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PCM IV Final > 2. HYHO: SPE 3-3 > Flashcards

2. HYHO: SPE 3-3 Flashcards

1
Q

Describe how often patients come into clinic with non-specific LBP and what is often the course?

A

>85% of pts that go to clinic have LBP and most improve in few weeks

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2
Q

Because it is not always possible to determine cause and to rule out SERIOUS cases of LBP, ______ is KEY in figuring out cause of LBP

A

HISTORY; ask about other symptoms!

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3
Q

When taking history for LBP, it is important to ask about _____.

A

Constitutional symptoms: unintentional WL/fever/sweats, hx of cancer, neurologic sx, injection drugs.

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4
Q

Factors that suggest LBP is due to a systemic disease (5), < 1% have serious systemic etiology

A
  1. Hx of cancer
  2. > 50 YO
  3. Unexplained WL
  4. Pain > 1 month; worse at night
  5. Not respond to previous therapies
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5
Q

Acute, subacute and chronic LBP

A
  1. Acute: < 4 weeks
  2. Subacute: 4-12 weeks
  3. Chronic: > 12 weeks
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6
Q

_______ is most commonly caused by herniation of intervertebral disc.

A

Spinal cord or cauda aquina compression

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7
Q

Cord Compression

  • _____ = usually FIRST symptom
  • _____________ = found in majority of patients when diagnosed
  • ___________ = late symptoms
A
  • Pain
  • Motor weakness & sensory findings
  • Bowel or bladder dysfunction
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8
Q

_________ = strongest risk factor for back pain from bone metastasis

A

History of cancer

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9
Q

Spinal epidural abscess

  • __________\_ = initial symptoms
  • Change overtime
A
  • Nonspecific symptoms (fever and malaise)
  • Localized BP => radicular pain => neurologic deficits
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10
Q

BP that gradually increases over week => months that MAY/MAY NOT present w fever

A

Vertebral osteomyelitis

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11
Q

Other etiologies outside of spine that cause LBP

A
  1. Pancreatitis
  2. Nephrolithiasis
  3. Pyelonephritis
  4. AAA
  5. Herpes Zoster
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12
Q

Name the lumbar nerve root

A
  • Blue => L4
  • Orange => L5
  • Green => S1
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13
Q

L4

  • Motor weakess:
  • To screen:
  • Reflex:
A

L4

  • Motor weakess: extension of quads
  • To screen: squat and rise
  • Reflex: knee jerk will be diminished
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14
Q

L5

  • Motor weakess:
  • To screen:
  • Reflex:
A

L5

  • Motor weakess: dorsiflex big toe and foot
  • To screen: walk on heels
  • Reflex: N/A
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15
Q

S1

Motor weakess:

To screen:

Reflex:

A

S1

Motor weakess: Plantarflex big toe and foot

To screen: walk on toes

Reflex: Diminshed ankle jerk reflex

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16
Q

OSE Sympathetics

  1. Head/neck (upper ESO)
  2. Heart
  3. Lungs
  4. UGI (lower ESO)
  5. SI/ascending colon
  6. Ascending and transverse colon
  7. Descending and sigmoid colon/rectum
  8. Adrenal glands
  9. GU tract + bladder
  10. Ureter (upper/lower)
  11. Extremeties (upper/lower)
A
  1. Head/neck (upper ESO) = T1-5
  2. Heart = T1- 6
  3. Lungs = T1 - 7
  4. UGI (lower ESO = T5-10
  5. SI/ascending colon= T9 - 11
  6. Ascending and transverse colon= = T10 - L2
  7. Descending and sigmoid colon/rectum = T12- L2
  8. Adrenal glands = T5 - 10
  9. GU tract + bladder = T10 - L2
  10. Ureter (upper/lower) = T10-11/ T12- L2
  11. Extremeties (upper/lower) = T2-7/ T11 - 12
17
Q

LBP _____ = no imaging

A

less than 4 weeks (acute LBP) bc most will improve rapidly

18
Q

Who should get imaging for LBP?

A
  1. Severe or progressive neurologic deficits
  2. Serious underlying conditions are suspected based on hx and PE
19
Q

________= emergent MRI and referral to specialist

A
  1. Spinal cord/cauda equina compression (new urinary retention/incontinence, new fecal incontinence, saddle anesthesia)
  2. Progressive and/or severe neurologic deficits (Significant/progressive motor deficits not localized to 1 nerve root)
20
Q

Imaging?

Radiculopathy due to 1 nerve root or with stable sx due to spinal stenosis

A

No, unless

  • High risk metastic cancer => plain XR + EST or CRP
  • Moderate - high risk of infection => MRI
21
Q

What are “red flag” sx for LPB?

A

Sx that may ID pts at risk for more dangerous cause of back pain and should get earlier imaging

22
Q

Red flag sx for LBP

A
  1. [Older age, prolong use of corticosteroids, severe trauma and contusion/abrasion] => increase risk of vertebral fracture
  2. Hx of cancer => increase risk of spinal cancer
23
Q

Imaging for suspected renoithiasis

A
  • CT of abdomen and pelvis W/O contrast using low-radiation.
  • If no CT => US of kidney & bladder + abdominopelvic XR
24
Q

What to do in PE for LBP? (4)

A
  1. Abdominal exam
  2. Structural exam
  3. Reflexes
  4. Strength and sensation
25
Q

Sx of cauda equina syndrome

A
  1. Urinary retention
  2. Saddle anesthesia
  3. Bilateral leg weakness
  4. Bilateral sciatica
26
Q

Sx of infection

A
  1. Fever
  2. Recent skin/UTI
  3. Immunosupression
  4. Use injection drugs
27
Q

Sx of cancer

A
  1. Hx of cancer
  2. Unexplained WL
  3. > 50
  4. Lasts > 1 month
28
Q

Sx of compression fracture

A
  1. > 70 YO
  2. F
  3. Corticosteroid use
  4. Hx of osteoporosis
  5. Trauma
29
Q

Sx of lumbar radiculopathy

A
  1. Sciatica
  2. Abnormal neurologic exam
30
Q

Tx of acute LBP

A
  1. Nonpharmacologic therapy: superficial heat and patient education
    1. Massage, acupuncture, spinal manipulation
  2. If not responsive or prefer meds: short-term (2-4 weeks) NSAIDS/ acetominophen if CI.
    1. Refractory pain => nonbenzo muscle relaxand
31
Q

For acute LBP, is bed rest and activity recommended?

A
  • No bed rest
  • Keep activity to a minmum; do not refer for XRCISE or PT unless have RF for chronic
32
Q

What should be included in patient education in LBP?

A
  1. Cause
  2. Prognosis
  3. Minimal value of diagnostic testing
  4. Recommendations for activity and work
  5. When to contact doc
33
Q

If not adequate relief or CI to other drugs, give = __________

A
  • Opoids (only for 3-7 days) and tramadolol (no longer than 2 weeks)
34
Q

When should pts with LPB be reassessed?

A

No improvement after 4 weeks of pharmocotherapy

35
Q

Predictors of chronic LBP? (5)

A
  1. Cannot cope with pain
  2. Functional impairment
  3. Poor health
  4. Psychiatric problem
  5. Nonorganic signs

PCM IV Final (12 decks)

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