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10 Cards in this Set

  • Front
  • Back
Key History -
Location
quality
radiation
severity (intensity)

context -
moving furniture
bending/twisting
trauma

timing - disturbs sleep

associated Sxs -
constitutional
incontinence

exacerbating and alleviating factors
h/o cancer
recurrent UTIs
diabetes
renal stones
IV drug use
smoking
Key PE -
VS
neuro exam -
esp. L4-S1 nerve roots
back palpation and range of motion
hip exam
consider rectal exam
45 y/o F
presents with low back pain that radiates to the lateral aspect of her left foot.
Straight leg raising is positive.
Pt. is unable to tiptoe.

What is Differential?
Disk herniation
lumbar muscle strain
tumor in vertebral canal
45 y/o F
presents with low back pain that radiates to the lateral aspect of her left foot.
Straight leg raising is positive.
Pt. is unable to tiptoe.

What is Workup?
XR - L-spine
MRI - L-spine
45 y/o F
presents with low back pain that started after she cleaned her house.
Pain does not radiate.
No sensory deficit or weakness in herlegs.
Paraspinal muscle tenderness and spasm are also noted.

What is Differential?
Lumbar muscle strain
disk herniation
AAA
vertebral compression fracture
45 y/o F
presents with low back pain that started after she cleaned her house.
Pain does not radiate.
No sensory deficit or weakness in herlegs.
Paraspinal muscle tenderness and spasm are also noted.

What is Workup?
XR - L-spine
45 y/o M
presents with pain in the lower back and legs during prolonged standing and walking
Pain is relieved by sitting and leaning forward (e.g., pushing a grocery cart).

What is Differential?
Lumbar spinal stenosis
lumbar muscle strain
tumor in vertebral canal
peripheral vascular disease
45 y/o M
presents with pain in the lower back and legs during prolonged standing and walking
Pain is relieved by sitting and leaning forward (e.g., pushing a grocery cart).

What is Workup?
XR - L-spine
MRI - L-spine (preferred)
CT - L-spine
ankle-brachial index
17 y/o M
presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class.
He also has area of loss of sensation in his left foot.
The pain and sensory loss do not match any known distribution.
He insists on requesting a week off from school because of his injury.

What is Differential?
Malingering
lumbar muscle strain
disk herniation
knee or leg fracture
ankylosing spondylitis
17 y/o M
presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class.
He also has area of loss of sensation in his left foot.
The pain and sensory loss do not match any known distribution.
He insists on requesting a week off from school because of his injury.

What is Workup?
XR - L-spine, knee
MRI - L-spine