Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med Exam 3 (Lauren) > Spinal Disorders > Flashcards

Spinal Disorders Flashcards

1
Q

What would you see on X-ray of lumbar spondylosis?

A

Osteophyte formation

Disc space narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do the nexus criteria and Canadian c-spine rules do?

A

tools that tell us when we don’t need imaging of a c-spine injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would you diagnose arterial or venous thoracic outlet syndrome?

A

Ultrasound ***

Chest X-ray to check for cervical rib

(If no cervical rib you can almost definitely rule out aTOS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can cervical spondylosis progress to radiculopathy or myelopathy

A

Yes, it can cause stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is spondylolysis

A

Fracture or separation in the pars interarticularis, usually in the lower lumbar vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Will lumbar strain/sprain cause an abnormal neuro/motor/DTR exam in legs?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a burst fracture?

A

Fracture of lower cervical vertebrae caused by direct axial load

Fragments all over the place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Spondylosis

A

Nonspecific, degenerative changes of the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What test can be done to check for cervical spondylosis?

A

Spurling test- put pressure on facet joints and turn head= pain
***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is spondylolisthesis?

A

Anterior displacement of a vertebral body due to bilateral defects of the posterior arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Saddle anesthesia

A

Cauda equina syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is the most common place to see spondylolisthesis?

A

Lumbar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What will you see on X-ray of lumbar spondylolisthesis

A

Forward translation of vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Who usually gets lumbar spondylolysis?

A

Adolescents with repetitive forced back extension***

Football players, gymnasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the clinical signs of cervical radiculopathy?

A

Neck pain/occipital headaches

Numbness/tingling in upper extremities that follow a dermatomal pattern

Unilateral

Pain may radiate down paraspinal muscles

Weakness and reduced grip strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common way to get spinal stenosis?

A

Spondylosis (arthritis in spine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In a cervical strain/sprain, is pain worse with motion?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first X-ray view you do for the spine

A

AP

Also do lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is there always back pain with lumbar spinal stenosis?

A

No it may just be leg pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for lumbar spondylosis?

A

PT: core strengthening

If facet arthritis is present, refer for MBB and RFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Should we do imaging for lumbar sprain/strain

A

No, not unless there was a dangerous MOI or you suspect cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the nexus criteria?

A

Absence of posterior midline tenderness

Alert and sober

No abnormal neurologic findings

No distracting injuries

*if all of these are present, don’t do c-spine imaging. BUT if one of these conditions is not met, you must do imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the cause of thoracic outlet syndrome?

A

Repetitive injury (ex. Pitchers)

Cervical rib anomaly (extra rib)

Muscular insertions are weird

Injury (fracturing rib/clavicle, or whiplash)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What what is the most common cause of neurogenic leg pain in the elderly

A

Lumbar spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of venous thoracic outlet syndrome

A

Typically related to vigorous repetitive UE activities

Swelling of arm *** Classic

Cyanosis

Pain in extremity

Fatigue in forearm within minutes of use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Can pateients have radiculopathy and myelopathy at the same time?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the treatment for vTOS?

A

Thrombolysis

Decompressive surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Is cauda equina syndrome an emergency?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the difference between strain and sprain

A

Strain- injury to muscle, tendon,

Sprain- injury to ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the treatment for nTOS?

A

PT for 4-6 wks

Steroids

Botox

Decompression surgery if needed

(This is not limb threatening so we try conservative tx first)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What causes neurogenic claudicatoin

A

Spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a CT Myelogram and who is it good for?

A

It’s a real time CT with contrast thats best for evaluation of spinal cord, nerveroots, meninges, disc abnormalities and its good for patients who cant undergo MRI due to metal or whatever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the diagnosis in >80% of people with lower back pain?

A

Lumbar strain/sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a Jefferson fracture

A

Fracture of C1 caused by axial compression (diving)

No spinal cord damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How long must the LBP last to diagnose lumbar spondylosis?

A

Longer than 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Is thoracic spine pain common?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the difference between the presentation of lumbar spondylolysis in a teen vs an older person?

A

In a teen, it’s going to be an isolated fracture

In an old person, its going to be accompanied by spondylolisthesis (the slippage usually causes the pars fracture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is a hangman’s fracture?

A

C2 fracture involveing Bilateral pedicles.
Caused by hyper extension with compression (high speed MVA)

May transects spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What nerve root causes pain in neck, shoulder, medial forearm, 4th and 5th fingers, medial hand

Numbness in medial forearm, medial hand, 4th and 5th digits

A

C8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

If they have lower back pain and a history of repeated lifting and twisting, or an acute onset of LBP following a trivial lifting or bending episode, what should you think?

A

Lumbar strain/sprain

41
Q

What is the treatment for aTOS?

A

Surgical embolectomy

Decompressive surgery

42
Q

What is the treatment for a cervical strain/sprain?

