Spine D/os, Neurodevelopmental D/os

Front 1

radiculopathy: defn

Back 1

Spinal pain radiating into a limb, implying nerve root impingement

Front 2

Axial pain: defn

Back 2

neck or back pain without radiation. most common condition seen in a general practice.

Front 3

myelopathy cannot occur below level _____

Back 3

L1-2 (spinal cord ends at the conus medullaris)

Front 4

Nerve root involvement is characterized by what?

Back 4

Decreased reflex in a characteristic pattern for EACH NERVE ROOT.

Front 5

Hallmark of sensory polyneuropathy

Back 5

glove and stocking distribution of sensory loss

Front 6

diabetic amyotrophy: defn

Back 6

Neuropathy that looks like a severe lumbar radiculopathy.

Pain beginning in low back or hip and spreading into thigh and knee. Severe muscle weakness and atrophy in the thigh often develops. There is a burning character to the sensation but it's generally intact or only mildly impaired.

Front 7

Cervical dermatomes:

1) Motor Signs (weakness)
2) Reflex signs
3) Sensory loss

for C5

Back 7

1) Weakness in deltoid
2) None
3) Sensory loss in shoulder

Front 8

Cervical dermatomes:

1) Motor Signs (weakness)
2) Reflex signs
3) Sensory loss

for C6

Back 8

1) Weakness in biceps
2) Diminished/loss of biceps reflex
3) Thumb/Thenar compartment

Front 9

Cervical dermatomes:

1) Motor Signs (weakness)
2) Reflex signs
3) Sensory loss

for C7

Back 9

1) Weakness in triceps
2) Diminished/loss triceps reflex
3) Index and middle finger

Front 10

Cervical dermatomes:

1) Motor Signs (weakness)
2) Reflex signs
3) Sensory loss

for C8

Back 10

1) Weakness in interossei muscles of hand
2) Horner's syndrome
3) Ring and pinkie

Front 11

RULE OUT THE FOLLOWING serious illnesses/ syndromes re: back

Back 11

1) Cord compression : acute or chronic
2) Profound or progressive weakness
3) Malignancy
4) Infection

Front 12

Cord compression: signs

Back 12

1) Spasticity
2) Hyperreflexia and Clonus
3) Loss of fine motor control in hands
4) Diffuse Weakness of Arms and/or Legs
5) Sensory Level - helps localize
6) Loss of Bowel/Bladder Control : especially urinary retention in acute compression

Front 13

Cervical roots supply sensation to __________

Back 13

neck and arms

Front 14

Lumbar roots supply sensation starting ________

Back 14

below inguinal ligament.

Front 15

T4 is sensation at _______

Back 15

nipple

Front 16

T10 is sensation at _____

Back 16

umbilicus

Front 17

When should metastatic cancer to spine be suspected?

Back 17

1) Patient older than 45

2) H/O cancer

3) Unexplained weight loss

4) Thoracic pain

5) Pain unrelieved or worse by bed rest.

Front 18

cancers commonly mets to spine

Back 18

Breast
Lung
Thyroid
Lymphoma
Kidney
Prostate

Front 19

T/F Metastatic pain is often worse at night in bed, unlike degenerative spinal pain

Back 19

T

Front 20

T/F Metastasis gives some warning of axial pain before development of neurologic symptoms, which may rapidly progress and be irreversible.

Back 20

T

Front 21

Metastasis to spine: Tx

Back 21

Radiation > Laminectomy

Can do both in appropriate patients.

Front 22

DISCITIS - at risk patients

Back 22

IV Drug users

Children

Postop discectomy patient

Front 23

DISCITIS - SYMPTOMS & SIGNS

Back 23

a) Severe axial pain with/out radicular pain

b) Severe paraspinal spasm

c) Exquisite percussion tenderness

Basically severe pain elicited by any movement of spine.

Front 24

T/F Discitis is often accompanied by fever.

Back 24

F. fever is rare.

Front 25

Discitis: lab results

Back 25

USUALLY NORMAL WBC.

Elevated CRP and sed rate.

Front 26

Discitis: tx

Back 26

ABX

Bed Rest

Surgical debridement

Front 27

EPIDURAL ABSCESS - SYMPTOMS

Back 27

Cord compression

Pain

Percussion tenderness

Fever

Much more serious than discitis, presents as PARALYSIS plus PAIN.

Front 28

EPIDURAL ABSCESS - Dx

Back 28

MRI is best

Plain films are usually normal.

Front 29

EPIDURAL ABSCESS - Treatment

Back 29

Surgical debridement followed by Abx.

Deficit is often irreversible, but early intervention may help.

Front 30

NECK OR BACK PAIN - MOST COMMON CAUSES

Back 30

Muscular pain

Degenerative disease

Front 31

RADICULAR PAIN -  COMMON CAUSES

Back 31

Muscular Spasm
Herniated Disc
Arthritic Spur

Front 32

____% of patients with muscular injury (severe pain, stiffness, and spasm) will be well within 3 weeks; ___% within 8 weeks.

