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Neurology - Physiology > BACKPAIN > Flashcards

BACKPAIN Flashcards

1
Q

The posterior parts of the vertebrae articulate with
one another at the diarthrodial facet join ts also called
____________

A

apophysial or zygapophysial joints),

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2
Q

The stability of the spine depends on the integrity

of the ________

A

vertebral bodies, pedicles and intervertebral discs
and on two types of supporting structures, ligamentous
(passive) and muscular (active)

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3
Q

The vertebral and paravertebral structures derive
their innervation from the ________________ (also known as recurrent meningeal or
sinuvertebral nerves).

A

meningeal branches of the

spinal nerves

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4
Q

The __________ is a common
site of entrapment of the traversing root by posterolaterally
herniated disc material and bony overgrowth

A

lateral recess

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5
Q

Deposition of________ and alterations of glycosarninoglycans combine
to decrease the water content of the nucleus pulposus;
concomitantly, the cartilaginous endplate becomes less
vascular

A

collagen and

elastin

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6
Q

increasing frequency of lumbar disc degeneration

and bulging, approaching 70 percent by the________

A

fiftieth year.

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7
Q

Four types of BACK pain may be distinguished:

A

local, referred,
radicular, and that arising from secondary muscular
spasm.

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8
Q

________ is caused by any pathologic process that
impinges on structures containing sensory endings,
including the periosteum of the vertebral body, capsule
of apophysial joints, annulus fibrosus, and ligaments.

A

Local pain

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9
Q

Referred pain in reference to the spine is of two types:
one that is projected from the __________and other
structures lying within the territory of the lumbar and
upper sacral dermatomes, and another that is projected
from ________ to the spine.

A

spine to viscera

pelvic and abdontinal viscera

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10
Q

Pain
caused by disease of the upper part of the lumbar spine
may be referred to the ________.

This has been
attributed to irritation of the_________
which are derived from the posterior divisions of the first three lumbar spinal nerves and innervate the superior portions of the buttocks.

A

medial flank, lateral hip, groin, and
anterior thigh

superior cluneal nerves,

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11
Q

Pain from the lower part of the
lumbar spine is usually referred to the lower buttocks
and posterior thighs and is a result of irritation of lower
___________which activate the same pool of intraspinal neurons as the nerves that innervate the posterior thighs

A

spinal nerves,

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12
Q

The mechanism is stretching, irritation,
or compression of a spinal root within or central
to the intervertebral foramen

A

RADICULAR

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13
Q

Any maneuver that stretches the nerve roote.

g., ___________

A

“straight-leg raising” in cases of sciatica-evokes

radicular pain.

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14
Q

pain thitt originates in the
buttock and is projected along the posterior or posterolateral
thigh. It results from irritation of the L5 or Sl nerve root

A

SCIATICA

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15
Q

In patients with severe circumferential constriction of
the ________ because of spondylosis ( lumbar stenosis),
sensorimotor impairment and referred pain are elicited
by standing and walking

A

cauda equina

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16
Q

Pain resu lting
from ________ usually occurs in relation to local
spinal irritation and may be thought of as a nocifensive
reflex for the protection of the diseased parts against
injurious motion.

A

m uscular spasm

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17
Q

A sagging gluteal fold suggests involvement of the

_____

A

Sl root.

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18
Q

Lateral bending is usually less revealing than forward
bending but, in ______________bending to the opposite side aggravates the
pain by stretching the damaged tissues

A

unilateral ligamentous or muscular

strain,

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19
Q

With ________
passive lumbar flexion causes little pain and is not
limited as long as the hamstrings are relaxed

A

umbosacral disc lesions and sciatica,

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20
Q

with the knees
flexed to 90 degrees, sitting up from the reclining position
is unimpeded and not painful; with knees extended,
there is pain and limited motion ________

A

(Kraus-Weber test)

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21
Q

Among the most helpful signs in detecting nerve
root compression is __________ (possible up to almost 90 degrees in normal individuals) with the
patient supine.

A

passive straight-leg raising

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22
Q

diseased. Straight raising of the opposite leg
(“crossed straight-leg raising,” Fajersztajn sign) may
cause sciatica on the opposite side and is a more specific sign of _________ than is the Lasegue sign

A

prolapsed disc

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23
Q

Asking
the seated patient to extend the leg so that the sole of the
foot can be inspected is a way of checking for a _______

A

feigned

Lasegue sign.

