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Clin Med II - Exam 2 > Ross - Back Pain > Flashcards

Ross - Back Pain Flashcards

1
Q

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

A

85%

3%

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2
Q

5 serious causes of back pain

A

cauda equina

cord impingement

AAA or dissection

pathological features

osteomyelitis

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3
Q

what are 3 causes of cord impingement

A

herniated disc

epidural abscess

epidural hematoma

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4
Q

spinal cord impingement findings are often

A

unilateral

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5
Q

pt’s that are high risk for emergent back pain

A

immunocompromised

etoh

ivdu

steroid users

DM

HIV

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6
Q

3 symptoms related to increased risk for emergent back pain

A

increasing chronic pain

nighttime pain

radicular pain

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7
Q

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

A

multiple visits

hx trauma

hx back surgery

fever

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8
Q

what might the previous pt’s need

A

emergent MRI

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9
Q

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

A

CT

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10
Q

do most ppl need imaging/labs for back pain

A

no!

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11
Q

tx for non most non emergent back pain

A

stay OUT of bed

ibuprofen

indications to return

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12
Q

what is spondylosis

A

nonspecific, degenerative dz

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12
Q

what is spondylosis

A

nonspecific, degenerative dz

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13
Q

what is spondylolysis

A

fx of pars

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14
Q

what is the pars (interarticularis)

A

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

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15
Q

what is spondylolisthesis

A

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

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16
Q

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

A

L5

S1

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17
Q

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

A

L4

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18
Q

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

A

L5

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19
Q

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

A

S1

20
Q

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

A

MRI w. contrast

ESR

avoidance of MRI and other imaging

21
Q

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

A

etoh abuse

DM

renal failure

night pain

3rd visit in last 20 days

→ 1 point each

22
Q

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

A

iv drug use

fever w.o focus

recent/current systemic infxn

immunosuppression

recent spinal fx/procedure

incontinence/retention

indwelling urinary catheter

→ 3 points each

23
Q

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

A

4

24
Q

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

A

consider avoiding MRI and other imaging

25
Q

herniated discs usually affect people in their __ decade of life

A

3rd → 20-29 yo

26
Q

herniated discs usually occur between (2)

A

L4/L5

L5/S1

27
Q

how do herniated discs present

A

abrupt onset of pain

unilateral

aggravated by walking, standing, coughing

persistent pain

28
Q

how do you diagnose herniated disc

A

MRI

29
Q

tx for herniated disc is __ at first,

but may need __ if pain persists

A

surgery → remove pressure from root

30
Q

indication for emergent surgery for herniated disc

A

motor finding of weakness

31
Q

__ symptoms in herniated disc may be repaired less emergently

A

sensory

32
Q

what test might be positive in herniated disc

A

straight leg

33
Q

__ is a catch all term for lower back pain

A

sciatica

34
Q

cauda equina syndrome affects which nerve root pairs

A

L2 - S5

35
Q

the cauda equina extends from __

to __

A

L1 - Co1

36
Q

cauda equina syndrome occurs when there is a

A

compression → reduction of volume for spinal roots

37
Q

4 causes of cauda equina

A

disc herniation

spinal abscess

hematoma

fx

38
Q

typical presentation of cauda equina syndrome

A

bilateral radicular pain

leg weakness w. difficulty walking on toes/heels

urinary/stool incontinence → loss of sphincter control

39
Q

what is a very sensitive test for cauda equina syndrome

A

urinary sphincter control test

40
Q

urinary sphincter test > __ is positive

A

150

41
Q

if a post void residual test is positive you should,

A

order MRI emergently

42
Q

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

A

65 yo or older

pt’s w. red flags

43
Q

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

A

emergent

44
Q

tx for acute back pain (5)

A

education

muscle relaxants

NSAIDs

early exercise

PT

45
Q

are narcotics ok for acute back pain?

A

short dose is ok

look pt up in data base

46
Q

tx for chronic back pain (3)

A

PT

NSAIDs

neuropathic pain meds

47
Q

name 2 neuropathic pain meds

A

TCAs

gabapentin

Clin Med II - Exam 2 (14 decks)

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