Chronic Low Back Pain Quiz
113 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which factor is NOT typically associated with the development of chronic low back pain?

  • High levels of physical fitness (correct)
  • Obesity
  • Aging
  • Smoking

What signifies discogenic low back pain as distinct from a herniated disc?

  • Severe nerve damage
  • Intact disc fibres (correct)
  • Absence of inflammation
  • Presence of disc herniation

What leads to the inflammatory response in discogenic low back pain?

  • Increased hydration of the disc
  • Formation of scar tissue in the annular fibres
  • The presence of relaxing chemicals in the nucleus pulposus
  • Inflammatory chemicals traveling into annular fibres and damaged end plates (correct)

Which of the following statements about the aging process and disc degeneration is accurate?

<p>About 60% of individuals in their 70s show signs of degeneration with little correlation to symptoms. (A)</p> Signup and view all the answers

What role do sinuvertebral nerves play in discogenic low back pain?

<p>They can burrow into the nucleus pulposus if the disc is severely damaged, leading to pain. (A)</p> Signup and view all the answers

What is a hallmark characteristic symptom indicative of a specific back condition?

<p>Pain in the back (C)</p> Signup and view all the answers

Which movement is likely to aggravate lower back pain according to the symptoms described?

<p>Forward bending (A)</p> Signup and view all the answers

Which of the following conditions requires an immediate referral to A&E due to potential complications?

<p>Cauda equina syndrome (A)</p> Signup and view all the answers

Which treatment option is suggested for pain relief in specific back conditions?

<p>Corticosteroid injections (A)</p> Signup and view all the answers

What symptom is NOT associated with cauda equina syndrome?

<p>Chronic migraines (B)</p> Signup and view all the answers

Which of the following is a criterion for the diagnosis of benign hypermobility joint syndrome?

<p>Beighton scale score of ≥4 (D)</p> Signup and view all the answers

What is a common trigger for cervicogenic headaches?

<p>Neck movements (A)</p> Signup and view all the answers

Which condition is associated with easy bruising and joint laxity?

<p>Benign hypermobility joint syndrome (A)</p> Signup and view all the answers

Which of the following statements is true regarding the treatment of back pain?

<p>No gold standard treatment exists. (D)</p> Signup and view all the answers

What sign may you see in patients with cauda equina syndrome?

<p>Dermatomal changes (D)</p> Signup and view all the answers

What is a characteristic symptom of lower motor neuron degeneration?

<p>Fasciculations (B)</p> Signup and view all the answers

Which diagnostic method can show denervation and reinnervation changes?

<p>Electromyography (EMG) (B)</p> Signup and view all the answers

Which condition is characterized by symptoms such as pain, numbness, and weakness in the hand, often triggered by prolonged elbow flexion?

<p>Cubital Tunnel Syndrome (D)</p> Signup and view all the answers

What type of pain is associated with the Lateral Cutaneous Nerve entrapment?

<p>Lateral thigh pain (B)</p> Signup and view all the answers

In advanced cases of motor neuron disease, which of the following may occur?

<p>Dysarthria (C)</p> Signup and view all the answers

Which of the following medications may modestly slow the progression of motor neuron diseases?

<p>Edaravone (D)</p> Signup and view all the answers

Which nerve entrapment syndrome typically occurs due to repetitive strain from typing?

<p>Median Nerve (B)</p> Signup and view all the answers

What symptom occurs in peripheral nerve injuries affecting the sensory component?

<p>Reduced discriminative touch (D)</p> Signup and view all the answers

Which type of tremor is characterized by shaking at rest, such as seen in Parkinson's disease?

<p>Resting tremor (A)</p> Signup and view all the answers

Which type of memory change is characterized by the inability to recall recent events?

<p>Short-term memory (C)</p> Signup and view all the answers

Which nerve is commonly associated with entrapment at the fibular head?

<p>Peroneal Nerve (C)</p> Signup and view all the answers

What is the typical symptom of entrapment of the obturator nerve?

<p>Medial thigh pain (D)</p> Signup and view all the answers

What are tropical signs of peripheral artery disease?

<p>Brittle nails and alopecia (D)</p> Signup and view all the answers

In differentiating leg pain, which type of pain is typically localized and not referred?

<p>Nerve root pain (B)</p> Signup and view all the answers

What are the types of hematomas associated with traumatic brain injury?

<p>Epidural, subdural, and intracerebral (B)</p> Signup and view all the answers

Which of the following is the gold standard for detecting hematomas in traumatic brain injury?

<p>CT scan of the head (D)</p> Signup and view all the answers

What symptoms are indicative of a subarachnoid hemorrhage?

<p>Sudden severe headache and neck stiffness (B)</p> Signup and view all the answers

What is the primary management approach for an aneurysmal rupture?

<p>Clipping or coiling of aneurysms (D)</p> Signup and view all the answers

In the Canadian C-Spine Rule, what age factor requires imaging?

<p>Age ≥65 years (D)</p> Signup and view all the answers

Which of the following would be excluded from the Canadian C-Spine Rule's application?

<p>Patients with a history of vertebral disease (A)</p> Signup and view all the answers

Which criterion mandates imaging in a patient assessed with the Canadian C-Spine Rule?

<p>Age ≥65 years (C)</p> Signup and view all the answers

What condition is commonly associated with polymyalgia rheumatica?

<p>Temporal arteritis (D)</p> Signup and view all the answers

What lab results indicate generalized systemic inflammation?

<p>Increased ESR/CRP levels (D)</p> Signup and view all the answers

Which medical management strategy is used to reduce intracranial pressure?

<p>Mannitol or hypertonic saline (C)</p> Signup and view all the answers

What is a common symptom of peripheral neuropathy?

<p>Loss of vibration sense (C)</p> Signup and view all the answers

What does the Glasgow Coma Scale assess?

