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MS II > Lumbar part 1 > Flashcards

Lumbar part 1 Flashcards

1
Q

The medical community knows how to approach the problem of LBP (true/false)

A

false

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2
Q

Most people with low back pain will get better no matter what you do (true/false)

A

false

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3
Q

List the risk factors related to LBP

A

smoking
spending more than 1hr/day in a car
spending more than 1hr/day in activity with vibratory forces
full term pregnancy with vaginal delivery
weak increase with repetitive heavy lifting

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4
Q

What are work requirements that are predictors?

A 
unexpected lifting 
lifting with rotation
static work positions 
vibration 
handling materials while seated
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5
Q 
Job satisfaction 
sense of value 
supervisor relationship and review 
time away from job 
these are _ factors
A

psychosocial

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6
Q

if away from job for 6 months, _ chance of return to work

A

50%

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7
Q

if away from job for 1 year, _ chance of return to work

A

25%

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8
Q 
Psychological distress 
attitudes and beliefs 
social environment
illness behavior 
_ model
A

biopsychosocial

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9
Q

It is important to start PT as early as possible (true/false)

A

true

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10
Q

Treat LBP patients with passive treatment in mind vs active treatment (true/false)

A

false

ACTIVE

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11
Q

Starting PT within _ days decreased the likelihood of having surgery or epidural steroid injections versus those seen after 90 days

A

30

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12
Q

The tissues involved need to AVOID controlled stress (true/false)

A

false

NEED controlled stress

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13
Q

The lumbar spine and associated soft tissues are the “hub” of weight-bearing and force attenuation (True/false)

A

true

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14
Q

What are the functions of the spine?

A

supports the body
facilitates movement
protects the spinal cord
shock absorber

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15
Q

The first sacral segment of the sacrum is loose and behaves like another lumbar vertebra, what is this development of the spine called?

a. lumbarization
b. sacralization
c. Schmorl Nodules
d. Scheurmanns disease

A

lumbarization

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16
Q

L5 fused to S1, this type of development in the spine can be called

a. lumbarization
b. sacralization
c. Schmorl Nodules
d. Scheurmanns disease

A

sacralization

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17
Q

_ is a stress response that is developmental and happens later in life

A

tropisims

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18
Q

A Schmorl node is described as a

A

intravertebral disc herniation

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19
Q

by itself, a Schmorl node is highly correlated to pain (true/false)

A

false

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20
Q

A schmorl node can be causing pain if its in combination with VB compromised (true/false)

A

true

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21
Q

if a patient has Schmorl node in correlation with _ or _ it could be mildly correlated to pain

A

osteoporosis

degeneration

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22
Q

This type of development in the spine is when vertebrae become wedged more than 5 degrees and it increases kyphosis

a. lumbarization
b. sacralization
c. Schmorl Nodules
d. Scheurmanns disease

A

Scheurmanns disease

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23
Q

Scheurmanns disease is associated with what other development of the spine?

A

schmorl node

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24
Q

Only the vertebrae is vascular in the fetus and infant (true/false)

A

false

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25
Q

Which structures in the fetus and infant are vascular?

A

vertebrae and disc

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26
Q

Blood vessels evolve from the growing disc during childhood (true/false)

A

false

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27
Q

Blood vessels disappear from the growing disc during childhood, but the vertebrae remains highly vascular (true/false)

A

true

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28
Q

The vertebrae remains highly vascular after childhood (true/false)

A

true

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29
Q

The adult disc is

a. vascular
b. avascular
c. nociceptive
d. all of the above

A

avascular

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30
Q

The disc cells depend on diffusion from _ _ at the margins of the disc to supply nutrients essential for _ activity and viability and to remove _ wastes

A

blood vessels
cellular
metabolic

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31
Q

List 4 reasons nutrient supply can fail

A

Changes in blood supply
sclerosis of the subchondral bone
endplate calcification
lifestyle choices

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32
Q

What small nutrients are supplied to the discs entirely by diffusion?

A

oxygen

glucose

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33
Q

Loss of nutrient supply can lead to

A

cell death
loss of matrix production
increase in matrix degradation
disc degeneration

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34
Q

What exercise produces some of the largest amount of fluid transfer in the IVD and decreases swelling/pressure?

