Term
| What are the 4 main categories of acute/chronic regional back pain? |
|
Definition
| Infection, Neurologic, MSK, Vascular |
|
|
Term
| Which of the following are major Red Flags for Back Pain: a) Fever, b)Pain less than 6 weeks, c) Night Sweats, d)Never used drugs, and e) 37.63 years old. |
|
Definition
a) Fever- YES
b)Pain less than 6 weeks- NO
c) Night Sweats-YES
d) Never used drugs-NO
e) 37.63 years old- NO |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt presents with Fevers, Chills, and Night Sweats, with neck stiffness and swelling? What if Tachycardia present with bulging of the pharyngeal wall? |
|
Definition
| Infection that is Superficial; Deep infection |
|
|
Term
| What are the 3 spaces for potential infection in the neck (R.D.P.)? |
|
Definition
| Retropharyngeal, Danger, Prevertebral |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt presents with pain in neck disproportionate to exam, Dyspnea (shortness of breath), voice change, and Stridor (Wheezing)? |
|
Definition
|
|
Term
| For what does Brudzinski's and Kernig test? What kind of pathology is it specifically (Infection, Neurologic, MSK, Vascular)? What indicates a positive in each test? |
|
Definition
| Meningitis; Deep Infection; Brudzinski's = knees elevate when head raised, Kernig = pain behind knee when attempting to straighten a flex knee. |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Elderly Pt presents with minor trauma to neck, w/ saddle anesthesia, bladder incontinence, and perianal sensory loss? |
|
Definition
|
|
Term
| What is the mechanism of injury for OAD (Occipito - Atlantal Dislocation)? What is the survivability of such injuries? |
|
Definition
| Ligamentous instability due to hyperextension and hyperflexion (Whiplash); High Mortality Rate |
|
|
Term
| What are the two common causes of cervical radiculopathy? What two disk sets are most commonly affected? What roots? |
|
Definition
| Cervical narrowing (arthritis), Cervical Disk Lesion; C5-C6 and C6-C7; Root C7 and C8 |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt presents with weakness in extremity, neck stiffness, radiating arm pain, reduced ROM. What is it specifically? |
|
Definition
| Neurological- Cervical Radiculopathy |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Rigorous workout, "slept funny", poor posture at desk, ATSU classroom chairs typically led to which etiology? |
|
Definition
|
|
Term
| Which cervical vertebra is most often injured? More males or females overall? |
|
Definition
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt presents with a tear-drop fracture of vertebral body after severe trauma, with radiating pain and global sensory motor deficits. |
|
Definition
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt presents with a headache, cranial nerves palsies, and a bruit (pulsing) sound upon auscultation. |
|
Definition
| Vascular- Vertebral Artery Insufficiency |
|
|
Term
| What is Discitis? What are key indicators in the history? Is it acute or chronic? |
|
Definition
| Infection of Vertebral Discs; Fever, night chills and pain; chronic |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Elderly Pt presents with limited motion of neck in the morning, stiff legs, urinary dysfunction, and electrical shocks with cervical flexion. What is it specifically? |
|
Definition
| MSK/Neurological- specifically, Cervical Spondylosis with Myelopathy (CSM) |
|
|
Term
| A positive Babinski's sign in an adult is indicative of what neurological condition? |
|
Definition
| CSM- Cervical Spondylotic Myelopathy |
|
|
Term
| What are the 4 special signs and tests for cervical myelopathy? |
|
Definition
| 1) Wasting of the shoulder girdle, 2) Myelopathic hand (atrophic intrinsic hand muscles), 3) Finger escape sign (splayed hand for 1 min), 4) Grip and Release Test (make 20 fists in 10 seconds). |
|
|
Term
| Static mechanical, dynamic mechanical, and spinal cord ischema factors are important pathophysiological components to what pathology? |
|
Definition
| CSM- Cervical Spondylotic Myelopathy |
|
|
Term
| Would you expect muscle wasting to be unilateral in cervical radiculopathy or myelopathy? How about hyper muscle stretch reflexes? |
|
Definition
| Cervical Radiculopathy; Myelopathy |
|
|
Term
| In addition to fever and night pain/sweats, what other symptom is expected if thoracic discitis that is relieved by flexing forward? |
|
Definition
|
|
Term
| Infection, Neurologic, MSK, Vascular: What is Osteomyelitis? Chronic or acute? |
|
Definition
|
|
Term
| What is Functional Thoracic Kyphosis? |
|
Definition
| Hump in thoracic region due to repeated posture (ie- hunched over desk). |
|
|
Term
| Unexplained weight loss (10 kg in 6 mo), not 17-50 yrs old, night pain, and no improvement with therapy for back pain may be Red Flags for what? |
|
Definition
|
|
Term
| If an elderly person has a normal temperature, does that mean that infection can be ruled out? |
|
Definition
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt presents with saddle anesthesia, urinary incontinence, muscle weakness, and a foot drop. What is it specifically? |
|
Definition
| Neurological- Lumbar- Cauda Equina Syndrome |
|
|
Term
| What kind of symptoms can be expected with a herniated lumbar disc? |
|
Definition
| unilateral leg pain, pain worse with sitting, positive straight leg raise test |
|
|
Term
| Infection, Neurologic, MSK, Vascular: Pt has low back pain and a history of osteoporosis. The Red Flag is specifically for what? |
|
Definition
|
|
Term
| Infection, Neurologic, MSK, Vascular: Elderly Pt presents with low back pain, even at rest, groin pain, abdominal pulsating mass, with a history of atherosclerotic disease. What is it specifically? |
|
Definition
| Vascular- Abdominal Aortic Aneurysm |
|
|
Term
| With DDD (Degenerative Disc Disease) or Root Compression, what is the term for leaning to one side due to muscle spasms? |
|
Definition
|
|
Term
| How does Spondylosis differ from Spondylolisthesis? |
|
Definition
| Spondylosis is a fracture in the vertebral arch (often lamina); Spondylolisthesis occurs onced the vertebral body is displaced. |
|
|
Term
| Elderly patient comes in with weakness or stiffness in the legs, unsteady gait, and clumsiness of the hands. Hyperreflexia is observed, ankle clonus, bilateral muscle wasting,and + Babinski sign is observed. What is the pathology? |
|
Definition
| Cervical spondylosis mylopathy |
|
|
Term
| Osteophytes spurs have developed, osteophyte overgrowth, buckling of the ligamentum flavum are all issues of (static mechanical or dynamic mechanical) of associated characteristics of cervical spondylosis mylopathy |
|
Definition
|
|
Term
| Patient complains of back pain with fevers, chills and night pain that interrupts sleep. Upon physical, the psoas sign is evident, there is also painful percussion over the spine What is the pathology? |
|
Definition
|
|
Term
| Patient comes in with pain in the thoracic region. Patient notes during the history and physical portion that patient has a history of kidney problems. Where might the pain generally actually originate from? |
|
Definition
| Abdominal area due to pylonephritis |
|
|
Term
| Patient comes in with pain in the thoracic cavity. Upon history of physical examination there is noted pain upon inhalation. Patient notes pain gets better with rest. What is the likely pathology? |
|
Definition
| Thoracic somatodysfunction |
|
|
Term
| Patient comes in with back pain. There is noted tenderness in the middle back, ROM for patient is painful. In the history portion patient reports lifting a heavy object. What is the likely etiology? |
|
Definition
|
|
Term
| Patient comes in with fever. Upon examinatino portion, hyperemia and swelling over the area of the back is noted. Patient had back surgery not to long ago. Upon microscopic examination. Patient tests for a gram postitive, coagulase positive, catalase positive organism. What is the likely pathology? |
|
Definition
|
|
Term
| Patient comes in with back pain. Upon inspection there is a noted lateral curve in the thoracic region. What is the likely pathology? |
|
Definition
|
|
Term
| Patient comes in looking like they have a variation of a stressed posture. Upon physical inspection. the pectoralis major and the latismus dorsi are noted for muscle hypertonicity. What is the likely pathology? |
|
Definition
| Functional thoracic kyphosis |
|
|
Term
| Patient comes in with neck pain. Upon history trismus is noted, tachycardia, neck swelling, fever/swells, and a bulging of the pharangeal wall. What is the likely etiology? |
|
Definition
|
|
Term
| Patient comes in with neck pain and a sore throat. voice change is noted upon inspection. What is the most likely etiology? |
|
Definition
|
|
Term
| Patient comes in with a headache in the occipital region. Upon physical inspection, there is a noted bruit. What is the most likely pathology? |
|
Definition
| Vertebral artery insufficiency |
|
|
Term
| Patient comes in with lower back pain in association with unilateral groin pain and leg pain. Patient complains the pain is worse when they are sitting and upon examination shoots up in pain when a straight leg test is performed. What is the likely pathology? |
|
Definition
|
|
Term
| Patient comes in with buttock pain. There is noted tenderness in the low back region. Reflexes are noted to be normal. What is the likely pathology? |
|
Definition
|
|
Term
| Patient comes in with pain that radiates to both buttocks. A noted "listing" is observed during the physical. What is a likely pathology? |
|
Definition
| DDD or nerve root compression/both |
|
|
Term
| Name at least 3 risk factors for Osteoporosis. |
|
Definition
| Age, low Calcium or Vit D, Excess Vitamin A, High caffeine and salt, aluminum, alcohol, little physical activity, smoking, fall, thinness |
|
|
Term
| What is the recommended intake of Calcium (mg/day) and Vitamin D (units/day) for a 25 year old? 75 rear old? |
|
Definition
| 1000 and 600; 1200 and 800 |
|
|
Term
