compression, conus and cauda oh my
itis's- Discitis & transverse myelitis
pearls
Epidural abscess and more itis
physical exam findings
100
Most common cause cauda equina?
herniated disc
100
How many patients have recurrence of transverse myelitis?
25-33%
100
Bugs to cover for epidural abscess?
staphylococcus and gram neg bacilli
100
Constant, severe back pain that is unrelenting...worse when lying down is suggestive of?
infection or cancer
200
Onset of what symptom starts the clock for diagnosing and managing cauda equina?
perineal anesthesia with bladder dysfunction
200
>90% patients with discitis present with what night time complaint?
unremitting neck and back pain that wakes them up at night
200
suspected traumatic spinal cord injury comes into the trauma bay, what is your first priority?
AIRWAY
as always... cmon now
200
Most common level for transverse myelitis?
thoracic
200
Flexion induced back pain is suggestive of what?
Herniated disc
300
What pathology is cord compression most commonly caused by?
cancer
300
Transverse myelitis tx?
methylprednisone 1000 mg qd
or
dexamethasone 200 mg qd
for 3-5 days
300
How long can you leave someone on a spine board?
2 hours
300
Most common bacterial cause?
staph aureus
300
Back pain made worse with extension?
Spondylolysis
400
Most common spinal cord level for compression?
thoracic>>cervical>>lumbar
400
2 must have antibiotics for discitis and the bugs you're covering?
Need MRSA, strep, pseudomonas, E. coli coverage
Vancomycin AND
(choose one) 2g rocephin OR 2g cefepime OR 2g ceftazidime OR 400 mg ciprofloxacin
400
2 must have characteristics to dx cauda equina?
urinary or rectal dysfunction or sexual dysfunction
AND
saddle anesthesia or hypothesia
400
Treatment of epidural abscess? 2 drugs
vancomycin + 3rd gen cephalosporin (cefotaxime, ceftriaxone, ceftazidime)
400
DAILY QUADRUPLE!!!!!!!! EARN 4 TIMES THE POINTS WITH NO LOSS if you can name 6/8 of the TUNA FISH red flags for back pain
Trauma, unexplained weight loss, neurologic symptoms, age >50 or anticoagulants, fever, IVDU or incontinence, steroids or spinal surgery/injections, history of cancer
500
What level is suggestive of conus medullaris syndrome vs cauda equina?
conus medullaris T12-L1
cauda equina L2 and below
500
Pick one to hang your hat on for discitis dx: ESR elevation, leukocytosis, fever
ESR elevation (seen in >90% pts)
500
Explain the slump test for radiculopathy
pain with this maneuver suggests neurogenic cause
500
primary vs secondary epidural abscess?
Primary- hematogenous spread to epidural space
Secondary-local extension