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spine conditions Flashcards

1
Q

what is an abdominal aortic aneurysm (AAA)?

A

dilation of the abdominal aorta (>3 cm)

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2
Q

what is the pain referral pattern of AAA?

A

loin to groin

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3
Q

what are s&s of AAA?

A

abdominal/flank pain
loin or groin pain
signs of shock: pale, clammy hands, rapid pulse, SOB, dizziness, weakness
pulsatile abdominal mass
asymmetrical pulses

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4
Q

what is the management for AAA?

A

3-4,4cm: monitor anual US
4,4-5,4 cm: 3 monthly US
>5,4: surgery

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5
Q

what is ankylosing spondylitis?

A

a type of inflammatory arthropathy which is most common in young males (15-30 years)

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6
Q

what are s&s of AS?

A

morning stiffness >30 min
LBP/pelvis/SIJ pain
pain improves with exercise
worse with rest
night pain
alternating buttock pain
peripheral enthesitis

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7
Q

which signs are present during physical exam in AS?

A

limited chest expansion (<7.5 cm)
limited schober’s test (<4-5cm)

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8
Q

what other conditions might be associated with AS?

A

conjunctivitis
aortic insufficiency
pulmonary fibrosis

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9
Q

what are the x-ray findings in AS?

A

romanus lesion
shiny corners
vertebral body squaring
non-marginal syndesmophytes

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10
Q

which blood tests can be done to diagnose AS?

A

FBC
HLA B27
ESR (erythrocytes sedimentation rate)

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11
Q

what are the s&s for cauda equina syndrome?

A

back pain
pain radiation down both legs
loss of urinary control or sensation
saddle anaesthesia
erectile dysfunction
LL weakness
decreased SMR

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12
Q

what are s&s of degenerative disc disease?

A

local back pain
relieved by rest, worse with activity
reduced ROM
sensation of weakness of the back
stiffness

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13
Q

what is DISH?

A

diffused idiopathic skeletal hyperostosis: ossification of ligaments, tendons and joint capsules

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14
Q

which ligaments are most commonly affected by DISH?

A

MC: anterior longitudinal ligament (ALL)
2nd MC: posterior longitudinal ligament (PLL)

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15
Q

which population type is most at risk for DISH?

A

male
>50
diabetes
alcoholism
obesity
hypertension

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16
Q

what are s&s of DISH?

A

often asymptomatic
stiffness
dysphagia

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17
Q

what are s&s of a compression fracture?

A

local spasm and swelling
tenderness
local flexion deformity
pain on percussion vibration

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18
Q

which physical exam test would be possible with a compression fracture?

A

supine sign

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19
Q

what are the x-ray findings for a NEW compression fracture?

A

anterior wedging (if posterior wedging –> pathological fracture)
zone of impaction
step off deformity

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20
Q

what are the x-ray findings for an OLD compression fracture?

A

anterior wedging
NO step off zone

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21
Q

what is a chance/seatbelt fracture of the spine?

A

a transverse fracture across the TPV, laminae and articular process due to a violent forced flexion with distraction force (lap seatbelt during MVA)

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22
Q

what are x-ray findings of a chance/seatbelt fracture?

A

widening of the intertransverse process space above level of fx
anterior-superior bone fragment

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23
Q

is a chance/seatbelt fracture stable or unstable?

A

UNSTABLE!

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24
Q

besides AAA, which other condition refers to the loin and groin area?

A

kidney stones/nephritis

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25
who is most at risk for kidney stones?
males 30-60 hypercalcaemia
26
what are s&s for kidney stones?
intense pain on side of abdomen pain may mimic MSK pain loin to groin pain nausea polyuria dysuria haematuria
27
what is the management for kidney stones?
small stones: pass through urine large stones: broken down by US/laser
28
what other condition can kidney stones cause?
urinary tract infection UTI
29
what is Maigne's syndrome?
condition affecting the cutaneous nerve T12-L2
30
what are the s&s of Maigne's syndrome?
manipulable lesion of TL junction UL or BL pain over iliac crest, TL and/or groin hypersensitivity on iliac crest (+ve skin rolling) local muscle guarding
31
what is multiple myeloma?
malignant proliferation of plasma cells within the bona marrow
32
who is most at risk MM?
male >60 afro-caribbean
33
what are the most common s&s of MM?
often asymptomatic anaemia renal impairment fatigue weight loss hypercalcaemia
34
what will the blood tests indicate in MM?
hypercalcaemia hyperuricemia abnormal protein electrophoresis
35
what is the most common site for a radiculopathy?
L5-S1
36
what are s&s for a lumbar radiculopathy?
LBP hip pain groin pain unilateral leg pain LMNL: decreased DTR, atrophy, fasciculations, weakness and hypotonia
37
what is the most common cause of a lumbar radiculopathy?
disc herniation
38
what are s&s of SIJ sprain?
pain over SIJ (UL or BL)
39
which tests are positive in SIJ sprain?
Gaenslens Fabere thigh thrust SIJ distraction SIJ compression Sacral thrust provocation SIJ instability tests
40
what is scheuermann's disease?
kyphosis in juvenile population (11-17 yrs)
41
what are s&s of scheuermann's disease?
pain and stiffness (lower Lx) increasing kyphosis over 1-2 months pain during forward flexion pain comes on towards end of day short hamstrings and pecs
42
what are the x-ray findings in scheuermann's disease?
schmorl's nodes elongated VB's anterior wedging disc height loss
43
what will be seen in the adams forward bending test in patients with scoliosis?
functional scoliosis: rib hump decreased on flexion structural: rib hump doe snot improve with flexion
44
what is the management of scoliosis?
NON-skeletally mature: <20°: observe 20-30°: observe and brace progressive 30-45°: brace >45°: surgical referral skeletally mature: <45°: conservative management >45°: surgical referral
45
what are spondyloarthropathies?
inflammatory arthropathies affecting the spine and etheses
46
which conditions coexist commonly with spondyloarthropathies?
conjunctivitis inflammatory bowel disease aortic insufficiency
47
which conditions are part of seronegative spondyloarthropathies?
AS psoriatic arthritis inflammatory bowel disease reactive arthritis/ reiter's syndrome enteropathic arthritis
48
which conditions commonly present with enteropathic arthritis?
ulcerative colitis crohn's disease
49
what are s&s of enteropathic arthritis?
morning stiffness >30 min improvement with exercise worse with rest waking during the night (radiographically identical to AS)
50
which joints are most commonly affected in psoriatic arthritis?
DIP PIP MCP (swollen fingers) SIJ
51
what is a common finding in psoriatic arthritis?
periostitis (mouse ear erosion)
52
which conditions commonly present with reactive arthritis/ reiter's syndrome?
STI (chlamydia) infections (salmonella, shigella etc)
53
what is commonly seen in patients with reactive arthritis/reiter's syndrome?
Reiter's triad: 1. urethritis 2. conjunctivitis 3. arthritis (can't see, can't pee, can't dance with me)
54
what is the most common site for reactive arthritis?
achilles tendinits (lover's heel)
55
what is another common finding in reactive arthritis?
swollen fingers (dactylitis)
56
what are the radiographic findings for AS and enteropathic arthropaties?
BL and symmetrical sacroiliitis marginal syndesmophytes bamboo spine disco-vertebral hanges (romanus lesion, shiny corners, VB squaring)
57
what are the radiographic findings for psoriatic arthritis and reactive arthritis?
BL and Asymmetrical sacroiilitis non-marginal syndesmophytes periostitis (psoriatic arthritis)
58
what is a spondyloysis?
stress fracture through the pars interarticularis of the lumbar spine
59
which athletes are most at risk for a spondylolysis?
sports that require extension under load (gymnasts, weight lifters etc.)
60
what are the 5 types of spondylolysis?
I. dysplastic (congenital) II. isthmic (stress fracture) III. degenerative IV. traumatic (acute fx in other areas than pars) V. pathologic VI. iatrogenic (post-surgical fusion)
61
what are s&s of spondylolysis?
often asymptomatic LBP pain in buttocks worse with standing/ walking/ extension relieved by sitting increased lordosis tight hamstrings waddling gait step off deformity
62
what physical examination tests are positive with spondylosysis?
single leg hyperextension McGill
63
what are s&s of facet sprain?
local pain around spinal level guarding, hypertonicity of surrounding muscles instability (+ve McGills) functionally poor movement patterns

conditions (29 decks)

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