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Physical Therapy > Clin med test 3 > Flashcards

Clin med test 3 Flashcards

1
Q

How many US citizens miss work daily due to LBP

A

10 million

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2
Q

How many days of work are missed in great Britain due to LBP

A

15 million

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3
Q

How much money does it cost us industries on account of missed days from LBP

A

14 billion

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4
Q

Who is at the highest risk for LBP

A

Truck drivers

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5
Q

Who is at the higher risk for LBP (Sedentary or heavy labor workers)

A

Same due to the poor posture of sedentary

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6
Q

Explain how LBP progresses as the population gets older

A

25 year olds will start to develop LBP
35 years old it will get moderate to severe
40-45 years old is the peak age for LBP

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7
Q

What is the best medical examination process for detecting LBP

A

Xrays have a “moderate” correlation to determining back pain. But even withexpert medical examination sometimes it is impossible to detect

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8
Q

What are the time periods for LBP to be self limiting

A

44% get better in one week
86% get better in a month
92% get better in 2 months

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9
Q

What are the rates of reoccurring LBP

A

90% chance of getting it aging

40% chance of developing sciatica

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10
Q

Why do visceral organ diseases present as low back pain

A

They refer pain to along the TL spine or Sacral area.

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11
Q

How to differentiate between Visceral organ and a musculo problem

A

Visceral organs generally to not change with movement

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12
Q

What comes first DJD or DDD

A

More likely DDD

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13
Q

Where will Herniations most often occur

A 
L4/L5
L5/S1 
L3/L4 
L2/L3 
L1/L2 
*In that order
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14
Q

Describe a protrusion herniation

A

The least severe
There is an angular bulge
Angular fibers still intact

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15
Q

Describe a prolapse herniation

A

Nucleus has migrated through the inner laminar layers but is still contained
The angular fibers will be disrupted

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16
Q

Describe disk extrusion herniation

A

Angular fibers have disrupted and the nucleus has now broken past the outer most layer

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17
Q

Describe a Sequestration hernia

A

Annular fibrosis is disrupted and the nucleus has now migrated outside the disk.

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18
Q

What are some clinical features with herniation of IVD

A 
Dramatic onset of symptoms 
Occurs day or 2 after rigorous activity 
Usually in early adult and middle aged people 
Acute sciatica 
Muscular spasms 
Pain with Motion, flexion and extension
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19
Q

What tests or measures to use for nerve irritation

A

Want to do a dermatome or myotomal testing

X-rays often not helpful

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20
Q

What imaging will be most useful in detecting nerve irritation

A

MRI
CT
Myelography
*in that order

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21
Q

What may prevent D2 from responding to extension repeated movements

A

The Kyphosis deformity

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22
Q

What may prevent D3 or 5 from responding to extension repeated movements

A

It may not respond to standing extension because it is on one side vs the other

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23
Q

What may prevent D4/6 from responding to extension repeated movements

A

They lay in the frontal plane, so they may respond better to frontal plane movements

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24
Q

Which derangements are easily reversible

A

D1-4 and D7

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25
Q

Which derangements are harder to fix

A

D5 and D6

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26
Q

What will degenerate first in the Disk with DDD

A

Nuclear pulposis

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27
Q

What are some physiological characteristics of the disc that occur with DDD

A

Disc height shortens
Angular fibrosis looses elasticity posteriorly
Angular fibrosis becomes thin and may even tear

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28
Q

What are schmorl’s nodes

A

Weakness of the cartilage endplate

29
Q

How common are schmorl’s nodes

A

Common but not clinically significant

30
Q

What can result from DDD

A

Compression on facet joints
DJD
Foraminal narrowing (stenosis)
Ligament laxity

31
Q

What can cause DJD

A 
Mechanical weakness or malalignment 
Trauma (MVA, Sports) 
Obesity, poor posture 
Smoking 
Infection
32
Q

How much more likely are you to get DJD if you smoke

A

3x more likely

33
Q

How does imaging help us detect stenosis

A

There will be decrease joint space on X-rays

34
Q

What can cause narrowing of the foremen in the spine

A 
Herniation 
Decreased joint space 
Osteophytes
DJD 
Ligamentous flavum folding
35
Q

What can compress the cauda equine

A

Central compression in the foremen (central stenosis)

36
Q

What are the signs of lateral stenosis vs central stenosis

A

Radicular pain that is unilateral

37
Q

What will stenosis mimic

A

Intermittent claudication

38
Q

What is a weird feature of stenosis

A

Flaccid bladder

39
Q

What can you rule out if there is no leg pain

A

Stenosis

40
Q

What is the difference between hypermobility and instability

A

Hypermobility will be too much movement in the joint with A/PROM
Instability will create aberrant movement

41
Q

Which is more severe hypermobility or instability

A

Instability

42
Q

What does Lumbargo mean

A

Low Back pain

43
Q

What are some clinical indications of segmental hyper extension

A

Better with flexion/worse ext
Local or referred to butt
Chronic or intermittent lumbargo

44
Q

What are some clinical indications for hyperflexion

A

Herniation
DDD
Relieved with Ext

45
Q

Will segment instability be worse or better with movement

A

Worse with movements, better at rest.

May centralize pain

46
Q

What can cause segmental hyperextension

A

Extension checkrein compromised
Sprains subluxations
Malalignment

47
Q

What role will DDD play in segmental instability

A

Aberrant or excessive moments in spine

48
Q

What can occur with segmental instability

A

Osteophytes

Sprain of facet joints

49
Q

What are the grades of displacements of the spine

A

Grade 1: 25%
Grade 2: 50%
Grade 3: 75%
Grade 4: 100%

50
Q

Will spondylosthesis feel better with flexion or extension

A

Flexion

Provides more stability

51
Q

Which lumbar are most likely to have spondylolosis

A

L5 85%

L4 15%

52
Q

What sports are more likely to have spondylolosis

A

Football Linemen
Gymnastics
Butterfly swimmers
Weight lifters

53
Q

What nationality Is most likely to have spondylosis

A

Eskimo

54
Q

What is the treatment for grade 1 slipping

A

Strengthen core

55
Q

What is the treatment for grade 2 slipping

A

Maybe a posterior fusion

56
Q

What is the treatment for a grade 3-4 slipped disc

A

Posterior fusion

57
Q

What is a laminectomy with decompression used for

A

Central Stenosis

58
Q

What are the indications for a disectomy

A

Conventional methods have been ineffective for 6 or more weeks
Neurological deficit
Recurring sciatica

59
Q

Microdisectomy

A

Disectomy of the disc using a scope

60
Q

What are some symptoms of caudal equine syndrome

A

Lower Back pain
Pain in the leg
Numbness in feet

61
Q

What is the treatment for cauda equina syndrome

A

Surgery

62
Q

What are the “tell tale signs” of cauda equina syndrome

A

Urinary incontinence
Sciatica
Saddle anesthesia

63
Q

What is saddle anesthesia

A

LOSS OF FEELING IN THE BUTT

64
Q

What is anklosing spondylitis

A

Stiffening of the spine from inflammation

Have a hunched over posture

65
Q

What is the ratio of male to femeale for anklosing spondylitis

A

4:1 males

66
Q

Will anklosing spondylitis be better or worse with activity

A

Better with activity and worse with rest

67
Q

Where can anklosing spondylitis refer and radiate to

A

Radiates to knee

Refers to trochanter and butt

68
Q

What are some treatments for anklosing spondylitis

A

NSAIDS
Education
PT (heat, PRE, Extension)

Physical Therapy (18 decks)

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