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25 Cards in this Set
- Front
- Back
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Name the dermatome: top of foot
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L5
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Name the dermatome: lateral side of foot (pinky toe)
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S1
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What is does grade 2 reflexes mean?
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Normal reflexes.
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How would you grade no reflexes?
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0
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What are indications for Lumbar Spine X-ray?
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no improvement after 1 month
fever >38C unexplained weight loss prolonged corticosteroid use significant trauma progressive neurologic deficit suspicion of ankylosing spondylitis History of cancer Alcohol or drug abuse |
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Why is history of cancer an indication for lumbar spine x-ray?
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possible mets to bone
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Why is alcohol or drug abuse an indication of lumbar spine x-ray?
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increased risk of osteomyelitits, trauma, fracture
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T/F plain film x-ray is gold standard for initial investigations for px presenting with LBP?
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False. Not gold standard. Not recommended.
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What differentiates acute from chronic LBP?
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Acute < 4wks
Chronic > 12wks |
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Px presents with chronic LBP.
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1. prescribe physical or therapeutic exercise
2. consider analgesics, referrals to community-based programs and CATs |
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What are your analgesic options for px with chronic LBP
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1. Acetaminophen
2. NSAIDs 3. Low-dose TCAs 4. short term cyclobenzaprine (for flare-ups) If severe: Opiods |
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Px presents with LBP lasting 4 months. He maintains his work as a shift-worker on 'light duties'. He enjoys drinking on the weekend. He is allergic to acetaminophen. What do you advise for pain management?
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NSAIDs with PPI
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What are 3 red flag symptoms associated with LBP?
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- Cancer, unexplained weight loss, fever
- Immunosuppression, prolonged use of steroids IV drug use - UTIs, bowel/bladder incontinence, bladder retention with overflow incontinence) - Pain, severe and worsening, not relieved by rest - Age >50 - Widespread neurological signs |
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What are 3 yellow flag symptoms
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psycho: belief that pain and activity are harmful, sickness behavoirs, low mood, social withdrawl
claims: problems with claims/compensation, hx back-pain, time off, other claims work: poor job satisfaction social: overprotective family or lack of support |
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On average, how long does LBP last?
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a few weeks.
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What does a positive Waddell sign indicate?
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suspicion that chronic LBP may be psychological (rather than organic)
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What is are the diagnostic categories of Waddell sign? How many do you need to have a positive sign?
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Presence of 3 of the following categories:
1. Tenderness tests (superficial, nonanatomic) 2. Simulation tests (sham maneuvers = axial loading, rotation) 3. Distraction tests (redo straight leg test, still +?) 4. Regional disturbances (weakness, sensory) 5. Overreaction |
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Name 3 other healthcare professionals you might refer a px with LBP to
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1. physiotherapist
2. chiropractor 3. osteopath 4. aqua therapist |
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How might you differentiate a discogenic LBP from a non-discogenic LBP?
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Straight Leg raise test (discogenic is positive) - with sciatic involvement
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What does mechanical LBP mean?
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source of pain in spine or structures that support the spine including:
vertebrae, discs, joints, ligaments, nerves, meninges |
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What is a positive straight-leg test? What does it suggest?
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patient supine. raises leg until painful. if between 30-60 degrees off the table it is positve.
positive straight-leg tests suggests disc herniation in contralateral side |
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What does a positive Lasegue's sign suggest?
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nerve root + sciatic nerve irritation
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What is discogenic pain?
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pain arising from degeneration in intervertebral discs
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What are symptoms that might suggest discogenic LBP?
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pain worsens with movements that increase intradiscal pressure: sitting, sneezing, coughing, spine extension
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What reflex does S1 mediate?
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Achilles Tendon
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