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Illness scripts > Back pain > Flashcards

Back pain Flashcards

1
Q

General groups of causes of low back pain

A
  • non-specific mechanical low back pain
  • spinal stenosis
  • disc herniation with radiculopathy
  • infectious/inflammatory
  • vertebral body metastasis
  • referred/non-orthopedic causes
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2
Q

Predisposing factors for mechanical low back pain

A
  • previous injury

- older age

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3
Q

Categories of mechanical low back pain

A
  • muscle strain

- degenerative disease

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4
Q

Discriminating features of mechanical low back pain

A
  • usually in lumbosacral area
  • generally does not radiate below knee
  • worse with activity and better with rest
  • generally does not wake pt. from sleep
  • acute, recurrent, or chronic
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5
Q

Physical exam features of mechanical low back pain

A
  • many features may appear normal
  • tenderness or spasms over paraspinal muscles
  • kyphosis for osteoporotic fracture
  • range of motion may be decreased
  • radiologic findings normal unless spondylolysis
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6
Q

Forms of degenerative disease in mechanical low back pain

A
  • disc herniation without root compression
  • spondylolisthesis
  • spondylolysis
  • osteoarthritis
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7
Q

Spondylolysis

A

defect in vertebral arch causing separation from vertebral body

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8
Q

Spondylolisthesis

A

vertebral body slides anteriorly over vertebral body below, may cause spinal cord compression
-common in pregnant women!

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9
Q

Pathophysiologic insult of spinal stenosis

A

hypertrophic degeneration of ligaments or facets, causing narrowing of canal

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10
Q

Predisposing factors for spinal stenosis

A
  • older age
  • congenital abnormalities (achondroplasia)
  • metabolic or endocrine disorders
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11
Q

Discriminating features of spinal stenosis

A
  • usually chronic
  • usually lumbosacral area
  • common associated buttock or leg pain
  • pain worse with walking or standing, relieved with sitting
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12
Q

Physical exam features of spinal stenosis

A

-nonspecific unless radiculopathy

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13
Q

Pathophysiologic insult of disc herniation with radiculopathy

A
  • herniation of nucleus pulposus

- nerve root injury secondary to compression or inflammation

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14
Q

Predisposing factors for disc herniation with radiculopathy

A
  • trauma or severe strain

- severe coughing or val salva maneuver

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15
Q

Discriminating features of disc herniation with radiculopathy

A
  • acute or acute on chronic
  • usually lumbosacral area
  • pain radiates down leg below knee!
  • associated numbness, tingling, or weakness or dermatomal sensory loss
  • may cause bladder or bowel dysfunction
  • usually worse with movement and better with rest
  • usually worse with coughing, val salva, or sitting
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16
Q

Physical exam features of disc herniation with radiculopathy

A
  • tenderness over paraspinal muscles
  • range of motion may be decreased
  • neurologic signs correlating with root level!
  • motor weakness, loss of light touch sensation, decreased reflexes
  • MRI or CT show disease
17
Q

Infectious/inflammatory conditions of lower back pain

A
  • vertebral osteomyelitis
  • discitis
  • epidural or paraspinous abscess
18
Q

Pathophysiologic insult of infectious/inflammatory causes of low back pain

A
  • localized inflammation

- acute (Staph aureus) or chronic

19
Q

Predisposing factors for infectious/inflammatory low back pain

A
  • IV drug use

- history of recent/intermittent infection

20
Q

Discriminating features of infectious/inflammatory low back pain

A
  • acute, progressive, or chronic
  • can occur at any location
  • no relief with rest
  • often wakes patients from sleep!
  • systemic symptoms: fever, chills, fatigue
  • if chronic, weight loss and night sweats
21
Q

Physical exam features of infectious/inflammatory low back pain

A
  • fever
  • point tenderness on palpation
  • may have limited range of motion
  • typically normal neurologically
  • MRI typically shows infection
  • other indicative labs: high WBC, high ESR/CRP, or blood cultures
22
Q

Predisposing factors for vertebral malignancy

A
  • history of previous or current cancer

- family history of cancer

23
Q

Pathophysiologic insult of vertebral malignancy

A
  • metastasis of cancer from primary site

- infiltration of bone tissue by malignant cells

24
Q

Discriminating features of vertebral malignancy

A
  • acute or chronic
  • localized or diffuse
  • constant, dull
  • presence at night or wakes patient from sleep!
  • no relief with rest
  • systemic symptoms: weight loss, night sweats, fever
  • variable neurologic symptoms, present if mass effect
25
Q

Physical exam features of vertebral malignancy

A
  • may be ill-appearing
  • point tenderness on palpation
  • may have limited range of motion
  • neurologic symptoms if mass effect
  • MRI may show metastases in vertebral bodies
26
Q

Types of referred/non-orthopedic causes

A
  • pancreatitis
  • pyelonephritis
  • aortic aneurysm
27
Q

Pathophysiologic insult of pancreatitis

A
  • inflammation of pancreas
  • may involve obstruction of pancreatic duct
  • release of destructive pancreatic enzymes, which autodigest pancreatic tissue
28
Q

Predisposing factors for pancreatitis

A
  • alcoholism
  • biliary tract disease
  • medication use
29
Q

Discriminating features of pancreatitis

A

DON’T MISS DX

  • acute and persistent
  • epigastric, radiating to back!
  • relieved somewhat with sitting forward
  • worse when supine
  • worse with alcohol or fatty meals
  • associated with fever, nausea, and vomiting
30
Q

Physical exam features of pancreatitis

A
  • possible fever and tachycardia
  • may be ill-appearing with apparent pain
  • epigastric tenderness, sometimes with abdominal rigidity
  • may have lower lung crackles or diminished breath sounds (with pleural effusion)
  • normal back and neurologic exams
  • ultrasound and CT may show disease
  • cholangiopancreatography (MR or endocope) may show
  • pancreatic enzymes elevated
  • high WBC, anemia
  • elevated BUN, liver enzymes, bilirubin
31
Q

Pathophysiologic insult of pyelonephritis

A
  • introduction of bacteria into bladder, ascending up ureters to kidneys
  • urinary stasis
  • inflammatory reaction
32
Q

Predisposing factors for pyelonephritis

A
  • frequent sexual activity or pregnancy
  • previous UTI or kidney disease
  • anatomic abnormalities
33
Q

Discriminating features of pyelonephritis

A
  • acute, gradual onset, progressive pain
  • lower abdominal or unilateral flank pain
  • associated fever, chills, nausea, vomiting, dysuria, hematuria, foul urine odor
  • elderly patients may present with altered mental status!
34
Q

Physical exam features of pyelonephritis

A
  • fever, tachycardia
  • may be ill-appearing
  • vomiting and anorexia may lead to dehydration
  • lower abdominal tenderness
  • costovertebral angle tenderness on palpation
  • urinalysis, urine culture, and/or renal ultrasound may show
35
Q

Pathophysiologic insult of aortic aneuysm

A
  • weakness in one or more layers of vessel wall
  • dilation of blood vessel often with blood accumulation in vessel wall
  • pressure may increase and lead to rupture
36
Q

Predisposing factors for aortic aneurysm

A
  • men
  • elderly
  • tobacco and alcohol use
  • atherosclerosis, HTN, trauma, syphilis
37
Q

Distinguishing features of aortic aneurysm

A
  • acute, acute on chronic, or chronic
  • acute severe pain associated with dissection
  • may have thoracic “tearing” chest pain or vague abdominal pain
  • assoc. features depend on location
38
Q

Physical exam features of aortic aneurysm

A
  • if thoracic:
  • bradycardia
  • differences in right carotid and left radial pulses
  • asymmetric arm blood pressures
  • if abdominal:
  • pulsatile mass in central abdomen
  • aortic bruit

Illness scripts (2 decks)

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