<p>Level of consciousness (B)</p> Signup and view all the answers

Which of the following findings would indicate a potential cervical spine injury?

<p>Presence of paresthesias in extremities (A)</p> Signup and view all the answers

What is the classic triad of symptoms associated with vitamin B12 and folate deficiency?

<p>Limb weakness, sore tongue, confusion (C)</p> Signup and view all the answers

Which condition is characterized by progressive weakness developing over days to weeks following a benign illness?

<p>Guillain-Barre Syndrome (A)</p> Signup and view all the answers

Which of the following tests is essential in diagnosing vitamin B12 deficiency?

<p>Vibration and finger/toe repositioning tests (A)</p> Signup and view all the answers

What symptom is often seen with diabetic neuropathy?

<p>Glove and stocking distribution of numbness (D)</p> Signup and view all the answers

What symptom is an early sign of Motor Neuron Disease?

<p>Fasciculations in tongue and limbs (C)</p> Signup and view all the answers

Which treatment modalities are used for Guillain-Barre Syndrome?

<p>Intravenous immunoglobulin and plasma exchange (A)</p> Signup and view all the answers

Which of the following is not a common sign of peripheral arterial disease?

<p>Numbness in the hands (A)</p> Signup and view all the answers

In which stage of Motor Neuron Disease might patients experience speech difficulties?

<p>Late stage (A)</p> Signup and view all the answers

What common complication can arise due to vitamin B12 deficiency?

<p>Peripheral neuropathy (A)</p> Signup and view all the answers

What is a significant feature that distinguishes Guillain-Barre Syndrome from diabetic neuropathy?

<p>Rapid onset of weakness (D)</p> Signup and view all the answers

How is peripheral arterial disease often diagnosed?

<p>Ankle-Brachial Index (B)</p> Signup and view all the answers

Which symptom indicates the presence of diabetic foot?

<p>Skin lesions and ulcers (D)</p> Signup and view all the answers

In what population is Motor Neuron Disease most commonly diagnosed?

<p>Adults aged 55 and above (B)</p> Signup and view all the answers

A typical symptom of Motor Neuron Disease is:

<p>Progressive muscle weakness (A)</p> Signup and view all the answers

What is the primary type of cerebrovascular disease, accounting for 80% of cases?

<p>Ischaemic (A)</p> Signup and view all the answers

What is a classic symptom of generalized seizures?

<p>Loss of conscious awareness (A)</p> Signup and view all the answers

What occurs to neurons during occlusion in cerebrovascular disease?

<p>They die immediately due to lack of blood supply. (A)</p> Signup and view all the answers

Which of the following is NOT a risk factor for epilepsy?

<p>Metabolic syndrome (C)</p> Signup and view all the answers

What defines a simple partial seizure?

<p>Rhythmic jerking motions without consciousness change (B)</p> Signup and view all the answers

What is a major consequence of a slow bleed during a haemorrhagic event?

<p>A haematoma forms and blood becomes toxic to cells. (A)</p> Signup and view all the answers

What is a significant risk factor for both ischaemic and intracerebral haemorrhagic stroke?

<p>Atrial fibrillation (D)</p> Signup and view all the answers

Which of the following best describes the postictal period after a seizure?

<p>State of confusion and potential loss of consciousness (C)</p> Signup and view all the answers

Which medication is considered an anticonvulsant that enhances GABAergic inhibition?

<p>Benzodiazepines (B)</p> Signup and view all the answers

Which symptom is more likely to be associated with a Transient Ischaemic Attack (TIA) than with a full-blown stroke?

<p>Headache (D)</p> Signup and view all the answers

What is the leading risk factor for developing Alzheimer's disease?

<p>Age 65 or older (A)</p> Signup and view all the answers

What is the distinguishing feature of complex partial seizures?

<p>Alteration of consciousness occurs (B)</p> Signup and view all the answers

What is a common symptom of cervical arterial dissection?

<p>Acute tearing pain in neck (D)</p> Signup and view all the answers

Which of the following cognitive impairments is NOT commonly associated with dementia?

<p>Hallucinations (B)</p> Signup and view all the answers

What is the appropriate initial test for assessing carotid artery issues?

<p>Blood pressure measurement (C)</p> Signup and view all the answers

Which symptom is most commonly associated with mild cognitive impairment (MCI)?

<p>Gradual difficulty with memory (D)</p> Signup and view all the answers

What behavior might indicate early stages of dementia?

<p>Obvious self-neglect of personal hygiene (D)</p> Signup and view all the answers

Which of the following management strategies is critical for handling undiagnosed neurological signs?

<p>Referral to a general practitioner (C)</p> Signup and view all the answers

What is the most common type of dementia?

<p>Alzheimer's disease (B)</p> Signup and view all the answers

Which of the following is NOT a symptom associated with vertebral artery issues?

<p>Pulsatile headache (D)</p> Signup and view all the answers

Which of the following symptoms does NOT typically occur during the aura preceding a seizure?

<p>Loss of bowel control (A)</p> Signup and view all the answers

What triggers the chemical cascade that can lead to neuronal death during occlusion?

<p>Calcium influx into the neurons (B)</p> Signup and view all the answers

What improvement was noted in patients participating in aerobic exercise for dementia risk reduction?

<p>Improvement in cerebral blood flow (D)</p> Signup and view all the answers

What is a primary emotional impairment associated with dementia?

<p>Hallucinations (D)</p> Signup and view all the answers

What condition is referred to as Giant Cell Arteritis primarily affecting?

<p>Superficial temporal arteries (B)</p> Signup and view all the answers

In treating epilepsy, which class of drugs primarily reduces neuronal excitability?

<p>Sodium channel blockers (A)</p> Signup and view all the answers

What type of tremor is characterized by rhythmic oscillation during posture?

<p>Postural tremor (A)</p> Signup and view all the answers

How long can symptoms of a TIA last before resolving?