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

A

extension

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35
Q

Disc degeneration is highly correlated to pain (true/false)

A

false

only in combo with other factors

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36
Q

What can be associated with DD and LBP?

A

aortic atherosclerosis and stenosis

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37
Q

When a child begins ambulating, the lumbar endplate changes from _ to _

A

convex to concave

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38
Q

What of the vertebral body contains the red marrow?

A

bony honeycomb

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39
Q

The purpose of this structure is to increase the stiffness of the vertical load-bearing trabeculae

a. vertical trabeculae
b. vertebral endplates
c. horizontal trabeculae
d. facet joints

A

horizontal trabeculae

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40
Q

(vertical/horizontal) load-bearing trabeculae support the vertebral endplates

A

vertical

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41
Q

This can be defined as central compression with bowing of endplates and central expansion of discs

a. vertical load bearing
b. horizontal load bearing
c. Scheurmanns disease
d. vertebral osteoporosis

A

vertebral osteoporosis

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42
Q

The lumbar vertebrae becomes _ and _ in old age with (increased/decreased) endplate concavity

A

shorter
wider
increased

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43
Q

What can change arthrokinematically in the low back?

a. the vertebral bodies become more convex
b. vertebral bodies wedge
c. vertebral end plates compression leads to increased concavity
d. vertebral end plates compression leads to increased convexity

A

vertebral end plates compression leads to increased concavity

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44
Q

Vertebral body fractures are twice as common as hip fractures (True/false)

A

true

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45
Q

Compression fractures of the vertebral body are poorly correlated to pain (True/false)

A

false

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46
Q

With aging, what changes happen at the lumbar disc?

a. more diffusion
b. loss of proteoglycans and water
c. less water and diffusion
d. loss of vascularization

A

loss of proteoglycans and water

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47
Q

The loss of stature in elderly is due to

a. loss in disc space
b. loss in disc height
c. loss in vertebral body shape
d. loss in vertebral body height

A

loss in vertebral body height

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48
Q

A tear in the annulus is also called

A

disc fissuring

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49
Q

A majority of lower lumbar discs from elderly show thinning degeneration (true/false)

A

false

50
Q

Selective bone loss + change in VB shape + change in IVD shape =

A

decreased lordosis

51
Q

What are the 3 parts of the intervertebral disc?

A

annulus fibrosus
cartilage endplates
nucleus pulposus

52
Q

The _ _ and the _ encase the nucleus pulposus

A

annulus fibrosus

cartilage endplate

53
Q

The purpose of the annulus fibrosus is to

a. absorb impact
b. diffuse water
c. resist tensile forces
d. absorb nutrients

A

resist tensile forces

54
Q

The outer annulus is

a. ligamentous
b. cartilaginous

A

ligamentous

55
Q

The inner annulus is

a. ligamentous
b. cartilaginous

A

cartilaginous

56
Q

The ligamentous outer annulus units the vertebral rims and

a. absorbs impact
b. resists tensile forces
c. has a load-bearing role
d. diffuses water

A

resists tensile forces

57
Q

The outer annulus has a (low/high) proteoglycan content

A

low

58
Q

The inner annulus has a (low/high) proteoglycan content

A

high

59
Q

The cartilaginous inner annulus purpose is to:

a. absorbs impact
b. resists tensile forces
c. has a load-bearing role
d. diffuses water

A

has a load-bearing role

60
Q

Which part of the intervertebral disc is innervated by nociceptive nerve fibers?

a. inner annulus
b. outer annulus
c. cartilage endplate
d. nucleus pulposus

A

outer annulus

61
Q

This structure of the intervertebral disc is hyaline cartilage, partly penetrated by small vascular buds from vertebra and is a pathway for diffusion of nutrients to disc

a. inner annulus
b. outer annulus
c. cartilage endplate
d. nucleus pulposus

A

cartialge endplate

62
Q

Which part of the IVD gives a pathway for diffusion of nutrients to the disc?