A

most people have spontanesou resolution in 4-6 wks although whiplash injuries may take longer

Short term opioids

NSAIDs

C-collar short term (don’t want atrophy)

Cervical pillows while sleeping

43
Q

What are the red flags for infection

A

Fever

Pain at rest

Immunocompromised patient

IV drug use

Hx of recent infection, espeically: UTI, cellulitis, or pneumonia****

44
Q

What are the symptoms of arterial thoracic outlet syndrome

A

Symptoms develop spontaneously unrelated to work/trauma

Almost ALWAYS associated with a cervical rib

Young patients- it’s a congenital anomaly

Thromboembolism in hand/arm

Arm/hand ischemia- pain, paresthesia, pallor, coolness

45
Q

What can cause cervical Radiculopathy in older patients

A

Degenerative disease causing narrowed foramen

Herniated disc

46
Q

What are Waddell’s signs?

A

Non-organic behavior or inappropriate findings. That are suggestive of drug-seeking:

Non anatomical pain

Simulation sign- using minimal axial compression or rotations cause unusually sever pain

Distractions sign- check straight leg raise when they;’re not paying attention and then again when they are and compare

Glove/stocking type paresthesia-Sensory/motor disturbance that does not follow a dermatomal pattern

Overreaction to light touch

47
Q

What is the treatment for cauda equina syndrome

A

IMMEDIATELY give dexamthasone 10mg IV

Emergent MRI or CT myelogram of the lumbar and sacral spine

Surgical consult for decompression or radiation if metastatic tumor

48
Q

What is myelopathy?

A

Damage to the spinal cord (not nerve root) and symptoms will be from lesion down

49
Q

What does the swimmers view allow us to see?

A

Cervicothoracic junction

50
Q

Will motor, sensory, and DTR dysfunction follow a nerve root pattern in lumbar HNP?

A

Yes

51
Q

What are the clinical signs of lumbar spondylolisthesis

A

Might be minimally symptomatic

Pain that radiated posteriorly to knees that is worse with standing

Hamstring spasms that make it hard to bend forward

Nerve compression symptoms are rare

52
Q

What is the most common site of a lumbar herniated disc

A

L4-L5

L5-S1

53
Q

What kind of imaging should be ordered for a herniated disc?

A

MRI if:

It’s super bad

Lasts 4 weeks+

Before surgery

(Xrays are unhelpful)

54
Q

What are the additional X-ray views you need to order of the C-spine when there’s trauma

A

Odontoid peg (C1 and C2)

Swimmers view (C7-T1)

Oblique R/L (facet joints)

55
Q

What causes cervical spondylosis?

A

Osteoarthritis of the cervical spine (facet joints are arthritic, or IV discs flatten due to DDD)

Osteophyte formation

Thickening of ligamentem flavum

56
Q

What is the treatment for lumbar spinal stenosis?

A

NSAIDs

PT

Opioids

Water exercise

ESI

Surgery (if they do not have spondylolisthesis, we can do a laminectomy or a spacer implant, or we can do a MILD if due to ligamentum flavum hypertrophy. If they DO have spondylolisthesis, we can do lumbar fusion )

57
Q

What are the clinical signs of a lumbar HNP?

A

Abrupt pain

Unilateral radical leg pain

Pain aggravated by sitting, walking, standing, coughing and sneezing

Pain radiated down buttocks to posterior/lateral leg down to foot

Lying on back with knees elevated or in fetal position relieves the pain**

Injury higher than L4 will cause anterior thigh pain (but that’s unusual)

58
Q

How would you diagnose neurogenic thoracic outlet syndrome?

A

Electrodiagnostic testing (EMG, NCS)

Brachial plexus block (like an MBB)

59
Q

What specialized exam will be positive in lumbar HNP?

A

Straight leg raise **classic

Reverse straight leg raise for higher injury

60
Q

When do we do cervical spine x-rays?

A

If traumatic injury or older patient

61
Q

What is the treatment for lumbar strain/sprain?

A

Avoid strenuous activity

NO BEDREST

NSAIDs

NO muscle relaxers

PT, TENs unit

Core strengthening

62
Q

What is a “Scotty Dog Fracture”

A

Lumbar spondylolysis

63
Q

What is the treatment for cervical myelopathy?

A

Spontaneously resolves in 2-8 wks

NSAIDs

PT with cervical traction** disc might pop back in

Possible surgical decompression

Pain management referral

ESI** calming inflammation may pop disc back in

64
Q

What is the treatment for cervical spondylosis

A

Symptoms may last several months

NSAIDs

PT

Possible surgical decompression

ESI

MBB+RFA

65
Q

What would you find on physical exam of lumbar spondylolisthesis

A

Diminished lumbar curve

Step off deformity if severe

Decreased forward flexion

Decreased ROM of straight leg raise. No pain it just wont go

66
Q

What are the symptoms of cervical myelopathy?

A

Trunk or leg dysfunction

Gait changes

Bowel/bladder changes

(Remember myelopathy is from the lesion down)

67
Q

What are the most common levels to have spondylolisthesis, causing spinal stenosis?

