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MS II > LBP part 2 > Flashcards

LBP part 2 Flashcards

1
Q

A patient is experiencing dull, constant, non-specific pain that spreads into the groin and thigh. Which LBP diagnosis fits the best?

a. spinal stenosis
b. disc lesion
c. radiculopathy
d. bulging disc

A

disc lesion

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2
Q

This patient is middle-aged, has a history of their back going out, has a physically demanding job, their pain moves towards the extremity and its taking longer to recover. What could they be diagnosed with?

a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy

A

disc lesion

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3
Q

This patient has pain AM and PM, flexed positions irritate them, sitting for awhile hurts and it is painful when they cough. What could these subjective clues suggest?

a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy

A

disc lesion

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4
Q

Movement, supine position and lumbosacral support eases this patients pain. What could these subjective clues suggest?

a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy

A

disc lesion

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5
Q

A patient had pain in sustained positions, movement makes it better, laying supine helps, they have more pain with a sneeze and vibration. What could these subjective clues suggest?

a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy

A

disc lesion

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6
Q

A patient has a protective deformity, loss of lordosis, flexion increases pain, and hypomobile with palpation. These signs could suggest which diagnosis?

a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy

A

disc lesion

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7
Q

It is important to educate patients that discs heal and movement is essential (true/false)

A

true

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8
Q

Which motion helps diffusion into the disc?

A

extension

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9
Q

What are ways to unload the spine for disc lesions?

A

traction
aquatic therapy
lumbosacral support

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10
Q

Ways to treat disc lesion

A 
mobilization
manipulation 
opening techniques
closing techniques 
directional preference 
exercise
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11
Q

An opening technique should be used for which type of disc lesion?

a. posterior lateral
b. posterior medial
c. direct posterior
d. multi directional

A

posterior lateral

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12
Q

Opening techniques for posterior lateral disc lesions include

A

traction
rotation with painful side up
central PA in SB away
lateral glides

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13
Q

Closing techniques for posterior medial disc lesions include

A

central PA
central PA in SB towards
unilateral on the painful side
techniques into extension

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14
Q

What are environmental factors that could be related to disc lesions?

A 
smoking
lifting 
job 
sedenatary lifestyles
food
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15
Q

Manipulation for a disc lesion can only be done

A

if symptoms are above the knee

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16
Q

Majority of people with low back pain have an _ problem

A

inflammation

could be pressing on the nerve

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17
Q

Various pro-inflammatory mediators and immune compounds are known to remove myelin from adjacent axons describes

A

radiculopathy

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18
Q

mechanical pressure on an exposed and unmyelined axon causes

a. somatic pain
b. referred pain
c. severe pain
d. a pain response

A

severe pain

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19
Q

The main role of neuroanatomy is:

it is designed to:

A

electrochemical communication

move, slide, glide

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20
Q

the spinal cord ends at

a. L2/L3
b. L3/L4
c. L1/L2
d. L4/L5

A

L1/L2

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21
Q

Sinuvertebral nerve includes

A

ventral dura
arachnoid
posterior longitudinal ligament
dural ligaments

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22
Q

The sacral plexus provides motor and sensory for the

A

posterior thigh
most of the lower leg
entire foot
part of the pelvis

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23
Q

Prone knee bend and side lying slump are used to test

a. L1-1/2 of L4
b. L1-L4
c. 1/2 of L4-S2
d. L4-S2

A

L1-1/2 of L4

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24
Q

The Straight leg raise and slump are used to test

a. L1-1/2 of L4
b. L1-L4
c. 1/2 of L4-S2
d. L4-S2

A

1/2 of L4-S2

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25
Q

This type of pain is a deep, burning, throbbing pain

a. somatic pain
b. referred pain
c. nociceptive
d. radiculopathy

A

radiculopathy

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26
Q

Pain in the distribution of the nerve root can be called

A

radicular pain

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27
Q

What is the cardinal sign for radiculopathy?

a. deep, burning, throbbing
b. proximal pain worse than distal pain
c. distal pain worse than proximal pain
d. pain locally in the back

A

distal pain worse than proximal pain

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28
Q

A patient demonstrates parasthesia, numbness, and longer reflex changes. This could suggest

a. referred pain
b. radiculopathy
c. somatic pain
d. nerve pain

A

radiculopathy

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29
Q

List 3 characterstics of radiculopathy

A

deep, burning, throbbing type pain
dermatomal patterns
distal pain > proximal pain

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30
Q

radiculopathy demonstrates in a _ pattern

A

dermatomal

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31
Q

What are the 4 signs of threatening nerve root pain?

