Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Family Medicine > Case 10: Low Back Pain > Flashcards

Case 10: Low Back Pain Flashcards

1
Q

Most back pain resolves within…

A

two to four weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Congenital causes of lower back pain

A

Kyphosis (curved forward)
Scoliosis
Spondylolysis (Scotty dog fracture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Traumatic causes of lower back pain

A

Lumbar strain

Compression fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Metabolic causes of lower back pain

A

Osteomalacia
Hyperparathyroidism
Paget’s disease
Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infectious causes of lower back pain

A 
Pyelonephritis
Osteomyelitis
Discitis
Herpes zoster
Epidural or spinal abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inflammatory causes of lower back pain

A

Ankylosing spondylitis
Sacroilitis
Rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neoplastic causes of lower back pain

A 
Multiple myeloma
Metastatic disease
Lymphoma
Leukemia
Osteosarcoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Degenerative causes of lower back pain

A

Disc herniation
Osteoarthritis
Facet arthropathy
Spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Vascular causes of lower back pain

A

Aortic aneurysm

Diabetic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Visceral causes of lower back pain

A 
PID
Prostatitis
Endometriosis
Kidney stones
Pancreatitis
Cholecystitis
Ovarian cyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 major categories of back pain

A
  1. Mechanical (97%) - from bones, muscles, nerves
  2. Visceral (from internal organs)
  3. Non mechanical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 most common causes of back pain

A

All mechanical

  1. Lumbar strain/sprain (70%)
  2. Age related degenerative joint changes
  3. Herniated disc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

RFs for lower back pain (5)

A
  1. Prolonged sitting (truck driver, desk job)
  2. Deconditioning
  3. Sub optimal lifting and carrying habits
  4. Repetitive bending and lifting
  5. Spondylolysis, disc space narrowing, spina bifida
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Red flags for serious illness or neuro impairment with back pain (5)

A
  • fever
  • unexplained weight loss
  • pain at night
  • neuro symptoms
  • bowel or bladder incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Disc herniation is worse with and better with?

A

Worse with sitting, leaning forward

Better with lying down or standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of disc herniation (4)

A
  • increased pain with coughing/sneezing/valsalva
  • radiation of pain down leg/foot
  • paresthesias
  • muscle weakness (foot drop)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Consider significant herniated nucleus pulposus

A
  • major muscle weakness (=3 out of 5 strength)

- foot drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Consider cauda equine syndrome if

A
  • urinary incontinence or retention
  • saddle anesthesia
  • fecal incontinence
  • bilateral LE weakness or numbness
  • progressive neuro deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prolonged use of corticosteroids increases probability of ______ ________ as source of LBP

A

Vertebral fracture (as does trauma, age >70, osteoporosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Recurrence of back pain is

A

High at 35 to 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Physical exam for LBP has 3 components

A
  • standing
  • sitting
  • supine
22
Q

Standing LBP physical exam

A
  1. Inspection for lordosis, kyphosis, scoliosis
  2. Palpation
  3. Range of motion: lumbar flexion, lumbar extension, lateral motion
  4. Gait: heel walk (L5) and toe walk (s1)
  5. Stoop test (go from standing to squatting) - in central spinal stenosis, squatting will reduce the pain
23
Q

Seated LBP physical exam

A
  1. Check for CVA tenderness
  2. Modified straight leg raise test
  3. Neurological exam (to assess for nerve root impingement syndromes)
24
Q

Modified straight leg raise test in seated LBP physical

A

Raise each leg while talking to pt

  • if pain is functional, action is possible w/o difficulty
  • if pain is structural, person will instinctively tripod (lean backward and support self with arms)
25
Q

2/5 strength

A

Voluntary movement in plane of gravity

26
Q

3/5 strength

A

Movement against gravity

27
Q

4/5 strength

A

Movement against some resistance

28
Q

L3

A

Patellar reflex
Sensation: lateral thigh
Motor: extend quads (squat down and rise)