<p>Usually less than 24 hours, commonly 30 minutes (C)</p> Signup and view all the answers

What characterizes the 'Jacksonian march' in seizures?

<p>Clonic movement following a body map in the brain (D)</p> Signup and view all the answers

What is the highest risk period for stroke following a TIA?

<p>First 24 hours (B)</p> Signup and view all the answers

In terms of dementia risk factors, which of the following is a modifiable risk factor?

<p>Hypertension (C)</p> Signup and view all the answers

Which assessment is typically undertaken as a basic screening for cognitive decline?

<p>Mini-Mental State Examination (MMSE) (B)</p> Signup and view all the answers

What is a characteristic symptom of Alzheimer's disease?

<p>Rapid forgetting and poor delayed memory recall (C)</p> Signup and view all the answers

What characterizes the headache associated with Temporal Arteritis?

<p>Constant and progressive, often bilateral (C)</p> Signup and view all the answers

What is a common reason to call an ambulance during a seizure?

<p>The seizure lasts longer than five minutes (C)</p> Signup and view all the answers

Which dietary factor is considered modifiable and may help in the prevention of dementia?

<p>Maintaining a Mediterranean diet (D)</p> Signup and view all the answers

What is a critical outcome of untreated Temporal Arteritis?

<p>Permanent blindness (D)</p> Signup and view all the answers

In evaluating a patient with TIA-like symptoms, what should be prioritized?

<p>Urgent referral to stroke clinic (C)</p> Signup and view all the answers

Which aspect of executive functioning is impaired in individuals with dementia?

<p>Inhibition (D)</p> Signup and view all the answers

What type of impairment is related to agnosias in dementia patients?

<p>Recognition of environmental elements (B)</p> Signup and view all the answers

Which of the following is NOT a sign of cognitive impairment in dementia?

<p>Diminished emotional responses (D)</p> Signup and view all the answers

What should be considered in the reassessment of management for a patient with known dementia?

<p>Recent GP discussions about management (D)</p> Signup and view all the answers

What characterizes essential tremor in its initial stages?

<p>Intermittent or emotionally triggered tremor (D)</p> Signup and view all the answers

Which of the following is the hallmark symptom of resting tremor?

<p>Pill-rolling quality of the fingers (A)</p> Signup and view all the answers

How does an endpoint tremor manifest during movement?

<p>Worsens as the target is approached (D)</p> Signup and view all the answers

What is a distinguishing feature of parkinsonian tremors?

<p>They occur at rest and may have a 'pill-rolling' quality (D)</p> Signup and view all the answers

Which tremor is typically associated with cerebellar dysfunction?

<p>Endpoint tremor (B)</p> Signup and view all the answers

In which condition might one observe a tremor that improves with alcohol?

<p>Essential tremor (C)</p> Signup and view all the answers

What condition can cause resting tremors as a rare variant?

<p>Essential tremor (A)</p> Signup and view all the answers

Which of the following tremor types is characterized by being absent at rest?

<p>Endpoint tremor (C)</p> Signup and view all the answers

What is the primary mechanism behind endpoint tremors?

<p>Cerebellar incoordination leading to oscillations (C)</p> Signup and view all the answers

What is a common effect of essential tremor on daily activities?

<p>Does not impede skilled manual tasks (C)</p> Signup and view all the answers

Which condition is associated with low-frequency resting tremors (4-6 Hz)?

<p>Parkinson's disease (D)</p> Signup and view all the answers

Which feature distinguishes drug-induced tremors from other types?

<p>Reversible upon discontinuation of the drug (A)</p> Signup and view all the answers

In what way does a psychogenic tremor differ from other tremors?

<p>Irregular and inconsistent patterns (D)</p> Signup and view all the answers

Which of the following can exacerbate essential tremor symptoms?

<p>Increased hunger and fatigue (B)</p> Signup and view all the answers

Which hallmark feature is associated with Wilson's disease?

<p>Wing-beating resting tremor (C)</p> Signup and view all the answers

Flashcards

Discogenic low back pain

Chronic low back pain caused by damage to the intervertebral disc and its surrounding structures, but without a herniation.

Disc Degeneration

Dehydration and degeneration of the intervertebral disc occurs due to repeated stress and normal aging, contributing to changes in its structure.

Uneven Loading on the Intervertebral Disc

Irregular forces on the intervertebral disc can lead to tears in the outer layers and micro-fractures in the adjacent bones.

Inflammatory Chemicals in the Nucleus Pulposus

The nucleus pulposus, the center of the intervertebral disc, releases inflammatory chemicals that spread to surrounding tissues, causing pain.

Signup and view all the flashcards

Sinuvertebral Nerves

These nerves, different from nerve roots, are found outside the disc and are highly sensitive to inflammation.

Signup and view all the flashcards

Cauda Equina Syndrome

This refers to the compression of the cauda equina, a bundle of nerve roots at the end of the spinal cord. It is usually caused by a disc herniation. It is a serious condition requiring immediate medical attention.

Signup and view all the flashcards

Benign Hypermobility Joint Syndrome

This disorder involves generalized joint laxity, leading to musculoskeletal symptoms without any underlying rheumatological disease. It often presents with joint pain, easy bruising, and a history of dislocations and subluxations.

Signup and view all the flashcards

Cervicogenic Headache

A headache that originates from a cervical spine structure, usually the facet joints or surrounding structures. It can be caused by irritation, compression, or muscle spasm.

Signup and view all the flashcards

Canadian C-spine Rule

The Canadian C-spine rule helps to determine if a patient with neck pain requires imaging. It considers factors such as the mechanism of injury, neurological symptoms, and age in the decision-making process.

Signup and view all the flashcards

Temporal Arteritis

A condition characterized by inflammation of the temporal arteries, causing symptoms like severe headache, scalp tenderness, jaw pain, and vision loss. It often affects older adults.

