Term
| vasculature supply to dura mater is provided by? |
|
Definition
middle meningeal artery and vein
innervation by trigeminal nerves V1/2/3
explains extradural heamatoma: middle meningeal artery
subdural heamatoma: due to veins emptying into dural sinuses |
|
|
Term
true or false?
arachnoid mater is avascular? |
|
Definition
true
it also doesn't have a nerve supply. |
|
|
Term
| which layer of the meninges thickens to form the denticulate ligaments? |
|
Definition
|
|
Term
| cauda equine is fromed by which nerve roots? |
|
Definition
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Term
| features of cauda equine syndrome |
|
Definition
saddle paraesthesia
incontinence or retention of feaces
reduced anal tone
paralysis or sensory loss
MRI needed urgently for diagnosis
mx: sent for surgery within 36 hours for surgical decompression. |
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Term
| referred causes of back pain |
|
Definition
ruptured AAA
pancreatitis
renal colic
pyelonephritis
peptic ulcer disease |
|
|
Term
| red flags of spinal fracture |
|
Definition
sudden onset severe central pain in spine, relieved by lying down
RTA or fall from height
point tenderness over vertebral body
osteoporosis
structural deformity of spine e.g step from one vertebra to another |
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Term
| red flags suggestive of cancer from back pain |
|
Definition
pain that still remains when lying down and in night
thoracic back pain
age >50 or < 20
hx of cancer
systemic symptoms |
|
|
Term
| red flags suggesting spondyloarthropathy |
|
Definition
early morning stiffness >45mins
night pain
gelling
pain easier with movement and worse after rest |
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Term
| red suggesting high risk of damage to compressed nerve |
|
Definition
significant muscle weakness/wasting
loss of tendon reflexes
positive Babinski reflex |
|
|
Term
xray features of cancer mets
prostate?
lung/thyroid/kidney?
breast? |
|
Definition
prostate mets look sclerotic
lung/thyroid/kidney mets look osteolytic
breat mets may be either |
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|
Term
| in xray 2cm may not be seen. which scan may be more sensitive in this case? |
|
Definition
| Technetium 99m scintillation scan. |
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|
Term
| urinary hydroxyproline is elevated in which bone disease? |
|
Definition
|
|
Term
| which back exercises can be taught to be done at home? |
|
Definition
|
|
Term
| what are yellow flag signs? |
|
Definition
chronic pain and psychological factors that can present as a barrier to active rehabilitation.
a belief that if something hurts we don't move it or aggravate it. |
|
|
Term
| refer for neurosurgical or ortho assesement for 1 week if there is ... |
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Definition
| progressive, persistent or severe neurological deficit. |
|
|
Term
which mediated pain is typically worse on extension of spine?
which pain is reproduced with flexion of the spine? |
|
Definition
facet mediated pain by extension
discogenic pain reproduced with flexion of spine. |
|
|
Term
| there is no disc between C1 and C2. what limits xs motion here? |
|
Definition
| ligaments and joint capsules |
|
|
Term
|
Definition
any neurological deficit related to the SC itself.
it can be due to compression of the SC by a prolapsed cervical disc. |
|
|
Term
| what is the gelatinous substance that can herniate and cause nerve compression in the spinal cord? |
|
Definition
|
|
Term
|
Definition
new symptoms in the very young or very old <20 or > 55 years old
weakness of >1 myotome or loss of sensation involving >1 dermatome
intractable or increasing pain |
|
|
Term
|
Definition
| flexing the neck causes electric shock like sensations down spine and into limbs |
|
|
Term
| which manoeuver is used to elicit radicular neck pain? |
|
Definition
Spurlings manoeuvre
neck is extended bent laterally and held down. |
|
|
Term
| what is positive Hoffmans reflex? UMN or LMN sign? |
|
Definition
UMN sign
basically when flicking a finger causes adjacent fingers to flex |
|
|
Term
| what is SCheuermann's disease? |
|
Definition
developmental disorder of thoracic spine. overcurvature results in hunchback.
