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M3 ORTHO > Spine > Flashcards

Spine Flashcards

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1
Q

Name Myotome and Dermatome of L2-L3 and associated reflexes

A

Myotome:Iliopsoas(hip flexion)
Dermatome:Medial aspect of thigh and knee
Reflex:Nil

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2
Q

Name Myotome and Dermatome of L4 and associated reflexes

A

Myotome:Tibialis Anterior
Dermatome: Medial calf,Medial foot
Reflex: Knee Jerk

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3
Q

Name Myotome and Dermatome of L5 and associated reflexes

A

Myotome: extensor digitorum Longus
Dermatome:Lateral calf,Lateral foot
Reflex: Nil

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4
Q

Name Myotome and Dermatome of S1 and associated reflexes

A

Myotome:Peroneus Longus and Brevis
Dermatome: sole of foot,side of foot including lateral malleolus
Reflex:ankle jerk

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5
Q

Name Myotome and Dermatome of S2-S5 and associated reflexes

A

Myotome:Clawing of toes:FDL?
Dermatome:Anal area
Reflex:Anal wink

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6
Q

Reason for palpating pulses at the end of every PE

A

As part of Neurovascular exam, to differentiate between neurogenic or vascular claudication

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7
Q

Possible indications of discogenic pathology

A

Pain worse on sitting,relieved on standing
Pain worse on flexion than extension
Impulse symptoms:Worse on coughing,straining to pass motion etc

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8
Q

Possible indications of Posterior column pathology

A

Pain worse on extension than flexion

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9
Q

Is generalized limb numbness indicative of radiculopathy

A

No. Need to be able to identify the dermatomal distribution

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10
Q

Name 3 common types of Intervertebral disc prolapse+ its effect on nerve roots

A

Postero-Lateral: Traversing nerve root affected( Most common type I think)
Far-lateral: Exiting nerve root affected
Central: Both traversing nerve roots affected( Bilateral symptoms)

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11
Q

Features of degenerated intervertebral disc

A

Dehydration of disc, reduced turgor, reduced disc height, syndesmophytes(?)

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12
Q

Most Common levels of Prolapsed Intervertebral disc

A

L4/L5 and L5/S1

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13
Q

What is the Meyerding classification for+describe the grades

A 
For Grading of Spondylolisthesis severity
Grade I:0-25% 
II:25-50%
III:50-75%
IV:75-100%
V: >100% (Spondyloptosis)
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14
Q

What is sequestrated disc prolapse?

A

condition in which a portion of the vertebral disc fragments and migrates into the spinal canal. The condition results when the nucleus pulposus of a herniated disc extrudes through the annular fibers and a piece of the nucleus breaks free.

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15
Q

What surgical procedure is commonly used for a prolapsed disc

A

Discectomy

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16
Q

What is spondylolysis

A

Fracture of the pars interarticularis of vertebrae: Scotty dog with collar sign

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17
Q

Common cause of Gibbus deformity(Severe kyphotic deformity, often with an “apex” at a single vertebral level)

A

Mycobacterium Tuberculosis of the spine(Spinal TB)

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18
Q

How does Spinal TB usually spread

A

Along the Anterior longitudinal ligament of the spine

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19
Q

Common principle for surgical management of spinal conditions

A

Depends on the level of disability in the patient, such as pain, neurological symptoms and bowel/urinary changes

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20
Q

Main differences between bulging and herniated intervertebral disc

A

Bulging: Annulus still intact but compresses structures while Herniated: Disc materials breaks through annulus