Signup and view all the flashcards

Facet Joint Arthritis

The facet joints are small joints in the spine that help with movement and stability. When they are affected by arthritis, they can cause pain, stiffness, and limited range of motion.

Signup and view all the flashcards

Cervical Osteoarthritis (OA)

This is characterized by stiffness and pain in the neck, often accompanied by limited range of motion, and triggered by movement or sustained positions. It typically affects individuals over 40 years old.

Signup and view all the flashcards

Nucleus Pulposus Inflammation

This is an inflammatory process that occurs in the nucleus pulposus (the center of the intervertebral disc), leading to pain, inflammation, and potential damage to the disc.

Signup and view all the flashcards

ESR/CRP levels

A blood test that measures the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), indicating inflammation in the body.

Signup and view all the flashcards

Temporal artery biopsy

A procedure in which a small sample of the temporal artery is removed and examined under a microscope.

Signup and view all the flashcards

Intracranial hematoma

A collection of blood outside of a blood vessel that forms a clot in the brain.

Signup and view all the flashcards

Epidural hematoma

A type of intracranial hematoma occurring between the skull and the dura mater, the outermost layer of the meninges.

Signup and view all the flashcards

Subdural hematoma

A type of intracranial hematoma between the dura mater and the arachnoid mater, the middle layer of the meninges.

Signup and view all the flashcards

Intracerebral hematoma

Bleeding within the brain tissue.

Signup and view all the flashcards

Glasgow Coma Scale (GCS)

A scale used to assess the level of consciousness after a traumatic brain injury.

Signup and view all the flashcards

CT scan of the head

A medical imaging technique used to detect intracranial hematomas.

Signup and view all the flashcards

MRI (magnetic resonance imaging)

A medical imaging technique that can be used to detect subacute or chronic intracranial hematomas in more detail.

Signup and view all the flashcards

Aneurysmal Rupture and Subarachnoid Hemorrhage (SAH)

A rupture of a cerebral aneurysm or arteriovenous malformation, resulting in bleeding into the subarachnoid space.

Signup and view all the flashcards

Subarachnoid Hemorrhage (SAH)

A bleeding in the space between the brain and the meninges.

Signup and view all the flashcards

Peripheral Neuropathy

A condition that affects the peripheral nerves, causing numbness, weakness, and pain.

Signup and view all the flashcards

Cerebrovascular Disease (CVD)

A problem disrupting the brain's blood supply. Divided into ischemic (80%) and hemorrhagic types.

Signup and view all the flashcards

Occlusive CVD (Stroke)

A type of CVD where a blood clot blocks an artery, leading to reduced blood flow to the brain.

Signup and view all the flashcards

Transient Ischemic Attack (TIA)

A temporary blockage of a blood vessel in the brain, causing transient neurologic symptoms.

Signup and view all the flashcards

Haemorrhage

Bleeding in the brain, caused by a ruptured blood vessel.

Signup and view all the flashcards

Vascular Malformations

Abnormal blood vessel formations in the brain, such as aneurysms or arteriovenous malformations (AVMs).

Signup and view all the flashcards

Neuron Death from Occlusion

The immediate effect of a stroke: Some neurons die due to lack of oxygen and energy.

Signup and view all the flashcards

Chemical Cascade of Neuron Damage

The delayed effect of a stroke: Neuron damage due to a cascade of chemical events triggered by the blockage.

Signup and view all the flashcards

Haematoma

A collection of blood outside a blood vessel, often caused by a slow leak.

Signup and view all the flashcards

Brain Damage from Haemorrhage

The effect of blood leaking into brain tissue: Damage caused by toxic chemicals released from broken red blood cells.

Signup and view all the flashcards

Intracerebral Haemorrhage

An artery rupture inside the skull, leading to a large blood pool.

Signup and view all the flashcards

TIA vs Migraine

Symptoms of TIA are similar to migraine, but must be investigated as potential stroke warning.

Signup and view all the flashcards

Cervical Arterial Dissection

A tear in the wall of an artery in the neck, causing a clot to form and potentially block blood flow to the brain.

Signup and view all the flashcards

External Carotid Claudication

Painful chewing, a symptom of temporal arteritis, caused by inflammation of the external carotid artery.

Signup and view all the flashcards

Folate and Vitamin B12 Deficiency

A deficiency of folate or Vitamin B12 can cause a range of neurological problems.

Signup and view all the flashcards

Motor Neuron disease (MND)

A condition marked by progressive degeneration of upper and lower motor neurons, causing weakness, paralysis, and eventual death.

Signup and view all the flashcards

Classic Triad of Vitamin B12 Deficiency

A classic triad of symptoms including limb weakness, sore tongue, and paraesthesia. These can arise from Vitamin B12 deficiency.

Signup and view all the flashcards

Peripheral Arterial Disease (PAD)

A condition where blood supply to the limbs is reduced due to atherosclerosis.

Signup and view all the flashcards

Intermittent Claudication

A common symptom of Peripheral Arterial Disease (PAD) where cramps, aching, or pain in the legs are triggered by exercise and relieved by rest.

Signup and view all the flashcards

Guillain Barre Syndrome

An acute inflammatory disorder of the peripheral nerves causing weakness and paralysis that typically develops after a respiratory or gastrointestinal illness.

Signup and view all the flashcards

Paraesthesia

Numbness and tingling in the hands and feet, often in a glove-and-stocking distribution pattern. A symptom of several nerve disorders.

Signup and view all the flashcards

Progressive Weakness

Weakness in the muscles, particularly affecting the extremities, often progressing from the feet upwards.

Signup and view all the flashcards

Duplex Ultrasound

A test that assesses blood flow to the legs and detects arterial stenosis.

Signup and view all the flashcards

Sensory Motor Examination (SME)

An examination that assesses sensation, strength, reflexes, and coordination in the extremities.

