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A. MLA Map Acute and Emergency > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

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1
Q

What % of the UK economy will have back pain in their adult life?

1 - 0.6%
2 - 6%
3 - 36%
4 - 60%

A

4 - 60%

  • lifetime prevalence is between 49 - 70%
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2
Q

What age does lower back pain generally pean in the UK?

1 - 21-30 y/o
2 - 30-40 y/o
3 - 41-50 y/o
4 - >55 y/o

A

3 - 41-50 y/o

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3
Q

Which of the following is NOT a red flag for back pain?

1 - weight gain
2 - fever
3 - persistent pain, even without movement
4 - night pain
5 - history of malignancy
6 - progressive bowel/ neurology dysfunction (saddle anaesthesia. bowel bladder issues)

A

1 - weight gain

  • typically patients lose weight in things that may cause red flags
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4
Q

Where does the spinal cord end and form the conus medularis?

1 - T10
2 - T12
3 - L1
4 - L3

A

3 - L1

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5
Q

The cauda equina is what the nerves below the end of the spinal cord form. These nerves are important and carry innervation for all of the following EXCEPT:

1 - nerves of GIT
2 - genitals
3 - internal and external anal sphincter
4 - detrusor vesicae
5 - muscles of the leg
6 - reflexes of the knee and ankle
7 - skin sensations of the legs and pelvis

A

1 - nerves of GIT

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6
Q

Cauda equina is a medical emergancy and can be caused by compression, trauma or damage to the nerves of the cauda equina. All of the following can cause cauda equina, but what is the most common cause of cauda equina?

1 - spinal stenosis
2 - disc herniation
3 - ankylosing spondylitis
4 - spondylolisthesis
5 - trauma
6 - malignancy

A

2 - disc herniation

  • ankylosing spondylitis = disc degeneration and inflammation
  • spondylolisthesis = protrusion of vertebral disc
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7
Q

In cauda equina patients can present with all of the following EXCEPT which one?

1 - saddle anesthesia
2 - bladder incontenance
3 - bowel incontenance
4 - increased erectile function

A

4 - increased sexual function

  • generally causes reduced erectile function
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8
Q

When comparing cauda equina and conus medularis, which typically presents with more pain?

A
  • cauda equina
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9
Q

When comparing cauda equina and conus medularis, which typically has radicular pain?

A
  • cauda equina
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10
Q

When comparing cauda equina and conus medularis, which presents with a sudden and bilateral onset?

A
  • conus medularis
  • cauda equina is gradual and unilateral
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11
Q

When comparing cauda equina and conus medularis, which presents with flaccid paralysis at the level of the level of the lumbar root?

A
  • cauda equina
  • conus medularis has normal motor function, unless S1-S2 are damaged
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12
Q

When comparing cauda equina and conus medularis, which can present with loss of ankle and knee reflexes?

A
  • cauda equina
  • conus medularis typically loses just ankle reflex
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13
Q

Dissociation of sensation is when there is loss of sensation in a selective manner. When comparing cauda equina and conus medularis, does dissociation occur in both?

A
  • generally occurs in conus medularis
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14
Q

What is the major difference between cauda equina and conus medularis when comparing them with lesions that occur higher up the spinal cord?

A
  • cauda equina and conus medularis = flaccitiy and areflexic
  • higher lesions = spasticity and hyperflexic
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15
Q

In patients with back pain we need to do a FBC and biochemistry. What are we looking for mainly in the FBC?

1 - WBC
2 - RBC
3 - haematocrit
4 - pH

A

1 - WBC

  • raised WBC may suggest infection causing problem
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16
Q

In patients with back pain we need to do a FBC and biochemistry. Which 2 of the following markers are signs of malignancy?

1 - anaemia
2 - Ca2+
3 - Na+
4 - neutrophils

A

1 - anaemia
2 - Ca2+

17
Q

X-rays are generally performed on patients with suspected trauma of the spine. But which imaging technique would be classed as the gold standard for looking at the spine?