A 
dermatome, distal > proximal 
severe pain, latency 
slight movement distal 
PM towards 
PL away
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32
Q

A patient demonstrates dermatomal pain, more distal, latency, slight movement is irritating. What can you suggest about these characteristics?

a. it could be somatic pain
b. it could be referred from an organ
c. don’t worry about this type of pain, it will go away
d. this is threatening nerve root pain

A

this is threatening nerve root pain

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33
Q

Signs of nerve root compression

A

numbness in the dermatome
heavy feeling in the extremity
hypersensitivity
cramping

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34
Q

in later stages, what do patients experience if they have nerve root compression?

A

loss of sensation
motor weakness/atrophy
decreased reflexes

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35
Q

A patients symptoms are better when they move, unload and are shifted. Loading and staying in sustained postures irritates their symptoms. What could they be diagnosed with?

a. spinal stenosis
b. disc lesion
c. radiculopathy
d. bulging disc

A

radiculopathy

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36
Q

Eases of radiculopathy

A

protective deformity
movement
unloading
upright postures

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37
Q

Aggs of radiculopathy

A 
positions stimulating neurodynamic tests 
loading
sustained postures
valsalva 
static stretches
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38
Q

This type of pain is common with nerve root pain

A

latent

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39
Q

Therapists should be careful with aggressive treatments on radiculopathy patients because of latent pain (true/false)

A

true

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40
Q

A shift upon movement, positive SLR and slump, compression and distraction will suggest

a. spinal stenosis
b. disc lesion
c. radiculopathy
d. bulging disc

A

radiculopathy

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41
Q

Which neurodynamic tests are positive with radiculopathy symptoms?

A

SLR
slump
sidelying femoral slump test

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42
Q

How can you manually treat radiculopathy to create more space?

A

lumbar rotation painful side on top

lateral flexion stretch painful side on top

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43
Q

Mid lumbar spine transverse and lower lumbar spine transverse towards the side of pain help

A

create space for radiculopathy

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44
Q

3 movements that help with radiculopathy

A

single knee to chest
double knee to chest
trunk rotation

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45
Q

Only do passive neural mobilization with radiculopathy patients (true/false)

A

false

both passive and active

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46
Q

A study showed that slump mobilization is beneficial for improving , and _ in patients with radiculopathy

A

short term disability
pain
centralization of symptoms

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47
Q

The lumbar facet joints are a _ joint

A

paired synovial

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48
Q

Lumbar facet joints guide _ and _ plane movement

A

sagittal and coronal

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49
Q

Lumbar facet joints restrain _ and _

A

axial rotation

excessive translation

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50
Q

What structure protects disc from torsional and shearing strains?

a. transverse process
b. facet joints
c. spinous process
d. ligamentum flavum

A

facet joints

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51
Q

Lumbar facet joint is a synovial joint, therefore it can get

A

stretched
strained
torn

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52
Q

Articular cartilage is (vascular/avascular)

A

avascular

53
Q

What structure needs movement for adequate nutrition?

a. lumbar disc
b. articular cartilage
c. facet joint
d. nerve root

A

articular cartilage

54
Q

Facet joint dysfunction can be due to

A

traumatic

aging

55
Q

An athlete has a traumatic fall with back pain. What could this suggest?

a. sprain to the facet joint
b. strain to the facet joint
c. radiculopathy
d. disc fracture

A

sprain to the facet joint

56
Q

Athletes’ movements, slip, fall, MVA, can cause this type of traumatic injury to the low back

a. sprain to the facet joint
b. strain to the facet joint
c. radiculopathy
d. disc fracture

A

sprain to the facet joint

57
Q

Sustained postures due to work, excessive loads like pregnancy or backpacks can cause this type of traumatic injury to the low back

a. sprain to the facet joint
b. strain to the facet joint
c. radiculopathy
d. disc fracture

A

strain to the facet joint

58
Q

What can cause radiculopathy due to inflammation and swelling?

