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MC > LBP > Flashcards

LBP Flashcards

1
Q

Back pain accounts for at least_______ of all presenting
problems in general practice in Australia and 6.5%
in Britain.

A

5%

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2
Q

The most common cause of back pain is a _______ but people
suffering from this type of back pain usually do not
seek medical treatment as most of these soft tissue
problems resolve rapidly

A

minor

strain to muscles and/or ligaments,

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3
Q

The main cause of back pain presenting to the
doctor is dysfunction of the intervertebral joints
of the spine due to injury, also referred to as
__________

A

mechanical back pain (at least 70%).

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4
Q

The second most common cause of back pain is
________(synonymous with osteoarthritis and
degenerative back disease). It accounts for about
10% of cases of low back pain

A

spondylosis

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5
Q

L5 and S1 nerve root lesions represent most of the

cases of_________presenting in general practice.

A

sciatica

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6
Q

what is the cause of disruption of the intervertebral disc in the cause of
back pain

A

minor intervertebral

derangement (MID).

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7
Q

The MID always involves _________ in the mobile segment, thus
initiating nociceptive activity in the posterior primary
dermatome and myotome.

A

one of the two

apophyseal joints

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8
Q

In theory, any structure with a nociceptive nerve
supply may be a source of pain. Such structures
include the______

A

ligaments, fascia and muscles of the
lumbosacral spine, intervertebral joints, facet joints,
dura mater and sacroiliac joints.`

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9
Q

This term has been introduced to identify psychosocial
and occupational factors that may increase the risk of
chronicity in people presenting with acute back pain

A

Yellow flag pointers

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10
Q

What are the Yellow flag pointers for LBP

A
  • abnormal illness behaviour
  • compensation issues
  • unsatisfactory restoration of activities
  • failure to return to work
  • unsatisfactory response to treatment
  • treatment refused
  • atypical physical signs
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11
Q

Pain characteristics

• \_\_\_\_\_\_\_\_\_ = inflammation (e.g.
sacroiliitis)
•\_\_\_\_\_\_\_\_\_\_\_= referred pain (e.g.
dysmenorrhoea)
•\_\_\_\_\_\_\_\_\_ = local pain (e.g.
muscular strain)
A

aching throbbing pain

deep aching diffuse pain

superficial steady diffuse pain

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12
Q

Pain characteristics

•_______ = bone disease (e.g. neoplasia,
Paget disease)
•________ = radicular pain (e.g. sciatica)

A

boring deep pain

intense sharp or stabbing (superimposed on a
dull ache)

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13
Q

Continuous pain, present day and night, is

suggestive of _____ or ______

A

neoplasia or infection

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14
Q

Pain on waking also suggests _______

A

inflammation or depressive illness

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15
Q

Pain provoked by activity and relieved by rest suggests
_________ while pain worse at rest and
relieved by moderate activity is typical of ____

A

mechanical dysfunction

inflammation.

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16
Q

Pain aggravated by standing or walking that is
relieved by sitting is suggestive of_______
Pain aggravated by sitting (usually) and improved
with standing indicates a _______

A

spondylolisthesis.

discogenic problem

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17
Q

Pain of the calf that travels proximally with walking
indicates _______; pain in the buttock
that descends with walking indicates _____

A

vascular claudication

neurogenic claudication

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18
Q

A useful screening test for a disc lesion and dural

tethering is the______

A

slump test

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19
Q

active movements in PE

A

Forward flexion
extension
lateral extension

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20
Q

Landmarks

• The tops of the iliac crest lie at the level of the
______interspace (or the L4 spinous process).
• The PSISs lie opposite ____

A

L3–4

S2.

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21
Q

If lateral deviation (scoliosis) is present it

is usually _______

A

away from the painful side.

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22
Q

What test?

The
patient lies supine with both knees extended and the
ankle dorsiflexed. The affected leg is raised slowly,
keeping the knee extended

A

SLR

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23
Q

What is the SLR if there is sciatica

A

If sciatica with dural
irritation is present, 20 ° to 60 ° of elevation causes
reproduction of pain.

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24
Q

The ________ is an excellent provocation test for
lumbosacral pain and is more sensitive than the SLR
test. It is a screening test for a disc lesion and dural
tethering

A

slump test

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25
Q

When to do slump test?

A

It should be performed on patients who
have low back pain with pain extending into the leg,
and especially for posterior thigh pain.

26
Q

Positive slump test?

A

A positive result is reproduction of the patient’s
pain, and may appear at an early stage of the test
(when it is ceased).

27
Q

Significance of the slump test

• If positive, it suggests ______.
• If negative, it may indicate lack of serious disc
pathology.
• If positive, one should approach ____

A

disc disruption

manual therapy
with caution

28
Q

The neurological examination consists of:

1 quick tests: _____
2 dural stretch tests: _____
3 specific nerve root tests (L4, L5, S1): ____

A

walking on heels (L5), walking on toes (S1)

slump test, straight leg raising

sensation, power, reflexes

29
Q

What nerve roots?

