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BRS Y2 > back pain > Flashcards

back pain Flashcards

1
Q

where does the spinal cord end

A

L2

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2
Q

Where to take lumbar puncture

A

L3/4 space to avoid spinal cord

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3
Q

back pain overview
duration for improvement and chronic condition

A

Common and acute pain

better in a few days-6weeks

12+weeks=chronic back pain

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4
Q

mechanical back pain 4 common cause and what is it worse with

A

worse with movement
MOAD
-Muscular tension
-Osteoarthritis of facet joint
-Acute muscle sprain
-Degenerative disc disease

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5
Q

what is facet joint

A

small synovial joints at posterior spinal column linking each verbetra

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6
Q

sciatica
how is the pain
cause

A

pain radiating down 1 leg

cause: disc herniation contacting exiting lumbar nerve root

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7
Q

how disc herniation occur

A

nucleus pulposus pushes through and extrudes annulus fibrosus

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8
Q

serious cause of backpain. 5 examples

A

LIIFT

large disc prolapse

infection

inflammatory spondylarthropathy

fracture

tumour

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9
Q

examples of infection in serious back pain

A

discitis,
vertebral osteomyelitis,
TB-microbiology

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10
Q

examples of inflammatory spondyloarthropathy in serious back pain

A

Ankylosing spondylitis
psoriatic arthritis
IBD

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11
Q

examples of tumour in serious back pain

A

metastatic cancer /myeloma

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12
Q

red flags of back pain

A

pain at night/night sweats
constant pain
weight loss
prev malignancy
Bladder or bowel disturbance (Sphincter dysfunction)
Leg weakness or sensory loss
Age <20 or >55 yrs
thoracic pain

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13
Q

cauda equina syndrome what is it and what happens if left untreated

A

Neurosurgical emergency
Untreated = permanent lower limb paralysis and incontinence

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14
Q

cauda equina syndrome signs/symptoms

A

Saddle anaesthesia
Bladder/bowel incontinence
Loss of anal tone on PR
Radicular leg pain
Ankle jerks may be absent

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15
Q

cauda equina syndrome: investigation, cause and treatment

A

urgent MRI spine

large disc herniation, bony mets, myeloma, TB

treat- according to cause- poss surgery

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16
Q

investigation of back pain without red flag

A

usually not needed- no X-Ray/MRI to diagnose non-specific low back pain

review if symptoms persist after 3-4 weeks and reassess underlying cause

17
Q

treatment for lower back pain without red flags

A

time
analgesia - NSAIDs
avoid bed rest
physio

18
Q

investigation- bloods what does it mean if ESR
CRP
FBC
ALP
Calcium
PSA is high ?

A

ESR-myeloma/TB/Chronic infection

CRP-infection/inflammation

FBC-anaemia in myeloma

ALP- bony mets

Calcium- myeloma/bony mets

PSA - prostate cancer with bony mets

19
Q

investigation - imaging- difference between radiograph, MRI, CT

A

Radiograph- cheap
CT- good for bony path/larger radiation dose
MRI- best for soft tissue (like tendons)/spinal imaging- expensive

19
Q

what is a wedge fracture

A

osteoporotic vertebral collapse

20
Q

inflammatory spondyloarthritis Extra-articular manifestations:

A

Anterior uveitis (iritis) – ocular inflammation

Apical lung fibrosis

Aortitis/aortic regurgitation

Amyloidosis – due to chronically serum amyloid A (SAA) depositing in organs

20
Q

herniated discs treatment

A

normally spontaneous improvement

treatment:
1. Conservative for LBP without sciatica
-Analgesia: NSAIDs
-Physiotherapy

  1. Nerve root injection (local anaesthetic and glucocorticoid)
  2. Surgery if neurological compromise or symptoms persist
21
Q

cause of dactylitis

A

enthesitis

22
Q

where is psoriasis typically present in inflammatory spondyloarthritis

A

extensor surfaces

23
Q

ankylosing spondylitis pathophysiology. What HLA gene/cytokines involved

A

Enthesitis
polygenic but mainly: HLA-B27
Cytokines:
TNF-alpha
(IL-17), (IL23)

24
Q

what is enthesitis

A

inflammation of entheses- site where tendon and ligament join bone

25
Q

untreated AS signs

A

-Spinal enthesitis
-Bridging syndesmophytes
(new bone growth between adjacent vertebra)
-Spinal fusion

26
Q

AS management

A
  1. physio
  2. a) NSAIDs- ibuprofen/selective COX 2 inhibitor (celecoxib)
    b) biological therapies if after trying 2 NSAIDs doesen’t work-
    anti-TNF-a (infliximab)
    anti-IL17

BRS Y2 (60 decks)

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