Neck and LBP

Question 0

myelopathy signs (2)

Answer 0

hyperactive reflexes (clonus), spasticity
weakness, muscle atrophy

Question 1

myelopathy affects?

Answer 1

upper motor neurons (CNS, brain, spinal cord)

Question 2

radiculopathy affects what?

Answer 2

lower motor neurons (after the nerve leaves the spinal cord)

Question 3

signs of radiculopathy (2)

Answer 3

hypoactive reflexes, flaccidity

weakness, muscle atrophy, fasiculations

Question 4

rapid deceleration injury w/ hyperextension of the neck, followed by flexion can cause?

Answer 4

cervical strain/sprain

Question 5

strain =

Answer 5

muscle-tendon injury

Question 6

sprain =

Answer 6

ligamentous injury

Question 7

gradual onset of neck stiffness & soreness, muscle tightness, headache starting at the back of the skull, shoulder pain

Answer 7

cervical strain/sprain

Question 8

acute onset of pain in lower back w/ identifiable event (lifting, twisting)
pain increases w/ activity and is improved w/ rest

Answer 8

lumbar strain/sprain

Question 9

in lower back: decreased ROM due to pain, tender to palpation, muscle spasm, normal neuro exam

Answer 9

lumbar strain/sprain

Question 10

Treatment for both cervical and lumbar strain/sprains (3)

Answer 10

limit activities (bed rest no more than 48 h), local ice/heat, massage = 48h “therapeutic trial”
NSAIDs, muscle relaxants, analgesics for 48-72h around the clock
PT, education

Question 11

majority of strains/sprains recover within?

Answer 11

4 weeks

Question 12

degenerative disk disease and hypertrophy of ligamentum flavum & facets in the cervical vertebrae

Answer 12

Cervical spondylosis

Question 13

A disorder with variable clinical presentations:
one level w/ variable radicular symptoms- neck tenderness &/or muscle spasm
multiple levels with bilateral symptoms
signs consistent with myelopathy

Answer 13

Cervical spondylosis

Question 14

Cervical spondylosis most commonly affects? (3)

Answer 14

C4-5
C5-6
C6-7

Question 15

where is herniated lumbar disk disease most common?

Answer 15

L4-5

L5-S1

Question 16

presents w/ symptoms consistent w/ L5 or S1 radiculopathy

Answer 16

Herniated lumbar disk disease

Question 17

Sciatica is a symptomatic hallmark of what?

Answer 17

Herniated lumbar disk disease

Question 18

Treatments of both Cervical Spondylosis and Herniated Lumbar Disk Disease (3)

Answer 18

NSAIDs, analgesics
muscle relaxants
PT, bed rest

Question 19

urinary retention, bilateral lower extremity weakness, “saddle anesthesia”, anal wink

Answer 19

Cauda Equina syndrome

Question 20

pathology of cauda equina syndrome

Answer 20

massive midline herniation due to trauma or metastatic disease

Question 21

treatment of cauda equina syndrome

Answer 21

based on etiology:
herniation = surgical decompression
metastatic disease = oncology consult, radiation therapy

Question 22

defect in the pars interarticularis, seen mostly on kids and teens

Answer 22

Spondylolysis

Question 23

“a collar on the scottie dog” on x-ray indicates?

Answer 23

Spondylolysis

Question 24

Spondylolysis results from?

Answer 24

repetitive hyperextension stress: gymnasts, divers, athletes

Question 25

Spondylolysis treatments?

Answer 25

rest & NSAIDs for LBP only

Question 26

anterior displacement of one vertebrae on another. Associated w/ degenerative disk disease

Answer 26

Spondylolisthesis

Question 27

where is spondylolithesis most common? (2)

Answer 27

L4-L5 | L5-S1

Question 28

back pain, worsened by bending, lifting, twisting | "step off" of spinous processes on exam

Answer 28

Spondylolithesis

Question 29

Spondylolisthesis treatment

Answer 29

NSAIDs, rest, conservative exercise

Question 30

condition that narrows the neural foramen, compressing spinal cord & or nerve roots

Answer 30

Lumbar spinal stenosis

Question 31

combination of degenerative disk disease & hypertrophy of ligamentum flavum & facets in lower back

Answer 31

Lumbar spinal stenosis

Question 32

progressive low back and bilateral leg pain that is worsened by standing &/or walking, improved by leaning forward or laying down

Answer 32

Lumbar spinal stenosis

Question 33

treatment of lumbar spinal stenosis? (4)

Answer 33

NSAIDs PT to retain ROM Refer to pain management for epidural steroid injections Surgery for intractable pain or neuro deficits

Question 34

night pain that is dull, progressive, persistent, worse w/ recumbency pt w/ hx of malignancy

Answer 34

Spinal tumor

Question 35

new LBP in a patient w/ hx of malignancy is what until proven otherwise?

Answer 35

metastasis

Question 36

what bone condition is associated with invasive procedures, drug abusers, diabetics, and the immunosuppressed?

Answer 36

Osteomyelitis/bone infection

Question 37

back pain, malaise, fever, sepsis, wound drainage, elevated ESR indicate?

Answer 37

spinal infection

Question 38

treatment of spinal infection? (2)

Answer 38

antibiotics | surgical drainage