10 - 45 yo M with low back pain

Question 1

in patients with central spinal stenosis, what maneuver will reduce the pain?

Answer 1

squatting

Question 2

patellar tendon reflex tests what nerve root(s)?

Answer 2

L3, 4

Question 3

medial hamstring reflex tests what nerve root(s)?

Answer 3

L5

Question 4

achilles tendon reflex tests what nerve root(s)?

Answer 4

S1

Question 5

where is pin prick done to test the L3 nerve root?

Answer 5

• lateral thigh

- medial femoral condyle

Question 6

where is pin prick done to test the L4 nerve root?

Answer 6

• medial leg

- medial ankle

Question 7

where is pin prick done to test the L5 nerve root?

Answer 7

• lateral leg

- dorsum of foot

Question 8

where is pin prick done to test the S1 nerve root?

Answer 8

• posterior calf
• sole of foot
• lateral ankle

Question 9

what is the functional test for L3 nerve root?

Answer 9

squat down and rise

Question 10

what is the functional test for L4 nerve root?

Answer 10

walk on heels

Question 11

what is the functional test for L5 nerve root?

Answer 11

walk on heels

Question 12

what is the functional test for S1 nerve root?

Answer 12

walk on toes

Question 13

squatting and rising tests what nerve root(s)?

Answer 13

L3

Question 14

walking on heels tests what nerve root(s)?

Answer 14

L4, L5

Question 15

walking on toes tests what nerve root(s)?

Answer 15

S1

Question 16

pain that improves with supine positioning suggests what musculoskeletal conditions?

Answer 16

• spinal stenosis

- disc herniation

Question 17

decompression should be performed within what time frame for cauda equina syndrome?

Answer 17

72 hours

Question 18

what is the role of EMG studies in radicular pain and lumbar spinal stenosis?

Answer 18

useful to confirm existence of radiculopathy (level of nerve involvement) and to exclude the presence of other peripheral nerve disorders

Question 19

when is diagnostic imaging indicated for acute back pain?

Answer 19

diagnostic testing, especially imaging, is not indicated until after 4-6 weeks of conservative treatment