1 - ultrasound
2 - MRI
3 - CT

A

2 - MRI

  • often identifies significant findings in asymptomatic patients requiring treatment
18
Q

In back pain should bed rest be encouraged?

A
  • no
  • unless spine is fractured
19
Q

All of the following are causes of spinal cord compression:

  • trauma
  • spinal tumours )benign or malignant)
  • prolapsed intervertebral disc
  • epidural or subdural haematoma
  • spinal infection:
  • vertebral osteomyelitis,
  • cervical spondylitic myelopathy
  • spinal manipulation
A
20
Q

Spinal cord compression is most commonly causes by disc herniation. Which 2 of the following are the most common site of disc herniation?

1 - L4-L5
2 - L5-S1
3 - L2-L3
4 - S1-S2

A

1 - L4-L5
2 - L5-S1

21
Q

The principle features of a chronic and subacute cord compression are all of the following EXCEPT what?

1 - tetraparaesis
2 - paraparaesis
3 - radicular pain at point of compression
4 - hemianopia
5 - sensory loss below the compression

A

4 - hemianopia

  • tetraparaesis = all 4 limbs
  • paraparaesis = lower limbs
    BOTH ARE REDUCED SENSATIONS AND WEAKNESS
22
Q

What is radicular pain?

1 - no pain
2 - nerve root pain
3 - colicky pain
4 - radiating pain

A

2 - nerve root pain

23
Q

Which infection can lead to cord compression in countries where the infection is common?

1 - tuberculosis
2 - clostridium difficile
3 - varicella-zoster virus
4 - neisseria gonorrhoeae

A

1 - tuberculosis

  • infection leads to vertebral and spinal space destruction
  • leads to paraparesis and eventually paralysis
24
Q

Is cord compression dangerous?

A
  • yes
  • medical emergency
25
Q

What is the main imaging of choice if you suspect a patient has spinal cord compression?

1 - X-ray
2 - CT
3 - MRI
4 - ultrasound

A

3 - MRI

26
Q

If a patient has a confirmed spinal cord compression, which of the following management options is most suitable?

1 - analgesia and bed rest
2 - back support
3 - steroid injections
4 - surgery

A

4 - surgery

  • medical emergency
  • delays can lead to permanent cord damage
27
Q

If there is a cord malignancy that is inoperable, how can the patient be treated?

1 - palliative care
2 - chemotherapy
3 - radiotherapy

A

3 - radiotherapy

28
Q

Malignancy is a potential cause of spinal cord compression. All of the following are causes of metastasis in bone, which can lead to spinal cord compression, EXCEPT:

1 - breast
2 - prostate
3 - colon
4 - lung

A

3 - colon

29
Q

In spinal cord compression, if a patient experiences bilateral leg weakness, and sometimes arm weakness, where is the compression most likely to be?

1 - cervical
2 - thoracic
3 - lumbar
4 - sacral

A

1 - cervical

30
Q

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. When looking at muscle contractions, do UMN or LMN have more contractions?

A
  • UMN = more muscle contractions
  • LMN = less muscle contractions
31
Q

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. When looking at muscle tone, do UMN or LMN have more muscle tone?

A
  • UMN = more muscle tone (hypertonic)
  • LMN = less muscle tone (hypotonic)
32
Q

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. When looking at reflexes, do UMN or LMN have more reflexes?

A
  • UMN = hyperreflexia
  • LMN = hyporeflexia
33
Q

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. Do patients with UMN or LMN have a negative Babinski sign?

A
  • UMN = positive test, indicating UMN lesion
  • LMN - negative test
34
Q

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. Both UMN and LMN have atrophy, but which is disuse and which is due to disuse innervation?

A
  • UMN = disuse atrophy
  • LMN = reduced innervation

A. MLA Map Acute and Emergency (42 decks)

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