A

facet joint dysfunction

59
Q

This age change is when the cartilage becomes soft in the lumbar spine is in young adults in response to compressive loading

a. osteoarthrosis
b. chrondromalacia
c. bony hypertrophy of facets
d. articular cartilage loss

A

chrondromalacia

60
Q

This facet joint change is thickening and sclerosis in the subchondral bone leading to hypertrophy of facets with osteophytes

a. osteoarthrosis
b. chrondromalacia
c. bony hypertrophy of facets
d. sprain

A

bony hypertrophy of facets

61
Q

Cartilage loss with age

a. osteoarthrosis
b. chrondromalacia
c. bony hypertrophy of facets
d. strain to the facet joint

A

osteoarthrosis

62
Q

What can cause pain in an older adult due to articular cartilage loss?

A

cartilage no longer protects the innervated subchondral bone

63
Q

Characteristics of symptoms include sharp, localized, unilateral, proximal pain more

a. radiculopathy
b. lumbar facet joint dysfunction
c. stenosis
d. OA

A

lumbar facet joint dysfunction

64
Q

How is pain distributed with facet joint dysfunction?

A

proximal pain > distal pain

65
Q

Patient has spasms, localized sharp pain, and points to it on either side of the spine. These characteristics could suggest

a. radiculopathy
b. lumbar facet joint dysfunction
c. stenosis
d. OA

A

lumbar facet joint dysfunction

66
Q

Gradual lumbar facet joint dysfunction can be due to

A

posture
loading
aging

67
Q

Lumbar facet joint dysfunction can be caused by sudden trauma only (true/false)

A

false

68
Q

A patients pain is aggravated walking a long time, laying on their stomach, when they extend and is made better when they sit or rest and lay down. What could this suggest?

a. radiculopathy
b. lumbar facet joint dysfunction
c. OA
d. stenosis

A

lumbar facet joint dysfunction

69
Q

Facet joint dysfunction aggs

A 
prolonged standing 
walking a long distance 
prone
extension/rotation
coughing 
progressive loading
OA: AM stiffness
70
Q

Facet joint dysfunction eases

A 
rest
sitting
supine
flexion 
movement
71
Q

What is the facet joint dysfunction capsular pattern?

a. F > SB, Rot > extension
b. F < SB, rot < flexion
c. E > SB, rot > extension
d. E > SB, rot > flexion

A

E > SB, rot > flexion

72
Q

Which posture does facet joint dysfunction avoid?

a. side bending
b. flexion
c. extension
d. rotation

A

extension

73
Q

A patient avoids extension, has repeated movements and their pain to palpation is localized on one side. What could these characteristics suggest?

a. stenosis
b. radiculopathy
c. disc lesion
d. facet joint dysfunction

A

facet joint dysfunction

74
Q

Facet joint dysfunction that is _ shows pain through the range

A

arthritic

75
Q

Spinal mobilization for a painful facet joint should include

a. small amplitude, slow rhythm
b. smooth, slow rhythm in the painful position
c. large amplitude, smooth and slow rhythm, symptom free position
d. small amplitude, fast rhythm in pain free position

A

large amplitude, smooth and slow rhythm, symptom free position

76
Q

Spinal mobilization for painful facet joints

A

PAIVM
symptom free positioning
large amplitdue
smooth, slow rhythm

77
Q

Which spinal mobilization directions should be used for facet joints?

