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Family medicine final > Lower Back Pain > Flashcards

Lower Back Pain Flashcards

1
Q

In the lying position, the pressure on the discs is ____ kg
when standing or walking ___ kg
when sitting ___ kg
when lifting a load ____ kg

A

In the lying position, the pressure on the discs is 25-75 kg
when standing or walking 100 kg
when sitting 135-180 kg
when lifting a load 275 kg

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2
Q

List risk factors for lower back pain (5)

A
  1. repetitive actions
  2. vibrations
  3. cigarettes (osteoporosis)
  4. massive thickness
  5. major skeletal abnormalities
    degenerative changes caused by disc aging
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3
Q

Major skeletal abnormalities leading to lower back pain (3)

A
  1. scoliosis >40%
  2. spinal stenosis
  3. ankylosing spondylosis
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4
Q

Degenrative changes caused by disc aging (2) that lead to lower back pain

A
  1. descrease nucleus pulposus
  2. thickening of the annulus fibrosus
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5
Q

Anamnesis for lower back pain

A
  1. mechanism of pain/injury
  2. duration, quality, and spread of pain
  3. precipitating factors
  4. facilitating and aggravating factors
  5. previous history of back problems
  6. other diseases/injuries
  7. medicines
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6
Q

What is relationship between history of malignancy and back pain?

A

In patients with a personal history of cancer, new back pain should be considered malignant until proven otherwise

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7
Q

Most commong cause of low back pain according to age:
>50
>65
>70
<40

A

> 50 malignancy
65 abdominal aortic aneurysm in a male current or former smoker
70 compression fracture with or without trauma
<40 ankylosing spondylitis

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8
Q

What could be a possible reason for low back pain for someone who has previously been treated with corticosteroids for more than 1 month?

A

Compression fracture

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9
Q

What could be a possible reason for low back pain for someone who uses injection drugs or has a current infection?

A

osetomyelitis or paraspinal abscess

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10
Q

what is the cause of pain: low back pain, but pain remains above the knee

A

hip pathlogy

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11
Q

what is the cause of pain: low back pain, but pain radiates down the leg below the knee

A

sciatica (irritation or compression of the L4-L5, S1, nerve roots, usually from a disk herniation)

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12
Q

what is the cause of pain: low back pain, but pain is localized in the abdomen or pelvis

A

visceral source

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13
Q

diagnosis: low back pain, but pain is electrical or shock-like

A

disk herniation

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14
Q

diagnosis: low back pain, pain is constant and nocturnal

A

malignancy when worse with rest
mechanical when improved with rest

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15
Q

low back pain, pain is colicky

A

referred pain from a visceral organ

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16
Q

pain with tearing/ripping quality

A

aortic dissection

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17
Q

diagnosis of cyclical low back pain

A

endometriosis

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18
Q

low back pain that has been persisten and progressive for over 1 month, older pt

A

malignancy in older pt

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19
Q

low back pain that has been persistent an progressive for over 3 months, younger pt

A

ankylosing spondylitis

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20
Q

low back pain worse in the morning and associated with morning stiffness

A

ankylosing spondylitis

21
Q

pain in the legs with standing that increases with cough or walking

A

neurogenic claudication from spinal stenosis

22
Q

low back pain that imrpoves with forward bending or sitting

A

spinal stenosis or spondylolisthesis

23
Q

low back pain that improves with excersice

A

ankylosing spondylitis

24
Q

low back pain that worsesn with bending forward or sitting

A

disk herniation

25
Q

if there is some connection to eating pattern (improves/worsens after eating, vomiting, nausea), low back pain is due to

A

GIT

26
Q

low back pain + fever

A

osteomylitis, malignancy, infection related to intra-abdominal or pelvic eitology

27
Q

physical exam of low back pain includes: (4)

A
  1. inspection
  2. palpation
  3. specific tests
  4. neurologic examination
28
Q

inspection during physical exam of low back pain include:

A
  1. walk
  2. position
  3. scoliosis
  4. kyphosis
  5. lordosis
29
Q

palpation of low back pain during physical exam includes

A
  1. paravertebral musculature
  2. spiny appendages
  3. sacroiliac joints
  4. abdominal palpation
30
Q

List specific tests for low back pain (4)

A
  1. movement in 4 directions
  2. leg lift
  3. PAtrics - FABRE test
  4. Valsava maneuver
31
Q

Describe test movement in 4 directions

A

anteflexion, retroflexion, lateroflexion, rotation

32
Q

ICD-10 for low back pain

A

M54. 5, referred to as “lumbago”

33
Q

What does “FABRE” stand for?

