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Clinical Reasoning > Test 2 Spine > Flashcards

Test 2 Spine Flashcards

1
Q

describe how intradiscal pressures increase during the seated position

A

body weight shifts forward as lordosis decreases

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2
Q

what percent of annular lamellae rings have a direct blood supply?

A

33%

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3
Q

which part of the spine has the least amount of annular disc lesions?

A

thoracic

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4
Q

a patient with LBP secondary to a disc lesion should be most palliative in which position?

A

laying supine

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5
Q

T or F, disc degeneration starts in the annulus first and is followed by the nucleus

A

false

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6
Q

T or F, when a patient rotates their spine to the left, only half of the lamellar rings are working to prevent overload/failure

A

true

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7
Q

a patient that has lumbar disc protrusion differs from a lumbar bulge in that

A

protrusion radiates leg pain

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8
Q

which position has the highest IVD pressure when the disc contains the nucleus

A

seated position

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9
Q

what causes circumferential tears?

A

forced overrotation

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10
Q

T or F, the degenerative process for the disc begins on a cellular level during the ages of 20-30

A

false

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11
Q

disc degeneration early because of

A

poor blood supply

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12
Q

disc degeneration starts in the nucleus as it

A

loses hydration

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13
Q

the intervertebral disc can fail under normal every day activities because the nucleus acts as

A

a liquid, leaking into cracks where the annulus has torn

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14
Q

the valsalva orthopedic test is done seated to increase what type of pressure

A

intradiscal

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15
Q

holding ones breath and bearing down during the valsalva test increases what type of pressure

A

inthrathecal

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16
Q

what percent of intradiscal pressure is on the annulus and facets while standing

A

80% on annulus, 20% on facets

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17
Q

intradiscal pressure while seated is 100% on the

A

annulus

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18
Q

which position gives the least intradiscal pressure

A

laying supine

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19
Q

which region of the spine is most likely to have a disc herniation?

A

lumbar

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20
Q

which region is least likely to have a disc herniation?

A

thoracic

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21
Q

nociceptive pain is only experienced on the outer 1/3 of the

A

annulus

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22
Q

describe antalgia

A

leaning away from pain

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23
Q

why do patients find comfort while in an antalgiac position

A

the canals are opened to create space relieving pain

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24
Q

glycosomingoglycans are toxic to

A

nerve tissue

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25
Q

pain in the annulus can be described as

A

dull, sharp, and/or achy

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26
Q

what is the dura mater that surrounds the spinal cord and cauda equina, contains cerebrospinal fluid

A

thecal (dural) sac

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27
Q

what vertebrae level does LBP usually occur?

A

L4/L5

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28
Q

T or F, high velocity and force can tear healthy lamellar rings

A

true

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29
Q

the nucleus moves through tears/fissures in the annulus under

A

low force

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30
Q

about how much of the nucleus pulposus is water?

A

80%

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31
Q

what motion damages ligaments?

A

pull and stretch

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32
Q

what motion damages muscles?

A

overstretch

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33
Q

fibers in the annulus begin to fail when

A

pressure is built up and there is a stretch

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34
Q

what motion causes a concentric tear/circumferential lesion

A

forced overrotation

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35
Q

the series of motions that causes a radial tear is

A

a bend, twist, and lift/force

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36
Q

what series of motions causes a transverse tear

A

a lateral bend and lift/force

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37
Q

which portion of an annulus has more lamellar rings?

A

the anterior portion

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38
Q

which part of the annulus is involved in a concentric tear

A

the outer layers of the annular wall

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39
Q

T or F, radial tears permeate from the central part of the disc and extends outward toward the annulus in the transverse plane

A

true

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40
Q

transverse tears are also known as

A

peripheral tears or rim lesions

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41
Q

transverse tears are horizontal ruptures of fibers, near the

A

insertion in the bony ring apophyses

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42
Q

T or F, during the valsalva maneuver capillaries in the thecal sac remain the same size

A

false

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43
Q

damage to the facets is usually caused by what type of force

A

shear force (hyperextension and rotation)

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44
Q

damages to the joints are usually caused by what type of motion

A

compressive force

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45
Q

a collection of symptoms that are not visible on imaging

A

syndrome

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46
Q

standing for long periods of time can lead to pain because of

A

creep

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47
Q

what is the best orthopedic test for lumbar facets?

A

standing kemps

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48
Q

most SI joint sprains are

A

internal ligaments

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49
Q

what are mechanical causes of LBP?

A

trauma, overuse, wear and tear

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50
Q

what tissues are effected during mechanical caused LBP?

A

muscles, joint facets, and SI

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51
Q

what is the systematic cause of LBP?

A

diseases process

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52
Q

what tissues are effected from systematic caused LBP?

A

GI tract, urinary, cardiac, reproductive organs, and bones

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53
Q

what are the top three cancers that metastasize to the spine?

A

breast, lung, and prostate

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54
Q

systematic sources of pain are usually unaffected by

A

postural change

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55
Q

rest alleviates pain from which source of pain

A

mechanical

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56
Q

pain with radiation is caused by which source of pain

A

systematic

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57
Q

which source of pain is usually poly articular?

A

systematic

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58
Q

mechanical pain can be described as

A

sharp, dull, achy, and burning

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59
Q

systematic pain can be described as

A

deep boring and radiating into the body

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60
Q

T or F, sprains and strains often occur simultaneously

A

true

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61
Q

a sprain in the lumbar region is usually due to the

A

annulus fibrosis

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62
Q

passive ROM picks up what type of damage?

A

ligament

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63
Q

active ROM picks up which type of damage?

A

muscle

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64
Q

the source of pain in scoliosis is

A

degeneration of joints

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65
Q

referred pain does not

A

travel, it is more localized

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66
Q

radicular pain travels further because it is associated with

A

a nerve root

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67
Q

what is the #1 cause for pain in the cervical region?

A

joint capsule

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68
Q

a whiplash injury involves both a

A

sprain and strain

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69
Q

what increases risk of reinjury?

A

scar tissue

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70
Q

scar tissue is responsible for decreasing

A

range of motion

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71
Q

scar tissue leaves muscles

A

weaker and less flexible

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72
Q

inflammatory arthritis is a type of

A

autoimmune response where the body attacks itself

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73
Q

osteoarthritis is caused by

A

wear and tear, inflammation of a joint

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74
Q

Ankylosing Spondylitis begins with inflammation and erosion, then progresses to

A

syndesmophytes and fusion of bone

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75
Q

which causes the least amount of LBP? facets, SI, or annulus?

A

SI, about 10% of injuries

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76
Q

the best type of orthopedic test to evaluate a muscle that has been strained is

A

contraction

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77
Q

T or F, facet joints cause pain when cartilage/capsule is damaged and long term seated posture is provocative

A

false

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78
Q

T or F, passive ROM is best used to evaluate muscle injuries

A

false, painful passive ROM is found with ligaments

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79
Q

T or F, patients with SI sprain would have a positive valsalva

A

false

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80
Q

a positive valsalva is an indication for

A

a space occupying lesion

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81
Q

cervical sprain is caused by what motion

A

hyperflexion or hyperextension

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82
Q

cervical sprain is a tear in the

A

facet capsule/annulus

83
Q

cervical disc bulges are usually what types of tears

A

circumferential and radial

84
Q

cervical disc bulge is what type of injury

A

annular, mechanical or degenerative

85
Q

cervical strain is torn

A

muscle fibers/fascia between muscle bundles

86
Q

cervical sprain can be caused by

A

trauma or repetitive overuse

87
Q

cervical sprain is referred from

A

ligaments

88
Q

a positive valsalva test and max foraminal compression is likely a sign of

A

cervical sprain

89
Q

cervical disc bulge is typically caused by

A

degeneration (sometimes trauma)

90
Q

what is the epidemiology for cervical disc bulge?

A

ages 40+, females more than males

91
Q

disc bulge in the cervical spine is usually at which spinal level?

A

C6-7

91
Q

cervical disc bulge pain is only from the

A

annulus

92
Q

a positive bechterews, valsalva, and SLR test might indicate

A

a lumbar disc protrusion

93
Q

what is provocative and palliative for a lumbar disc protrusion?

A

seated position (increase LBP), supine position (relief)

94
Q

the most common spinal level for lumbar disc bulge is

A

L4/5 and L5/S1

95
Q

a lumbar disc bulge in spinal levels L3 or higher is common in

A

people over 60 years old

96
Q

a lumbar disc prolapse occurs when

A

all lamellar rings fail (bend, twist, and lift/overrotation)

97
Q

lumbar disc prolapse also causes

A

leg pain, from nerve compression

98
Q

lumbar disc prolapse is usually caused by

A

95% degeneration (5% trauma)

99
Q

lumbar disc prolapse refers no pain in which position

A

sitting and laying supine

100
Q

lumbar disc prolapse gives a positive test for

A

the valsalva maneuver

101
Q

an SI sprain is commonly caused by what type of fall

A

on butt or on outstretched leg

102
Q

SI sprain refers pain at the

A

PSIS (fortin finger sign)

103
Q

positive SI compression, faberes, nachlas, ely, and yeoman test indicates

A

SI sprain

104
Q

pain getting out of a chair is an indication of

A

SI sprain

105
Q

LBP facet joint syndrome is a result of

A

sprained capsule, forced overflexion

106
Q

what tissue is injured in LBP facet joint syndrome?

A

cartilage and caspule in hyperextesion

107
Q

LBP facet joint syndrome only reciprocates pain when

A

prolonged standing occurs

108
Q

a positive standing kemps test is an indication of

A

LBP facet joint syndrome

109
Q

which spinal curvatures are caused by LBP facet joint syndrome?

A

hyperlordosis and increased sacral angle

110
Q

chronic whiplash syndrome occurs if symptoms last

A

more than six months

111
Q

DISH is the ossification of the

A

ALL

112
Q

DISH is caused by an increase in

A

calcium salts

113
Q

DISH usually effects how many segments and which region of the spine?

A

4+ segments, 80% thoracic

114
Q

Which joints are not involved in DISH?

A

facets and SI

115
Q

T or F, DISH is an inflammatory arthritis

A

false

116
Q

ankylosing spondylitis is

A

an inflammatory arthritis that fuses the spine

117
Q

AS is found in which epidemiology?

A

males, dx by age 20

118
Q

what region is AS pain mostly found

A

SI and hip, spinal stiffness

119
Q

which spinal curvature is commonly associated with AS

A

hyperkyphosis

120
Q

what type of onset is found with AS

A

pain for more than 5 months, insidious onset

121
Q

psoriatic arthritis is

A

an inflammatory arthritide that effects the spine and extremities

122
Q

psoriatic arthritis is developed in what percentage of people?

A

30%

123
Q

psoriatic arthritis joint symptoms appear

A

10 years after skin condition

124
Q

what symptom is commonly found with psoriatic arthritis

A

sacrolitis

125
Q

sacrolitis is a type of

A

bacterial infection, injury arthritis

126
Q

sacrolitis is associated with

A

AS and inflammatory arthritis

127
Q

sacrolitis pain is commonly found in

A

butt and low back

128
Q

PUD is a type of

A

visceral somatic referred pain caused by bacteria

129
Q

PUD pain is commonly felt

A

gastric- after eating
duodenal- 2-3 hours after eating

130
Q

PUD symptoms can include

A

middle back burning pain, stomach pain, and dark stool

131
Q

AAA pain can be described as

A

tearing/ripping mid back pain

132
Q

what type of onset is found with AAA?

A

acute onset, asymptomatic until rupture

133
Q

symptoms of AAA include

A

nausea, dizziness, shortness of breath, low BP, and increased HR

134
Q

patients are at a higher risk for AAA from

A

hypertension, coronary artery disease, and smoking

135
Q

spinal metastasis is the process of

A

cancer cells moving from one area and traveling through the circulatory system to a new area

136
Q

what fraction of breast cancer moves to the spine?

A

2/3

137
Q

what percent of lung cancer spreads to the thoracic spine?

A

70%

138
Q

which cancer is responsible for being the #1 malignancy death in men

A

lung cancer

139
Q

osteoporotic compression fractures have what type of onset?

A

sudden onset, silent until fails

140
Q

osteoporotic compression fractures epidemiogly

A

40-50% of women over 80, males are 50% less likely

141
Q

signs of osteoporotic compression fractures include

A

increased kyphosis and shortened height

142
Q

osteoporotic compression fracture risk factors include

A

post menopause, poor diet, lack of exercise, and steroid/prednisone use

143
Q

endometriosis occurs in what percentage of women?

A

4-15%

144
Q

osteomyelitis is

A

a bacterial infection of bone

145
Q

symptoms of osteomyelitis include

A

fever, chills, and pain (most commonly lumbar)

146
Q

osteomyelitis risk factors include

A

IV drug use, HIV, immune suppression, and infection

147
Q

the most common primary spine cancer is

A

multiple myeloma

148
Q

multiple myeloma causes what type of pain

A

deep bone pain

149
Q

scheuermann’s disease is a type of

A

endplate trauma

150
Q

scheuermann’s disease is caused by

A

parts of the vertebral body growing at different rates causing kyphosis

151
Q

shingles is a type of

A

viral infection with rash along nerve tract

152
Q

what are 2 thoracic non inflammatory issues?

A

DISH and osteoarthritis

153
Q

scoliosis is common is what percentage of the population?

A

2-3%

154
Q

What percent of people have systemic pathology?

A

5%

155
Q

experiencing unexplained weight loss, fevers, and sweats while also being over the age of 50 points towards what kind of diagnoses?

A

systemic

156
Q

when pain occurs for longer than 6 weeks, is unresponsive to treatment, and starts before the age of 40 this is a good indication that the diagnoses is

A

systemic

157
Q

lumbar disc bulge is anatomically

A

annular failure from circumferential tear

158
Q

lumbar disc bulge is caused by what action

A

forced overrotation

159
Q

a lumbar disc bulge is usually what type of progression?

A

95% degenerative/overuse

160
Q

lumbar disc bulges, protrusions, and prolapse are usually seen at what age?

A

30-50

161
Q

lumbar disc prolapse differs from other lumbar disc injuries in that

A

seating position is not provocative, standing is the most uncomfortable

162
Q

which test is negative and positive for disc prolapse

A

valsalva is negative, SLR is positive

163
Q

lumbar disc protrusion can be described anatomically as

A

annular failure with radial fissure, but at least one lamellar ring is intact

164
Q

lumbar disc prolapse can be described anatomically as

A

all lamellar rings failing

165
Q

lumbar disc protrusion and prolapse are both caused by what action

A

bend, twist, lift, and overrotation

166
Q

lumbar disc bulge pain comes from the

A

annulus

167
Q

lumbar disc protrusion pain comes from

A

annulus and nerve root compression

168
Q

lumbar disc prolapse pain comes from

A

nerve root compression

169
Q

circumferential tears are caused by what motion

A

overrotation

170
Q

radial tears are caused by what motion

A

bend, twist, and lift

171
Q

facet joint syndrome is caused by what motion

A

forced overflexion or hyperextension

172
Q

facet joint syndrome can be described anatomically as

A

a sprained capsule in hyperflexion, cartilage and capsule in hyperextension

173
Q

facet joint syndrome is commonly found in ages

A

50 and over

174
Q

there is an increased risk for facet joint syndrome with

A

hyperlordosis and increased sacral base angle

175
Q

SI sprains are more common in those who

A

are female, pregnant

176
Q

SI sprain can be described anatomically as

A

external ligaments being damaged

177
Q

which test is positive when testing for facet joint syndrome

A

standing kemps

178
Q

pain is most provocative for facet joint syndrome with

A

prolonged standing, walking, and stairs

179
Q

positive patricks, fabres, nachlas, ely, and yeamans tests indicate

A

SI sprain

179
Q

pain with SI sprain is found where on the body

A

PSIS

180
Q

pain in SI sprains is worse in which position

A

prolonged sitting and getting up from chair

181
Q

pain in the lumbar region with SI sprain indicates a strain in which muscle

A

erector spinae

182
Q

a disc bulge in L3 or higher is most common is those

A

over the age of 60

183
Q

what is the most common tissue causing LBP

A

disc bulge

184
Q

cervical sprain can be described anatomically as

A

tear is facet caspule and/or annulus

185
Q

cervical strain can be described anatomically as

A

torn muscles fibers or fascia between bundles

186
Q

cervical sprains and strains differ from bulges in that they are caused by

A

trauma, or repetitive overuse

187
Q

pain in a neck sprain comes from

A

ligaments

188
Q

pain in neck strains comes from

A

muscles

189
Q

arm/hand pain radiation in a neck injury indicates

A

a cervical bulge

190
Q

a cervical bulge differs from the other cervical injuries in test in that

A

it shows positive compression tests but is negative for distraction

191
Q

which cervical injury will have positive PROM

A

cervical sprain

192
Q

which cervical injury will have positive RROM

A

cervical strain

193
Q

V in vindicate

A

vascular (AAA)

194
Q

I in vindicate

A

inflammation/infection
osteomyelitis (bacterial), PUD, shingles, Scheuermans (end plate trauma)

195
Q

N in vindicate

A

neoplasm
metastasis, multiple myeloma

196
Q

D in vindicate

A

degenerative
DISH (ALL), osteoporosis, deg. disc lesions, osteoarthritis

197
Q

I in vindicate

A

Idiopathic/iatrogenic
scoliosis

198
Q

c in vindicate

A

congenital

199
Q

a in vindicate

A

autoimmune
Psoriatic arthritis, AS

200
Q

t in vindicate

A

trauma
sprain, strain, tram. disc lesions, whiplash

201
Q

e in vindicate

A

endocrine
endometriosis

Clinical Reasoning (1 decks)

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