Back 32

70; 90

Front 33

Chronic version of muscular back injury is _____

Back 33

myofascitis

Front 34

Facet hypertrophy of lumbar spine (due to OA) causes what syndrome?

Back 34

neurogenic claudication

Front 35

4 things present in neurogenic claudication and not in vascular claudication.

Back 35

1) Back pain

2) Need to squat or lie down rather than stand still to relieve pain

3) Stooped walk

4) Good peripheral pulses

Front 36

worsens with cough, sneeze,
and valsalva
Pain is positional in nature


Characteristic of what?

Back 36

disc disease

Front 37

Nerve stretch tests look for __________.

Back 37

neural impingement

Front 38

2 nerve stretch tests

Back 38

1) Straight leg raise

2) Spurling's maneuver

Front 39

Spurling's maneuver: defn

Back 39

very specific and sensitive physical examination maneuver in diagnosing cervical spondylosis or acute cervical (neck) radiculopathy.

extending the neck, rotating the head, and then applies downward pressure on the head. The test is positive when the pain arising in the neck radiates in the direction of the corresponding dermatome ipsilaterally.

Front 40

STANDARD CONSERATIVE THERAPY for muscular axial spin pain

Back 40

1) PT or chiropractor

2) NSAIDs

3) Activity as tolerated

Front 41

activity instructions for acute low back pain

Back 41

Continuing ordinary activities within limits permitted by the pain leads to more rapid recovery than either bedrest or backmobilizing exercises.

Patients should rest as needed.

Front 42

When should special imaging be ordered in back pain?

Back 42

Development of<b> significant weakness or bladder/bowel dysfunction.</b>

Front 43

Gold standard for evaluating nerve root impingement

Back 43

myelogram

Front 44

Radicular symptoms with nerve root compression will start to respond to conservative therapy within ___ weeks

Back 44

2-3

Front 45

Provides best view of cord

Back 45

MRI

Front 46

Provides best bony detail

Back 46

CT

Front 47

SURGICAL INDICATIONS FORRADICULOPATHY

Back 47

1) Bowel/bladder dysfunction

2) Profound weakness

3) Failure to respond to conservative tx

Front 48

What is the goal of surgery for radicular back pain?

Back 48

to reduce compression of cord or nerve roots.

This is why it helps with limb pain rather than axial pain.

Front 49

Lower back surgery: what is it?

Back 49

Posteriorly with a <b>discectomy</b>.

More extensive boney compression removed with a <b>multilevel laminectomy</b>.

Front 50

Neck/cervical surgery: what is it?

Back 50

Anteriorly with a discectomy and fusion
Posteriorly with a foraminotomy or laminectomy

Front 51

Discectomy : success rate after 10 years

Back 51

93-95%

Front 52

___% of surgical patients have failed back syndrome

Back 52

5

Front 53

failed back syndrome: defn

Back 53

persistent pain following back surgeries

Front 54

Surgical success is dept on primary complaint of _________

Back 54

limb pain

Front 55

Surgical success is dept on pain in what kind of distribution?

Back 55

dermatomal

Front 56

Complications of back surgery

Back 56

1-5% RISK OF
INFECTION
NEW NUMBNESS OR WEAKNESS
CSF LEAK

5-15% RISK OF
FAILURE TO HELP SYMPTOMS IN PROPERLY SELECTED PATIENTS

Front 57

______ particularly due to a pars defect has a high rate of successful pain relief with fusion

Back 57

spondylolisthesis

Front 58

Spinal Cord Stimulation: defn and rationale

Back 58

Uses Gate Theory of Pain.

Electrodes placed in the epidural space over the thoracic spinal cord connected to a generator in abdomen or buttock

“Try it before you buy it” - must have successful percutaneous trial.
Was effective only for leg pain, newer electrodes may be effective for back pain as well

Front 59

FOR RADICULOPATHY WITHOUT CORD COMPRESSION, PROFOUND WEAKNESS OR BLADDER INVOLVEMENT
: what is the progression of intervention?

Back 59

1) Conservative treatment first

2) Further imaging for conservative tx failure

3) Sx for nerve root decompression

Front 60

Fluid filled cyst or areas within spinal cord

Back 60

Syrinx

Front 61

Dural AV fistula: what is it?

Back 61

Most common type of spinal AVM in adults. Easy to treat surgically.

Front 62

Acute cord compression: symptoms

Back 62

Urinary retention

Profound weakness

Sensory level

Front 63

Sx for radiculopathy is very successful if __________

Back 63

imaging studies corroborate nerve root compression and radiculopathy is biggest complaint.

Front 64

Nonprogressive Impairment of movement and posture since birth or early infancy

Back 64

cerebral palsy

Front 65

Although characterized by their motor dysfunction, children with cerebral palsy frequently have other associated impairments, which include __________

Back 65

language delay, seizures, strabismus, dysphagia, orthopedic deformities, and cognitive problems.

Front 66

prevalence of cerebral palsy

Back 66

~1/500

Front 67

T/F Evidence suggests that 70% to 80% of cerebral palsy cases arise from antenatal factors and that birth asphyxia contributes approximately 10% of cases

Back 67

T

Front 68

T/F Most children with cerebral palsy are born pre-term.

Back 68

F. Majority (>50%) are born at term.

Front 69

Lissencephaly: defn

Back 69

literally means smooth brain, is a rare brain formation disorder caused by defective neuronal migration during the 12th to 24th weeks of gestation resulting in a lack of development of brain folds (gyri) and grooves (sulci).

Front 70

Prenatal/prepregnancy risk factors statistically correlated with CP include the following:
(6)

Back 70

1) Maternal thyroid disorder

2) Previous SAB

3) Previous loss of newborn

4) Maternal MR

5) Maternal seizure d/o

6) H/O delivery of a low birthweight baby, or with motor deficit, MR, or sensory deficit

Front 71

Factors during pregnancy that also are correlated statistically with CP include the following:

(6)

Back 71

Polyhydramnios
Treatment of the mother with thyroid hormone
Treatment of the mother with estrogen or progesterone
A fetus with congenital malformation
Maternal seizure disorder, severe proteinuria, or high blood pressure
Bleeding in the third trimester

Front 72

During the perinatal period, infants of mothers whose placentas show evidence of _____ were more likely than others to have CP

Back 72

chorionitis (increases prematurity risk - unclear if it's direct or indirectly related)

Front 73

T/F Multiple gestation pregnancy is unrelated to cerebral palsy.

Back 73

F. It is a risk factor. May be due to prematurity, or IUGR.

Front 74

Spastic diplegia: defn

Back 74

form of cerebral palsy (CP) that is a neuromuscular condition of hypertonia and spasticity in the muscles of the lower extremities of the human body, usually those of the legs, hips and pelvis.

Front 75

Most common form of cerebral palsy

Back 75

Spastic diplegia

Front 76

Spastic quadriplegia: defn

Back 76

version of spastic diplegia that affects all four limbs (arms and legs) rather than just the legs. It is defined by spasticity, rather than the paralysis that defines quadriplegia

Front 77

Spastic hemiplegia: defn

Back 77

Unilateral spasticity

Front 78

3 major types of cerebral palsy

Back 78

1) Bilateral spasticity
2) Unilateral spasticity
3) Extrapyramidal (dyskinetic)

Front 79

Extrapyramidal (dyskinetic) cerebral palsy: characteristics

Back 79

Athetoid cerebral palsy or dyskinetic cerebral palsy is mixed muscle tone – both hypertonia and hypotonia mixed with involuntary motions.

Have bradykinesia, dystonia, choreoathetosis, and hemiballismus.

Front 80

choreoathetosis: defn

Back 80

occurrence of involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing).

Front 81

athetosis : defn

Back 81

symptom characterized by involuntary convoluted, writhing movements of the fingers, arms, legs, and neck.

Front 82

______ cerebral palsy has a pattern of arm affected greater than leg.

Back 82

Hemiplegic

Front 83

Overwhelmingly spastic diplegia is a disorder of _______.

Back 83

the premature infant

Front 84

Independent ambulation and normal intelligence should be expected in this CP

Back 84

Spastic hemiplegia

Front 85

characterized by abnormalities of voluntary movement involving balance and position of trunk and limbs in space

Back 85

ataxic cerebral palsy

Front 86

5 commonly associated problems with cerebral palsy

Back 86

Mental retardation
Epilepsy
Vision and/or hearing impairment
Swallowing dysfunction (dysphagia)
Strabismus

Front 87

Cerebral palsy: Early postnatal motor signs

Back 87

poor head or trunk control, persistent or asymmetric fisting, or obligatory extensor postures

Front 88

Cerebral palsy: Early neurobehavioral signs

Back 88

are excessive docility or irritability

Front 89

earliest indication of significant motor disability

Back 89

delayed disappearance of a primitive reflex or the presence of one to an abnormal degree.

Front 90

tonic labyrinthine response : defn

Back 90

the neck is extended when supine and leads to shoulder retraction, leg extension, and either elbow flexion or extension and pronation of the arms. Flexion of the neck causes flexion of the extremities.

Front 91

Cerebral palsy: etiology

Back 91

evidence of ischemic injury is noted most commonly.

Front 92

Which form(s) of CP is most likely to have an abnormal CT scan?

Back 92

Hemiplegic
Ataxic
(about 90% for both)

Front 93

Which form(s) of CP is least likely to have an abnormal CT scan?

Back 93

Dyskinetic (about 35%)

Front 94

T/F Maternal thyroid function may be very important in development of CP

Back 94

T

Front 95

______ has been considered a neuroprotective therapy in term neonates with perinatal asphyxia due to its ability to slow the cascade of hypoxic-ischemic injury

Back 95

Selective head cooling

Front 96

_______________ may be the source of highest morbidity leading to aspiration and limiting caloric intake in CP

Back 96

Gastroesophageal reflux

Front 97

Spasticity tx in CP

Back 97

Variety of muscle relaxants used: baclofen, diazepam, tizanidine, botox

Neurosurgical procedures including dorsal rhizotomy, intrathecal baclofen pump

Front 98

Dystonia/dyskinetic variant of CP: tx

Back 98

L-DOPA, trihexyphenydyl

Front 99

Pervasive developmental disorders: primary features

Back 99

impairment of social reciprocity, impaired communication and restricted and repetitive interests and activities

Front 100

Pervasive developmental disorders: names

Back 100

autistic disorder, Asperger disorder, pervasive developmental disorders not otherwise specified, Rett disorder, and childhood disintegrative disorder.

Front 101

Autism: defn

Back 101

Abnormal/impaired development in social interaction and communication skills evident in 1st 3 years

Front 102

Dx criteria for autism

Back 102

(1) qualitative impairment in social interaction
(2) qualitative impairment in communication
(3) restricted, repetitive, and stereotyped patterns of behavior, interest, and activities

Front 103

Dx criteria for Asperger's

Back 103

(1) qualitative impairment in social interaction
(2) restricted, repetitive, and stereotyped patterns of behavior, interest, and activities
(3) no clinically significant general delay in language (eg, single words by age 2 years, communicative phrases used by age 3 years)
(4) no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (except social interaction), and curiosity about the environment in childhood. In addition, there is clinically significant impairment in social, occupational, or other important areas of functioning

Front 104

Autism - Etiologies

Back 104

only certain in 15-20% of cases.

changes in cerebellar volume are associated

Front 105

Autism: tx

Back 105

Predominantly behavioral.

Early education interventions/special programs are particularly helpful

Some psych meds used: SSRIs, stimulants, anti-seizure drugs

Front 106

Rett syndrome: defn

Back 106

After normal early development, girls with Rett syndrome lose acquired skills within 6-30 months. Loss of acquired speech. Seizures age 3-4.

Front 107

Rett syndrome: stages

Back 107

Stage I: Apparently normal development (6-18 months)

Stage II: Regression period with stereotypy and autistic features

Stage III: Seizures and ataxia occur (age 3)

Stage IV: Severe disability and scoliosis

Front 108

Rett Syndrome: cause

Back 108

mutations in X-linked MECP2, encoding methyl-CpG-binding protein 2

Front 109

Childhood Disintegrative Disorder : defn

Back 109

Rare form of autism. Strong male preponderance.

Avg age of onset is 3-4 yo. Until then, child is developing normally. Then regression occurs with dramatic loss of vocabulary skills.

Front 110

Gender predominance in
A) Rett Syndrome
B) Childhood Disintegrative Disorder
C) Intellectual disability/MR

Back 110

A) Girls
B) Boys
C) Boys

Front 111

Intellectual disability/ MR: what type is most common?

Back 111

mild is more common than severe

Front 112

What are the IQ point ranges for the following:
A) Profound MR
B) Severe MR
C) Moderate MR
D) Mild MR
E) Borderline intellectual functioning

Back 112

A) below 20
B) 20-34
C) 35-49
D) 50-69
E) 70-79

Front 113

Proton MR spectroscopy measures what? What is it used for?

Back 113

Proton MR spectroscopy measures the resonance of molecules in the brain. Can allow for analysis of amount of metabolic products in brain (eg., cerebral lactate in mitochondrial disorders, creatine deficiency in other disorders)

Front 114

Pelvic nuclear and x-irradition during pregnancy can lead to what?

Back 114

MR, especially between 7-15 weeks gestation

Front 115

dyslexia: defn

Back 115

more frequent in girls than boys and may run in families. An individual with dyslexia may mix up letters within words and sentences while reading. He may have difficulty spelling words correctly while writing. Letter reversals are common. Sequencing tasks may be difficult.

Front 116

dysgraphia: defn

Back 116

unintelligible handwriting and spelling problems.

Front 117

dyscalculia: defn

Back 117

difficulty understanding and using math concepts and symbols

Front 118

dyspraxia: defn

Back 118

a person with dyspraxia may mix up words and sentences while talking. There is often a discrepancy between language comprehension and language production.

Front 119

ADHD: symptoms

Back 119

inattention, hyperactivity, and impulsivity. These symptoms appear early in a child's life.