pts cant consciously correct their posture |
|
|
Term
| what does the straight leg raise test for? |
|
Definition
?prolapsed intervertebral disc
leg pain suggest lateral protusion
back pain suggest but cannot confirm central disc collapse |
|
|
Term
| for the roots of the sciatic nerve to be involve where must the pain be? |
|
Definition
|
|
Term
| after you have done a straight leg raise and elicited pain how would you perform a sciatic stretch test? |
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Definition
| lower leg until pain disappears then dorsiflex foot. this increases tension in nerve roots and aggravates any pain or paraesthesia. it is called a positive stretch test. |
|
|
Term
describe the bowstring test.
what does it test for? |
|
Definition
tibial nerve root irritation
do straight leg raise. once level of pain has been reached flex knee slightly and apply firm pressure with thumb in popliteal fossa over stretched tibial nerve.
radiating pain and paraesthesia suggest nerve root irritation. |
|
|
Term
| describe how to perform the femoral stretch test |
|
Definition
pt should be prone
anterior thing fixed to couch
each knee is flexed in turn. this causes pain in femoral nerve roots L2-4
the test is positive if pain is felt in the anterior compartment of the thigh |
|
|
Term
| abdominal reflex testing is used to test for suspected cord compression of which part of the spine? |
|
Definition
thoracic cord compression
muscle of upper quadrants supplied by T7-10 and lower quadrant by T10-L1 |
|
|
Term
| surgical rx for spinal stenosis? |
|
Definition
|
|
Term
|
Definition
conservative: weightloss, physio with forward flexion exercises,
Medical: NSAIDs, epidural steroid injections
surgical: laminectomy |
|
|
Term
| which level does spinal cord terminate? |
|
Definition
|
|
Term
|
Definition
gait disturbance
clumsy weak hands
loss of sexual, bladder or bowel fx
Lhermittes sign, UMN signs in lower limbs, LMN signs in upper limbs |
|
|
Term
lesions in which region can cause quadriplegia
and lesions in which lesion can cause paraplegia? |
|
Definition
cervical lesions - can cause quadriplegia
thoracic lesions - paraplegia |
|
|
Term
| what features are seen in Brown-Sequard's syndrome? |
|
Definition
loss of vibration and proprioception on the same side
loss of pain and temperature of the opposite side. |
|
|
Term
| characteristic triad of neurogenic shock? |
|
Definition
hypotension
relative bradycardia
hypothermia |
|
|
Term
| what are the 3 recommended standard views of c spine? |
|
Definition
|
|
Term
| which imaging should be first line in high risk pts to check fro fractures xray or CT? |
|
Definition
| CT as plain xrays are insensitive to small fractures. |
|
|
Term
when to do MRI if:-
clinical features suggest spinal mets?
features suggest SCC |
|
Definition
MRI in 1 week if ? spinal mets
MRI in 24 hours if features suggest SCC
MRI sooner including out of hours if emergency rx is needed. |
|
|
Term
| what is the serious consequence associated with spinal cord injury at or above T6? |
|
Definition
Autonomic dysreflexia
if not treated properly can lead to seizures, stroke and even death |
|
|
Term
| features of autonomic dysreflexia? |
|
Definition
uncontrolled HTN
severe headache
intense sweating and skin blotches above level of injury
cold and clammy below level of injury
restlessness
chest tightness
bradycardia
dilated pupils |
|
|
Term
| describe the 3 types of decompression surgery? |
|
Definition
laminectomy
discectomy
spinal fusion |
|
|
Term
| mechanical causes of back pain? |
|
Definition
lumbar muscle sprain
herniated nucleus pulposus
spinal stenosis
compression fracture |
|
|
Term
| systemic causes of backpain? |
|
Definition
vertebral discitis
malignancy
CT disease |
|
|
Term
| define spondyloarthropathy |
|
Definition
| any joint disease of the vertebral column |
|
|
Term
| with regards to MRI scan and sciatica. for how long must it be present in order to qualify for an MRI scan? |
|
Definition
6 weeks.