A

cartilage endplate

63
Q

In erect posture, 85% of axial loads pass through the

a. vertebral column
b. IVD discs
c. vertebral bodies and IVD
d. ligaments

A

vertebral bodies and IVD

64
Q

The avascular adult disc is nourished by _ from vascular buds at the vertebral body disc interface

a. absorption
b. diffusion
c. secretion
d. none of the above

A

diffusion

65
Q

The disc receives nourishment from

A

diffuson in IVD and

small vessels in outermost annulus

66
Q

How does the disc resist axial load?

A

intradiscal pressure

capacity of its PG to absorb and hold water

67
Q

Which component of the IVD assists the nucleus in load-bearing?

a. cartilage endplate
b. inner annulus
c. outer annulus
d. none of the above

A

inner annulus

68
Q

How does the disc change throughout the day?

A

fluid changes and squeezes out throughout the day

69
Q

This concept is defined as prolonged axial loading reduces stature by squeezing water out of the discs

a. disc pressure
b. swelling pressure
c. flexion creep
d. extension creep

A

flexion creep

70
Q

Increased loading on the nucleus and inner annulus fibers, more likely to damage, disc loaded more

a. morning
b. evening
c. consistent throughout the day
d. this happens with any LBP

A

morning

71
Q

Increased loading on the nucleus and outer annulus fibers, more likely to damage and facet joints are loaded more

a. morning
b. evening
c. same throughout the day
d. this happens with any LBP injury

A

evening

72
Q

Intradiscal disc pressure is related to breathing rhythms (true/false)

A

true

73
Q

With (inspiration/expiration) pressure increases in the IVD

A

inspiration

74
Q

With (inspiration/expiration) pressure decreases in the IVD

A

expiration

75
Q

What kind of tears can occur in the annulus?

A

annulus tears
rim lesions
high intensity zones

76
Q

A patient has local pain, especially after loading, pain lasts a day or two and goes away. It comes back but pain lasts a little longer, but eventually goes away. This leads to

A

progressive radial tears with scar formation

tears get larger and reach outer rims

77
Q

The annulus weakens over time with progressive tears (true/false)

A

true

78
Q

Radial fissuring often affects the _ annulus and is painful when it reaches the _ of the annulus

A

posterior

outer third

79
Q

Genetics, heavy lifting, and frequent loaded positions can lead to

a. avascular disc changes
b. less diffusion in the IVD
c. osteoporosis
d. disc degeneration

A

disc degeneration

80
Q

This change in the disc is a progressive deformation (strain) of a structure, or of tissues under prolonged loading (stress)

a. disc degeneration
b. creep
c. hysteresis
d. disc fissuring

A

creep

81
Q

Functional changes in the disc lead to increased _ and _

A

creep

hysteresis

82
Q

This change in the disc is the recovery from distortion, the lag of recovery from deformation after a load has been removed

a. disc degeneration
b. creep
c. hysteresis
d. disc fissuring

A

hysteresis

83
Q

What are the functional changes in the disc?

A

increased disc stiffness
decreased ranges of movement
increased creep and hysteresis

84
Q

What can cause diurnal loss of stature due to loss of water from the disc from axial loading in erect posture

a. disc stiffness
b. disc degeneration
c. decreased ROM
d. hysteresis

A

hysteresis

85
Q

Discs are NOT designed to bulge out (true/false)

A

false

86
Q

Buckling of the inner annulus, disc bulges inward

A

metaplastic proliferation

87
Q

Metaplastic proliferation can lead to

A

compression of the nerve root

88
Q

Studies show that disc bulges (do/do not) absorb over time

A

do

89
Q

What did the study on sequestration show with regards to radicular pain?

