Ross - Back Pain

Question 1

__% of people have back pain in their life
__% of people have emergent back pain

Answer 1

85%

3%

Question 2

5 serious causes of back pain

Answer 2

cauda equina

cord impingement

AAA or dissection

pathological features

osteomyelitis

Question 3

what are 3 causes of cord impingement

Answer 3

herniated disc

epidural abscess

epidural hematoma

Question 4

spinal cord impingement findings are often

Answer 4

unilateral

Question 5

pt’s that are high risk for emergent back pain

Answer 5

immunocompromised

etoh

ivdu

steroid users

DM

HIV

Question 6

3 symptoms related to increased risk for emergent back pain

Answer 6

increasing chronic pain

nighttime pain

radicular pain

Question 7

PMH indicative of high risk for emergent back pain (4)

Answer 7

multiple visits

hx trauma

hx back surgery

fever

Question 8

what might the previous pt’s need

Answer 8

emergent MRI

Question 9

what imaging to order if you suspect fx w. back pain

Answer 9

CT

Question 10

do most ppl need imaging/labs for back pain

Answer 10

no!

Question 11

tx for non most non emergent back pain

Answer 11

stay OUT of bed

ibuprofen

indications to return

Question 12

what is spondylosis

Answer 12

nonspecific, degenerative dz

Question 12

what is spondylosis

Answer 12

nonspecific, degenerative dz

Question 13

what is spondylolysis

Answer 13

fx of pars

Question 14

what is the pars (interarticularis)

Answer 14

part of vertebrae between inferior and superior articular processes of facet joint

Question 15

what is spondylolisthesis

Answer 15

fractured pars (spondylolysis) interarticularis separates → injured vertebrae slips anterior

Question 16

what nerve roots are involved in 95% of all disc herniations

Answer 16

L5

S1

Question 17

what nerve root:

pain along the front of the leg, weak extension of leg at knee joint, sensory loss about the knee, loss of knee-jerk reflex

Answer 17

L4

Question 18

what nerve root: pain along the side of the leg, weak dorsiflexion of foot, sensory loss in web of big toe

Answer 18

L5

Question 19

what nerve root: pain along back of leg, weak plantarflexion of foot, sensory loss along back of calf and lateral aspect of foot, loss of ankle jerk

Answer 19

S1

Question 20

the CMT for non-traumatic back pain determines whether a pt needs (3)

Answer 20

MRI w. contrast

ESR

avoidance of MRI and other imaging

Question 21

minor criteria for CMT for non-traumatic low-back pain (5)

Answer 21

etoh abuse

DM

renal failure

night pain

3rd visit in last 20 days

→ 1 point each

Question 22

major criteria for CMT for non traumatic low-back pain (7)

Answer 22

iv drug use

fever w.o focus

recent/current systemic infxn

immunosuppression

recent spinal fx/procedure

incontinence/retention

indwelling urinary catheter

→ 3 points each

Question 23

__ points or more on the CMT for non-traumatic back pain requires an ESR

Answer 23

4

Question 24

a CMT for non-traumatic back pain \<4 means you should

Answer 24

consider avoiding MRI and other imaging

Question 25

herniated discs usually affect people in their __ decade of life

Answer 25

3rd → 20-29 yo

Question 26

herniated discs usually occur between (2)

Answer 26

L4/L5 L5/S1

Question 27

how do herniated discs present

Answer 27

abrupt onset of pain unilateral aggravated by walking, standing, coughing persistent pain

Question 28

how do you diagnose herniated disc

Answer 28

MRI

Question 29

tx for herniated disc is __ at first, but may need __ if pain persists

Answer 29

surgery → remove pressure from root

Question 30

indication for emergent surgery for herniated disc

Answer 30

motor finding of weakness

Question 31

\_\_ symptoms in herniated disc may be repaired less emergently

Answer 31

sensory

Question 32

what test might be positive in herniated disc

Answer 32

straight leg

Question 33

\_\_ is a catch all term for lower back pain

Answer 33

sciatica

Question 34

cauda equina syndrome affects which nerve root pairs

Answer 34

L2 - S5

Question 35

the cauda equina extends from \_\_ to \_\_

Answer 35

L1 - Co1

Question 36

cauda equina syndrome occurs when there is a

Answer 36

compression → reduction of volume for spinal roots

Question 37

4 causes of cauda equina

Answer 37

disc herniation spinal abscess hematoma fx

Question 38

typical presentation of cauda equina syndrome

Answer 38

bilateral radicular pain leg weakness w. difficulty walking on toes/heels urinary/stool incontinence → loss of sphincter control

Question 39

what is a very sensitive test for cauda equina syndrome

Answer 39

urinary sphincter control test

Question 40

urinary sphincter test \> __ is positive

Answer 40

150

Question 41

if a post void residual test is positive you should,

Answer 41

order MRI **emergently**

Question 42

what 2 pt's with back pain need xrays for sure

Answer 42

65 yo or older pt's w. red flags

Question 43

what type of imaging do pt's w. red flags need

Answer 43

emergent

Question 44

tx for acute back pain (5)

Answer 44

education muscle relaxants NSAIDs early exercise PT

Question 45

are narcotics ok for acute back pain?

Answer 45

short dose is ok *look pt up in data base*

Question 46

tx for chronic back pain (3)

Answer 46

PT NSAIDs neuropathic pain meds

Question 47

name 2 neuropathic pain meds

Answer 47

TCAs gabapentin