Approach to Back Pain Flashcards

1
Q

presence of nighttime pain

A

infection or malignancy

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2
Q

buttock or shooting leg pain that radiates below the knee; sciatica

A

disc problem

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3
Q

bowel or bladder dysfunction

A

nerve root compression

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4
Q

weakness/numbness/tingling

A

nerve root compression

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5
Q

abdominal or pelvic pain

A

pancreatitis or pyelonephritis

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6
Q

fever and chills

A

infection or malignancy

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7
Q

weight loss

A

malignancy

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8
Q

bilateral and nonspecific pain

A

mechanical

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9
Q

better with rest and worse with activity or position change

A

nonspecific back pain

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10
Q

worse with sitting, coughing, or sneezing

A

disc herniation

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11
Q

presence of swelling or masses

A

malignancy or infection

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12
Q

presence of erythema

A

infection

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13
Q

abnormalities in symmetry/new curvature problems

A

malignancy

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14
Q

tenderness over spinous process

A

fracture or infection of that vertebrae

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15
Q

tenderness of sacroiliac joint

A

spondylitis

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16
Q

sciatic nerve tenderness

A

disc herniation

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17
Q

paraspinal muscle tenderness

A

disc herniation

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18
Q

tenderness over costovertebral angle

A

pyelonephritis

19
Q

Shoulder abduction

A

C5

20
Q

elbow flexion (brachialis/biceps)

A

C6

21
Q

elbow extension (triceps)

A

C7, C8

22
Q

wrist flexion (flexor carpi radialis)

A

C7

23
Q

wrist flexion (flexor carpi ulnaris)

A

C8

24
Q

wrist extension

A

C6, C7, C8

25
Q

Finger abduction of fingers 1-5

A

T1

26
Q

Hip flexion

A

L1, L2

27
Q

Hip extension

A

S1

28
Q

Knee Flexion

A

L5, S1

29
Q

Knee extension

A

L3, L4

30
Q

Dorsiflection

A

L4

31
Q

Plantar flexion

A

S1, S2

32
Q

babinski maneuver

A

stroke lateral aspect of sole from heel to ball, curving medially across ball of big foot. Normal response: plantar flexion of big toe

33
Q

inability to walk on heel

A

problem with dorsiflexion; L4, L5

34
Q

inability to walk on toe

A

calf weakness; S1, S2

35
Q

straight leg raise

A

puts pressure on L5 and S1 nerve root; pain suggestive of disc herniation

36
Q

Mechanical Low Back pain

A
  • Insult:* nonspecific
  • Predisposing factors:* injury, old age
  • History:*
    a. acute, recurrent, or chronic
    b. lumbosacral (no radiopathy)
    c. worse with activity, better with rest
    d. does not wake from sleep
  • Exam:* most things normal
37
Q

Spinal Stenosis

A
  • Insult:* degeneration of ligaments causing narrowing of canal
  • Predisposing factors:* old age, congenital abnormalities, metabolic or endocrine disorders; associated with degenerative disease
  • History:*
    a. chronic
    b. lumbosacral, but buttock or bilateral pain is common
    c. worse with walking or standing but relived by sitting
  • Exam:* nonspecific
38
Q

Disc Herniation

A
  • Insult:* herniation of nucleus pulposus; compression of nerve root
  • Predisposing factors:* trauma or strain, coughing
  • History:*
    a. acute or acute on chronic
    b. worse with sitting or cough
    c. pain radiates below knee and causes tingling/weakness/numbness
    d. may cause bowel or bladder dysfunction
    e. worse with movement better with rest
  • Exam:* tenderness over paraspinal muscles, motor weakness, decreased reflexes, loss of light touch sensation
39
Q

Infectious/Inflammatory disease

A
  • Insult:* localized inflammation
  • Predisposing factors:* IV drug use, recent infection
  • History:*
    a. can occur in any location
    b. no relief with rest, wakes from sleep
    c. fever, chills, fatigue
    d. may involve weight loss, night sweats
  • Exam:* fever, looks ill
40
Q

Malignancy

A
  • Insult:* tumor, usually metastasis
  • Predisposing factors:* previous cancer, family history of cancer
  • History:*
    a. acute or chronic
    b. constant, dull
    c. present at night and wakes from sleep, not relieved by rest
    d. weight loss, night sweats, fever
    e. may/may not have neurologic symptoms
  • Exam:* may look ill or feverish
41
Q

Pancreatitis

A
  • Insult:* inflammation of pancreas
  • Predisposing factors:* alcoholism, biliary tract disease, medication use
  • History:*
    a. acute and persistent pain
    b. begins epigastric, radiates to back
    c. relieved by sitting forward
    d. worse when lying down
    e. worse with alcohol or fatty meals
    f. associated with nausea and vomiting
  • Exam:* epigastric tenderness, diminished breath sounds
42
Q

Pyelonephritis

A
  • Insult:* kidney infection
  • Predisposing factors:* frequent sexual activity or pregnancy, previous UTI or kidney disease, anatomic abnormalities
  • History:*
    a. acute, progressive pain
    b. fever, chills, nausea, vomiting, dysuria, hematuria, foul urine odor
    c. elderly patients may have altered mental status
  • Exam:* lower abdominal tenderness, costovertebral angle tenderness
43
Q

Aortic Aneurysm

A
  • Insult:* break in vessel wall
  • Predisposing factors:* men, elderly, tobacco and alcohol use, atherosclerosis, trauma, syphilis
  • History:*
    a. acute, severe pain associated with dissection
    b. tearing chest pain, vague lumbar or groin pain
    c. pain could extend to shoulder, hoarseness
    d. may have constipation, bloating, urinary retention
  • Exam:*
    a. may have bradycardia, difference in blood pressures and pulses
    b. pulsatile mass in central abdomen