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24
Q

Maneuvers in the lateral decubitus position yield less

information but are useful in eliciting ________

A

joint disease.

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25
Q

In cases of _________, abduction of the
upside leg against resistance reproduces pain in the
sacroiliac region, sometimes with radiation of the pain
to the buttock, posterior thigh, and symphysis pubis

A

sacroiliac joint disease

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26
Q

A helpful indicator of hip
disease is the ___________: with the patient supine, the heel
of the offending leg is placed on the opposite knee, and
pain is evoked by depressing the flexed leg and externally
rotating the hip.

A

Patrick test

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27
Q

T2-weighted MRI performed
with elimination of the hyperintense signal of fat
__________allows inflammation and edema to be
visualized in the bone marrow and paravertebral soft tissues
that normally contain fat

A

(“fat suppression”, i.e., the short Tl inversion recovery or

“STIR” sequence),

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28
Q

A common anomaly is fusion of the fifth lumbar
vertebral body to the sacrum__________or, conversely,
separation of the first sacral segment, giving rise
to 6, rather than the usual 5 lumbar vertebrae _________

A

(“sacralization”)

“lumbarization”

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29
Q

_________ consists of a congenital and probably genetic
bony defect in the pars interarticularis (the segment at the
junction of pedicle and lamina) of the lower lumbar vertebrae

A

Spondylolysis

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30
Q

These constitute b y far the most frequent causes o f low

back pain

A

tra u m at i c D i s o rd e rs of t h e Low B a c k

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31
Q

The term __________ may be preferable for minor, self-limiting injuries that are usually associated with lifting heavy loads when the back is in a mechanically disadvantaged position, or there may have been a fall, prolonged uncomfortable postures such
as in air travel or car rides, or sudden unexpected motion,
as may occur in an auto accident.

A

acute low back strain

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32
Q

__________ is the most
likely diagnosis when there is tenderness over the sacroiliac joint and pain radiating to the buttock and posterior thigh, but this always needs to be distinguished from the sciatica of a herniated intervertebral disc

A

Sacroiliac joint and ligamentous strain

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33
Q

Recurrent attacks are typical of ________ that affects the vertebrae and facet joints

A

degenerative

spine disease

34
Q

A fractured transverse process, which is almost
always associated with________ of the
spine and causes tearing of the paravertebral muscles and a local hematoma, produces deep tenderness at the site of the injury

A

high-impact rotary injury

35
Q

In some circumstances, tears of the
paravertebral musculature may be associated with extensive
bleeding into the retroperitoneal space. There
may be a delayed subcutaneous hematoma in the flanks
__________

A

(Grey-Turner sign

36
Q

These benign tumors characteristically
cause severe nocturnal pain located in one
region of the parasagittal spine that awakens the patientfrom a peaceful sleep;

The typical appearance
is a _____________ surrounded by a rim of
bony sclerosis

A

osteoid osteoma

well-demarcated lytic lesion

37
Q

TREATMENT OF VERTE BRAL COMPRESSION FRACTURE For the mundane thoracic and lumbar fracture associated
with osteoporosis, _________ are usually
adequate.

A

bed rest, and analgesics

38
Q

This condition i s a major cause o f severe and chronic or
recurrent low back and leg pain. It occurs mainly during
the third and fourth decades of life when the nucleus
pulposus is still gelatinous

A

H e r n i at i o n of L u m b a r I nte rve rte b ra l D i scs

39
Q

in HNP,

The disc between the_________ is most often
involved, and, with decreasing frequency, that between
the fourth and fifth (lA-LS), third and fourth (L3-lA), second
and third (L2-L3), and-quite infrequently-the_________

A

fifth
lumbar or first sacral vertebrae (L5-S1 )

 first
and second (Ll-L2) lumbar vertebrae
40
Q

In more severe cases of disc disease, a small
piece of the nucleus may be entirely extruded as a “free fragment”, sometimes called a___________
and be mobile enough to affect a root at an adjacent level or to give rise to unusual precipitating features of radicular pain

A

sequestered disc fragment,

41
Q

The fully developed syndrome of the common prolapsed intervertebral lower lumbar disc consists of _____, ________ and________

A

(1) pain in the
sacroiliac region, radiating into the buttock, thigh, and
the calf, a symptom broadly termed sciatica;
(2) a stiff or unnatural spinal posture; and often
(3) some combination
of paresthesia, weakness, and reflex impairment.