Bulging USUALLY insidious progression while herniated USUALLY acute

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21
Q

Adequacy for C spine lateral XR

A

C1-C2 and C7-T1 junctions

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22
Q

Sacral sparing significance

A

Suggests incomplete rather than complete spinal cord injury

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23
Q

Components of sacral sparing

A

Anal wink
Perianal sensation
Firm anal tone

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24
Q

Trick for identifying level of C spine imaging

A

Look for ice cream cone upside down: odontoid peg of C2

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25
What is Maloneys Arc
The Shentons line of shoulder dislocation
26
What are the 3 columns compromising spinal stability
Anterior: ant. 2/3 of vertebral body/disc Middle:post 1/3 of vertebral body/disc and PLL Posterior: everything posterior to PLL
27
Chance fracture definition
Flexion distraction injury often causing disruption of all 3 columns of spine
28
Where does lateral corticospinal tract decussate
In the brain
29
Where does lateral corticospinal tract decussate
In the brain
30
Scoring of Spinal Cord injury
ASIA A: Complete SCI B C D: Incomplete
31
Prognosis for ASIA A Spinal Cord Injury
Poor likelihood of rehab, but may not be a true ASIA A
32
Types of spinal cord injury
Brown Sequard Central cord Posterior cord Anterior cord
33
Pattern of central cord syndrome
Cervical is outermost fibres, sacral lower. Hence UL affects more than LL
34
Pattern of brown sequard
Retain PT-I and MO-C
35
Most common cause of anterior cord syndrome
Vascular cause: anterior spinal artery?
36
Signs of neurogenic shock
Hypotension with BRADYCARDIA
37
Most impt parts of managing neurogenic shock
Prevent secondary injury Immobilisation Vasopressors if shock Oxygen supplementation Fluid rhesus not as impt
38
Indication to send spinal cord injury to HD
High spinal cord injury: Risk of phrenic nerve injury(C3-C5)
39
How to check for resolution of spinal shock
Return of bulbocavernosus reflex after 48hrs. Tug on glans penis or urinary catheter
40
Type of urinary incontinence in Cauda Equina Syndrome
Overflow incontinence
41
What does disruption of Scottie dog suggest and what is common demographic
Pars interarticularis fracture Often hyperextension injury in gymnasts
42
Score for spinal instability
TLICS -Morphology -Posterior Column integrity -Neurology
43
Manifestations of spinal injuries
Neurological compromise or structural instability
44
Most common MOI for central cord syndrome
Hyperextension injury from fall etc
45
Cause of anterior cord syndrome
Disruption of blood supply from anterior spinal artery
46
How to try ddx CES and CMS
Unilateral vs bilateral Saddle vs perianal Areflexic,atrophy vshyperreflexic, fasciculations Late vs early presentation Unlikely vs common impotence
47
Nexus criteria for spine acronym
NSAID Neuro deficit Spinal tenderness AMS Intoxication Distracting injury
48
Red flag for possible CES that may progress
Bilateral straight leg raise positive
49
3 components of balance
Vision Proprioception Vestibular
50
3 components of balance
Vision Proprioception Vestibular
50
3 components of balance
Vision Proprioception Vestibular
51
4 gaits in spine exam
Antalgic, myelopathic, tredelenberg and high stepping
52
Signs of inverted supinator jerk
Finger flexion esp Thumb and index Elbow extension Smth else?
53
Pathophysiology of inverted supinator jerk
Lesion at C5/C6 where C6 nerve root exits. C7 and below is UMN lesion hyperreflexic hence finger flexion and elbow extension
54
Pathophysiology of finger escape sign
Generalised weakness. Imbalances of forces as extensors are stronger, and intrinsics are weaker Hence small finger is abducted
55
5 special tests for Cervical Myelopathy and 2 bonus
1. Lhermitte's test 2. Finger escape(ulnar deviation of digiti minimi) 3. Hoffman's test 4. Grip and release 5. Inverted Supinator jerk Bonus: Ankle clonus >3 beats and babinski positive
56
Etiologies of Cervical myelopathy
1. Degenerative Cervical Spondylosis 2. Ossification of Posterior Longitudinal Ligament(OPLL) 3. Malignancy primary or secondary 4. Epidural abscess 5. TB Spine(Pott's disease) 6. Trauma/ fracture 7. Kyphoscoliotic deformities 8. Congenital spinal stenosis
57
Classification system for cervical myelopathy
JOA( Japanese Orthopaedics Association)
58
Causes of winking/ blinking owl sign on spine XR
1. Spinal metastasis 2. TB or other infections 3. Intraspinal malignancies (e.g. hemangioma, spinal cord tumours like astrocytoma) 4. (Uncommon) primary bone lesion, lymphoma
59
Blood test for ankylosing spondylitis
HLAB 27( Human leukocyte antigen B 27)
60
Most common level on spondolysis
Most commonly L5 on S1
61
What to look for in XR of Adolescent Idiopathic Scoliosis
Cobb angle( Scoliosis severity) >10 and Risser staging(Skeletal maturity)
62

M3 ORTHO (10 decks)

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