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43 Cards in this Set
- Front
- Back
What is the second most common clinic visit cause?
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lower back pain (LBP)
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What risk factor is one of the most important in LBP?
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genetics
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What ligament accounts for up to 80% of LBP?
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iliolumbar ligament
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Gluteus maximus, medius, and minimus all originate where?
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ilium-medial to lateral
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Gluteus maximus, medius, and minimus attach where?
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maximus: gluteal tuberosity
medius: superior posterior greater trochanter minimus: anterior inferior greater trochanter |
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What are the 3 patterns of back pain:
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axial-pain in back/buttocks (non-nerve)
radicular-source of pain in back/buttocks; travels (nerve irritation) pseudoradicular-pain from back that travels to legs (originates from tendons, joints, and ligaments) |
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T or F: leg pain>back pain in radicular pattern
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true
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When should people seek medical attention for back pain?
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leg pain>back pain; balance/bladder/bowel problems; sudden weight loss; after trauma; progressively worsening; and pain>6 weeks
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When is back pain emergent?
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1. weakness in legs-spinal cord problems
2. bowel or bladder-conus medullaris syndrome 3. "saddle anesthesia"-cauda equina syndrome 4. acute back pain with tearing sensation-dissecting aortic aneurysm |
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Patients with functional deficits should be sent to what specialist?
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physiatrist
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What specialist performs spinal injections under fluoroscopic guidance?
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interventional pain specialist
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When would you refer to an interventional pain specialist?
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localized pain without profound neurologic deficits
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Patients with systemic pain, joint pain, rash, and abnormal labs should be referred to whom?
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rheumatologist
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Neurological abnormalities that can not be localized or identified should be referred to whom?
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neurologist
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Profound and/or emergent neurologic deficits should be referred to whom?
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neurosurgeon
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What are the most important tools that can be used in diagnosing back pain?
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history and physical
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X-ray lumbar views should include what?
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flexed and extended l-spine
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MRI is useful in viewing what tissues?
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bones, discs, joints, nerves, soft tissue
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CT is useful in viewing what?
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bony anatomy
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What imaging is excellent for bone metabolism?
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nuclear bone scan
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What imaging is useful in spondylolisthesis?
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SPECT
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What is useful in imaging vascular problems?
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angiogram
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What treatments for LBP were discussed in this lecture?
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interventional spine injections; radiofrequency ablation-burns nerves; vertebroplasty or kyphoplasty-cements vertebrae; surgery
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How can a differential diagnosis be approached?
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tissue-based approach
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A nerve root impingement is also called what?
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radiculopathy
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Facet arthropathy and spondylolisthesis are possible causes of what?
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LBP
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Deep pain and tenderness over ischial tuberosity is indicative of what?
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ischial bursitis
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What is narrowing of the spinal canal referred to as? Where can pain be referred?
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spinal stenosis; legs
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Difference between spondlyosis, spondylolysis, and spondylolisthesis:
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1. spondylosis-arthritis in spine
2. spondylolysis-breakdown of vertebral structure 3. spondylolithesis-forward slipping of one vertebra on one below it |
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Discogenic pain:
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pain cannot be reproduced with surface palpation; provocative discography
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Discitis:
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Severe pain out of proportion to physical exam
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Spondylolisthesis:
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(“Scottie dog” neck broken) and flexion/extension views
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Sacroiliac ligament enthesopathy
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negative sacroiliac provocative maneuvers
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Sacral or pelvic occult fracture:
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false positive hip exam
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Often compensatory from SI ligament injury:
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Gluteal bursitis/ tendinopathy
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Hip intraarticular pathology:
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labral tear; scour test
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Pain at rest, history of cancer, pain out of proportion to exam:
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tumor
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Lumbosacral plexopathy:
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non-radicular distribution; not consistent with single dermatome or myotome
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Neuroclaudication seen in:
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spinal stenosis
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Cauda equina syndrome: lower motor neuron lesion:
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saddle anesthesia
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Conus medullaris syndrome: upper motor neuron lesion:
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perianal anesthesia; hyperreflexia
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Tumor diagnostics:
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nuclear bone scan
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Hip intraarticular pathology diagnostics:
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arthrogram of labrum
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