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CAM III > Spine > Flashcards

Spine Flashcards

1
Q

What are red flags in a pt’s hx for spinal issues?

A 
Bowel or bladder dysfunction
Fever/fatigue (constitutional)
Wt loss
Saddle paresthesia
Progressive neuro decline
Trauma
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2
Q

Sensory testing for C1-C2

A

Front of face

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3
Q

Motor testing for C1-C2

A

Neck flexion

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4
Q

Sensory testing for C3

A

Lateral face and skull

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5
Q

Motor testing for C3

A

Lateral flexion

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6
Q

Sensory testing for C4

A

Supraclavicular

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7
Q

Motor testing for C4

A

Shoulder shrug

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8
Q

Sensory testing for C5

A

Lateral shoulder/upper arm

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9
Q

Motor testing for C5

A

Shoulder abduction

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10
Q

Reflex testing for C5

A

Bicipital (musculocutaneous)

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11
Q

Sensory testing for C6

A

Lateral lower arm and hand (thumb and index finger)

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12
Q

Motor testing for C6

A

Elbow flexion and wrist extension

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13
Q

Reflex testing for C6

A

Brachialradial (musculocutaneous)

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14
Q

Sensory testing for C7

A

Palmar aspect of hand- middle 3 fingers

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15
Q

Motor testing for C7

A

Elbow extension and wrist flexion

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16
Q

Reflex testing for C7

A

Triceps (radial)

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17
Q

Sensory testing for C8

A

Medial lower arm and hand

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18
Q

Motor testing for C8

A

Finger flexion and thumb extension

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19
Q

Sensory testing for T1

A

Medial elbow and upper arm

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20
Q

Motor testing for T1

A

Finger abduction

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21
Q

Kyphosis

A

Exaggerated rounding of back

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22
Q

Causes of kyphosis

A

Usually after osteoporosis/disc degeneration weakens the spine
Birth malformations

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23
Q

Tx of kyphosis

A 
Maintain good bone quality with 
diet
exercise
osteoporosis meds
Bracing in children
Exercises
Spinal fusion is last resort
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24
Q

What are signs of scoliosis?

A

Uneven shoulders
Curve in spine
Uneven hips (ASIS should be even in nl presentation)

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25
Q

What is considered mild scoliosis?

A

Cobb angle of 10-20 degrees

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26
Q

What is considered moderate scoliosis?

A

Cobb angle 21-40 degrees

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27
Q

What is considered severe scoliosis?

A

Cobb angle >40 degrees

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28
Q

How is a Cobb angle taken?

A

Find which one is bent most, then find one turned the most opposite way
Find the intersection

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29
Q

What should tx be for a Cobb angle of >20?

A

Monitor

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30
Q

What should tx be for a Cobb angle of 20-29?

A

Braced according to risk

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31
Q

What should tx be for a Cobb angle of >30?

A

Braced

32
Q

What are the general components of low back pain?

A 
80% of people with back pain
Most <3 mos
Hx of lifting/twisting
Nl neuro exam
Pain with ROM
Generalized diffuse pain
33
Q

How should one proceed in an exam and dx of low back pain?

A

Clinical dx
No imaging needed
R/o red flags

34
Q

When should one image in low back pain?

A 
Neuro signs
Bony pain
Stepoff
Saddle anesthesia
Bowel/bladder sx
35
Q

Myelopathy

A

Something pressing on the spinal cord itself
A functional disturbance or pathological change in the spinal cord
Usually progressive

36
Q

Upper motor neuron signs of myelopathy

A 
Weakness
Spasticity
Altered tonus
Hyperreflexia
Hoffman's sign
37
Q

Hoffman’s test

A

Relax pt
Flick middle finger
Nl: only middle finger should move
Abnl: Index finger moves as well

38
Q

Lower motor neuron signs of myelopathy

A 
Weakness
Atrophy
Hyporeflexia
Flaccidity
Fasciculations
Bowel/bladder dysfunctions
39
Q

Radiculopathy

A

Motor/sensory disturbance due to specific nerve root compression

40
Q

S/sx of radiculopathy

A 
Pain
Weakness
Numbness
Sensory loss
Reflex changes
41
Q

What is considered an acute case?

A

<6 wks

42
Q

What is considered a chronic case?

