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Flashcards in back pain Jaynstein Deck (50)
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1
Q

Whats considered acute LBP?

A

acute is <4 week

2
Q

What is subacute LBP?

A

4-12 weeks

3
Q

What is chronic LBP?

A

> 12 weeks
~20weeks of pts will into chronic

4
Q

What are the RF of developing chronic LBP?

A
  • Psychosocial factors are the strongest predictor
  • Congenital spine abnormalities
  • Smoking
  • Occupation
  • Prior episode of LBP
  • Physical unfitness
  • Increasing age
5
Q

What are the red flags of backpain?

A

TUNA FISH

6
Q

What are important of history question for backpain?

A

All of oldcaarts
- prior h/o same
- history of IVDU
- systemic infection
- loss of bowel/bladder control but urinary retention to urinate is bad sign!
- Any Chiropractic manipulation?

7
Q

What are signs of cancer?

A
  • 50 years old
  • H/o of CA, possible for metastic dz
  • Breast, lung and prostate for metastasize to spine/bone
  • weight loss
  • Pain more than 1 month duration
  • Failure to improve conservative therapy
  • Pain with unrelieved with rest (at night
8
Q

What is the workup for CA in back?

A

CBC, plain films, direct to possible source

9
Q

Spinal infection comes from?

A

Urinary infection, indwelling cathers, skin infection and IVDU

10
Q

T/F Fever is sensitive for spinal infxn

A

False, not sensitive

11
Q

What is the most sensitive for spinal infection?

A

Spinal tenderness

12
Q

What is the workup for spinal infection?

A
  • ua, cbc, blood cultures, lactate
  • ESR is the most sensitive and specific lab
  • MRI wwo imaging study of choice
13
Q

Compression fracture is most often occurs in patients with ___?

A

Osteoporosis

14
Q

T/F Pts on long-term corticosteroid therapy have a compression fx until proven otherwise

A

True

15
Q

If you think pt has compression fracture, what is the 1st dx imaging?

A

Plain film

16
Q

T/F If pt has + fracture then you dont need to get a CT

A

True, if pt has negative xray then get a CT w.o contrast to r/o fracture

17
Q

What is the treatment for compression fracture?

A

Kyphoplasty/Vertebroplasty

18
Q

what are the characteristics of ankylosing spondylitis?

A
  • Morning stiffness
  • Improvement with exercise
  • Onset of pain at age < 40
  • Pain progression, slowly
  • Pain > 3 months
19
Q

Whats the most important indicator in AS?

A

reduced flexion

20
Q

What is + in majority of AS?

A

HLA-B27

21
Q

Whats the next thing you should x-ray?

A

Pelvic Xray
(Bilateral and symmetric sacroilitis) because they have scral changes first before the back

22
Q

Whats the next thing you should x-ray after sacral?

A

lumbar spine
- Bone sclerosis
- Bamboo sign is present in <10% patients

23
Q

Lumbar disc hernation

A
  • Have sciatica
  • Don’t need surgery
  • H/o of recurrent LBP prior to sciatica
24
Q

What is the most sensitive test for disc herniation?

A

SLR
and positive crossed straight leg raise

(other side with no pain will cause pain on the effected side)

25
Q

Positive SLR and CSLR

A

Less concerning bc its expected with disc herniation.

if its with neuro defecits, then its concerning.

26
Q

What are physical findings for lumbar disc herniation?

A
  • Ankle dorsiflexion weakness, great toe extensor weakness, and decreased pinprick sensation are also clinically helpful
27
Q

T/F lumbar spine imaging studies will reveal an asymptomatic anatomic disc herniation

A

True

28
Q

When should you order MRI?

A

After 6 weeks after doing conservative symptoms.

If they have more neuro syms earlier then order the dx imaging early

29
Q

What is Spinal stenosis

A

Narrowing of the spinal canal leads to nerve impingement /cord compression

30
Q

Spinal stenosis sx

A

pain in the legs, and sometimes neuro deficits, that occurs after standing or walking

31
Q

How can you differentiate spinal stenosis from PVD?

A

check pulses, PVD will have decreased pulse

32
Q

What is the average age surgical intervention for spinal stenosis?

A

age 55 and with 4 years of symptoms

33
Q

T/F Spinal stenosis pain is provoked by bike riding

A

False, it does not cause pain when riding a bike

34
Q

How does spinal stenosis progress?

A

Back pain slowly progresses to constant pain with leg “stiffness” or pain

35
Q

T/F Pain in increased with spine flexion for spinal stenosis?

A

false, it is increased with spine extension

36
Q

Whats the imaging for spinal stenosis?

A

L-spine
or
MRI or CT L/S WO contrast

37
Q

What is cauda equina?

A

Massive midline disc herniation leading to spinal cord compression

38
Q

Is cauda equina emergency?

A

YES YES

39
Q

What is a factor for cauda equina?

A

disc herniation!!

40
Q

Signs for cauda equina?

A
  • Urinary retention (loss of bowel/bladder but LATE)
  • Anesthesia (saddle region anesthesia)
  • Decreased rectal tone (
  • Sciatica
  • +SLR
  • Sensory and motor deficits
41
Q

What is the next step for Cauda Equina?

A
  • Emergent MRI
  • Emergent Neurosurgery consult
42
Q

T/F is a good H&P does not cause any concerns for any of the backpain then no additional workup is required

A

TRUE

43
Q

T/F No imaging or other diagnostic tests are needed initially in a patient with nonspecific low back pain.

A

True

44
Q

When should you obtain spine imaging?

A

high risk pt with vertebral compression fracture
- infection, cauda equina syndrome, progressive/severe neuro deficits
- Risk factors for cancer
- Radiculopathy or spinal stenosis
- with progressive neuro symptoms with NO improvement after >6weeks.

45
Q

What labs should you consider?

A
  • ESR
  • CBC (maybe if they have infection or cancer)
  • Lactate, blood culture (maybe if they have infection or cancer)
46
Q

Treatment for LBP?

A

Active
- PT, massage, acupuncture, manipulation

47
Q

What is pharm treatment for LBP?

A
  • Combo active therapy with meds
  • first-line is NSAIDs or APAP
  • Second line muscle relaxers or antidepressants
48
Q

What about other treatment of LBP?

A
  • Topical meds
  • Trigger point injection
  • Nerve pain
49
Q

What should you avoid with LBP treatment

A

Benzo’s and opiates

Benzo’s are potent muscle relaxers, possible to do one dose of benzo (valium) to help relax/decrease pain to continue oral meds.

50
Q

What is goal for LBP?

A
  • Try to get back to baseline in 4 weeks
  • Walk 20min, 3-4 times a week
  • Re-eval in 4 weeks, sooner if uncontrolled pain, progressive symptoms
  • ER precaution