A

L4-L5

L5-S1

68
Q

Should we give muscle relaxers and tell our pt to go on bed rest if they have a lumbar strain/sprain

A

NO

69
Q

What nerve root causes:
Neck, shoulder, scapula lateral arm, lateral forearm and lateral hand pain

Numbness in lateral forearm, thumb and index finger

A

C6

70
Q

What are the Canadian c-spine rules?

A

Condition 1:
X-ray any patient with: age 65+, dangerous MOI, paresthesia in extremities

Condition 2: if none of those factors are met, you need to see if it’s safe to check their ROM. (Simple rear end MVA, sitting up, walking, delayed neck pain)
If they can not move their neck 45 degrees in both directions, then you need to X-ray.
If they can, then no x-rays are needed.

71
Q

Do you do flexion/extension X-ray views of the c spine right away?

A

No, must clear c spine first

72
Q

What kind of imaging needs to be done with lumbar spinal stenosis?

A

X-rays to T10

MRI over CT

CT myelogram is helpful but invasive

EMG/NCS if you cant figure out their leg pain

73
Q

What makes the neurogenic claudication of lumbar spinal stenosis worse?

A

Standing

Walking

74
Q

What are EMG and Nerve conduction studies

A

EMG-detects response of muscle to nerve stimulation

NCS- determines specific site of lesion

Always ordered together

75
Q

What are the signs of cauda equina syndrome?

A

Leg weakness in multiple distributions (L3-S1)

LBP with radiation into legs

SADDLE ANESTHESIA*** S2-S4

Urinary retention with or w/o overflow incontinence

Decreased anal sphincter tone

Sexual dysfunction

76
Q

What is the treatment for lumbar spondylolisthesis

A

Surgery

77
Q

What makes lumbar spondylosis worse and what makes it better?

A

Worse: bending or lifting

Better: lying down

78
Q

What nerve root causes pain in neck shoulder middle finger and hand

Numbness in index and middle finger

A

C7

79
Q

What makes the neurogenic claudcation feel better?

A

Leaning forward

SHOPPING CART SIGN**

80
Q

What is Radiculopathy?

A

Caused by a “pinched nerve” root and you have symptoms in a dermatomal distribution

81
Q

What is the most common cause of a cervical strain/sprain?

A

Whiplash

82
Q

Wat is the hallmark symptom of lumbar spondylosis?

A

LBP that radiates to buttocks

83
Q

What is thoracic outlet syndrome?

A

Compression of the neurovascular bundle above the first rib and behind the clavicle

(Subclavian artery and brachial plexus)

84
Q

Will someone with lumbar spinal stenosis have a wide based gait?

A

Yes

85
Q

Why would you use an oblique view to look at lumbar spine

A

To visualize the articular facets and the pars interarticularis

86
Q

What is the biggest cause of thoracic spine injury

A

Trauma.

So we wanna look for bruising and step-offs

87
Q

What is the most common type off thoracic outlet syndrome

A

Neurogenic is 95%

Compression of brachial plexus

88
Q

What are some of the ref flags of malignancy?

A

Unexplained weight loss

Failure of pain to improve

Pain >1 month

Pain at night (wakes from sleep)

History of cancer

50+ years old

New onset of spine pain in pt with known malignancy (50-70% of pts with terminal cancer will have vertebral Mets)

89
Q

What vertebrae is affected 90% of the time by lumbar spondylolysis

A

L5

90
Q

What are the symptoms of neurogenic thoracic outlet syndrome

A

Reproducible with elevation of arm (ex. While painting**)

Upper extremity pain

Dysesthesia (severe paresthesia/bugs crawl)

Weakness/numbness in hand, arm, shoulder (NOT dermatomal…its not a spinal root being compressed)

Weakness of hypothenar muscles

Numbness in ulnar or median nerve distribution

Tender over scalene muscles

91
Q

What nerve root causes:
neck shoulder and scapula pain

Lateral arm numbness

A

C5

92
Q

What are the three types of thoracic outlet syndrome

A

Neurogenic- brachial plexus compression 95%

Arterial- subclavian artery compression 1%

Venous- subclavian vein compression 3%

93
Q

How does C2 get fractured

A

Forceful flexion or extension of neck (MVA, assault)

94
Q

What can cause cervical Radiculopathy in young patients

A

Herniated disc

95
Q

What is lumbar spondylolysis?

A

A fracture of the pars interarticularis

“Scotty Dog Fracture”

96
Q

What is the most common symptom of cervical spondylosis

A

Decreased ROM of c spine

97
Q

What is the most common cause of lumbar spinal stenosis?

A

Spondylosis

98
Q

What is sciatica?

A

Radiculopathy in a lumbar nerve root (L4, L5, or S1)

Symptoms along the posterior or lateral aspect of the lower leg to foot or ankle

Clin Med Exam 3 (Lauren) (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions