Week 10: RAT

Question 1

Which of the following one of the conditions would likely have the LEAST promising prognosis for non-surgical care?

A) lumbar spinal stenosis
B) lumbar disc herniation
C) lumbar spondylolysis
D) lumbar spondylolisthesis
E) lumbar facet syndrome

Answer 1

A) lumbar spinal stenosis

Question 2

Based on likelihood ratios (LRs), what 1 answer contains the 2 strongest clues from the PE that would support a lumbar spinal stenosis dx?

A) positive romberg and wide stance
B) neurogenic claudication and P with sustained extension
C) loss of achilles reflex and LE muscle weakness
D) pain increased with sitting and relieved by repetitive extension

Answer 2

A) positive romberg and wide stance

Question 3

Aside from HVLA manipulation and treating MFTPs, what were 2 other main conservative therapeutic interventions for spinal stenosis contained in the CSPE protocol?

A) knees to chest exercises and flexion distraction therapy
B) prone extension exercises every 2 hours and CMT to lumbar spine
C) core stab exercises and encouraging the patient to try walk further despite the leg pain
D) limit the amount of time sitting and STM addressing a lower cross syndrome

Answer 3

A) knees to chest exercises and flexion distraction therapy

Question 4

Which of the following would usually NOT be considered a LBP complicator/contributor? Why?

A) hypertonic hamstrings
B) lower cross syndrome
C) quadratus lumborum MFTP
D) shaking when attempting to do a sit up

Answer 4

C) quadratus lumborum MFTP

MFTPs are biomechanical.

Question 5

For patients with lumbar spinal stenosis, indicate common (>50%) or uncommon (<50%) for each of the following:

Positive straight leg raise

Answer 5

Uncommon

Question 6

For patients with lumbar spinal stenosis, indicate common (>50%) or uncommon (<50%) for each of the following:

positive Romberg test

Answer 6

Uncommon

Question 7

For patients with lumbar spinal stenosis, indicate common (>50%) or uncommon (<50%) for each of the following:

Patient has sx of CES

Answer 7

Uncommon

Question 8

CES occurs in approximately ___% of stenosis cases?

Answer 8

6%

Question 9

Indicate a negative finding that would actually be a pertinent negative for spinal stenosis

Answer 9

Absence of neurogenic claudication

Question 10

What are 4 different ways that spinal degeneration can actually become the primary pain generator in a patient?

Answer 10

Spinal stenosis
Instability (structural)
Spondylotic compression of nerve root (e.g. spur/osteophyte in IVF)
Osteoarthritis (aka degenerative joint/degenerative disc disease)

Question 11

For each of the following conditions, indicate the ancillary study that would be ordered first:

To confirm that a patient has suspected spinal stenosis after radiograph

Answer 11

MRI

Question 12

For each of the following conditions, indicate the ancillary study that would be ordered first:

To confirm occult pars Fx that was not well visualized on x-ray

Answer 12

MRI or CT

Question 13

For each of the following conditions, indicate the ancillary study that would be ordered first:

To screen for PAD

Answer 13

Doppler US

Question 14

For each of the following conditions, indicate the ancillary study that would be ordered first:

To confirm a PAD diagnosis before surgery

Answer 14

MRA

Question 15

Your 65yo patient has leg pain with walking. What 2 diagnoses would usually be at the top of your list?

Answer 15

Spinal stenosis

PAD

Question 16

What’s the typical age for herniated disc? Spinal stenosis?

Answer 16

Disc hern: 30-55

Spinal stenosis: 60+