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M3 ORTHO > Spine > Flashcards

Spine Flashcards

1
Q

Name Myotome and Dermatome of L2-L3 and associated reflexes

A

Myotome:Iliopsoas(hip flexion)
Dermatome:Medial aspect of thigh and knee
Reflex:Nil

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2
Q

Name Myotome and Dermatome of L4 and associated reflexes

A

Myotome:Tibialis Anterior
Dermatome: Medial calf,Medial foot
Reflex: Knee Jerk

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3
Q

Name Myotome and Dermatome of L5 and associated reflexes

A

Myotome: extensor digitorum Longus
Dermatome:Lateral calf,Lateral foot
Reflex: Nil

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4
Q

Name Myotome and Dermatome of S1 and associated reflexes

A

Myotome:Peroneus Longus and Brevis
Dermatome: sole of foot,side of foot including lateral malleolus
Reflex:ankle jerk

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5
Q

Name Myotome and Dermatome of S2-S5 and associated reflexes

A

Myotome:Clawing of toes:FDL?
Dermatome:Anal area
Reflex:Anal wink

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6
Q

Reason for palpating pulses at the end of every PE

A

As part of Neurovascular exam, to differentiate between neurogenic or vascular claudication

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7
Q

Possible indications of discogenic pathology

A

Pain worse on sitting,relieved on standing
Pain worse on flexion than extension
Impulse symptoms:Worse on coughing,straining to pass motion etc

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8
Q

Possible indications of Posterior column pathology

A

Pain worse on extension than flexion

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9
Q

Is generalized limb numbness indicative of radiculopathy

A

No. Need to be able to identify the dermatomal distribution

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10
Q

Name 3 common types of Intervertebral disc prolapse+ its effect on nerve roots

A

Postero-Lateral: Traversing nerve root affected( Most common type I think)
Far-lateral: Exiting nerve root affected
Central: Both traversing nerve roots affected( Bilateral symptoms)

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11
Q

Features of degenerated intervertebral disc

A

Dehydration of disc, reduced turgor, reduced disc height, syndesmophytes(?)

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12
Q

Most Common levels of Prolapsed Intervertebral disc

A

L4/L5 and L5/S1

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13
Q

What is the Meyerding classification for+describe the grades

A 
For Grading of Spondylolisthesis severity
Grade I:0-25% 
II:25-50%
III:50-75%
IV:75-100%
V: >100% (Spondyloptosis)
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14
Q

What is sequestrated disc prolapse?

A

condition in which a portion of the vertebral disc fragments and migrates into the spinal canal. The condition results when the nucleus pulposus of a herniated disc extrudes through the annular fibers and a piece of the nucleus breaks free.

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15
Q

What surgical procedure is commonly used for a prolapsed disc

A

Discectomy

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16
Q

What is spondylolysis

A

Fracture of the pars interarticularis of vertebrae: Scotty dog with collar sign

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17
Q

Common cause of Gibbus deformity(Severe kyphotic deformity, often with an “apex” at a single vertebral level)

A

Mycobacterium Tuberculosis of the spine(Spinal TB)

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18
Q

How does Spinal TB usually spread

A

Along the Anterior longitudinal ligament of the spine

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19
Q

Common principle for surgical management of spinal conditions

A

Depends on the level of disability in the patient, such as pain, neurological symptoms and bowel/urinary changes

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20
Q

Main differences between bulging and herniated intervertebral disc

A

Bulging: Annulus still intact but compresses structures while Herniated: Disc materials breaks through annulus

Bulging USUALLY insidious progression while herniated USUALLY acute

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21
Q

Adequacy for C spine lateral XR

A

C1-C2 and C7-T1 junctions

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22
Q

Sacral sparing significance

A

Suggests incomplete rather than complete spinal cord injury

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23
Q

Components of sacral sparing

A

Anal wink
Perianal sensation
Firm anal tone

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24
Q

Trick for identifying level of C spine imaging

A

Look for ice cream cone upside down: odontoid peg of C2

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25
Q

What is Maloneys Arc

A

The Shentons line of shoulder dislocation

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26
Q

What are the 3 columns compromising spinal stability

A

Anterior: ant. 2/3 of vertebral body/disc

Middle:post 1/3 of vertebral body/disc and PLL

Posterior: everything posterior to PLL

27
Q

Chance fracture definition

A

Flexion distraction injury often causing disruption of all 3 columns of spine

28
Q

Where does lateral corticospinal tract decussate

A

In the brain

29
Q

Where does lateral corticospinal tract decussate

A

In the brain

30
Q

Scoring of Spinal Cord injury

A

ASIA

A: Complete SCI
B C D: Incomplete

31
Q

Prognosis for ASIA A Spinal Cord Injury

A

Poor likelihood of rehab, but may not be a true ASIA A

32
Q

Types of spinal cord injury

A

Brown Sequard
Central cord
Posterior cord
Anterior cord

33
Q

Pattern of central cord syndrome

A

Cervical is outermost fibres, sacral lower. Hence UL affects more than LL

34
Q

Pattern of brown sequard

A

Retain PT-I and MO-C

35
Q

Most common cause of anterior cord syndrome

A

Vascular cause: anterior spinal artery?

