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PCM III Final > low back pain HYHO > Flashcards

low back pain HYHO Flashcards

1
Q

what constitutional symptoms should you ask about with low back pain?

A
  • unintentional weight loss, fever, or night sweats
  • history of malignancy
  • precipitating events
  • therapies attempted
  • neurologic symptoms (eg, weakness, falls/gait
    instability, numbness/other sensory changes,
    or bowel/bladder symptoms)
  • stability or progression of symptoms
  • history of recent bacterial infections
  • recent history/current use of injection drugs,
    corticosteroid medications, or recent history of
    epidural/spinal procedures.
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2
Q

what features suggest underlying systemic disease

A

cancer hx, age >50 years, unexplained weight
loss, duration of pain >1 month, nighttime pain, and
unresponsiveness to previous therapies.`

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3
Q

how long is acute back pain

A

less than 4 weeks

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4
Q

how long is subacute back pain

A

4-12 wks

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5
Q

how long is chronic back pain

A

more than 12 wks

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6
Q

what is extremely imp to rule out serious causes of LBP?

A

HISTORY

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7
Q

what is the most common cause of cauda equina compression?

A

herniation of intervertebral disc

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8
Q

what are some signs and symptoms of spinal cord or cauda equina compression??

A
  • pain usually 1st symptom of cord compression, but motor (usually
    weakness) and sensory findings are present in the majority of pts
    at diagnosis.

-Bowel and/or bladder dysfunction are generally late
findings

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9
Q

what improves outcomes of spinal cord or cauda equina compression?

A

early diagnosis and treatment

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10
Q

what is the most common site of metastasis.

A

bone

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11
Q

what is the strongest

risk factor for back pain from bone metastasis.

A

A history of cancer (excluding nonmelanoma skin cancers)

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12
Q

Spinal epidural abscess symptoms

A

rare but serious cause of back pain. Initial
symptoms (eg, fever and malaise) often nonspecific; over time, localized
back pain may be followed by radicular pain and, left untreated, neurologic
deficits.

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13
Q

Vertebral osteomyelitis symptoms –

A

most pts with vertebral osteomyelitis will
present with back pain, which gradually increases over weeks to months;
fever may/may not be present

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14
Q

what outside the spine can cause low back pain?

A

pancreatitis,
nephrolithiasis, pyelonephritis, abdominal aortic aneurysm, or herpes
zoster.

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15
Q

what motor weakness is seen with L4 compression?

A

extension of quadriceps

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16
Q

what is the screening examination for L4?

A

squat and rise

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17
Q

what reflex is diminished with L4 compression?

A

knee jerk

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18
Q

what motor weakness is seen with L5 compression?

A

dorsiflexion of great toe and foot

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19
Q

what is the screening examination for L5?

A

heel walking

20
Q

what reflex is diminished with L5 compression?

A

no reliable

21
Q

what motor weakness is seen with s1 compression?

A

plantar flexion of great toe and foot

22
Q

what is the screening examination for S1?

A

walking on toes

23
Q

what reflex is diminished with S1 compression?

A

ankle jerk

24
Q

should you get imaging for LBP less than 4 wks?

A

-most dont require imaging and will improve rapidly

25
Q

should you get imaging if pt has neuro defects?

A

Indications for imaging in the presence of neurologic
symptoms depends upon the nature of the symptoms and the pt’s risk
factors for cancer and/or an infectious etiology of back pain.

26
Q

what imaging should pt with symptoms of spinal cord or cauda equina compression
or progressive and/or severe neurologic deficits get?

A

immediate MRI for further evaluation and urgent specialist referral.

27
Q

what are signs and symptoms of spinal cord compression that would need urgent MRI?

A

new urinary retention, urinary
incontinence from bladder overflow, new fecal incontinence, saddle
anesthesia, and significant motor deficits not localized to a single nerve
root.

28
Q

do pts with radiculopathy attributable need immediate imaging?

A

no unless there is a risk of metastatic cancer or moderate to high risk of
infection.

29
Q

who else besides pts with symptoms of cord compression should get an urgent MRI?

A

those who have a risk of metastatic cancer or in whom there is
moderate to high risk of infection

30
Q

what has been shown to increase the probability of finding spinal malignancy?

A

history of cancer

31
Q

what are red flags associated with the highest post test probability of a vertebral fracture

A
  • older age
  • prolonged use of corticosteroids
  • severe trauma
  • presence of contusion or abrasion
32
Q

what imaging should you do for suspected renolithiasis

A

CT of the abdomen and pelvis without contrast
performed using low-radiation-dose protocols is the preferred exam
for most adults with suspected nephrolithiasis.

33
Q

what should you do if CT is not available for renolithiasis

A

ultrasound of the kidneys and bladder,

sometimes in combination with abdominopelvic radiography, is the second-
line option for initial imaging.

34
Q

what is included in the PE for low back pain?

A

abdomen, structural exam, reflexes, strength

and sensation.

35
Q

cauda equina syndrome clinical clues

A
  • urinary retention
  • saddle anesthesia
  • bilateral leg weakness
  • bilateral sciatica
36
Q

infection clinical clues

A
  • fever
  • recent skin or urinary infection
  • immunosuppression
  • injection drug use
37
Q

malignancy clinical clues

A
  • cancer history, esp active cancer
  • unexplained weight loss
  • age >50
  • duration > 1 month
38
Q

compression fracture clinical clues

A
  • age over 70
  • female
  • corticosteroid use
  • hx of osteoporosis
  • trauma
39
Q

lumbar radiculopathy clinical clues

A
  • sciatica

- abnormal neuro exam

40
Q

what is the treatment for LBP?

A

x Most patients with acute LBP improve
regardless of specific management.

x Try nonpharmacologic therapy with
superficial heat.

x Massage, acupuncture, and spinal
manipulation are other reasonable options
depending upon pt preference, cost and
accessibility.

41
Q

what is not a treatment for LBP?

A

bed rest

42
Q

what pharmacological approaches can you use for LBP?

A

-try short-term (2 to 4
weeks) treatment with a nonsteroidal antiinflammatory drug (NSAID)
as initial therapy.
Acetaminophen is an acceptable alternative in pts
with a contraindication to NSAIDs,

43
Q

if initial pharmacotherapy for LBP is not working what can you add?

A

can add a

nonbenzodiazepine muscle relaxant.

44
Q

when should you use opioids for LBP and what is duration?

A

●Reserve opioids and tramadol for pts who do not have adequate
relief from or have contraindications to other drugs.

Be very cautious
with opioids, and if used, the duration should be limited to 3 to 7
days.

45
Q

how long should tramadol be prescribed for?

A

Tramadol should not be prescribed for more than 2 weeks.

46
Q

when should pts with LBP be reassessed?

A

after 4 wks of pharmacotherapy if dont improve

47
Q

what are predictors of disabling chronic LBP at 1 yr?

A

maladaptive pain coping
behaviors, functional impairment, poor general health status,
presence of psychiatric comorbidities, or nonorganic signs.

PCM III Final (11 decks)

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