A

> 12 wks

43
Q

What is considered radicular pain?

A

Radiating, tingling/numb/shock

44
Q

Spondylosis

A

Disc space narrowing

45
Q

S/Sx of spondylosis

A 
Neck pain
Dec ROM
Muscle spasms
Trouble sleeping
Antalgic gait
46
Q

Spondylolysis

A

Sometimes neck of Scotty dog is broken- pars defect or pars fx
Get oblique spine views

47
Q

Cause of spondylolysis

A

Trauma cause

Tumbling, other sports that have high impact on the legs

48
Q

Spondylolysthesis

A

One vertebral body is shucked on the other- concern for pars defect

49
Q

S/sx of spondylolisthesis

A

Back pain
Worse with activity (bending/lifting)
Trouble with lumbar flexion
Muscle spasms

50
Q

Grade I spondylolisthesis

A

1-25% slip

51
Q

Grade II spondylolisthesis

A

26-50% slip

52
Q

Grade III spondylolisthesis

A

51-75% slip

53
Q

Grade IV spondylolisthesis

A

76-100% slip

54
Q

Tx for spondylolisthesis

A

Stable can be left alone
Can tell when unstable when back pain is increasing
Most are gradual
Fusion

55
Q

Causes of radicular pain

A

Young-herniated disc

Older-foraminal narrowing

56
Q

S/sx of cervical radiculopathy

A 
Numbness
Paresthesias
Muscle spasms
Weakness
Dec coordination
57
Q

PE of cervical radiculopathy

A 
Decreased or painful ROM
Sensory changes
Muscle weakness
Decreased reflexes
Pos Spurlings maneuver
58
Q

Conservative tx for cervical radiculopathy

A 
Spontaneous resolution in 6-12 wks
NSAIDs
Steroids
PT
Traction
Refer if failure of tx, atrophy, weakness, myelopathy
59
Q

What is the MC cause of sciatica?

A

Bulging or herniated disc

60
Q

Test for sciatica

A

Straight leg test

Pain at 30-70 degrees radiates below the knee

61
Q

Tx for sciatica

A 
Most will resolve
Heat or cold
NSAIDs/steroids/muscle relaxants
Injections
PT
Surgery
62
Q

Cervical sprain/strain components

A 
Usually caused by whip lash through an MVA
Muscles and/or ligaments
Decreased ROM, TTP
Nl neuro exam
Could take 6 mos to resolve
RICE is mainstay of tx
63
Q

Compression fx

A 
Wedge-shaped vertebra
Osteoporosis
Midline pain
Kyphosis
Look for the vertebra that's different
64
Q

Tx for compression fxs

A

Pain control
Brace
Surgery referral
Kyphoplasty

65
Q

What is a risk of a kyphoplasty?

A

Could get more fxs above and below d/t weak structures

66
Q

Jefferson fracture

A

Fracture to C-1 (atlas)

67
Q

Dx of Jefferson fx

A

Open mouth view

68
Q

Cause of hangman fx

A

Spinous process is broken

69
Q

Hangman fracture

A

Fracture to C-2 (axis)

70
Q

Spinal stenosis

A

Narrowing of canal
Compression of nerve roots
Older pts
Usually degenerative in nature

71
Q

S/sx of spinal stenosis

A 
Neurogenic claudication
Radiculopathy
Worse with walking/prolonged standing
Better with rest/laying down
Relief with stooping
Back pain that shoots downward
Worse with extension
72
Q

Spinal stenosis tx

A

NSAIDs
Therapy
Epidural injections
Surgery/fusion

73
Q

Causes of cauda equina syndrome

A 
Disc herniation
Epidural abscess
Epidural hematoma
Trauma
Burst fxs
74
Q

Tx for cauda equina syndrome

A

Surgical emergency
Must decompress ASAP
NPO

75
Q

What differentiates a spinal epidural abscess?

A

Fever

76
Q

S/sx of spinal epidural abscess

A 
Severe back pain
"Shocking" or "shooting"
Sensory changes
Motor weakness
B/b dysfunction
Fever/malaise
77
Q

What are the most common cancers to metastasize to the spine?

A 
Breast
Lung
Thyroid
Kidney
Prostate

CAM III (12 decks)

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