Signup and view all the flashcards

Complete Blood Count (CBC)

A blood test used to measure the concentration of red blood cells, Vitamin B12, and folate.

Signup and view all the flashcards

Cranial Nerve Involvement

A neurological disorder affecting the cranial nerves, leading to symptoms like dysphagia, dysarthria, diplopia, and facial droop.

Signup and view all the flashcards

Nerve Conduction Studies

Nerve conduction studies are a type of electrical test that measures the speed and strength of nerve signals.

Signup and view all the flashcards

Plasma Exchange

A medical procedure involving the removal of blood plasma and replacement with donor plasma or a substitute, often used in the treatment of autoimmune diseases.

Signup and view all the flashcards

Immunoglobulin Therapy

A type of treatment for neurological conditions that uses high doses of antibodies to suppress the immune system.

Signup and view all the flashcards

What is epilepsy?

A brief change in behavior caused by abnormal and synchronized firing of nerve cells in the brain.

Signup and view all the flashcards

What is idiopathic epilepsy?

The most common type of epilepsy, where the cause is unknown.

Signup and view all the flashcards

What is a partial seizure?

A type of seizure that begins in one hemisphere of the brain and may not affect consciousness.

Signup and view all the flashcards

What is a complex partial seizure?

A type of partial seizure where consciousness is altered.

Signup and view all the flashcards

What is a generalized seizure?

A seizure that begins in both hemispheres of the brain simultaneously.

Signup and view all the flashcards

What is an absence seizure?

A type of generalized seizure common in children, characterized by brief lapses in consciousness.

Signup and view all the flashcards

What is a grand mal seizure?

A type of generalized seizure characterized by a combination of tonic and clonic movements, sometimes with loss of consciousness.

Signup and view all the flashcards

What is an aura?

The period immediately before a seizure, often characterized by specific symptoms.

Signup and view all the flashcards

What is the ictus?

The stage of a seizure where the actual seizure occurs.

Signup and view all the flashcards

What is the postictal period?

The period after a seizure when the brain recovers.

Signup and view all the flashcards

What is mild cognitive impairment (MCI)?

A condition where cognitive abilities are lower than expected for someone of the same age, but dementia or ADL impairment are not present.

Signup and view all the flashcards

What is dementia?

A syndrome characterized by progressive deterioration of intellect, behavior, and personality, affecting daily living activities.

Signup and view all the flashcards

What is Alzheimer's disease?

The most common type of dementia, characterized by a slow, progressive decline in cognitive function.

Signup and view all the flashcards

What is vascular dementia?

A type of dementia caused by blood vessel damage in the brain.

Signup and view all the flashcards

What is frontotemporal dementia?

A type of dementia characterized by behavioral changes, such as inappropriate behavior or impulsivity.

Signup and view all the flashcards

Dementia

A decline in cognitive abilities, such as memory and language, that affects daily living activities.

Signup and view all the flashcards

Alzheimer's disease

A type of dementia caused by Alzheimer's disease.

Signup and view all the flashcards

Agnosia

A loss of the ability to recognize familiar objects, people, or places.

Signup and view all the flashcards

Apraxia

A loss of the ability to perform purposeful movements despite normal motor ability.

Signup and view all the flashcards

Executive functioning impairments

Difficulty with the control of thoughts and actions, impacting planning, organizing, and adapting to new situations.

Signup and view all the flashcards

Mild cognitive impairment (MCI)

A progressive decline in memory and cognitive abilities, typically starting with mild cognitive impairment.

Signup and view all the flashcards

Montreal Cognitive Assessment (MoCA)

A medical test used to assess cognitive function and screen for dementia.

Signup and view all the flashcards

Amyloid plaques

The buildup of amyloid proteins in the brain, a key characteristic of Alzheimer's disease.

Signup and view all the flashcards

Mediterranean diet

A diet emphasizing fruits, vegetables, whole grains, and olive oil, potentially lowering the risk of dementia.

Signup and view all the flashcards

Metabolic syndrome

A condition characterized by high blood pressure, abdominal obesity, and high blood sugar.

Signup and view all the flashcards

Age

A major risk factor for Alzheimer's disease, particularly in individuals over 65.

Signup and view all the flashcards

Memory loss

A primary symptom of Alzheimer's disease, affecting memory recall and learning new information.

Signup and view all the flashcards

Disorientation

A common symptom of Alzheimer's disease that involves a lack of awareness of time, location, or personal identity.

Signup and view all the flashcards

Endpoint tremor

A type of tremor that occurs during purposeful movement, becoming more pronounced as the target is approached.

Signup and view all the flashcards

Resting Tremor

A rhythmic, involuntary movement that occurs when a muscle is relaxed and at rest. It often lessens or disappears with voluntary movement.

Signup and view all the flashcards

Essential Tremor

The most common type of tremor disorder, often with a family history. It is a slowly progressive tremor that often starts in one hand and affects both hands and sometimes other body parts.

Signup and view all the flashcards

Cerebellar Tremor

A type of tremor associated with cerebellar dysfunction. It is characterized by an irregular tremor that is most prominent during voluntary movement and disappears at rest.

Signup and view all the flashcards

Postural Tremor

A tremor that occurs when a limb is held against gravity, usually seen in essential tremor.

Signup and view all the flashcards

Kinetic Tremor

A tremor that occurs during movement, often seen in essential tremor.

Signup and view all the flashcards

Abnormal Tremor

A tremor that is caused by a medical condition, such as Parkinson's disease, stroke, or medication.

Signup and view all the flashcards

Psychogenic Tremor

A tremor that is caused by a mental or emotional issue rather than a physical one.

Signup and view all the flashcards

Drug-Induced Tremor

A type of tremor that is caused by certain drugs or medications. It may resolve after the drug is stopped.

Signup and view all the flashcards

Mild Cerebellar Dysfunction

A type of tremor that is associated with damage or dysfunction in the cerebellum or its connections.

Signup and view all the flashcards

Tremor Definition

An abnormal, rhythmic movement of a body part that is involuntary.

Signup and view all the flashcards

Essential Tremor Resting Variant

A condition that may occur in the later stages of essential tremor, but is rare, resulting in tremors at rest.

Signup and view all the flashcards

Resting Tremor Definition

A condition characterized by involuntary, rhythmic, oscillating movements that occur when a muscle group is relaxed and at rest. It typically diminishes or disappears with voluntary movement and is most commonly associated with basal ganglia dysfunction.

Signup and view all the flashcards

Fasciculations

Visible muscle twitching, often in the limbs, due to degeneration of lower motor neurons. This is a hallmark sign of motor neuron disease (MND), where nerve cells in the spinal cord controlling voluntary movement deteriorate.

Signup and view all the flashcards

Spasticity

Increased muscle tone, making the limbs stiff and difficult to move. This is a characteristic sign of upper motor neuron damage, where the brain's control over muscle movement is disrupted.

Signup and view all the flashcards

Hyperreflexia

Exaggerated reflexes in response to stimuli. This is another hallmark sign of upper motor neuron damage. Often seen in MND patients, when the brain's control over movement is disrupted and reflexes become overactive.

Signup and view all the flashcards

Dysarthria

Difficulty forming words due to problems controlling the muscles involved in speech. This is a common issue in advanced motor neuron disease (MND), as the disease progresses and affects muscles throughout the body.

Signup and view all the flashcards

Dysphagia

Difficulty swallowing, leading to choking or gagging when eating. This is a symptom of motor neuron disease (MND), where degeneration of motor neurons affects muscles involved in swallowing.

Signup and view all the flashcards

Respiratory Difficulties

Difficulty breathing, often a sign of advanced motor neuron disease (MND) affecting the muscles involved in breathing. It can lead to problems with shortness of breath, requiring assisted ventilation in severe cases.

Signup and view all the flashcards

Electromyography (EMG)

A medical test that measures the electrical activity of muscles. It's a key diagnostic tool for MND, as it reveals denervation and reinnervation changes, characteristic signs of the disease.

Signup and view all the flashcards

Magnetic Resonance Imaging (MRI)

A powerful imaging technique that uses magnetic fields and radio waves to produce detailed pictures of the brain, spinal cord, and other tissues. It's used in diagnosing MND to rule out structural lesions that might mimic the disease.

Signup and view all the flashcards

Genetic Testing

A laboratory test used to analyze genes in search of specific alterations. This is relevant in MND, especially for familial forms, to identify genes linked to the disease.

Signup and view all the flashcards

Riluzole

A medication used in the treatment of motor neuron disease (MND), it can modestly slow disease progression by regulating a certain molecule in the brain.

Signup and view all the flashcards

Edaravone

A drug used in the treatment of motor neuron disease (MND) that can modestly slow down disease progression by acting on a particular molecule in the brain.

Signup and view all the flashcards

Supportive Care

A group of therapies that help improve quality of life and manage symptoms for people with MND, including physiotherapy for physical function, speech therapy for communication difficulties, and nutritional support for maintaining well-being.

Signup and view all the flashcards

Palliative Care

A supportive approach to managing medical conditions like MND, focusing on pain relief, symptom control, and improving quality of life, especially in advanced stages of the disease.

Signup and view all the flashcards

Sciatic Nerve Entrapment

A condition affecting the sciatic nerve, where it becomes compressed or irritated. It's often caused by overuse, muscle tightness, or structural abnormalities.

Signup and view all the flashcards

Carpal Tunnel Syndrome

A condition where the median nerve becomes compressed in the wrist area, leading to pain, numbness, and tingling in the thumb, index, middle, and half of the ring finger.

Signup and view all the flashcards

Ulnar Nerve Entrapment

A condition where the ulnar nerve becomes compressed in the elbow area (cubital tunnel). It can cause pain, numbness, and tingling in the little finger and half of the ring finger. Triggered by repetitive elbow flexion, prolonged pressure or injury.

Signup and view all the flashcards

Study Notes

Low Back Pain

  • Common Causes and Risk Factors: Discogenic pain, ankylosing spondylitis, aging, obesity, smoking, vibrations, excessive axial loads, genetic susceptibility.
  • Chronic Back Pain Progression (Pathophysiology): Damage to discs and vertebral endplates leads to new blood vessel growth and sinuvertebral nerve ingrowth into the disc, causing inflammation. Abnormal disc stresses and normal fluid loss cause dehydration and degeneration. This uneven loading leads to annular fibre tears, microfractures in endplates, and structural changes in ligaments and facets. The nucleus pulposus releases inflammatory chemicals, creating a cycle of inflammation that recruits more blood vessels.
  • Holistic Treatment Planning Beyond Manual Therapy and Exercise: Medical treatments include corticosteroid injections, radiofrequency treatments (potential for nerve destruction), nucleoplasty (RF to shrink nucleus pulposus, but may grow back), discectomy, and fusion. MRI is often reserved for specific cases like substantial trauma, certain age groups, loss of function, or other serious symptoms.

Discogenic Low Back Pain

  • Definition: Chronic low back pain caused by disc damage involving the development of new blood vessels and sinuvertebral nerves burrowing into the back of the disc, causing inflammation (not a herniation). An annular fiber tear leads to loss of disc material (not a herniation — fibres intact).
  • Pathophysiology: Abnormal stresses and normal loss of fluid in the disc leading to dehydration and degeneration. This uneven loading leads to tears in annular fibres, microfractures in the end plates of vertebrae, and structural changes to ligaments and facets. Chemicals released from the nucleus pulposus cause an inflammatory response, drawing new blood vessels and nerves into the damaged disc.
  • Risk Factors: Age, obesity, smoking, vibrations from transportation, excessive axial loads, and genetic susceptibility.
  • Symptoms: Pain in the back (not legs) aggravated by lifting, bending, sitting/standing, or Valsalva maneuvers (coughing, sneezing). Symptoms are often worse the next day after injury.
  • Diagnosis: Crucial to establish a thorough clinical history. Local tenderness, muscular hypertonicity, reduced range of motion, and abnormal movement patterns (e.g., a "catch" during movement) are common. Valsalva maneuver is positive for local pain but not leg pain.
  • Imaging: An MRI is often not directly correlated to symptoms and generally recommended only in specific cases, which include substantial trauma or trauma in patients ≥50 years old, or other serious symptoms or conditions.

