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MSK 1 > Spine Red Flags > Flashcards

Spine Red Flags Flashcards

1
Q

MSK based spinal flags

A

fracture
cervical instability
malignancy

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2
Q

neurological related spine red flags

A

cervical myelopathy
cauda equina

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3
Q

cardiovascular related spine flags

A

vertebral basilar insufficiency
abdominal aortic aneurysm
myocardial infarction
pneumothorax

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4
Q

infections of the spine

A

osteomyelitis
sacroiliitis

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5
Q

what causes spinal fractures

A

axial loading and trauma

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6
Q

what % of calcaneal fractures are associated with _________

A

10%
low thoracic or lumbar fx

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7
Q

risk factors to consider in spinal fx

A

trauma
osteoporosis
hx of spinal fracture
hx of cancer

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8
Q

ages related to spinal fracture risk factors

A

females >65
males >75

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9
Q

what in a patient’s history would make you suspicious of osteoprosis

A

history of osteoporosis
late onset menarche (>16 y/o)
early menopause (<45)
corticosteroid use >3 mo

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10
Q

if a superficial bone is tender to palpation after trauma, think

A

fracture

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11
Q

presentation of cervical fx

A

neck pain that worsens with motion
instability s/s
possible cord and/or vertebral artery s/s

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12
Q

during flexion, explain the motion of the dens

A

will push into the spinal cord during flexion

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13
Q

high risk factors in the Canadian C-Spine Rule that indicate a CT scan

A

65 or older
dangerous mechanism
paresthesia in extremities

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14
Q

dangerous mechanisms can be described as

A

fall from > 3 feet or 5 stairs
axial load to head
MVC

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15
Q

In the Canadian C-Spine rules, what are factors that would not allow for safe ROM assessment

A

not a simple MVC
unable to sit up in ER
inability to ambulate
midline c-spine tenderness
immediate onset of neck pain

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16
Q

if cervical AROM is less than ____,
CT scans are indicated

A

45°

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17
Q

when is the Canadian C-spine rule not applicable

A

non-trauma cases
glasglow coma scale <15
unstable vitals
age <16
acute paralysis
known vertebral disease
previous C-Spine surgery
pregnancy

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18
Q

what is the sensitivity of the canadian c-spine rule

A

90-100%

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19
Q

what is the NEXUS criteria?

A

criteria in which all must be negative for CT scan to not be indicated

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20
Q

what are the criteria in the NEXUS criteria

A

no posterior midline cervical spine tenderness
no evidence of intoxication
normal level of consciousness
no focal neurological deficit
no painful distraction injury

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21
Q

sensitivity of the NEXUS criteria

A

83-100%

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22
Q

which criteria has been very successful in identifying odontoid fx

A

NEXUS

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23
Q

what portion of the body are there more distracting injuries? what are examples

A

UE>LE

fx, degloving, crush, burns or large visceral injuries

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24
Q

red flags for a vertebral fx in patients presenting with LBP

A

> 70 y/o
corticosteroid use
trauma
contusion/abrasion

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25
Q

what warrants lumbar radiography? which directions?

A

lumbar compression
minor traumatic fx

A-P and lateral views

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26
Q

what on an MRI will indicate a pathologic lumbar fracture

A

abnormal bone marrow signal

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27
Q

what types of scans can be done on a lumbar fx

A

lumbar radiography
CT w/o contrast
MRI w/o contrast

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28
Q

IFOMPT upper c-spine instability risk factors

A

history of trauma
infection
congenital collagenous compromise
inflammatory arthritides
recent head/neck/dental surgery

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29
Q

on the beighton scale, what constitutes congenital collagenous compromise

A

> 4 of 9

30
Q

how would an infection lead to cervical spine instability

A

alter connective tissue integrity
- could erode bone
- spondylitis then stenosis
- grisel’s syndrome

31
Q

s/s of upper cervical spine instability

A

occipital HA / numbness and neck pain
severe limitation of neck AROM
- all planes
<45° rotation
cervical myelopathy
pupil changes
dizziness
positive ligamentous integrity tests

32
Q

ligamentous integrity tests related to Upper C-Spine Instability

A

sharp-purser
alar ligament
aspinall

33
Q

what films will be taken for those with upper cervical spine instability

A

open mouth odontoid
- spread of lateral masses of C1/2
lateral c-spine
- flexion and extension views

34
Q

what distances between C1/2 and atlanto dens interval are significant

A

<3 mm = normal
>5mm = increased risk of cord compression
>8mm = indicates surgical fixation

35
Q

film indication for pt with blunt force c-spine trauma

A

CT scan

36
Q

when is MRI indicated in the spine

A

neurological clinical examination findings
suspicion of ligamentous / vascular injury

