Back pain

Question 1

red flags for back pain

Answer 1

non-mechanical - worse at night, doesnt vary with activity - or constant pain
Hx of cancer / steroids
structural deformity
>6wks of severe back pain
new onset <20yo / >60yo
systemics
major and new neuro deficit
saddle anaesthesia +/-bladder/bowel upset

Question 2

< ___ is pathological stiffness on the Schobers test

Answer 2

<18cm

Question 3

> ___ is hypermobile in Schobers test

Answer 3

> 24cm

Question 4

foot dorsiflexion and EHL are supplied by which spinal nerve

Answer 4

L5

Question 5

testing for nerve irritation by applying pressure behind the knee = ___ test

Answer 5

bowstring test

Question 6

__% false +ve on MRI of prolapsed disc

Answer 6

76%

Question 7

Sx for prolapsed disc is only for __ - doesnt help other symptoms

Answer 7

leg pain (just speeds up recovery - if left the outcome would be the same it would just take longer)

Question 8

conservative Rx of disc prolapse =

Answer 8

bed rest > mobilise when can
anti-inflam +/- muscle relaxant
physio

Question 9

behavioural symptoms of back pain

Answer 9

tip of coccyx pain
whole leg pain/numb/gives way
no pain free spells
intolerance of Rx
emergency admission

Question 10

psychological yellow flags for back pain =

Answer 10

belief back pain is harmful
avoidance behaviour
low mood/withdrawal
passive not active

Question 11

2ndry causes of scoliosis

Answer 11

neuromuscluar
tumour
spina bifida

Question 12

in kyphosis centre of gravity is __ to spine

Answer 12

anterior

Question 13

kyphosis is prominent in spina bifida due to _

Answer 13

erector spinae havent migrated posterior to the spine and so pull it forward

Question 14

defect in pars interarticularis of vertebra

Answer 14

spondylolysis

Question 15

forward slippage of 1 vertebra on another =

Answer 15

spondylolisthesis

Question 16

complete slippage of 1 vertebra over another =

Answer 16

spondyloptosis

Question 17

painless urinary retention with overflow is a sign of

Answer 17

cauda equina

Question 18

causes of secondary spinal cord damage

Answer 18

cord swelling
oedema
ischaemia
thrombosis
venous obstruction

Question 19

central spinal cord injury is typically due to a __ injury
__ worse than __
prognosis is good/bad

Answer 19

hyperextension
arms worse than legs
good

Question 20

Brown-Sequard spinal cord injury =>
prognosis =
usually associated with a __

Answer 20

ipsilateral paralysis + contralateral hypoaesthesia
best prognosis of spinal cord injuries
#

Question 21

anterior spinal cord injury features -
causes = __/__
prognosis =

Answer 21

motor+pain+ temp sensation loss
deep touch, position and vibration preserved
trauma/vascular causes
poor

Question 22

Frankel/ASIA grading of spinal cord injuries

I/A > V/E

Answer 22

I = complete motor and sensory loss
II = complete motor and incomplete sensory loss
III = incomplete motor loss
IV = useful motor and incomplete sensory loss
V = normal

Question 23

spinal damage in children may cause ___ which leads to cessation of growth and ___

Answer 23

ring epiphysis damage

kyphosis

Question 24

rigid spine, long lever arms and soft porotic bone are features of

Answer 24

ank spond

Question 25

In Ank spond the natural position of the C spine is usually ___ and so this is the position it is immobilised in

Answer 25

flexion

Question 26

only MRI back pain if

Answer 26

red flags / considering Sx

Question 27

``` spinal claudication age = M:F major factor = __/___ to relieve __ is easy ```

Answer 27

``` >50yo F2:1M obesity lean forward/stoop cycling ```

Question 28

xray of spinal claudication can sometimes show

Answer 28

v degenerative hypertrophic spine with narrow interpedicular distance and obliteration of neural foramena

Question 29

pattern of discogenic pain

Answer 29

background and worse with activity + flexion | as day goes on = deep seated central low back pain

Question 30

if severe discogenic pain can get ___ Sx

Answer 30

anterior fusion

Question 31

features of facet arthropathy

Answer 31

``` stiff in morning restless difficulty sitting/driving/standing worse on extension better with activity radiation to buttocks and legs ```

Question 32

Rx of facet arthropathy

Answer 32

excise facets and fuse

Question 33

question mark spine = | sign of

Answer 33

loss of lumbar lordosis and exaggerated thoracic kyphosis | ankylosing spondylitis

Question 34

treatment of PMR wo GCA

Answer 34

15mg prednisolone

Question 35

in vertebrae___ lies inferior to pedicle

Answer 35

neural foramen

Question 36

When to do CT for spinal trauma ?

Answer 36

xray normal but high clinical suspicion | xray shows # but need more detail/ to see if there are more

Question 37

cant see IV ligaments on CT/xray but if ___ then can assume intact and spine is stable

Answer 37

normal spinal alignment

Question 38

on MRI ligaments normally appear : | damaged =

Answer 38

``` norm = black damaged = light ```

Question 39

MRI used for spinal injury if

Answer 39

need spinal lig detail | neuro deficit and cant see cause on CT/xray

Question 40

signs of bone tumours seen on MRI

Answer 40

``` early = bone marrow infiltration late = extradural mass + spinal cord compression ```

Question 41

signs of bone tumours seen on CT/xray

Answer 41

``` bone destruction (decreased density) sclerosis (increased density) vertebral collapse (pathological #) ```

Question 42

MRI can show this precursor feature of disc prolapse

Answer 42

disc dehydration

Question 43

spinal cord can only be seen on this imaging modality

Answer 43

MRI