| What is needed to convert Vitamin D3 to Cholecalciferol? Where is Cholecalciferol converted to 25-OH-cholecalciferol? Where is 25-OH-cholecalciferol converted to 1,25-(OH)2-cholecalciferol (Calcitriol)? What type of patient is ideal to receive commercially synthesized Calcitriol? What does Calcitriol do for calcium? |
|
Definition
| UV light; Liver; Kidney; Pt w/ Renal Failure; increased absorption in GI tract and decreases excretion in kidneys to improve osteoblast/clast activity |
|
|
Term
| Are bisphosphonates, Salmon Calcitonin, RANK Ligand (Denosumab), and estrogen based treatments- bone anabolic or bone anti-resorptive in action? |
|
Definition
| Bone Anti-resorptive in action |
|
|
Term
| What drugs class inhibits farnesyl pyrophosphate synthase, resulting in osteoclast apoptosis? What is the name stem for these drugs? |
|
Definition
| N-BP (Nitrogen containing Bisphosphates); "dronate" |
|
|
Term
| What type of drugs can result in severe espophageal irritation, often requiring pt to stand or sit up-right for 30 minutes? What is the half-life of these drugs? Is it possible to administer to pt w/ renal failure? |
|
Definition
| Bisphosphates; 10 years; Yes, through an IV (Zoledronic acid) yearly |
|
|
Term
| What is the term for prolonged inhibition of bone remodeling? |
|
Definition
|
|
Term
| Why would we want to use calcitonin from a Salmon be used at all? |
|
Definition
| Longer acting that human calcitonin to support BMD |
|
|
Term
| What drug inhibits the RANK Ligand and ultimately osteoclast formation and activity? What is the safe duration of therapy for this drug to avoid adverse reactions such as osteonecrosis of the jaw or hypocalcemia? |
|
Definition
| Denosumab; Unknown duration for safe therapy |
|
|
Term
| Why is Raloxifene or Bazedoxifene (Duavee) preferable to just straight estrogen for osteoporosis treatment? |
|
Definition
| Fewer side effects due to agonist/antagonist activity (agonist- inhibit osteoclasts, antagonist- at estrogen receptors in breast/uterine tissues) but not as effective as other treatments. |
|
|
Term
| What drug has bone anabolic action for the treatment of osteoporosis? What human body hormone does it specifically mimic? |
|
Definition
| Teriparatide (34 amino acids); PTH ( 84 amino acids) |
|
|
Term
| What is the main "Black Box" risk for using Teriparatide to treat osteoporosis? What is the safest maximum time for use? |
|
Definition
| Osteosarcoma; 2 year maximum |
|
|
Term
| Pain stimulation outside the Anterolateral pathway through the Spinomesencephalic tract to the amygdala can help explain what component of pain? The Spinohypothalamic tract? |
|
Definition
| Emotional Component; Neuroendocrine and Cardiovascular Responses |
|
|
Term
| The Neospinothalamic tract projects from the brainstem to what region of the Thalamus? How about the Paleospinothalamic (from brainstem to what area of the Thalamus)? Which is preferred for "fast" pain fibers (A-delta)? |
|
Definition
| Lateral Thalamus (Neo); Medial Thalamus (Paleo); Neospinothalamic tract |
|
|
Term
| What are the 3 main cortexes that receive sensory information? What is there What does each do? |
|
Definition
| Somatosensory- primary input; Cingulate- Limbic; Insular- pain response modulation |
|
|
Term
| What often occurs if there is a lesion on the Insular Cortex? |
|
Definition
| Patient can feel and discriminate pain types, but does not elicit the expected emotional response |
|
|
Term
| What is Thunberg's illusion? It which cortex does this occur? |
|
Definition
| Pain felt with simultaneous stimuli (hot/cold) but not with individual stimuli; Anterior Cingulate Cortex |
|
|
Term
| What two main pathway sites help the body change pain sensitivity? |
|
Definition
| At the nocioreceptor and the CNS synapses |
|
|
Term
| What is the term for an increased sensitivity to pain after experiencing a high level of pain? |
|
Definition
|
|
Term
| In addition to neuropeptides, what is released in the dorsal horn to enhance transduction of pain? Does it occur just in the synapse or does it diffuse like neuropeptides? Why? |
|
Definition
| Glutamate; just in synapse- due to efficient re-uptake mechanisms (unlike neuropeptides) |
|
|
Term
| Glutamate is the neurotransmitter for many pain fiber types, but which receptor is preferred for A-delta fibers, NMDA or AMPA? What fiber would likely use the other? |
|
Definition
|
|
Term
| What channel receptor would you want to specifically block to lessen or stop "Wind-up" from occurring? |
|
Definition
| NMDA (C-fiber)- repetitive firing leads to continued glutamate release |
|
|
Term
| What is an Enkephalin? Where is it release and where does it primarily act? Does it modulate all descending or ascending information? |
|
Definition
| Enkephalin is an endogenous ligand that helps modulate pain; released in the PAG (Periaqueductal Grey Matter) of the midbrain and acts at the dorsal horn; Neither- modulates descending pathway for pain but leaves other sensory pathways intact. |
|
|
Term
| What drug class will inhibit nociceptive firing, similar to encephalins, in the PAG and dorsal horns? |
|
Definition
|
|