A

ALL patients recovered within 3-6 weeks

90
Q

Correlated resorption of sequestered IVD herniation at

a. 5 months
b. 3-6 months
c. 7 months
d. 4-9 months

A

4-9 months

91
Q

Most herniated discs heal spontaneously (true/false)

A

true

92
Q

Which disc lesion has the highest probability of spontaneous disc regression?

a. disc extrusion
b. disc sequestration
c. disc protrusion
d. disc bulging

A

disc sequestration

93
Q

Discs are swollen more in the

a. morning
b. evening
c. middle of the day
d. none of the above

A

morning

94
Q

The time of day that an MRI is done does not affect the results of the MRI (true/false)

A

false

95
Q

Where is the most common disc lesion located?

a. L4/L5 or L5/S1
b. L1/L2
c. L5/S1 or L2/L3
d. L2/L3

A

L4/L5 or L5/S1

96
Q

What happens with an endplate fracture?

a. nerve damage
b. blood goes into the disc and can lead to irritation of the DRG
c. less space at the joints and causes stenosis
d. disc bulge losing water

A

blood goes into the disc and can lead to irritation of the DRG

97
Q

The annulus is affected, rim lesion, audible pop, immediate pain, local pain and no distal pain. These characteristics fit

a. soft lesion
b. hard lesion
c. annulus lesion
d. entire disc lesion

A

hard lesion

98
Q

This type of disc lesion shows a favorable response to treatment and spinal manipulation can be done

a. soft lesion
b. hard lesion
c. somatic pain
d. entire disc lesion

A

hard lesion

99
Q

A progressive small annulus tear, the nucleus is involved, pain increases, distal symptoms, morning pain is worse. These characteristics fit

a. entire disc lesion
b. hard lesion
c. annulus lesion
d. soft lesion

A

soft lesion

100
Q

This type of disc lesion is slow to respond to treatment, and should not have spinal manipulation

a. soft lesion
b. hard lesion
c. somatic pain
d. entire disc lesion

A

soft lesion

101
Q

Which direction do patients favor the most with a disc lesion?

a. posterior-medial
b. posterior-lateral
c. flexion
d. extension

A

posterior lateral

102
Q

With a posterior-lateral direction preference, leaning (towards/away) eases pain

A

away

103
Q

With a posterior-lateral direction preference, leaning (towards/away) increases pain

A

toward

104
Q

How should you treat a patient that prefers a posterior-lateral direction?

a. stretch the ligaments
b. strengthen the core
c. opening techniques
d. work into pain

A

opening techniques

105
Q

With a posterior-medial direction preference, leaning (towards/away) increases pain

A

away

106
Q

With a posterior-medial direction preference, leaning (towards/away) decreases pain

A

towards

107
Q

A patient shifts away one day then shifts towards another day, which direction do they prefer?

a. posterior-lateral
b. posterior-medial
c. alternating disc lesion
d. direct posterior

A

alternating disc lesion

108
Q

This patient is often “stuck” in flexion with severe guarding. Which is their direction preference?

a. posterior-lateral
b. posterior-medial
c. alternating disc lesion
d. direct posterior

A

direct posterior

109
Q

Aggs of disc lesion

A 
valsalva
AM and PM 
flexed position 
sustain positions
vibration
110
Q

Eases of disc lesion

A

movement
supine
avoiding sustained positions
lumbosacral support

111
Q

Somatic pain as hip bursitis

A

L4 disc

112
Q

Somatic pain at the coccyx is referred from

A

L5 disc

113
Q

Somatic pain at the T/L junction

A

L5 spinous process and to either side

114
Q

How does the disc receive blood supply as an adult when it becomes avascular?

A

through diffusion from blood vessels in the disc margins

115
Q

loss in stature is due to loss in the disc height (true/false)

A

false

vertebral body height

116
Q

The first structure to fail in a disc lesion

a. annulus fibrosis
b. nucleus purposes
c. cartilage endplate
d. outer annulus

A

cartilage end plate

117
Q

A compression fracture is related to pain (true/false)

A

true

118
Q

Treat posterior disc lesion with (mobilization/traction)

A

traction

119
Q

In the acute phase treat a disc lesion with _ mobilization (at/below) the level

A

PA

at

120
Q

How do you treat chronic disc lesion?

A

levels are stiff

spinal stabilization

121
Q

Alternating disc lesion treat with (mobilization/traction)

A

mobilization

122
Q

Which part of the meninges is stressed mechanically with neurodynamic tests?

a. dura mater
b. arachnoid
c. pia mater
d. all of the above

A

dura mater

MS II (17 decks)

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