• femoral stretch test (prone, flex knee,
extend hip)
• motor—extension of knee
• sensation—anterior thigh
• reflex—knee jerk (L3, L4)
A

L3

30
Q

What nerve roots?

  • motor—resisted inversion foot
  • sensation—inner border of foot to great toe
  • reflex—knee
A

L4

31
Q

What nerve roots?

• motor: walking on heels, resisted extension
great toe
• sensation—middle three toes (dorsum)
• reflex—nil

A

L5

32
Q

What nerve roots?

  • motor: walking on toes, resisted eversion foot
  • sensation—little toe, most of sole
  • reflex—ankle jerk (S1, S2)
A

S1

33
Q 
Investigations for back pain can be classified into
three broad groups: 
1
2
3
A

front-line screening tests;
specific disease investigations;
and procedural and
preprocedural tests

34
Q

Continuous pain (day and night) = _____

A

neoplasia, especially malignancy or infection

35
Q

The other three metastases are from

A

thyroid,

kidney/adrenal and melanoma

36
Q

Pain with standing/walking (relief with sitting)

=______

A

spondylolisthesis

37
Q

In a young person with inflammation think of

_____

A

ankylosing spondylitis

38
Q

Stiffness at rest, pain with or after activity, relief

with rest =______

A

osteoarthritis

39
Q

Pain provoked by activity, relief with

rest = _______

A

mechanical dysfunction

40
Q

T or F

The rule of thumb for the lumbar nerve root
lesions is L3 from L2–3 disc, L4 from L3–4, L5
from L4–5 and S1 from L5–S1.

A

T

41
Q

A ___________ from anticoagulation
therapy can give intense nerve root symptoms
and signs

A

retroperitoneal bleed f

42
Q

Back pain in children

Tumours causing back pain include ____ and ____

A

the benign
osteoid osteoma and the malignant osteogenic
sarcoma

43
Q

______ is a very small tumour
with a radiolucent nucleus that is sharply demarcated
from the surrounding area of sclerotic bone. Although
more common in the long bones of the leg, it can
occur in the spine

A

Osteoid osteoma

44
Q 
Spondylolisthesis can occur in older children,
usually due to a 
1
2
3
A

slip of L5 or S1, because the articular
facets are congenitally absent or because of a stress
fracture in the pars interarticularis

45
Q

_______ is still the most

common cause of back pain in the elderly

A

Traumatic spinal dysfunction

46
Q

The two nerve roots that account for most of
these problems are L5 and S1 and the commonest
disc lesion is _____closely followed by L5–S1.

A

L4–5,

47
Q

The pain is caused by
extreme stretching of the interspinous ligaments
or of the nerve roots. The onset of back pain in
many of these patients is due to concurrent disc
degeneration rather than a mechanical problem

A

Spondylolisthesis

48
Q

What should be avoided Spondylolisthesis?

A

hyperextension.

49
Q

_______ also known as degenerative
osteoarthritis or osteoarthrosis, is a common
problem of wear and tear that may follow vertebral
dysfunction, especially after severe disc disruption
and degeneration

A

Lumbar spondylosis,

50
Q

Lumbar spondylosis Cx

A

leading to subluxation of the facet joints

spinal canal stenosis

51
Q

The ______ are a group
of disorders characterised by involvement of the
sacroiliac joints with an ascending spondylitis and
extraspinal manifestations, such as oligoarthritis and
enthesopathies

A

seronegative spondyloarthropathies

52
Q

Tests for non-organic back pain

(the ‘migratory pointing’ test

A

Magnuson method

53
Q

How to do Magnuson method

A

1 Request the patient to point to the painful sites
2. Palpate these areas of tenderness on two
occasions separated by an interval of several
minutes, and compare the sites

54
Q

Tests for non-organic back pain

What test?

  1. Ask the patient to kneel on a low stool, lean over
    and try to touch the floor.
    2 The person with non-organic back pain will
    usually refuse on the grounds that it would
    cause great pain or that he or she might
    overbalance in the attempt
A

Burn’s ‘kneeling on a stool’ test

55
Q

This may be effective for relatively isolated points
using 5–8 mL of local anaesthetic. Studies indicate that
it is likely to be more beneficial for chronic back pain

A

Trigger point injection

56
Q

This enzyme has been advocated for the treatment

of acute nuclear herniation that is still intact

A

Chymopapain

57
Q

Corticosteroid injection under radio-image intensification
is widely used in some clinics. The procedure
is delicate and expertise is required

A

Facet joint injection

58
Q

Physical therapy

______ are the best form of physical therapy

A

Active exercises

59
Q

Physical therapy

_____ at the end range is a safe,
effective method

A

Passive spinal stretching

60
Q

Physical therapy

________
is a gentle, repetitive, rhythmic movement within the
range of movement of the joint

A

Spinal mobilisation

61
Q

_______ is a high velocity thrust
at the end range of the joint. It is generally more
effective and produces a faster response but requires
accurate diagnosis and greater skill

A

Spinal manipulation

MC (90 decks)

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