Cauda Equina Syndrome

  • Cause: Compression of the cauda equina caused by tumors, trauma/spondylolisthesis, infections, ankylosing spondylitis, lumbar central stenosis, or disc herniation.
  • Prevalence: Only 2% of lumbar disc patients are affected.
  • Symptoms: Saddle anesthesia (loss of sensation around the buttocks and groin), bowel and bladder disturbances. These disturbances can include difficulty with initiating or stopping urination (leading to retention and overflow incontinence), incontinence, or constipation. Unilateral or bilateral sciatica, low back pain, leg weakness, and sensory deficits are also possible.
  • Differential Diagnosis: The key to suspecting Cauda Equina Syndrome is to ask if there is a difference in sensation when wiping after bowel movement.
  • Signs: Sensory (dermatomal changes), muscle (myotomal weakness), and reflex (hypo/areflexia) deficiencies.
  • Treatment: Immediate and urgent referral to A&E – failure to recognize these signs can result in permanent incontinence.

Benign Hypermobility Joint Syndrome

  • Cause: A connective tissue disorder involving generalized joint laxity.
  • Symptoms: Joint pain in multiple areas – neck, shoulders, low back, hips, knees, and ankles. Symptoms could include easy bruising, subluxation, dislocation, meniscal tears, and hiatus hernia (a condition when part of the stomach protrudes through the diaphragm).
  • Prevalence: Decreases with age, higher frequency in females.
  • Diagnosis: Uses Brighton criteria (questionnaire) and Beighton score to assess degree of joint laxity.
  • Additional Criteria: Back pain of at least 3 months; dislocation or subluxation in 3 or more joints or 1 joint more than 3 times; and ≥3 instances of sports-related injuries.
  • Diagnostic Criteria: Beighton score ≥4; arthralgia (joint pain) in 4+ joints for ≥3 months; back pain ≥3 months; 3+ previous sports injuries.

Headaches and Neck Pain

  • Cervicogenic Headache: Headache originating from a cervical spine structure (periosteum, ligaments, osseous, nerve irritation, or reflex muscle spasm).
  • Red Flags (Intracranial Hemorrhage): A sudden onset of neurological dysfunction requiring immediate referral.
  • Canadian C-spine Rule: A clinical decision-making tool to determine the need for imaging in potential c-spine injuries in alert, stable patients ≥16 years old.

Cerebrovascular Disease

  • General: Any condition disrupting blood supply to the brain. 80% are ischemic, while the other 20% are hemorrhagic.
  • Categories: Occlusive CVD (stroke), TIA, hemorrhage, vascular malformations (aneurysms, AVM). Associated Conditions: Diabetes, vascular diseases, hematocrit issues, and collagen diseases (like Marfans).
  • Ischemic Stroke: Neuron death due to oxygen deprivation. ATP pump failure leads to depolarization, neurotransmitter release, calcium influx, and protease/lipase activation, causing further damage.
  • Hemorrhagic Stroke: Slow blood leaks (hematoma) lead to toxin release (heme) causing free radical formation and cell damage. Rapid bleeds (arteries) lead to immediate neuron loss and oedema (swelling), which further occludes blood flow.
  • Risk Factors: Hypertension (major factor in 90% of stroke cases), atrial fibrillation, history of TIA, stroke, aneurysm, diabetes, and vascular/hematocrit diseases. Family history slightly increases risk.
  • Transient Ischemic Attack (TIA): Sudden, focal neurological symptoms resolving within 24 hours—often within 30 minutes. Possible causes are vasospasm, embolus, or thrombosis of a narrowed vessel. TIA is a precursor to infarction, so requiring urgent referral.

Peripheral Neuropathy

  • Mechanisms (B12 deficiency, diabetic neuropathy): B12 deficiency leads to axonal damage. Diabetic neuropathy involves demyelination and ischemia. Sensory ataxia is a gait pattern.
  • Differential Diagnosis (Guillain-Barré): Guillain-Barré involves progressive, ascending muscle weakness, occurring 2-4 weeks after a minor illness (distinguishes it from other conditions).
  • Physical Exam Tests: Vibration testing, reflex testing, proprioception testing.
  • Peripheral Arterial Disease (PAD): Hallmark is intermittent claudication (leg pain during exercise).
  • Motor Neuron Disease (MND): Progressive, painless, asymmetric weakness spreading through the body.

Temporal Arteritis

  • Definition: Systemic inflammatory vasculitis of unknown cause, particularly affecting the superficial temporal arteries.
  • Symptoms: Bilateral, constant, progressive, pulsatile headache; tender scalp; worse at night; painful jaw muscles; associated with other conditions (e.g., polymyalgia rheumatica). TIA possible, visual acuity loss and blindness are potential red flags.
  • Diagnosis: Elevated ESR/CRP levels, temporal artery biopsy (confirmation).
  • Management: Urgent referral.

Intracranial Hematoma

  • Traumatic Brain Injury (TBI): Often from head trauma; types include epidural, subdural, and intracerebral. Common in TBI: loss of consciousness, headache, nausea/vomiting, altered mental status, unequal pupils/blurred vision, seizures, and focal neurological deficits.
  • Aneurysmal Rupture and Subarachnoid Hemorrhage (SAH): Rupture of a cerebral aneurysm or AVM leading to bleeding into the subarachnoid space; causes sudden, severe "thunderclap" headache, neck stiffness, photophobia, altered mental status/coma.
  • Neuro Tests (Both types): GCS, CT scan (immediate detection), MRI (subacute/chronic). Treatment for both may include emergency surgical evacuation, ICP reduction, and observation.

