HYHO SPE3-3 Lumbar Strain/Nephrolithiasis

Question 1

Features suggesting systemic disease related to low back pain

Answer 1

Cancer hx

>50 yo

Unexplained weight loss

Pain >1 month

Nighttime pain

Unresponsiveness to previous therapies

Question 2

3 types of low back pain and duration

Answer 2

Acute <4 weeks

Subacute 4-12 weeks

Chronic >12 weeks

Question 3

Most common cause of spinal cord or cauda equina compression

Answer 3

Herniation of intervertebral disc

Question 4

When are bowel and bladder dysfunctiont typically found in a low back pain complaint?

Answer 4

Late

Pain is 1st, motor and sensory dysfunction 2nd, bowel/bladder 3rd

Question 5

What is the strongest risk factor for back pain from bone metastasis?

Answer 5

Hx of CA (excluding nonmelanoma skin CA)

Question 6

What dermatomes are tested for lumbar nerve root compromise? What muscles/actions are they associated with?

Answer 6

L4 - quadriceps extension

L5 - Great toe/foot dorsiflexion

S1 - Great toe/foot plantarflexion

Question 7

What reflexes are diminished with lumbar nerve root compromise?

Answer 7

L4 - knee jerk

L5 - none

S1 - Ankle jerk

Question 8

Genitourinary tract sympathetic viscerosomatic levels?

Ureter sympathetic VS levels?

Answer 8

T10-L2 - GU tract

T10-T11 - Upper Ureter

T12-L2 - Lower ureter

Question 9

Do pts with nonspecific LBP <4 weeks need imaging?

Answer 9

No

Most pts who present to primary care settings will have nonspecific pain w/o associated sx and will improve rapidly

Question 10

Red Flag sx for pts at risk for more dangerous cause of back pain

Answer 10

Spinal malignancy - hx of CA

Vertebral fx - older age, prolonged use of steroids, severe trauma, presence of contusion/abrasion

Question 11

What test should immediately be done for a pt with sx of spinal cord or cauda equina compression?

Answer 11

Immediate MRI

Followed by urgent specialist referral

Question 12

Sx of spinal cord or cauda equiina compression

Answer 12

New urinary retention

Urinary incontinence from bladder overflow

New fecal incontinence

Saddle anesthesia

Question 13

Do pts with radiculopathy attributable to a single nerve root due to spinal stenosis need immediate imaging?

Answer 13

No

Unless there is a risk of metastatic CA or moderate-high risk of infection

Question 14

If there is low risk/suspicion for vertebral/spinal malignancy and infection, what tests should you order?

Answer 14

Plain radiography

ESR/CRP

Question 15

What is the preferred test for most adults with suspected nephrolithiasis?

Answer 15

CT abdomen/pelvis w/o contrast performed using low-radiation dose protocols

If unavailable, US kidneys and bladder

Question 16

Clinical clues for compression fx

Answer 16

>70 yo

Female

Corticosteroid use

Hx of osteoporosis

Trauma

Question 17

What do you give a pt with LBP who preferrs pharmacologic therapy or in whom nonpharmacologic approaches are inadequate?

Answer 17

Short term NSAID (2-4 weeks)

Or acetaminophen in pts contraindicated for NSAIDs

Question 18

Predictors of developing disabling chronic LBP at 1 year

Answer 18

Maladaptive pain coping behaviors

Functional impairment

Poor general health status

Psychiatric comorbidities

Question 19

How long should opioids be used for back pain?

Answer 19

3-7 weeks

Tramadol should not be prescribed >2 weeks