Back Injuries

Question 1

Are most spine complaints life threatening??

Answer 1

NO! Most have non-specific etiology WITHOUT life threatening complications

Question 2

What is important to look for when asking for the history from a patient with a back complaint?

Answer 2

Look for concerning risk factors

Question 3

Back pain for less than 6 weeks

Answer 3

Acute

Question 4

Back pain for 6-12 weeks

Answer 4

Sub-acute

Question 5

Back pain for greater than 12 weeks

Answer 5

Chronic

Question 6

Night pain (esp. that wakes the patient up), unrelenting pain, pain worsened by cough or valsalva, pain with ANY neurologic deficit

Answer 6

Back pain that raises alarm for concern

Question 7

What 3 neurologic components should you test in the physical exam on a patient with a back pain complaint?

Answer 7

Strength, reflexes

Question 8

Toe walking tests which nerve?

Answer 8

S1

Question 9

Plantar flexion tests which nerve?

Answer 9

S1, S2

Question 10

Heel walking tests which nerve?

Answer 10

L5

Question 11

Squat and rise tests which nerve?

Answer 11

L4

Question 12

Achilles reflex is which nerve?

Answer 12

S1

Question 13

Patellar reflex is which nerve?

Answer 13

L3-L4

Question 14

Should you get labs on a patient with back complaints?

Answer 14

Nah

Question 15

Best imaging for back pain and gold standard for suspected infection, neoplasm, or compression syndromes of the spine?

Answer 15

MRI

Question 16

CT is good for ??

Answer 16

Vertebral fractures

Question 17

Treatment for non-specific back pain?

Answer 17

Ibuprofen or Tylenol, muscle relaxants, SHORT TERM opioids

Question 18

Should your recommend activity or bed rest to people with back pain?

Answer 18

ACTIVITY!

Question 19

Think of this in a patient who complains of radicular back pain

Answer 19

Sciatica

Question 20

SLR and crossed SLR is positive in a person with?

Answer 20

Sciatica

Question 21

How do you treat sciatica?

Answer 21

Conservatively if there are no risk factors and neurologic compromise

Question 22

Pai is worse with standing and extension, relieved with rest and flexion; Pseudoclaudication in leg

Answer 22

Spinal stenosis

Question 23

How do you confirm a diagnosis of spinal stenosis?

Answer 23

CT or MRI

Question 24

How do you treat spinal stenosis?

Answer 24

Same as non-specific back pain, refer to spinal surgeon

Question 25

If a patient has spinal cord compression, cauda equina syndrome, conus medullaris syndrome what do you do before diagnostic testing?

Answer 25

10mg dexamethasone IV before diagnostic texting

Question 26

If you suspect a spine tumor what should you get?

Answer 26

MRI

Question 27

Gold standard for diagnosing a spinal infection?

Answer 27

MRI