Low Back Pain

Question 1

What potential cause of LBP does a hx of cancer suggest?

Answer 1

Cord Compression

Question 2

What common physical findings are associated with Cord Compression?

Answer 2

Vertebral tenderness, sensory level hypereflexia

Question 3

What potential cause of LBP does a hx of Fever/high ESR suggest?

Answer 3

Epidural abscess

Question 4

What common physical findings are associated with an Epidural Abscess?

Answer 4

Vertebral tenderness, sensory level hyperreflexia

Question 5

What potential cause of LBP does a hx of Bowel/bladder incontinence and erectile dysfunction suggest?

Answer 5

Cauda Equina

Question 6

What common physical findings are associated with Cauda Equina?

Answer 6

Bilateral leg weakness and saddle anesthesia

Question 7

What potential cause of LBP does a hx with age<40, worse with rest and improves with activity suggest?

Answer 7

Ankylosing Spondylitis

Question 8

What common physical findings are associated with Ankylosing Spondylitis?

Answer 8

Decreased Chest Mobility

Question 9

What potential cause of LBP is associated with a hx of Pain/numbness of the medial calf or foot?

Answer 9

Disk Herniation

Question 10

What common physical findings are associated with a disk herniation?

Answer 10

Loss of knee and ankle reflexes, (+) straight leg raise test

Question 11

What would cord compression at T4 cause?

Answer 11

Sensory loss below the nipples

Question 12

What would cord compression at T10 cause?

Answer 12

Sensory loss below the umbilicus

Question 13

What physical exam feature is highly suggestive of cord compression?

Answer 13

Point tenderness with spine percussion

Question 14

Where is hyperreflexia found in cord compression?

Answer 14

Below the level of compression

Question 15

What diagnostic features distinguishes an Epidural abscess from cord compression?

Answer 15

High Fever and elevated ESR

Question 16

What pathogen is most commonly responsible for an Epidural Abscess?

Answer 16

Staphylococcus Aureus

Question 17

What level is most common for Disk Herniation?

Answer 17

L4/L5 and L5/S1

Question 18

What is a Positive straight leg raise test?

Answer 18

Patient has pain going into the buttock and below the knee when leg is raised above 60 degrees

highly sensitive: (-) excludes herniation with 95% sensitivity

Question 19

What motor deficit is associated with the L4 Nerve root?

Answer 19

Dorsiflexion of the foot

Question 20

What reflex is associated with the L4 Nerve root?

Answer 20

Knee Jerk

Question 21

What sensory area is associated with the L4 Nerve root?

Answer 21

Inner calf

Question 22

What motor deficit is associated with the L5 Nerve root?

Answer 22

Dorsiflexion of the toe

Question 23

What reflex is associated with the L5 nerve root?

Answer 23

none

Question 24

What sensory area is associated with the L5 nerve root?

Answer 24

Inner Forefoot

Question 25

What Motor Deficit is associated with the S1 nerve root?

Answer 25

Eversion of the foot

Question 26

What reflex is associated with the S1 never root?

Answer 26

Ankle Jerk

Question 27

What sensory area is associated with the S1 nerve root?

Answer 27

Outer foot

Question 28

What is the best initial test?

Answer 28

Plain X-ray; cancer with compression, infection, fracture

Question 29

What is the most accurate test?

Answer 29

MRI

Question 30

What is the most accurate test if MRI is contraindicated?

Answer 30

CT: must give intrathecal contrast to increase accuracy (CT Myelogram)

Question 31

How do you treat cord compression?

Answer 31

Systemic Glucocorticoids Chemo for lymphoma Radiation for solid tumors Surgical decompression

Question 32

How do you treat an Epidural Abscess?

Answer 32

Steroids for acute neurological defecits Antistaphylococcal antibiotics Gentamycin added for endocarditis Surgical drainage

Question 33

What antistaphylococcal antibiotics are commonly used for Epidural Abscess?

Answer 33

Vancomycin or Linezolid: until sensitivty is known If sensitive: Beta-lactams: oxacillin, nafcillin, Cefazolin

Question 34

What is the treatment for Cauda Equina?

Answer 34

Surgical Decompression

Question 35

What is the treatment for Disk Herniation (Sciatica)?

Answer 35

NSAIDs + continue normal activity Yoga Steroid Injections into epidural space Surgery if focal neurological deficits develop or progress

Question 36

What abx are used for MRSA epidural abscess?

Answer 36

Vancomycin Linezolid Daptomycin

Question 37

What is Lumbar spinal Stenosis?

Answer 37

Narrowing of the spinal canal leading to pressure on the cord

Question 38

When does pain occur in Lumbar Spinal Stenosis?

Answer 38

When back is in extension and cord presses back against the ligamentum flavum Worse with exertion with leaning back

Question 39

How does Lumbar Spinal Stenosis commonly present?

Answer 39

Pt >60 with pack pain while walking radiating into the buttocks and thighs bilaterally Pain worse walking downhill: alleviated by sitting or leaning forward Unsteady gait and leg weakness when walking Diminished LE reflexes in 25% of patients

Question 40

What is the most accurate test for Lumbar Spinal Stenosis?

Answer 40

MRI

Question 41

How do you treat Lumbar Spinal Stenosis?

Answer 41

Weight loss and Pain meds: NSAIDs, opiates, Aspirin first Steroid injection into Lumbar Epidural space PT and exercise: Bicycling or swimming Surgical correction to dilate the spinal canal