Evaluation of Lower Back Pain

Question 1

90% of all low back pain will resolve in ____ weeks without intervention

Answer 1

6

Question 2

99% of all low back pain will resolve in ____ weeks

Answer 2

12

Question 3

What are the goals of lower back pain treatment?

Answer 3

Hasten recovery
Control pain
Facilitate rehabilitation

Question 4

What is the first question in the initial approach to back pain?

Answer 4

What is the most serious thing this could be?

Question 5

What are some indicators of ominous history?

Answer 5

Bilateral radicular pain
Saddle area anesthesia
Urinary incontinence
Urinary retention
Increased urinary frequency

Question 6

What is the treatment for cauda equina syndrome?

Answer 6

Surgical decompression within 24-48 hours

Question 7

What to rule out if pt presents with weak and rapid pulse?

Answer 7

Retroperitoneal hemorrhage

Question 8

What to rule out if pt presents with low blood pressure?

Answer 8

Retroperitoneal hemorrhage

Question 9

Make a mark on the skin midway between the PSIS
Make a mark 5 cm down from this point
Make a mark 10 cm up from initial point
With trunk flexed, should stretch to a minimum of 20 cm

Answer 9

Shober test

< 20 cm indicates significant loss of lumbar motion

Question 10

Gluteus medius innervation

Answer 10

L5 root

Question 11

What does a positive Trendelenberg test indicate?

Answer 11

Weakness of gluteus medius (compromise of L5 nerve root)

Question 12

Straight Leg Raising Test produces no symptoms to 90 degrees of hip flexion. What does this indicate?

Answer 12

Normal straight leg raising test

Question 13

Pt has low back pain and cannot stand on toes due to muscle weakness. Which nerve root is compressed?

Answer 13

S1

Question 14

Pelvic rock test reproduces pt’s pain. What is the most likely diagnosis?

Answer 14

Sacroiliitis

Question 15

Pt with low back pain presents with fever and percussive pain at L1, L2, L3, and L4. What is the most like diagnosis?

Answer 15

Osteomyelitis

Question 16

Which of the following muscles is innervated by L2-L4?

Extensor digitorum brevis
Extensor hallucis longus
Gluteus medius
Quadriceps
Tibialis anterior

Answer 16

Quadriceps

Question 17

Which test looks for the same pathology as the Valsalva?

Answer 17

Naffziger test

Question 18

Shober test shows post flexion number of 16 cm. Most likely dx?

Answer 18

Ankylosing spondylitis

Question 19

Lower extremity weaknes
Low back pain
Neck pain
Left Babinski response

Most likely dx?

Answer 19

Multiple sclerosis

Question 20

Grade 0 muscle strength is defined as…

Answer 20

Flaccid paralysis

Question 21

Which test will exacerbate symptoms of any space-occupying lesion in the spinal canal?

Answer 21

Valsalva

Question 22

Which test will determine the presence of an extension lumbar spine somatic dysfunction?

Answer 22

Sphinx test

Question 23

In which test will pain radiating down the anterior thigh imply femoral nerve entrapment or disease?

Answer 23

Nachalas

Question 24

What is a relative contradindication for OMT for low back pain?

Answer 24

Herniated nucleus pulposus

Question 25

Which muscle is the most overlooked cause of low back pain?

Answer 25

Quadratus lumborum

Question 26

Rapidly alternating muscle contraction and relaxation upon dorsiflexion of ankle indicates with diagnosis?

Answer 26

A disconnect between upper and lower motor neurons

Question 27

Weakness of both gastrocnemius and soleus muscles indicates compression of which nerve root?

Answer 27

S1

Question 28

Positive Gaenslen test indicates which condition?

Answer 28

Sacroiliitis

Question 29

What is the best indication for OMT for low back pain?

Answer 29

Somatic dysfunction

Question 30

Tibialis anterior is associated with which reflex?

Answer 30

Patellar

Question 31

Extensor hallucis longus is associated with which reflex?

Answer 31

There is no reflex associated

Question 32

Which test will determine the presence of a lumbar somatic dysfunction?

Answer 32

Sphinx test

Question 33

Which imaging modality would most accurately image herniated nucleus pulposus?

Answer 33

MRI

Question 34

Herniated nucleus pulposus is most likely found at which level?

Answer 34

L4-L5

Question 35

Loss of sensation in the web space between first and second toes would indicate compression of which nerve root?

Answer 35

L4-S1

Question 36

With pt supine, you restrain the sternum and passively flex the neck. This reproduces pain in the lower thoracic region. Which test is this?

Answer 36

Soto Hall