Week 1 Questions

Question 1

What are pain referral patterns in the back for kidney disease, colon disease, sigmoid colon/rectum, urinary pain, pancreatitis?

Answer 1

Kidney: in an upside-down U shape above the belt and wrapping around the lateral thigh

Urinary bladder: midline at the upper butt crack and then medial gluteal folds continuous with medial thigh

Colon: mid lumbar spine (L3)

Gynecological disorders: rarely above L4

Sigmoid colon, rectum, pelvic: sacral

Pancreatitis: thoracolumbar

Question 2

What types of bone conditions does ALP increase in?

Answer 2

Hyperactive bone/blastic lesions

• Paget’s disease
• healing fracture
• growing bones
• pregnancy
• liver disease

Question 3

Your patient has low back pain secondary to spinal cancer. What would be the likely results in the following tests?

• CRP
• CBC
• Blood chemistry panel

Answer 3

CRP: elevated
CBC: anemia, altered WBC
Blood chemistry panel: increased serum Ca2+ and ALP

Question 4

Your patient has low back pain, loss of calcium seen on X-ray, elevated ESR of 90mm/hr. What condition do you think of first?

Answer 4

Multiple myeloma

Note: 2 others cause elevated ESR >100
2 - temporal arteritis
3 - polymyalgia rheumatica

Question 5

Your patient has loss of vibration (pallesthesia). What are some disease that affect the spinal cord that would be in your DDX? What are disease of peripheral nerves you should consider?

Answer 5

Top 3 spinal cord:

1. Tabes dorsalis
2. B12 deficiency
3. MS

Top 3 peripheral neurology:

1. Diabetes
2. B12 deficiency,
3. Alcoholism

Question 6

Where do temperature signals cross the body in the CNS? What else travels with temperature?

Answer 6

At the spinal level

Because temperature is in the lateral spinothalamic tract that decussates at the spinal level (along with pain and crude touch)

Question 7

Where does vibratory sense cross the CNS? What else travels with vibration?

Answer 7

In the medulla

Because vibration is in the posterior/dorsal column (along with proprioception and fine touch)

Question 8

What are the top 3 causes of spinal cord compression in the TLJ region of the spine IN ORDER?

Answer 8

Disc herniation
Stenosis
Space occupying lesion - osteophytes

Question 9

Besides leg symptoms, what 2 questions do you need to ask a patient to screen for cord involvement (radiculopathy) and LBP?

Answer 9

Bowel, bladder chances?

Numbness, tingling, weakness?

Question 10

What conditions can a positive Romberg test suggest?

Answer 10

Myelopathy
Peripheral nerve lesion (diabetic neuropathy)
Multiple nerve root lesions (spinal stenosis)
Cerebellar disease
Vestibular disorders

Question 11

What are 5 key exam findings that suggest CES?

Answer 11

Urinary retention
Overflow incontinence
Saddle anesthesia
Bowel incontinence
Sexual dysfunction

Ask Rhea about this