42
Q

In HNP, The most comfortable position may
be lying on the back with legs flexed at the knees and hips and the shoulders raised on pillows to obliterate the _________

A

lumbar

lordosis.

43
Q

In cases of root compression, pain is also characteristically provoked by pressure along the course of the sciatic nerve at the _____________ (sciatic notch,
retrotrochanteric gutter, posterior surface of thigh, and head of the fibula)

A

classic points of Valleix

44
Q

Many variations of the
Lasegue maneuver have been described (with numerous eponyms), the most useful of which is accentuation
of the pain by dorsiflexion of the foot ___________ or
of the great toe _________

A

(Bragard sign)

(Sicard sign).

45
Q

Lasegue maneuver

with the healthy leg may evoke sciatic pain on the contralateral side), but usually of lesser degree ______

A

(Fajersztajn

sign)

46
Q

Sciatica may be provoked by forced flexion
of the head and neck, coughing, or pressure on both
jugular veins, all of which increase intraspinal pressure
__________

A

(Naffziger sign).

47
Q

Lesions of the fifth lumbar root (LS) produce pain in
the region of the hip and ___________(to
the lateral malleolus), and less often, the dorsal surface
of the foot and the first or second and third toes

A

posterolateral thigh (i.e., sciatica) and, in more than half such cases, lateral calf

48
Q

With lesions of the ____________), the pain is felt
in the midgluteal region, mid-posterior part of the thigh,
posterior region of the calf to the heel, outer plantar surface of the foot, and fourth and fifth toes

A

first sacral root S1

49
Q

The less-frequent lesions of the ______________ give rise to pain in the anterior part
of the thigh and knee and anteromedial part of the leg
(fourth lumbar), with corresponding sensory impairment
in these dermatomal distributions

A

third (L3) and fourth

(L4) lumbar roots

50
Q

Very large __________
may compress the entire cauda equina with a dramatic
syndrome that includes intense low back and bilateral
sciatic pain, incomplete paraparesis, loss of both ankle
jerks, and, most characteristic, varying degrees of urinary
retention and incontinence

A

central disc protrusions

51
Q

In herniated disc, The needle EMG study is abnormal, showing fibrillation
potentials in denervated muscles after 1 or 2 weeks,
but it may remain normal in ______

A

10 percent of cases

52
Q

Loss or marked asymmetry of
the H reflex is another useful indication of S1 radiculopathy,
but this simply corroborates the ______

A

loss of an Achilles

reflex.

53
Q

types of disc herniation

  1. extension of a disc (or discs) beyond the margins of the interspace _________.
  2. asymmetrical extension of the disc beyond the margin of the interspace ________
  3. and in only 1 percent was there more extreme extension of the disc _______
A

(bulging)

(protrusion),

(extrusion or sequestration).

54
Q

a general constellation
of bone, joint and ligamentous changes that
narrow the spinal canal and neural foramina

A

Lu m ba r S p i n a l Ca n a l Ste n osis ( “ Lu m b a r Ste n osis”
and N e u ro g e n i c C l a u d icati o n )

55
Q

A prominent feature of many cases of the degenerative
spinal disorder is displacement and malalignment of
one vertebral body in relation to the adjacent one, or
________

A

spondylolisthesis

56
Q

There is burning leg pain and continuous
and complex rhythmic movements of the toes, as the
name implies. Symptoms may begin on one side but
become bilateral. Lumbar nerve root compression, most
often from lumbar stenosis, or other types of peripheral
damage underlie most cases.

A

painful legs-moving toes

57
Q

Atherosclerosis of large and medium-sized arteries often leads to symptoms that are induced by exercise ________ but may also occur at rest ________

A

(intermittent claudication)

ischemic rest pain

58
Q

If the atherosclerotic
narrowing or occlusion implicates the aorta and iliac
arteries, it may also cause hip and buttock claudication and impotence in the male __________

A

(Leriche syndrome).

59
Q

The pain is described as a stiffness that
is centered in the affected part of the spine. It is increased initially by movement and is associated with limitation of motion but is often worse on arising in the morning

A

DOA

60
Q

In contrast to the spinal claudicatory syndrome, ____________ make the pain better in DOA

A

warming up and progressive mobilization

61
Q

osteoarthritic degeneration of the
facet joint gives rise to a focal parasagittal lumbar back
pain, with tenderness over the joint
but without signs of root compression.

A

F acet Sy n d ro m e

62
Q

In Facet syndrome, If the diagnosis is established by local injection, pain centers offer radiofrequency ablation of the ______ nerves that innervate the joint as a means of
permanent relief

A

small recurrent

sensory

63
Q

Approximately 95 percent of patients with ankylosing spondylitis are marked by the histocompatibility antigen __________

A

HLA-B27

64
Q

In advanced stages of AS,
a __________ syndrome may complicate
ankylosing spondylitis, the result apparently of an
inflammatory reaction and proliferation of connective
tissue

A

cauda equina compression

65
Q

A fracture of a vertebral body in an otherwise healthy
young or middle-aged person should alert the physician
to the possibility of an underlying ______

A

metastasis

66
Q

Sudden, excruciating midline back pain (le coup de poignard or “the strike of the dagger”)-often with rapidly
evolving paraparesis, urinary retention, and numbness
of the legs-may armounce the occurrence of

A

intraspinal hemorrhage

67
Q

Diseases of the pancreas are apt to cause pain in the

back, being more to the right of the spine if the_______ is involved and to the left if the _________

A

head of the pancreas

body and tail are
implicated

68
Q

may
evoke pain in the lower thoracic or lumbar spine with
a tendency to radiate to the lower part of the abdomen,
groins, anterior thighs, or flank.

A

Retroperitoneal neoplasms

69
Q

A tumor in the ________
region often produces a urillateral lumbar ache with radiation toward the groin and labia or testicle; there may also be signs of involvement of the upper lumbar 􀂚pinal roo􀅚

A

iliopsoas

70
Q

Inflammatory diseases and neoplasms of the _______
cause pain that may be felt in the lower abdomen, the
midlumbar region, or both.

A

colon

71
Q

Pain
from a lesion in the trariSverse colon or first part of the
descending colon may be _______; its level
of reference is to the _______

A

central or left-sided

second and third lumbar vertebrae

72
Q

Retroperitoneal appendicitis may have an odd referral of pain to the_______

A

low flarlk and back.

73
Q

The pain of neoplastic infiltration of______

may be projected to the low back and is continuous, becoming progressively more severe

A

pelvic nerve plexuses

74
Q

among the most difficult patients t o manage are
those with chronic low back pain who have already
had one or more laminectomies and sometimes a fusion without substantial relief

A

Fa i l ed Back Synd ro m e

75
Q

Pain of brachial plexus origin is experienced in the
______, or in the axilla and around the
shoulder; it may be worsened by certain maneuvers
and positions of the arm and neck __________

A

supraclavicular region

extreme rotation

76
Q

Pain localized to the shoulder region, worsened by
motion, and associated with tenderness and limitation of movement, especially internal and external rotation and abduction, points to a ______

A

tendonitis, subacromial bursitis,

or tear of the rotator cuff or labrum of the shoulder joint

77
Q

With a laterally situated disc herniation between the
fifth and sixth cervical vertebrae, the symptoms and signs
are referred to the___________

The full syndrome
is characterized by pain at the trapezius ridge and tip

A

sixth cervical root

78
Q

Compression of the eighth cervical root at (C7-Tl
disc) may mimic _________. The pain is along the
medial side of the forearm and the sensory loss is in the
distribution of the medial cutaneous nerve of the forearm
and of the ulnar nerve in the hand

A

ulnar nerve palsy

79
Q

The centrally situated disc is often painless, and
the cord syndrome may simulate______ and ________. Bilateral hand numbness,
paresthesia, or similar altered sensation is common

A

multiple sclerosis or a

degenerative neurologic disease

80
Q

In the case o f cervical disc with radicular pain, a _________ is sometimes beneficial

A

closefitting foam collar

81
Q

_________ alone
is not recognized as an indication for surgery in cervical spondylosis.

sx approach is________

A

Mild weakness

anterior approach (transdiscally), which leaves the posterior
elements intact and allows for retained stability of
the spine.

Neurology - Physiology (44 decks)

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