Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > Acute back pain/osteoporosis > Flashcards

Acute back pain/osteoporosis Flashcards

1
Q

List five red flags for lower back pain

A 
duration >6 weeks
weight loss
incontinence
bowel function
saddle anaesthesia 
pain worsened by coughing, sitting, or valsalva maneouvre, any neurological defect, age <18y >50y, cancer hx 
fever
nocturnal pain
fever, night sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Yellow flags for back pain?

A

social withdrawal, emotional problems, lack of support/overprotective family, belief that pain and activity are harmful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Four differentials for lower back pain?

A

Non-specific: muscle spasm, muscle sprain/strain, ligamentous injury

Vertebral compression fracture

Metastatic cancer

Cauda equina syndrome

Infections

Sciatica

Ankylosing spondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name five risk factors for osteoporosis

A
  1. early menopause
  2. smoking hx
  3. alcohol hx
  4. steroid use
  5. parent with hip fracture
  6. obesity
  7. female
  8. LOW BMI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is osteoporosis formally diagnosed?

A

DXA scanning, T score <-2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management of osteoporosis?

A
  1. Resistance training
  2. Lifestyle modification- smoking cessation, reducing alcohol
  3. Oral calcium
  4. Oral vitamin D
  5. Biphosphonate therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acronym for surgical history (routine questions)

A 
AMPLE
allergies
medications
PMH
last eaten or drank
events leading to presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the components of a myeloma screen?

A

LDH, calcium/bone profile, ESR, urine bence jones protein, immunoglobulins and protein electrophoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the MOA of biphosphonates?

A

antiresorptive- bind to bone surface, once absorbed by osteoclasts, they activate apoptosis and result in cellular death of osteoclasts. Reduced bone loss but do not add new bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name a biphosphonate typical prescribed

A

alendronic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would you advise a patient to administer their biphosphonate?

A
  • once per week
  • take first thing in the morning before food and other meds.
  • Drink plenty of water and sit upright for 30 mins and don’t eat or drink anything in this time. -Wait at least 4 hours before taking calcium/vit D supplement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name three side effects of biphosphonates

A

nausea, osteonecrosis of jaw, oesophageal ulceration, heartburn/indigestion, headache, tiredness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why should you not take calcium with alendronic acid?

A

calcium inactivates it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What would be an alternative biphosphonate to alendronic acid?

A

zolendronic acid, give as IV infusion once yearly!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which conditions are associated with osteoporosis?

A

T1D
osteogenesis imperfects
hyperthyroidism/hyperparathyroidism, chronic malnutrition, malabsorption e.g. crohn’s disease, chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of fragility fractures?

A

osteoporosis and osteopenia

17
Q

Name three of the most common bone fractures relating to osteoporosis

A
  1. Femoral neck fracture
  2. Vertebral fracture
  3. Distal radius fracture
18
Q

Three differentials for back pain

A 
Mechanical 
  Strain/idiopathic 
  Trauma 
  Pregnancy  
  Disc prolapse 
  Spondylolisthesis (forward shift of one vertebra)

Degenerative: spondylosis, vertebral collapse, stenosis

Inflammatory: Ank spond, Paget’s

Neoplasm: Mets, myeloma

Infection: TB, abscess

19
Q

Three conservative options for back pain?

A

Physical activity
Advice on stooping, handling
Physio
Pyschosocial

20
Q

Two examples of neurosurgical emergencies associated with back pain

A

Acute cord compression

Acute cauda equina compression

21
Q

Two signs/symptoms of acute cord compression?

A

 Bilateral pain: back and radicular
 LMN signs at compression level
 UMN signs and sensory level below compression
 Sphincter disturbance

22
Q

Two signs/symptoms of cauda equina?

A

 Alternating or bilateral radicular pain in the legs
 Saddle anaesthesia
 Loss of anal tone
 Bladder ± bowel incontinence

23
Q

Two causes of acute cord compression and cauda equina syndrome

A

prolapse
tumours
abscess

24
Q

Define osteoporosis

A

a skeletal condition characterized by decreased density (mass/volume) of normally mineralized bone. This leads to decreased mechanical strength, thus making the skeleton more likely to fracture.

25
Q

Four risk factors for osteoporosis?

A 
SHATTERED
  Steroids 
  Hyperthyroidism, HPT, HIV 
  Alcohol and Cigarettes 
  Thin (BMI <22) 
  Testosterone Low  
  Early Menopause 
  Renal / liver failure 
  Erosive / inflam bone disease (e.g. RA, myeloma) 
  Dietary Ca low / malabsorption
26
Q

Which is the gold standard test in osteoporosis?

27
Q

Two indications to perform DEXA scan?

A

 Low-trauma #
 Women ≥65yrs c¯ one or more risk factors
 Before giving long-term steroids (>3mo)
 Parathyroid disorders, myeloma, HIV

28
Q

DEXA result T=1. What does this imply?

A

bone density normal

29
Q

DEXA result T= -2. What does this imply?

A

osteopenia T -1 - -2.5

30
Q

DEXA result T= -3. What does this imply?

A

osteoporosis

31
Q

What is a FRAX score?

A

estimates the probability of a fracture within the next 10 years

32
Q

Two conservative options for managing osteoporosis?

A

stop smoking
drink less alcohol
Ca and Vit D rich diet
visual assessment- prevention of falling (+mobility aids?)

33
Q

What is the first line treatment for osteoporosis?

A

Biphosphonate- alendronate

34
Q

MOA of biphosphonates?

A

inhibit osteoclastic bone resorption

35
Q

Two SE of biphosphonates?

A

 GI upset
 Oesophageal ulceration / erosion- Take plenty of water on an empty stomach
and refrain from lying and don’t eat for 30min.
 Diffuse musculoskeletal pain
 Osteonecrosis of the jaw

36
Q

Name two biphophonates

A

alendroate/alendronic acid and zoledronic acid

37
Q

Name one other drug indicated in osteoporosis and provide its MOA

A

Teriparetide: PTH analogue → new bone formation

Denosumab: anti-RANKL → ↓ osteoclast activation

38
Q

List three lifestyle factor changes that promote bone health?

A

weight bearing exercise
smoking cessation
excessive alcohol cessation

39
Q

Which co-existing diagnosis often exists alongside osteoporosis? Name a blood test that would confirm this diagnosis

A

Osteomalacia

25-hydroxyvitamin D level

Rheumatology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions