wk 1 & 2 quiz diagnosis and LBP

Question 1

__: decision regarding the pt complaint; the act of identifying a dx or a condition from s/s

Answer 1

diagnosis

Question 2

____: a test that detects a symptom or sign

Answer 2

positive findings

Question 3

_____: condition/ diagnosis given the signs and symptoms

Answer 3

indications

Question 4

___: presence of specific S/S suggesting with almost certainty that the target condition is present

Answer 4

pathongnomic

Question 5

_____: ability of a test to identify those WITH the dx (true pos. rate)

Answer 5

test sensitivity

Question 6

___: ability of a test to identify those w/o the dx (true neg. rate)

Answer 6

test specificity

Question 7

____: the use of current best evidence in making decisions about the care of a pt.

Answer 7

evidence based medicine

Question 8

____: a list of cc that are possible given a particular set of s/s/ clinical finings

Answer 8

differential diagnosis

Question 9

___:” A working hypothesis” formulated from significant items in hx, and physical findings, a tentative dx; or a working dx

Answer 9

clinical Impression

Question 10

_____: any s/s that may suggest the presence of a serious health cc that may be life threatening or disabling

Answer 10

red flag

Question 11

most LBP is ___ and recovers in ___wks

Answer 11

uncomplicated and recovers in 6 wks

Question 12

2012 Prospective study: there was ___ of surgery for thoe who went to a chiro first

Answer 12

reduced odds

Question 13

Which etiology caused LBP the most

Answer 13

disc disruption (39%)

5% of those are herniations

Question 14

Which pop under goes spinal stenosis the most

Answer 14

older pop –> degeneration process

Question 15

origin of LBP is often assumed to be ____, but it might not be mechanical LBP. It might be from ____ factors

Answer 15

thought to be: degenerative conditions

but might be: biochemical and inflam factors

Question 16

in nonmechanical LBP a study was conducted that concluded 37% of disc herniations where caused by ___

Answer 16

bacteria (p.acnes)

Question 17

bact. may be the cause of __% of chronic LBP

Answer 17

40%

Question 18

Central portion of the disc is called: ___

derived from the cells of ___

Answer 18

called: nucleus pulposus
from: primitive notocord

Question 19

outer portion of the disc is called ___

Answer 19

caled: annulus fibrosis

Question 20

What are the two parts of the annulus fibrosis connected to :

Answer 20

inner fibers: cartilagenous endplate

outer Sharpy fibers: attached to the VB

Question 21

What are shapy fibers?

Answer 21

the outer portion of the annulus fibrosis that are attached to the VB

Question 22

What two lig.s strengthen the disc space

Answer 22

ALL (stronger- resist extension)

PLL (resist flexion)

Question 23

Which is stronger? ALL vs. PLL

- what do they attach to?

Answer 23

ALL - resist extension

attach to: annulus fibrosis

Question 24

Herniation occurs when the ___ moves through the torn ___

Answer 24

nucleus pulposus moves through the annular disc

Question 25

___: any dx that affects the spinal N roots

Answer 25

radiculopathy

Question 26

What is the first change of an aging disc

Answer 26

in the nucleus--> from soft gel to fibrous lumps

Question 27

the strength of a disc is contributed to:

Answer 27

fluid and proteoglycans in the disc

Question 28

____: gradual deformation of the disc when under constant load

Answer 28

creep

Question 29

a primary cause of disc degeneration is :

Answer 29

failure of the nutrient supply to the disc cells

Question 30

(5) factors that can affect blood supply to the VB

Answer 30

``` o Atherosclerosis o Long term exercise or lack of it o Mechanical stress/ injury o Major risk factors: heavy physical work, lifting, truck driving, obesity and smoking o Genetic ```

Question 31

3 phases of progressive degenerative changes in the annulus nuclear complex:

Answer 31

1. dysfunction: tears 2. instability: internal disruption 3. restabilization: osteophytes and traction spurs = stenosis

Question 32

____ tears: from shear stress from loading in bending and torsion

Answer 32

circumferential tears

Question 33

__:avulsion of annulus w/ sclerosis and osteophytosis of the bone

Answer 33

rim lesion | the annulus is attached to the VB, so it takes the bone with it

Question 34

___disruption: inward buckling

Answer 34

internal disc disruption

Question 35

____fissures: starting in inner annulus

Answer 35

radial fissures

Question 36

_: displaced nuclear mat. Causing the outer annulus to bulge

Answer 36

annular protrusion

Question 37

__:nuclear mat. Escapes from disc

Answer 37

nuclear extrusion

Question 38

____: Nucleus protrudes through inner but not outer layer of annulus

Answer 38

contained disc

Question 39

___: nuclear mat. Penetrates through annulus

Answer 39

non-contained disc

Question 40

_____: mild displacement of the annular fibers, PLL is intact

Answer 40

bulge

Question 41

___: fibers of the annulus are thinned with some tearing , PLL intact

Answer 41

protrusion

Question 42

_____: rupture of the annular fibers → nuclear mat. Emerges through the annulus , NP remains confined by the PLL

Answer 42

Extrusion | Pt with severe Back pain and sciatica are 3x more likely to have this

Question 43

o Pt with severe Back pain and sciatica are 3x more likely to have :____

Answer 43

disc extrusion

Question 44

_____: PLL is disrupted and the nucleus protrudes into the epidural space → disc tiss is expelled from disc and no longer attached

Answer 44

sequestration

Question 45

98% of lesions are to __ or ___ in the back

Answer 45

L4-L5 or L5-S1

Question 46

If a lesion is present in the L5-S1 what are three probable signs

Answer 46

Pain in S1 area : sciatic patho. achilles DTR (s) deficit in S1 dermatome

Question 47

If a lesion is present in the L4-L5 what are three probable signs

Answer 47

weak ext. hallicus weakness pain in post/lat thigh and calf (s) deficit of L5 dermatome

Question 48

During a bulging disc there will be an increase during ___ motion and ___ is absent

Answer 48

pain incr with flexion | No Dejerine's triad

Question 49

What is dejerine's triad

Answer 49

pain during: cough, sneeze, or bowel movement

Question 50

name 5 test for Lower Lumbar Radiculopathy/ Sciatica (L4-S3)

Answer 50

* SLR * Bowstring * Bragard’s * Lasegue’s * Sicard’s

Question 51

name 2 test for Lower Lumbar radiculopathy/ femoral N: (L2-L4)

Answer 51

* Femoral N traction test | * Nachlas Test

Question 52

(2) imaging techniques used to diagnosis disc degeneration

Answer 52

MRI and CT

Question 53

___ testing is used to test for Decr motor and sensory potentials in extrusion and sequestration

Answer 53

electrodiagnostic testing

Question 54

What management technique is used when patient has primary leg pain or pain that is too severe for less invasive management

Answer 54

epidural steroid injections