Canadian C-Spine Rule

  • Inclusion: Alert, stable patients ≥16 with neck pain or suspected cervical spine injury after trauma.
  • Exclusion: Non-traumatic injuries, known vertebral disease, penetrating trauma, pregnancy.
  • High-Risk Criteria (Mandates Imaging): Age ≥65; dangerous mechanism of injury (falls from height, axial load trauma, high-speed collisions); presence of paresthesias.
  • Low-Risk Criteria (Allows ROM assessment): Simple rear-end collisions (without specific factors); sitting position in ED; ambulatory since injury; delayed onset of pain; and absence of midline cervical tenderness.
  • Active Range of Motion: Can actively rotate neck 45 degrees bilaterally? If no, imaging needed.

Seizures

  • Epilepsy: Brief changes in behavior due to disordered, rhythmic neural firing. Risk factors include idiopathic causes, congenital defects, genetic factors, drugs, infections, and vascular conditions.
  • Seizure Types: Partial (simple/complex) and generalized (absence/grand mal).
  • Symptoms: Consciousness change, clonic movements, tonic positions, sensory changes—often indicative of the origin point in the cortex (temporal, parietal, occipital).
  • Treatment: Anticonvulsants to reduce excitability (e.g., phenytoin, carbamazepine), enhance GABAergic inhibition (e.g., phenobarbital), or block GABA reuptake.

Memory Changes and Tremors

  • Types of Memory: Short term, procedural, working memory.
  • Types of Tremors: Resting, action, endpoint. Tremors classified by when the tremor is apparent: at rest, with movement, or at the end of a movement (endpoint).

Mild Cognitive Impairment (MCI)

  • Definition: A cognitive syndrome where cognitive ability is not equal to same-aged peers, but without dementia or ADL impairment.

Dementia

  • Definition: Progressive deterioration of intellect, behavior, and personality impairing ADLs.
  • Types: Alzheimer's disease (60%), vascular dementias (20%), frontotemporal dementia, dementia with Lewy bodies.
  • Risk Factors: Age, family history, hypertension, metabolic syndrome/diabetes, vascular events, smoking are common risk factors for dementia, and may be potentially changeable (modifiable) with lifestyle changes.
  • Symptoms: Cognitive, emotional/behavioral, and ADL deficits. These deficits are progressive over the decades (although vascular dementia may develop faster).

Alzheimer's Disease

  • Symptoms: Memory impairment (cardinal sign - rapid forgetting/poor delayed memory recall), disorientation in time/place, visuospatial difficulties, procedural memory impairment ("how to do"), language impairment, depression, aggression, agitation, and wandering.

Tremors

  • Essential Tremor: Most common, often familial. Slowly progressive postural/kinetic tremor (often in upper limbs), worsening with emotion, hunger, fatigue, or temperature changes.
  • Resting Tremor: Involuntary, rhythmic oscillations at rest; most common in Parkinson's disease and related syndromes.
  • Endpoint Tremor: Tremor worsens as the target is approached; associated with cerebellar dysfunction causing oscillations due to errors in movement calculation and correction.

Peripheral Nerve Entrapments (Mononeuropathies)

  • Median Nerve: Most common location is the wrist (Carpal Tunnel). Causes include repetitive strain injury from typing, pregnancy, or hypothyroidism. Compression might occur.
  • Ulnar Nerve: At the elbow (Cubital Tunnel), typically from prolonged elbow flexion or compression.
  • Radial Nerve: Entrapment at the elbow; radial tunnel syndrome (controversial), tennis elbow (lateral epicondylitis)-like presentation.
  • Posterior Interosseous Nerve (PIN): Entrapment in the supinator muscle.
  • Sciatic Nerve: Overuse, SIJ dysfunction, piriformis syndrome, gluteus medius/minimus entrapment, hamstring attachments.
  • Lateral Cutaneous Nerve: "Meralgia parasthetica," entrapment at the inguinal ligament.
  • Obturator Nerve: Entrapment in the fascia.
  • Peroneal Nerve: May be entrapped at fibular head, due to injuries (e.g., to the distal knee region), cysts around the knee, or compartment syndrome.
  • Tibial Nerve: Commonly from ankle/tibia fxs or dislocations; less often in the tarsal tunnel.

General Clinical Management

  • Seizures: Time duration, multiple seizures without recovery, breathing difficulty require ambulance.
  • Memory Changes: Types (short-term, long-term, working), differentiating factors.
  • Tremors: Differentiating various tremor types (resting, postural, kinetic, etc.) by symptoms and patterns.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Description

Test your knowledge on the factors related to chronic low back pain, including discogenic pain and disc degeneration. This quiz incorporates essential aspects of anatomy and physiology regarding low back pain, making it suitable for students and healthcare professionals alike.

More Like This

Chronic Kidney Disease and Coding Guidelines
5 questions

Chronic Kidney Disease and Coding Guidelines

FreedRhyme avatar
FreedRhyme
AAP Prep: Chronic Urticaria & Hemolytic Syndrome
17 questions

AAP Prep: Chronic Urticaria & Hemolytic Syndrome

WellRunHydrogen avatar
WellRunHydrogen
Low vs. High Ankle Sprains Quiz
10 questions

Low vs. High Ankle Sprains Quiz

UndisputedLesNabis8909 avatar
UndisputedLesNabis8909
Discogenic Low Back Pain Overview
6 questions

Discogenic Low Back Pain Overview

DeliciousHexagon6467 avatar
DeliciousHexagon6467
Use Quizgecko on...
Browser
Open
Browser
Browser