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24 Cards in this Set

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301. Most common spinal neoplasm?
a. Metastatic carcinoma.
302. What are common primary neoplasms that met to spine?
1. Breast
2. Lung
3. Prostate
4. Kidney
5. Thyroid.
303. What is a characteristic and worrisome complaint of spinal tumours?
a. Night pain!
304. How are neoplasms of spine classically distinguished from infection on MRI?
a. Neoplasms classically do not involve the disc space (as opposed to infection).
305. Possible sources of vertebral osteomyelitis?
a. UTI
b. Skin abscess
c. Indwelling catheter
d. IV drug abuse
306. Appearance of vertebral osteomyelitis on MRI?
a. Infection involves disc space.
307. Complications vertebral osteomyelitis?
a. Epidural abscess develops in the context of bacteremia or osteomyelitis.
b. If not promptly treated, it can compromise the blood supply to the spinal cord, w/rapid progression to motor and sensory deficits.
c. In presence of neurologic symptoms, this is a surgical emergency.
d. Compression fracture w/collapse of vertebral body.
308. Cauda equina syndrome?
a. Occurs after spinal trauma or central lumbosacral disc herniations, which compresses multiple S1, S2, S3, S4 nerve roots.
309. Symptoms of Cauda Equina syndrome?
a. Bilateral sciatica
b. Saddle anaesthesia over buttocks/perineum.
c. Low back pain, lower extremity weakness
d. Bowel or bladder dysfunction- frequency, retention, incontinence.
e. Impotence, perianal anaesthesia, lax anal sphincter.
310. Workup of Cauda Equina syndrome?
a. Immediate MRI is indicated to ID any lesions that can be treated surgically.
b. Cauda equina syndrome is a surgical emergency!
311. 3 most common cause of back pain?
1. Musculoligametnous strain
2. Degenerative disc disease
3. Facet arthritis
312. What factors exacerbate pain in disc herniation?!?
a. Maneuvers that increase intraspinal pressure, such as coughing or sneezing
b. Forward flexion- sitting, driving, or lifting; worsens the leg pain.
313. When do pts w/spinal stenosis have leg pain?
a. On back extension- pain worsens w/standing or walking (relief w/bending or sitting).
314. Note: Majority of pts w/lumbar disc herniation and sciatica improve w/conservative care. Only about 10% will require surgical intervention.
314. Note: Majority of pts w/lumbar disc herniation and sciatica improve w/conservative care. Only about 10% will require surgical intervention.
315. Spondylolisthesis?
a. Forward slipping of the cephalad vertebra on the caudad vertebra
b. In adults, this is usually due to degenerative changes in disc and facet joints that have progressed to instability.
316. Steps in conducting the back exam?
a. Observe posture and gait. Check for asymmetry and spinal curvature
b. Note the ROM of the lumbosacral region (extension, flexion, rotation, side-bending).
c. Palpate for focal tenderness in the spine (tumour, fracture, infection, disc herniation) or sacroiliac joint tenderness.
d. Perform a complete neurologic exam (also grade muscle strength from 0-5).
317. What is the utility of the straight leg raising test & when is it positive?
a. Sensitive test for nerve root compression.
b. If a compressed L5 or S1 nerve root is stretched, radicular pain is produced.
c. The test result is positive if radiculopathy is reproduced when the leg is elevated to 30-60° w/the pt supine.
d. The earlier the onset of pain (i.e., at a lower elevation), the more specific the result and greater the severity of disc herniation.
318. What is a more specific finding with straight-leg raising?
a. Contralateral leg pain produced by straight-leg raising.
319. Test for L4 root function and function of L4 root?
a. Patellar tendon reflex (knee jerk)
b. L4:
1. Ankle dorsiflexion
2. Sensation anteromedial leg.
320. How do you Test for L5 root function and what does L5 govern-motor and sensory?
a. Dorsiflexion of ankle and big toe against resistance!
b. Sensation along lateral shin and dorsum of foot.
321. How do you Test for S1 root function and what does S1 govern-motor and sensory?
a. Ankle DTR (achilles reflex)
i. S1 function:
1. Ankle plantar Flexion (Gastrocnemius muscle
2. Sensation of lateral foot and heal.
322. Reflex L4?
a. Patella
323. Reflex L5?
a. Hamstring
324. Reflex S1?
a. Achilles or ankle