Back Pain

Question 1

NIGHT PAIN is worse than daytime pain for these patients

Answer 1

Patients with cancer

Question 2

Name the systemic disease or specific cause of back pain:

inflammatory process leading to “bamboo spine” and sclerosis/fusion of pelvic joints

Answer 2

Ankylosing spondylitis

Question 3

T/F: Ankylosing spondylitis is most commonly seen in young females.

Answer 3

False. Young males.

Question 4

Which of the following is NOT a treatment of spinal stenosis?
A. PT
B. Therapeutic injections
C. Medications
D. Surgery

Answer 4

All are treatments for spinal stenosis

Question 5

Name the systemic disease or specific cause of back pain:

Older patients, degenerative changes on MRI

Answer 5

Spinal stenosis

Question 6

Which of the following is NOT a feature of spondyloysis?
A. Common in gymnastics
B. Compression fracture in the pars of the vertebrate
C. Often in lower thoracic spine
D. Common in immature spines

Answer 6

C. Often in low lumbar (L5)

Question 7

T/F: The recommended treatment for Spondylolisthesis is braces and strengthen core muscles.

Answer 7

False. Best treatment for Spondylolisthesis is screw fixation.

The statement is true for Spondylolysis

Question 8

Name the systemic disease or specific cause of back pain:

shifting of the vertebral body forward which tugs on nerve roots (which ones most commonly?)

Answer 8

Spondylolisthesis

L5/S1

Question 9

T/F: Scoliosis usually presents without pain.

Answer 9

True

Question 10

Which of the following is TRUE about back pain with radiculopathy?
A. Presents with reproducible radiating leg pain
B. Must be direct compression of nerve
C. Disc herniation requires surgery
D. Most herniations will cause radiculopathy

Answer 10

A

B. Not necessary to be direct compression. Could be a chemical radiculitis/inflammation process. Treat with epidural steroid injection.

C. Disc herniation RARELY require surgery (2%) unless it’s CAUDA EQUINA SYNDROME

D. Not all herniations cause radiculopathy symptoms. Many are asymptomatic. A lot of NORMAL people will have abnormal findings on MRI so be careful when ordering.

Question 11

Most common herniation levels
Cervical:
Lumbar:

Answer 11

C6/7: Triceps mm, middle finger dermatome

L5: Extensor hallus longus mm, 2/3rd toe dermatome

Question 12

T/F: Self management options are just as effective as medical/surgical intervention for patients with nonspecific or mechanical low back pain.

Answer 12

True

Question 13

Which of the following is FALSE about Cauda Equina Syndrome?
A. Severe back pain
B. Leg weakness
C. Saddle anesthesia
D. Constipation/colon incontinence

Answer 13

D. Bladder retention/incontinence

Question 14

Treatment for Cauda Equina Syndrome

Answer 14

SURGERY required

Question 15

Name the systemic disease or specific cause of back pain:
Positive nerve tension signs
Pain “out of proportion to examination”

Answer 15

Cauda Equina Syndrome

Nerve tension signs: Stretch suspected nerves by checking reflexes or stretching lower extremities– “tug on the nerve root”

Question 16

Most common type of back pain

Answer 16

Nonspecific

Question 17

T/F: Activity is much worse than inactivity in ankylosing spondylitis.

Answer 17

False. Inactivity is much worse

Question 18

Which of the following is NOT a red flag for low back pain?
A. Prior history of cancer
B. Depression
C. Steroid use
D. Infection
E. Trauma, compression fracture
F. Ankylosing spondylitis

Answer 18

B