A

F - FLEXION of the hip and knee on the painful leg
AB - ABDUCTION of the leg
ER - EXTERNAL ROTATION of the knee (heel to the knee of the healthy leg)
E - EXTENSION (fix the opposite hip and press the knee)

34
Q

FABRE test: back pain

A

compression fracture

35
Q

FABRE test: pain in the sacroilliac joint

A

pathology in that joint

36
Q

FABRE: hip pain

A

degenrative changes in the hip joint

37
Q

FABRE: pain spreads towards the toes

A

radiculopathy

38
Q

FABRE: no pain

A

other etiology

39
Q

Neurological exam of low back pain consists of

A
  1. position
  2. muscle strength
  3. sensibility
  4. reflexes
40
Q

what reflexes do we check with low back pain

A
  1. anal
  2. cremasteric
  3. patelar
  4. achilles
41
Q

Describe: L5-S1 disc herniation (S1 nerve root): (50% of cases)

A

Pain radiation: into posterior thigh, posterior and lateral calf, and heel
Sensory deficit: posterior calf, and lateral aspect of foot
Motor deficit: plantar flexors – have patient walk on toes
Reflex deficit: ankle

42
Q

Describe: L5-S1 disc herniation (S1 nerve root): (50% of cases)
pain radiation, sensory deficit, motor deficit, reflex deficit

A

Pain radiation: into posterior thigh, posterior and lateral calf, and heel
Sensory deficit: posterior calf, and lateral aspect of foot
Motor deficit: plantar flexors – have patient walk on toes
Reflex deficit: ankle

43
Q

Describe : L4-5 disc herniation (L5 nerve root): (40% of cases)

pain radiation, sensory deficit, motor deficit, reflex deficit

A

Pain radiation: into lateral thigh, anterior calf and dorsum of the foot, +/- great toe
Sensory deficit: anterior calf, dorsum and medial aspect of foot, first web space, +/- great toe
Motor deficit: dorsiflexors - have patient walk on heels, or dorsiflex great toe against resistance
Reflex deficit: none

44
Q

Describe: disc herniation (L4 nerve root): (10% of cases)
pain radiation, sensory deficit, motor deficit, reflex deficit

A

Pain radiation: into lateral and anterior thigh, medial calf, medial foot, +/- great toe
Sensory deficit: medial calf and foot, +/- great toe
Motor deficit: Quadriceps
Reflex deficit: knee

45
Q

should we order imaging for sciatica according to NICE2016

A

let specialists decide that, do not order it routinely

46
Q

Treatment of low back pain

A

NON-PHARMACOLOGICAL (CORRECT ATTITUDE AND POSTURE)

PHARMACOLOGICAL (NSAIDs, muscle relaxant, aggravating activities)

If the symptoms persists beyond 4 weeks, physical therapy should be considered; MRI (if radicular symptoms become bothersome)

47
Q

Steps for pharmacological therapy of low back pain

A
  1. NSAIDS (Take into account GIT, liver, cardiotenal toxicity) at lowest effective dose
  2. weak opioids (with ot without paracetamol)
  3. do not offer paracetamol alone
  4. do not offer: opioids for chronic pain, SSRI, SNRI or TCA, gabapentinoids or antiepileptics
48
Q

low back pain red flags ( a lot of them, just read)

A

Progressive neurologic deficit
Recent bowel or bladder dysfunction
Saddle anesthesia
Traumatic onset
Age > 50
Male with diffuse osteoporosis or compression fracture
Cancer history
Insidious onset
No relief at bedtime or worsens when supine
Constitutional symptoms (e.g. fever, weight loss)
Hx UTI/other infection, IV drug use, TB exposure
Immune suppression, Steroid use history
Previous surgery

Family medicine final (15 decks)

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