A

PA
unilateral PA
transverse

78
Q

Spinal mobilization for painful facet joints should go into some degree of discomfort (true/false)

A

true

79
Q

PAIVM should be the spinal mobilization technique for

a. painful facet joints
b. stiff facet joints
c. hypermobile facet joints
d. any type of facet joint dysfunction

A

painful facet joint

80
Q

PPIVM should be the spinal mobilization technique for

a. painful facet joints
b. stiff facet joints
c. hypermobile facet joints
d. any type of facet joint dysfunction

A

stiff facet joints

81
Q

Pain is normal with aging (true/false)

A

false

82
Q

Aging is strongly correlated to low back pain (true/false)

A

false

83
Q

Which low back pain problem is correlated to age?

a. ID disruption
b. facet joint pain
c. SI joint dysfunction
d. OA

A

OA

84
Q

Which ligaments contribute to stenosis?

a. anterior and posterior longitudinal ligament
b. interspinous and supraspinous ligament
c. posterior longitudinal and ligamentum flavum
d. ligamentum flavum and anterior longitudinal ligament

A

posterior longitudinal and ligamentum flavum

85
Q

Why is a contraction of the TA important?

A

pulls on thoracolumbar fascia then lifts ligamentum flavum and creates space in the canal

86
Q

What happens with degenerative spinal stenosis?

A

space narrows, ligamentum flavum buckles

87
Q

What are the types of stenosis?

A

degenerative spinal stenosis
vascular stenosis
postural/positional stenosis

88
Q

What changes happen over time resulting in spinal stenosis?

A 
facet joint hypertrophy
thickened facet joint capsules
thickening of the ligamentum flavum 
flattening of the VB 
disc bulges
89
Q

What degenerative changes happen over time to the vertebral body?

A

loses trabeculae

traction spurs/osteophytes

90
Q

What degenerative changes happen over time to the IVD?

A

fluid content

fissuring

91
Q

What degenerative changes happen over time to the facet joints?

A

capsule, cartilage, ligaments
sclerosis leads to bony ankylosis
spinal stenosis

92
Q

Fluid content and fissuring changes happen to what structure with age

a. vertebral body
b. IVD
c. facet joint
d. ligament function

A

intervertebral disc

93
Q

Loss of trabeculae and traction spurs or osteophytes changes happen to what structure with age

a. vertebral body
b. IVD
c. facet joint
d. ligament function

A

vertebral body

94
Q

Capsule, cartilage, ligaments, sclerosis, stenosis are changes that affect what structure with age

a. vertebral body
b. IVD
c. facet joint
d. ligament function

A

facet joints

95
Q

Ligamentum flavum hypertrophy and facet cysts show

a. symptoms
b. no symptoms

A

no symptoms

96
Q

Disc bulge, ligamentum flavum hypertrophy and facet cysts show

a. no symptoms
b. symptoms

A

symptoms

97
Q

What are reasons for progressive changes to the spine resulting in stenosis?

A 
aging 
changes in posture and function
increased use of AD
changes in gait 
decreased lordosis
98
Q

A older patient with AM stiffness, decreased lordosis, and progressive pain as the day goes on could suggest which pathology

a. postural stenosis
b. facet joint dysfunction
c. OA
d. degenerative stenosis

A

degenerative stenosis

99
Q

A patient who has a history of physical hard work, changes in gait pattern, relies on their AD, and has a change in their gait pattern could suggest

a. vascular stenosis
b. degenerative stenosis
c. OA
d. postrual stenosis

A

degenerative stenosis

100
Q

Foraminal stenosis is (bilateral/unilateral)

A

unilateral

101
Q

Canal stenosis is (bilateral/unilateral)

A

bilateral

102
Q

Symptoms more in the legs, AM stiffness and a progression of increased spread of pain can suggest

a. degenerative stenosis
b. facet joint dysfunction
c. OA
d. vascular stenosis

A

degenerative stenosis

103
Q

The early phase of degenerative stenosis is felt in the

a. legs and thighs
b. glutes and hips
c. in the feet
d. in the feet up to the glutes

A

in the feet

104
Q

The middle phase of degnerative stenosis is felt in the

a. feet
b. glutes and hips
c. legs up to thighs
d. feet up to glutes and hips

A

legs up to thighs

105
Q

The late phase of degenerative stenosis is felt in the

a. glutes and hips
b. feet up to the glutes and hips
c. thighs and glutes
d. feet only

