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45 Cards in this Set
- Front
- Back
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What is the 2nd most common reason for a person to present to the doctor?
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back pain
1st is upper respiratory infection |
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What are the most common causes of back pain?
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muscular injuries and age related degenerative processes in the intervertebral disks and facet joints
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what is responsible for 95% of cases of nerve root impingement?
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disk herniation
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What is the most common site for disk herniation?
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L5-S1 - #1
L4-5 - #2 |
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A pt presents with low back pain to the ER. On exam you find that the patellar jerk reflex, dorsiflexsion of foot reflex motor, and medial aspect of the tibia sensory on the right are all impaired. The pt does not complain of any sciatica. What level and nerve root is injured?
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Level: L3-4
Nerve Root: L4 |
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A pt presents with inability to extend the right big toe. He also complains of sensory loss to the dorsum of his foot and the base of his foot along the big toe and into the first digit. What level and nerve root is injured?
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Level: L4-5
Nerve Root: L5 |
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A pt presents with pain shooting down his right leg. He complains of loss of sensation in his buttock, posterior thigh, calf, lateral ankle, and foot. You find he has a negative ankle jerk reflex. What nerve root and level is injured?
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Level: L5-S1
Nerve Root: S1 |
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A pt presents with fever, night pain, weight loss, and bone pain.
Should you think mechanical back pain or something much more serious? |
much more serious
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What is a sharp pain that radiates down the back or side of the leg past the knee?
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sciatica
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What is a common cause of sciatica?
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disk herniation with nerve root impingement
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A pt presents with difficulty urinating, fecal incontinence, complains of progressive weakness in the legs, saddle anethesia. What is this and how should it be worked up?
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Dx: Cauda equina
Workup: medical emergency! |
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This Dx is usually seen after the age of 50. It is a degenerative dz and pts complain of back pain / paresthesia of the lower extremities that worsens with standing or back extension?
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spinal stenosis
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A young 7 yr old presents to the ER with back pain. She was practicing her back handsprings (hyperextension) when she fell and began crying and said her back hurt. What is this most likely?
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spondylosis or spondylolisthesis
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How can you quickly differentiate between a possible back tumor or infection and spondylolithesis?
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Pain from spondylolithesis, spondylosis, and scheuermann dz usually improve somewhat with rest
pain from tumor, infection, or inflammatory dz can cause night time wakening due to pain and DO NOT improve with rest |
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a 24 yr old presents with low back pain. he was lifting a 150lbs box when his back felt a sharp pain. the onset was acute, and is lateralized to his right back and right posterior upper thigh. What type of back pain is this?
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most likley muscular
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A 43 yr old female has had recurrent back pain. She describes the pain as "trivial stress". She frequently complains that the pain radiates to her back leg. On x-ray you see that thier appears to nerve impingement on N L5-S1. What is this?
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disk herniation
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What is this?
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disk herniation
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A 65 yr old man complains of pain in his lower extremity that is worse when walking and relieved by sitting down. The symptoms mimics vascular insufficiency (pseudoclaudication). He has osteoarthritis and this pain has gotten worse over the years. What is this?
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Spinal stenosis
usually from old age or can be congenital symptoms - pseudoclaudication |
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A 43 yr old female complains of pain in her lower back when she hyperextends. The pain radiates down he leg. This has been a chronic problem for her. This is what you see on Xray. What is the Dx?
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spondylolythesis
most commonly nerve root L5/S1 impingement |
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A 70 yr old female presents with osteoarthritis and acute back pain. She says the pain is limited to her lower back. What is the Dx.
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compression fracture
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A 54 yr old male complains of low back pain. He says the pain continues throughout the night and he has been losing sleep for over a month. He has tried different positions to relieve the pain but none have been much help / not supine position. What is the Dx?
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Neoplasm
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A 32 yo male comes to the ER with acute fever, and spinal tenderness. He had back surgery a week ago. What is the dx?
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osteomyelitis
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A 12 yr old (young age) presents with refusal to walk, fever, signs of sepsis, and on radiograph shows narrowing of disk space. What is the dx?
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Inflammatory diskitis
cause: staph aureus |
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A 12 yr old presents with morning spinal stiffness, IBS, sacroilitis, chest expansioin "bamboo spine". You find he is HLA-B27 (+). What is the dx?
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ankylosing spondylitis
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What is this?
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bamboo sign
ankylosing spondylitis |
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a pt presents with back pain on hyperextension. it has been occuring for over 10 yrs. He complains of back, buttock pain with lordosis, which increases with activity. He also has very tight hamstrings. What is the dx?
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Spondylolysis
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What is this?
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spondylolysis
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A 22 yr old (young age) presents with a rounded back, vertebral wedge, and end plate irregularity. He also complains of fatigue. what is this?
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scheuermann disease
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What is this?
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scheuermann disease
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based on straight leg testing how can you differentiate between hernated disk and sciatica?
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Ipsilateral Striaght leg test is more sensitive for a herniated disk
contralateral straight leg test with pain in the opposite leg is more specific for a herniated disk |
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When should you perform a xray for a person with low back pain?
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no x-rays unless the pain persists for more then 6 mo
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Why might you order a CBC for low back pain?
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screens for infection or anemia ass with multiple myeloma or occult malignancy
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What might an ESR tell you about back pain?
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may be high in pts with malignancy, infection, or connective tissue damage
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a pt presents with low back pain. how long should you tell them it will take before they recover?
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80-90% recover within 6wks
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If a pt hurts thier back should you tell them to rest or move?
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MOVEEEEE
bed rest is NOT recommended, unless pain is so severe to preclude nl activities. rest should not be more than 2 to 3days |
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WHat is a safe inexpensive first line choice for back pain?
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Acetominophen
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COX-2 inhibitors may be safer on the stomach but what can they still cause?
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adverse effects on the kidneys and on fluid balance
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What is another complication of COX-2 inhibitors that you need to be careful for?
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cardiac disease
Vioxx is a COX-2 inhibitor also increase risk of heart attack and stroke |
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If a pt has radicular low back pain, what can you give her?
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gabapentin
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What can you give a pt for chronic low back pain?
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Tricyclic Antidepressants
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What is the workup for cauda equina syndrome?
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surgery
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When should a pt with a herniated disk consider diskectomy?
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after 4-6wks of conservative Rx
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When is pain considered chronic
(ie what length of time?) |
after 6 mo
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What is the chance that a person has of EVER being employed again if they do not return to work after 6 mo from their back pain?
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50%
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4 Key points
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4 key points
1. majority of cases of acute low back pain are due to mechanical factors and resolve within 4-8 wks with conservative tx 2. SLR is positive if sciatica (not tightened hamstrings) is reproduced with elevations of the leg less than 60 degrees 3. Surgical treatments are indicated for cauda equina syndrome and for pts with intractable pain with worsening neurological deficits 4. Red flags such as fever, night pain, weight loss, and bone pain suggest something other then mechanical back pain |
