Week 6: RAT

Question 1

Which of the following would be single strongest clue supporting a radiculopathy?

A) repetitive cervical extension centralizes the arm Sx
B) loss of vibratory sense in the little finger
C) cervical compression causes arm pain
D) patellar hyperreflexia
E) shoulder abduction relieves the arm Sx

Answer 1

B) loss of vibratory sense in the little finger

Question 2

Which of the following would offer the strongest indication of a radiculitis?

A) shoulder abduction increases arm pain
B) valsalva reproduces arm pain
C) SLR causes severe LBP
D) achilles hyperreflexia
E) ankle clonus

Answer 2

B) valsalva reproduces arm pain

Question 3

In the following question, why is B the correct answer?

Which of the following would offer the strongest indication of a radiculitis?
A) shoulder abduction increases arm pain
B) valsalva reproduces arm pain
C) SLR causes severe LBP
D) achilles hyperreflexia
E) ankle clonus

Answer 3

Valsalva reproduces arm pain because it increases intrathoracic pressure backing up venous pressure into the spinal column - the pressures would irritate an inflamed nerve (radiculitis).

Question 4

SLR causing severe LBP is a [positive/negative/unsure] sign and suggests what?

Answer 4

Negative. It suggests that the NR is not involved.

Question 5

SLR causing severe leg pain past the knee is a [positive/negative/unsure] sign and suggests what?

Answer 5

Positive sign, indicative of lumbar herniation, tumor, stenosis, etc.

Question 6

Your patient landed hard on her snowmobile after hitting a mogul and becoming airborne; she experienced immediate low back pain. Which of the following would be highest on your DDX?

A) disc derangement
B) disc herniation with NR damage
C) lumbar strain
D) lumbar sprain
E) facet syndrome

Answer 6

D) lumbar sprain

Question 7

Your patient has signs and Sx of lumbar radicular syndrome. Which of the following would be at the top of your probable DDX list?

A) disc derangement
B) spinal stenosis
C) metastatic bone cancer
D) facet syndrome
E) spurs lodged in the IVF

Answer 7

B) spinal stenosis

Question 8

Based on the results from your Hx and PE, you suspect that your patient may have a spinal disease. Which of the following packages of ancillary studies would be best to order first?

A) ESR, CBC, ALP
B) CRP, CBC, blood chem screen
C) ESR, CBC, HLA-B27
D) CBC, ESR, urinalysis

Answer 8

B) CRP, CBC, blood chem screen

Question 9

HLA-B27 is indicated in a patient with what?

Answer 9

Suspected arthritic condition such as seronegative arthropathies, especially Ankylosing Spondy (AS).

Question 10

What 2 ancillary tests can actually confirm that the nerves/nerve roots are damaged ad not functioning properly?

Answer 10

1. Nerve conduction tests

2. Needle electromyelography (EMG)

Question 11

Tell me what a facet block is and what it’s useful for?

Answer 11

The intra-articular joint space is injected with 3 things: corticosteroids, local anesthetic, contrast medium.

Facet blocks can be both diagnostic and possible treatment for facet syndrome.

Question 12

Your patient has a low back flexion load sensitivity and has to sit all day at work. What are 2 specific activity modifications you could suggest (besides saying “don’t sit”)?

Answer 12

1. Take frequent breaks if you need to sit: stand and stretch
2. Do Bruggers occasionally while sitting (every 20 minutes)

Question 13

What are 3 specific diagnoses to think of first when a patient has LBP but no leg Sx due to high load flexion injury?

Answer 13

Posterior ligament sprain
Compression fracture
Disc derangement/herniation
(Pg 30 in the intern guide)

Question 14

Excluding disease, what are 3 common SI injury Dx covered in class?

Answer 14

SI syndrome
SI sprain
SI joint dysfunction

Question 15

Your 68 year old patient has LBP, no leg Sx, but is getting progressive foot drop. What lumbar diagnosis would you be most concerned about? And what are two ancillary studies you’d run (and why)?

Answer 15

SOL

Radiography then MRI because of the progressive and profound muscle weakness