A

feet up to the glutes and hips

106
Q

A patients symptoms are made worse with extension, prolonged walking, standing and are made better with sitting and movement. What could this suggest?

a. vascular stenosis
b. facet joint dysfunction
c. OA
d. degenerative stenosis

A

degenerative stenosis

107
Q

a patient shows progressive symptoms of stenosis including a loss of bladder control

a. continue treatment and do nothing
b. continue treatment but tell the doctor
c. do a neuro screening and continue with treatment
d. stop treatment and refer out immediately

A

stop treatment and refer out immediately

108
Q

Physical presentation of stenosis

A

loss of extension

hypomobility

109
Q

Symptoms are distal, bilateral, feet are cold all the time, they have trouble walking and see changes in their skin. These characteristics could suggest

a. degenerative stenosis
b. vascular stenosis
c. postural stenosis
d. any of the above

A

vascular stenosis

110
Q

With vascular stenosis what motions make it better? What makes it worse?

A

walking and sitting increases pain

standing is better

111
Q

Vascular stenosis can be associated with what co morbidities?

a. hypertension, diabetes, alcohol abuse
b. smoking, hypertension, type 1 diabetes, peripheral neuropathies
c. diabetes, peripheral neuropathies, peripheral vascular disease and smoking
d. smoking, diabetes, peripheral neuropathies, hypertension

A

diabetes, peripheral neuropathies, peripheral vascular disease and smoking

112
Q

This type of stenosis is a narrowing in certain postures

A

postural stenosis

113
Q

In postural stenosis, the canal narrows in which position?

A

anterior pelvic position

114
Q

Postural stenosis happens over a short period of time and it doesn’t take much to produce these symptoms (true/false)

A

false

115
Q

Which postural changes increase lumbar extension that contribute to postural stenosis

A

obesity
pregnancy
high heels
ligamentous laxity

116
Q

A younger patient shows pain with extension, increased symptoms over time, walking eases pain. This could suggest

a. vascular stenosis
b. postural stenosis
c. degenerative stenosis
d. facet joint dysfunction

A

postural stenosis

117
Q

Progressive neurological symptoms of stenosis include

A

cord compression
babinski
clonus

118
Q

What speed should the patient walk at for treadmill testing for LSS?

a. 0.9 mph
b. 1.0 mph
c. 1.2 mph
d. 2.0 mph

A

1.2 mph

119
Q

What should be measured with treadmill testing for LSS?

A

time to first symptoms

total ambulation time

120
Q

Exercise treadmill testing has a poor test-retest reproducibility (true/false)

A

false

121
Q

What is the best treatment for LSS?

A

PA hip mobs

122
Q

Which diagnoses of LBP experiences the most latent pain?

a. disc lesion
b. radiculopathy
c. facet joint dysfunction
d. stenosis

A

radiculopathy

123
Q

A patient has to move for pain to go away, loading their back is irritating and they have a deep, burning type of pain. Which diagnosis is most likely?

a. disc lesion
b. radiculopathy
c. facet joint dysfunction
d. stenosis

A

radiculopathy

124
Q

A pt has dull, constant, nonspecific pain and climbs up their thighs when they come up from hip flexion. What could this suggest?

a. disc lesion
b. radiculopathy
c. facet joint dysfunction
d. stenosis

A

disc lesion

125
Q

Which LBP diagnosis most likely shows aberrant motion?

a. stenosis
b. radiculopathy
c. facet joint dysfunction
d. disc lesion

A

disc lesion

126
Q

Dull, constant, non-specific pain can suggest

a. disc lesion
b. facet joint dysfunction
c. radiculopathy
d. any of the above

A

disc lesion

127
Q

Deep, burning, throbbing pain can suggest

a. disc lesion
b. facet joint dysfunction
c. radiculopathy
d. any of the above

A

radiculopathy

128
Q

Sharp, stabbing, localized, unilateral pain can suggest

a. disc lesion
b. facet joint dysfunction
c. radiculopathy
d. any of the above

A

facet joint dysfunction

MS II (17 decks)

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