakness

Question 4

back pain red flags

Answer 4

<20 >55
severe night pain 
neurological change 
unexplained weight loss
systemically unwell
immunosuppressed, PWID, HIV. TB
Thoracic pain 
trauma
previous cancer

Question 5

true/false - with mechanical back pain you should stop all exercise and rest

Answer 5

false - dont exercise intensely but dont stop all exercise

Question 6

lifestyle advice to patient with mechanical back pain?

Answer 6

keep moving
stay at work if you can
restrict exercise but dont cut it out
weight control

Question 7

describe how referred leg pain would feel

Answer 7

dull achy
poorly localised to buttock/thigh
above knee

Question 8

where may referred back pain be from?

Answer 8

kidneys 
colon
uterine/ovarian 
pancreas 
gallbladder
PUD

Question 9

what pathologies might cause a possible spinal pathology

Answer 9

primary/secondary tumour
inflammatory disease
fracture
infection

Question 10

what conditions may cause nerve root problems

Answer 10

disc prolapse

spinal stenosis

Question 11

what is the most common back pain and what causes it

Answer 11

mechanical

no underlying cause besides possibly degenerative disease

Question 12

how does degenerative disc disease lead to nerve root pain?

Answer 12

disc degenerates leading to nerve becoming pinched as it leaves the spinal cord

Question 13

what is spondylolysis

Answer 13

defect/fracture in pars interarticularis

Question 14

what is spondylosthesis

Answer 14

total displacement of pars interarticularis

Question 15

yellow flags for chronic back pain

Answer 15

low mood 
high levels pain/disability
believing activity is harmful
low education 
obesity 
problem with claims 
job dissatisfaction 
heavy lifting

Question 16

what is mechanical back pain?

Answer 16

recurrent relapsing and remitting back pain

Question 17

what is spondylosis

Answer 17

intervertebral discs lose water so less cushioning and increased pressure on facet joints leading to secondary OA

Question 18

when would surgery be indicated for mechanical back pain

Answer 18

severe unrelenting disease that only affects one spinal level

Question 19

an acute disc tear causes what kind of pain?

Answer 19

nerve root pain - shooting pain with altered sensation and unilateral reduced power

Question 20

how may OA cause nerve root pain

Answer 20

osteophyte formation may impinge on nerve roots

Question 21

pathophysiology of spinal stenosis

Answer 21

spondylosis, bulging discs, bulging ligamentuum flavum or osteophytosis reduce space for cauda equina so multiple nerve roots become compressed

Question 22

how is spinal stenosis claudication different from PVD

Answer 22

pain is burning not cramping
pedal pulses preserved
distance is inconsistent
no pain uphill

Question 23

true/false - PR exam in suspected cauda equina is voluntary

Answer 23

false - it is negligent not to do one

Question 24

severe crush fractures in the vertebral body that are not traumatic may be?

Answer 24

osteoporotic

Question 25

what risks are associated with <20 in back pain

Answer 25

primary tumour or infection | spondylolisthesis

Question 26

what risks are associated with >55/60 in back pain

Answer 26

arthritis/osteoporotic crush fracture | neoplasia and metastatic disease

Question 27

what risks are associated more with back pain that is worse at night?

Answer 27

tumour/infection

Question 28

what risks are associated with back pain with systemic upset

Answer 28

tumour/infection

Question 29

what cervical instaility does downs syndrome carry

Answer 29

atlanto-axial subluxation with potential cord compression

Question 30

what cervical instability does RA carry

Answer 30

atlanto-axial subluxation due to destroyed joint between atlas and dens ruptured transverse ligament

Question 31

criteria for clinically clearing C spine?

Answer 31

``` GCS 15 with no alcohol intoxication no obvious significant head injury no hx lost consciousness no midline tenderness on palpation c spine no pain on gentle active movement ```

Question 32

if the C spine cannot be clinically cleared what happens

Answer 32

c spine must be radiologically cleared with AP/lateral and odontoid peg views

Question 33

above what level can a C spine fracture be fatal and why

Answer 33

C3 as C3,4,5 innervate diaphragm

Question 34

management of C spine fracture?

Answer 34

stable - in a collar | unstable - surgical stabilisation and external fixation with halo vest

Question 35

management of C spine dislocation/subluxation?

Answer 35

reduction and halo vest or operative stabilisation

Question 36

what type of thoracolumbar fractures are seen in the elderly and how are they managed

Answer 36

osteoporotic wedge fracture | symptomatic management

Question 37

cause of thoracolumbar fractures in non-elderly patient

Answer 37

RTA, high energy fall from height

Question 38

how are stable thoracic/lumbar fractures managed

Answer 38

back brace to prevent kyphosis and flexion | plaster jacket for lumbar to protect lordosis

Question 39

indication for spinal surgery following thoracolumbar fracture

Answer 39

neuro deficit unstable injury lost vertebral height displacement

Question 40

what types of injuries can cause spinal cord injury

Answer 40

laceration compression stretch contusion

Question 41

what is spinal shock

Answer 41

lost sensation and motor function and lost reflexes below level of injury usually resolves within 24 hours with return of reflex

Question 42

what reflex is absent in spinal shock and its return signifies its end

Answer 42

bulbocavernosus | reflex contraction of anal sphincter with squeeze of glans, tapping mons pubis or pulling catheter

Question 43

what is neurogenic shock and how is it managed

Answer 43

temp shutdown of sympathetic outflow leading to bradycardia and hypotension usually 24-48 hours priapism IV fluids, vasopressors and atropine

Question 44

what is complete spinal cord injury

Answer 44

no sensory or voluntary movement below level of injury reflexes should return classed by level at which there is partial function but has poor prognosis

Question 45

what is an incomplete spinal injury

Answer 45

some neuro function distal to injury, greater the function the better the prognosis sacral sparing, perianal sensation, big toe flexion and anal contraction signifies incomplete

Question 46

true/false - in a patient with known spinal injury and hypotension the most likely cause is neurogenic shock

Answer 46

false - neurogenic shock is a possibility but hypovolaemic shock is most likely