36
Q

Signs of neurogenic shock

A

Hypotension with BRADYCARDIA

37
Q

Most impt parts of managing neurogenic shock

A

Prevent secondary injury
Immobilisation
Vasopressors if shock
Oxygen supplementation
Fluid rhesus not as impt

38
Q

Indication to send spinal cord injury to HD

A

High spinal cord injury: Risk of phrenic nerve injury(C3-C5)

39
Q

How to check for resolution of spinal shock

A

Return of bulbocavernosus reflex after 48hrs. Tug on glans penis or urinary catheter

40
Q

Type of urinary incontinence in Cauda Equina Syndrome

A

Overflow incontinence

41
Q

What does disruption of Scottie dog suggest and what is common demographic

A

Pars interarticularis fracture

Often hyperextension injury in gymnasts

42
Q

Score for spinal instability

A

TLICS
-Morphology
-Posterior Column integrity
-Neurology

43
Q

Manifestations of spinal injuries

A

Neurological compromise or structural instability

44
Q

Most common MOI for central cord syndrome

A

Hyperextension injury from fall etc

45
Q

Cause of anterior cord syndrome

A

Disruption of blood supply from anterior spinal artery

46
Q

How to try ddx CES and CMS

A

Unilateral vs bilateral
Saddle vs perianal
Areflexic,atrophy vshyperreflexic, fasciculations
Late vs early presentation
Unlikely vs common impotence

47
Q

Nexus criteria for spine acronym

A

NSAID

Neuro deficit
Spinal tenderness
AMS
Intoxication
Distracting injury

48
Q

Red flag for possible CES that may progress

A

Bilateral straight leg raise positive

49
Q

3 components of balance

A

Vision
Proprioception
Vestibular

50
Q

3 components of balance

A

Vision
Proprioception
Vestibular

50
Q

3 components of balance

A

Vision
Proprioception
Vestibular

51
Q

4 gaits in spine exam

A

Antalgic, myelopathic, tredelenberg and high stepping

52
Q

Signs of inverted supinator jerk

A

Finger flexion esp Thumb and index
Elbow extension
Smth else?

53
Q

Pathophysiology of inverted supinator jerk

A

Lesion at C5/C6 where C6 nerve root exits. C7 and below is UMN lesion hyperreflexic hence finger flexion and elbow extension

54
Q

Pathophysiology of finger escape sign

A

Generalised weakness. Imbalances of forces as extensors are stronger, and intrinsics are weaker Hence small finger is abducted

55
Q

5 special tests for Cervical Myelopathy and 2 bonus

A
  1. Lhermitte’s test
  2. Finger escape(ulnar deviation of digiti minimi)
  3. Hoffman’s test
  4. Grip and release
  5. Inverted Supinator jerk

Bonus: Ankle clonus >3 beats and babinski positive

56
Q

Etiologies of Cervical myelopathy

A
  1. Degenerative Cervical Spondylosis
  2. Ossification of Posterior Longitudinal Ligament(OPLL)
  3. Malignancy primary or secondary
  4. Epidural abscess
  5. TB Spine(Pott’s disease)
  6. Trauma/ fracture
  7. Kyphoscoliotic deformities
  8. Congenital spinal stenosis
57
Q

Classification system for cervical myelopathy

A

JOA( Japanese Orthopaedics Association)

58
Q

Causes of winking/ blinking owl sign on spine XR

A
  1. Spinal metastasis
  2. TB or other infections
  3. Intraspinal malignancies (e.g. hemangioma, spinal cord tumours like astrocytoma)
  4. (Uncommon) primary bone lesion, lymphoma
59
Q

Blood test for ankylosing spondylitis

A

HLAB 27( Human leukocyte antigen B 27)

60
Q

Most common level on spondolysis

A

Most commonly L5 on S1

61
Q

What to look for in XR of Adolescent Idiopathic Scoliosis

A

Cobb angle( Scoliosis severity) >10 and Risser staging(Skeletal maturity)

62
Q
A

M3 ORTHO (10 decks)

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