29
Q

L4

A

Patellar
Sensation: medial calf/ankle
Motor: dorsiflex foot (walk on heels)

30
Q

L5

A

Sensation: lateral calf, dorsum of foot, big toe
Motor: dorsiflex big toe (walk on heels)

31
Q

S1

A

Achilles reflex
Sensation: posterior calf, sole of foot, lateral ankle
Motor: Plantar flex ankle (walk on toes)

32
Q

Supine LBP physical exam

A
  1. Abdominal exam (AAA, tenderness)
  2. Rectal exam only if there are alarm symptoms - look for bleeding or decreased done
  3. Passive straight leg test
  4. Crossed leg test
  5. FABER test
  6. Pelvic compression test
  7. Observe muscle atrophy
33
Q

Straight leg test

A

Sensitive, but not specific (a negative test makes herniated disc unlikely)
Normal leg can be raised 80 degrees - + test if
- leg raised <80 degrees: sciatica (+ pain w dorsiflexion) or tight quads (no pain w dorsiflexion)
- pain that radiates down leg (disc herniation)
- pain in opposite leg (root compression due to central disc herniation)

Less sensitive and specific test than MRI

34
Q

Crossed leg test

A

Raise asymptomatic leg
+ test if pain in contralateral leg: highlights degree of disc herniation - if positive, large central herniation present

35
Q

FABER test

A

positive test indicates sacroiliitis

36
Q

Pelvic compression test

A

Forcibly press hips together - positive test indicates sacroiliitis

37
Q

Differential Dx for LBP

A
  1. Lumbar strain
  2. Disc herniation
  3. Degenerative joint disease
  4. Spinal stenosis
  5. Cauda equine syndrome
  6. Pyelonephritis
  7. Malignancy
  8. Ank spondy
  9. Spondylolisthesis
  10. Prostatitis
  11. Pancreatitis
  12. Spinal fracture
38
Q

Pain worse with movement or sitting

A

Think mechanical cause

  • lumbar strain
  • disc herniation
  • degenerative arthritis
39
Q

Cauda equine syndrome

A
  • due to large mass effect - acute disc herniation compresses the cauda equine - pain radiates down leg with numbness + bladder/bowel incontinence
  • if present, DECOMPRESSION IN 72 HRs (surgical emergency)
40
Q

Malignancy as cause of LBP

A

Pain localized to affected bones: dull, throbbing pain that progresses slowly that increases with cough
- seen in pts > 50

41
Q

Ank spondy

A

Chronic, painful inflammatory arthritis primarily affecting spine and SI joints

  • pts 15 to 40 yrs old
  • Morning stiffness that improves with activity
42
Q

Spondylolisthesis

A

Anterior displacement of vertebra or vertebral column

  • any age
  • aching back and posterior thigh discomfort that increases w activity or bending
43
Q

Is early MRI associated with improved outcomes in patients with acute back pain or radiculopathy?

A

No!

75% of herniated discs improve with 6 weeks of conservative therapy

44
Q

In absence of red flags or findings suggestive of systemic disease, diagnostic testing, is …

A

Not indicated until after 4-6 weeks of conservative management

45
Q

Radiation exposure to ovaries in a single plain Xray of lumbar spine is equal to

A

Getting a daily chest Xray for more than a year

46
Q

Conservative Tx for acute low back pain

A
  • NSAIDs, acetaminophen, muscle relaxants
  • local therapy with heat/cold
  • NO bed rest- resume regular activities!
47
Q

Referral to surgeon or advanced imaging (MRI/CT) should be considered if

A

Pain does not improve in 4-6 weeks or if neuro deficits appear/progress
- can also refer to pain clinic for epidural spinal injection

48
Q

Opioids are

A

second line treatment for back pain

and oral steroids are never the answer

49
Q

PT for LBP?

A

Some data shows that tailored PT is more effective for acute back pain compared to pts who just stay active

50
Q

Acupuncture for LBP?

A

Limited evidence

Family Medicine (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions