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spine conditions Flashcards

1
Q

what is an abdominal aortic aneurysm (AAA)?

A

dilation of the abdominal aorta (>3 cm)

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2
Q

what is the pain referral pattern of AAA?

A

loin to groin

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3
Q

what are s&s of AAA?

A

abdominal/flank pain
loin or groin pain
signs of shock: pale, clammy hands, rapid pulse, SOB, dizziness, weakness
pulsatile abdominal mass
asymmetrical pulses

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4
Q

what is the management for AAA?

A

3-4,4cm: monitor anual US
4,4-5,4 cm: 3 monthly US
>5,4: surgery

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5
Q

what is ankylosing spondylitis?

A

a type of inflammatory arthropathy which is most common in young males (15-30 years)

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6
Q

what are s&s of AS?

A

morning stiffness >30 min
LBP/pelvis/SIJ pain
pain improves with exercise
worse with rest
night pain
alternating buttock pain
peripheral enthesitis

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7
Q

which signs are present during physical exam in AS?

A

limited chest expansion (<7.5 cm)
limited schober’s test (<4-5cm)

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8
Q

what other conditions might be associated with AS?

A

conjunctivitis
aortic insufficiency
pulmonary fibrosis

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9
Q

what are the x-ray findings in AS?

A

romanus lesion
shiny corners
vertebral body squaring
non-marginal syndesmophytes

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10
Q

which blood tests can be done to diagnose AS?

A

FBC
HLA B27
ESR (erythrocytes sedimentation rate)

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11
Q

what are the s&s for cauda equina syndrome?

A

back pain
pain radiation down both legs
loss of urinary control or sensation
saddle anaesthesia
erectile dysfunction
LL weakness
decreased SMR

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12
Q

what are s&s of degenerative disc disease?

A

local back pain
relieved by rest, worse with activity
reduced ROM
sensation of weakness of the back
stiffness

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13
Q

what is DISH?

A

diffused idiopathic skeletal hyperostosis: ossification of ligaments, tendons and joint capsules

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14
Q

which ligaments are most commonly affected by DISH?

A

MC: anterior longitudinal ligament (ALL)
2nd MC: posterior longitudinal ligament (PLL)

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15
Q

which population type is most at risk for DISH?

A

male
>50
diabetes
alcoholism
obesity
hypertension

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16
Q

what are s&s of DISH?

A

often asymptomatic
stiffness
dysphagia

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17
Q

what are s&s of a compression fracture?

A

local spasm and swelling
tenderness
local flexion deformity
pain on percussion vibration

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18
Q

which physical exam test would be possible with a compression fracture?

A

supine sign

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19
Q

what are the x-ray findings for a NEW compression fracture?

A

anterior wedging (if posterior wedging –> pathological fracture)
zone of impaction
step off deformity

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20
Q

what are the x-ray findings for an OLD compression fracture?

A

anterior wedging
NO step off zone

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21
Q

what is a chance/seatbelt fracture of the spine?

A

a transverse fracture across the TPV, laminae and articular process due to a violent forced flexion with distraction force (lap seatbelt during MVA)

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22
Q

what are x-ray findings of a chance/seatbelt fracture?

A

widening of the intertransverse process space above level of fx
anterior-superior bone fragment

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23
Q

is a chance/seatbelt fracture stable or unstable?

A

UNSTABLE!

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24
Q

besides AAA, which other condition refers to the loin and groin area?

A

kidney stones/nephritis

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25
Q

who is most at risk for kidney stones?

A

males 30-60
hypercalcaemia

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26
Q

what are s&s for kidney stones?

A

intense pain on side of abdomen
pain may mimic MSK pain
loin to groin pain
nausea
polyuria
dysuria
haematuria

27
Q

what is the management for kidney stones?

A

small stones: pass through urine
large stones: broken down by US/laser

28
Q

what other condition can kidney stones cause?

A

urinary tract infection UTI

29
Q

what is Maigne’s syndrome?

A

condition affecting the cutaneous nerve T12-L2

30
Q

what are the s&s of Maigne’s syndrome?

A

manipulable lesion of TL junction
UL or BL pain over iliac crest, TL and/or groin
hypersensitivity on iliac crest (+ve skin rolling)
local muscle guarding

31
Q

what is multiple myeloma?

A

malignant proliferation of plasma cells within the bona marrow

32
Q

who is most at risk MM?

A

male
>60
afro-caribbean

33
Q

what are the most common s&s of MM?

A

often asymptomatic
anaemia
renal impairment
fatigue
weight loss
hypercalcaemia

34
Q

what will the blood tests indicate in MM?

A

hypercalcaemia
hyperuricemia
abnormal protein electrophoresis

35
Q

what is the most common site for a radiculopathy?

A

L5-S1

36
Q

what are s&s for a lumbar radiculopathy?

A

LBP
hip pain
groin pain
unilateral leg pain
LMNL: decreased DTR, atrophy, fasciculations, weakness and hypotonia

37
Q

what is the most common cause of a lumbar radiculopathy?

A

disc herniation

38
Q

what are s&s of SIJ sprain?

A

pain over SIJ (UL or BL)

39
Q

which tests are positive in SIJ sprain?

A

Gaenslens
Fabere
thigh thrust
SIJ distraction
SIJ compression
Sacral thrust provocation
SIJ instability tests

40
Q

what is scheuermann’s disease?

A

kyphosis in juvenile population (11-17 yrs)

41
Q

what are s&s of scheuermann’s disease?

A

pain and stiffness (lower Lx)
increasing kyphosis over 1-2 months
pain during forward flexion
pain comes on towards end of day
short hamstrings and pecs

42
Q

what are the x-ray findings in scheuermann’s disease?

A

schmorl’s nodes
elongated VB’s
anterior wedging
disc height loss

43
Q

what will be seen in the adams forward bending test in patients with scoliosis?

A

functional scoliosis: rib hump decreased on flexion
structural: rib hump doe snot improve with flexion

44
Q

what is the management of scoliosis?

A

NON-skeletally mature:
<20°: observe
20-30°: observe and brace progressive
30-45°: brace
>45°: surgical referral

skeletally mature:
<45°: conservative management
>45°: surgical referral

45
Q

what are spondyloarthropathies?

A

inflammatory arthropathies affecting the spine and etheses

46
Q

which conditions coexist commonly with spondyloarthropathies?

A

conjunctivitis
inflammatory bowel disease
aortic insufficiency

47
Q

which conditions are part of seronegative spondyloarthropathies?

A

AS
psoriatic arthritis
inflammatory bowel disease
reactive arthritis/ reiter’s syndrome
enteropathic arthritis

48
Q

which conditions commonly present with enteropathic arthritis?

A

ulcerative colitis
crohn’s disease

49
Q

what are s&s of enteropathic arthritis?

A

morning stiffness >30 min
improvement with exercise
worse with rest
waking during the night
(radiographically identical to AS)

50
Q

which joints are most commonly affected in psoriatic arthritis?

A

DIP
PIP
MCP (swollen fingers)
SIJ

51
Q

what is a common finding in psoriatic arthritis?

A

periostitis (mouse ear erosion)

52
Q

which conditions commonly present with reactive arthritis/ reiter’s syndrome?

A

STI (chlamydia)
infections (salmonella, shigella etc)

53
Q

what is commonly seen in patients with reactive arthritis/reiter’s syndrome?

A

Reiter’s triad:
1. urethritis
2. conjunctivitis
3. arthritis
(can’t see, can’t pee, can’t dance with me)

54
Q

what is the most common site for reactive arthritis?

A

achilles tendinits (lover’s heel)

55
Q

what is another common finding in reactive arthritis?

A

swollen fingers (dactylitis)

56
Q

what are the radiographic findings for AS and enteropathic arthropaties?

A

BL and symmetrical sacroiliitis
marginal syndesmophytes
bamboo spine
disco-vertebral hanges (romanus lesion, shiny corners, VB squaring)

57
Q

what are the radiographic findings for psoriatic arthritis and reactive arthritis?

A

BL and Asymmetrical sacroiilitis
non-marginal syndesmophytes
periostitis (psoriatic arthritis)

58
Q

what is a spondyloysis?

A

stress fracture through the pars interarticularis of the lumbar spine

59
Q

which athletes are most at risk for a spondylolysis?

A

sports that require extension under load (gymnasts, weight lifters etc.)

60
Q

what are the 5 types of spondylolysis?

A

I. dysplastic (congenital)
II. isthmic (stress fracture)
III. degenerative
IV. traumatic (acute fx in other areas than pars)
V. pathologic
VI. iatrogenic (post-surgical fusion)

61
Q

what are s&s of spondylolysis?

A

often asymptomatic
LBP
pain in buttocks
worse with standing/ walking/ extension
relieved by sitting
increased lordosis
tight hamstrings
waddling gait
step off deformity

62
Q

what physical examination tests are positive with spondylosysis?

A

single leg hyperextension
McGill

63
Q

what are s&s of facet sprain?

A

local pain around spinal level
guarding, hypertonicity of surrounding muscles
instability (+ve McGills)
functionally poor movement patterns

conditions (29 decks)

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