37
Q

risk factor of spinal malignancy

A

hx of cancer

38
Q

s/s of spinal malignancy

A

progressive/constant severe pain
night pain w/ minimal relief
systematically unwell
unexplained weight loss
spine tenderness and warmth
neurological s/s

39
Q

what amount of weight loss in what time frame is significant

A

5-10% loss over 1-3 mo

40
Q

what rules out cancer causing LBP

A

<50 years
no explained weight loss
no hx of cancer
responding to conservative care in a month

41
Q

if a spinal radiograph shows, _____________ then a contrast MRI is indicated

A

disc margin destruction
bony lesion suggestive of malignancy / infection

42
Q

what is the cluster associated with cervical myelopathy

A

> 45 y/o
ataxic gait
babinski’s, reverse supinator, hoffman’s signs

43
Q

which gender is cervical myelopathy more prevalent? what is the avg age / what is the most prevalent symptom

A

male (3:1)
64
UE radicular pain

44
Q

what film is indicated with myelopathy suggestion

A

either MRI or CT with contrast

45
Q

what is a positive Lhermitte sign

A

sharp shooting sensation in arm and leg when the extended leg is lifted and the c-spine is flexed

46
Q

what nerve pairs are in the cauda equina

A

L2-5
S1-5
Coccygeal nerve

47
Q

risk factors of cauda equina syndrome

A

disc herniation
spinal stenosis
surgery
tumor
trauma
hematoma
epidural abcess

48
Q

s/s of cauda equina syndrome

A

bladder/bowel changes
sexual changes
sensory disturbances
global/progressive LE weakness
reduced anal tone

49
Q

what sensory disturbances are associated with cauda equina syndrome

A

saddle anesthesia
LE L4,5 S1

50
Q

red flags are more so _____ in cauda equina syndrome? which red flags

A

sensitive

saddle anesthesia
reduced anal tone
bowel incontinence

51
Q

common cause of vertebral/internal carotid dissections

A

tear of tunica intima or outer adventitial layer via vaso vasorum damage

intramural hematoma causes blood flow alterations

52
Q

where is the vertebral artery most commonly injured

A

C1-2 –> contralateral to rotation

53
Q

explain VBI testing and its effectiveness

A

is not very sensitive

54
Q

instead of normal VBI testing, what should be done when suspecting vascular pathology

A

peripheral/cranial nerve screen
blood pressure assessment
palpation/auscultation of common and IC arteries
coordination and gait assessment

55
Q

vertebral artery 5 D, 3 N, 1 A

A

D:
dizziness, dysphagia, dysarthria, drop attack, diplopia

N:
nausea, numbness in face, nystagmus

A: ataxia

56
Q

age risk factor for MI males and females

A

male >40, female >50

57
Q

female only risk factors of MI

A

increased testosterone before menopause
increased HTN during menopause
autoimmune disease
stress, depression

58
Q

what prodromal symptoms may precede an MI in women? what timeline?

A

unusual fatigue
sleep disturbances
dyspnea
indigestion
anxiety
heart racing
UE/LE weakness

59
Q

s/s of MI

A

shortness of breath

substernal chest pain or squeezing pressure

radiating pain in referral distribution

angina >30min that is unrelenting

pallor / perspiration

60
Q

risk factor of abdominal aortic aneurysm

A

> 50 y/o
male
smoker
family hx
genetic condition
weight lifting
anticoagulants

61
Q

what cm measurement is suggestive of an aneurysm

A

4 or more CM

62
Q

locations of pain associated with abdominal aortic aneurysm

A

back
abdominal
groin
posterior thigh

63
Q

pneumo s/s

A

dyspnea
dry cough
change in respiratory movements in affected side
neck vein distension
sharp, sudden thoracic wall pain
referred shoulder / abdominal pain

64
Q

risk factors for spinal infection

A

IV drug use
recent infection / surgery
immunosuppression
history of TB

65
Q

s/s of spinal infection

A

general infection symptoms
unexplained weight loss
neuro s/s
spinal tenderness

66
Q

if a radiograph shows disc margin destruction/bony lesion what would be indicated? why?

A

involved MRI without contrast
spinal malignancy or infection

67
Q

findings associated with vertebral osteomyelitis

A

deep, constant pain, > with WB
spinal rigidity
fever, malaise

68
Q

Spondylarthritis

A

noninfectious inflammatory, rheumatic condition

69
Q

extraarticular manifestations of SpA

A

enthesitis
uveitis
dactylitis

70
Q

s/s ankylosing spondylitis

A

insidious LBP >3 mo
SI symptoms / buttock pain
awaken in the night
morning stiffness >30 min

71
Q

what is the nickname of ankylosing spondylitis

A

bamboo spine with a dagger sign

MSK 1 (12 decks)

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