anything less is managed conservatively |
|
|
Term
| how is spinal claudication relieved? |
|
Definition
| by bending forwards or sitting |
|
|
Term
| 3 types of hemiarthroplasties. what are they? |
|
Definition
unipolar - femoral head and neck replaced
bipolar - femoral head and neck and acetabular cup
resurfacing - replacing the surface of the femoral head: done in young people |
|
|
Term
| when should pts undergo outpt follow up after a hip replacement? |
|
Definition
|
|
Term
| complications of hip replacement surgery |
|
Definition
post op pain and constipation
UTI or retention: catheter needed
VTE
chest infection
implant fracture
wound infection |
|
|
Term
| what are the 3 types of knee replacement available? |
|
Definition
unicompartmental
unconstrained bicompartmental
constrained bicompartmental |
|
|
Term
| features of unicompartmental knee replacement? |
|
Definition
replacement of medial or lateral tibiofemoral compartment only
usually used for OA
not suitable for those with RA |
|
|
Term
| features of unconstrained bicompartmental knee replacement? |
|
Definition
most common from of knee replacement
femoral part metal
tibial part metal and plastic
patella component: polyethylene and metal |
|
|
Term
| from the 3 types of knee replacements which is the most common type of knee replacement? |
|
Definition
| unconstrained bicompartmental |
|
|
Term
| when considerable bone loss is involved such as in bone tumours which type of knee replacement may be used? |
|
Definition
| constrained bicompartmental replacement |
|
|
Term
| features of constrained bicompartmental knee replacement? |
|
Definition
the joint works like a fixed hinge
is more prone to loosening |
|
|
Term
| which severe consequence is associated with spinal cord injury at or above T6? |
|
Definition
| autonomic dysreflexia. if not rx promptly it can lead to seizures stroke and even death |
|
|
Term
| indications for surgical referral in joint pain? |
|
Definition
progressive loss of mobility
tendon rupture
nocturnal pain |
|
|
Term
| contraindication to knee surgery replacement? |
|
Definition
sepsis in knee
poor knee extensor function
relative CI
past hx of knee osteomyelitis
infection around incisional line area
obesity |
|
|
Term
| post op care after knee replacement? |
|
Definition
early mobilisation within 24 hours is encourage
most pt walks on 2nd post op day |
|
|
Term
| driving and knee replacement? |
|
Definition
if left knee and car automatic then driving can be resume in 1 week
if manual and right knee then 4-6 weeks after you may start driving |
|
|
Term
| complications of knee joint replacement? |
|
Definition
VTE
infection
patellofemoral instability
vascular complications
aseptic loosening |
|
|
Term
| what do you know about omega 3? |
|
Definition
there are long chain ones from oily fish
there are short chain ones from plants
our body uses the long chain ones.
just 1 portion of oily fish a week (2 portions of fish in total 1 of which should be oily fish) can help your heart and possibly your brain and joints. |
|
|
Term
| many people swear by cod liver oil. is it true that they lubricate your joints? |
|
Definition
No this is not true.
But they have been found to reduce pain and inflammation if you suffer from RA. They are also showing promise in people who suffer from OA, the type we associate with wear and tear. |
|
|
Term
| what might evening primrose oil be used for? |
|
Definition
|
|
Term
| what does acupuncture involve? |
|
Definition
inserting small needles into various points in the body to stimulate nerve impluses.
western acupuncture can be used as an analgesic or anaesthetic agent. |
|
|
Term
| what problems could acupuncture be considered for? |
|
Definition
headaches and migraine
neckpain
nausea and vomiting during chemo
back pain
P6 accupoint stimulation for nausea and vomiting post op or during pregnancy |
|
|
Term
| side effects of accupunture |
|
Definition
|
|
Term
| what is the relevance of THR logo on herbal medicines? |
|
Definition
this is the Traditional Herbal Registration. any medicines that have been approved can carry this logo. Herbal medicines aren't regulated so you cannot tell about the dose and purity of the medicines.
By carrying this logo you can tell the product has the correct dose and is of high quality. |
|
|
Term
| uses for evening primrose? |
|
Definition
PMS
breast pain
endometriosis
hot flushes |
|
|
Term
cannabis and its uses
what is name of the cannabis spray that can be used as a muscle relaxant? |
|
Definition
for muscle spasm, cancer pain
Sativex is the name of the spray. it contains dronabinol and cannabidiol |
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