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Primary care > Back pain > Flashcards

Back pain Flashcards

1
Q

Common causes of back pain in <30

A

Trauma/fracture

Posture

Spondylolisthesis, disc prolapse

Ankylosing spondylitis

Pregnancy

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2
Q

Common causes of back pain in 30-50

A

Postural

Prolapsed disc

Discitis, spondyloarthropathy

Degenerative changes

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3
Q

Common causes of back pain 50+

A

Myeloma

Metastatic malignancy

Degenerative joint disease

Prolapsed disc

Paget’s disease

Osteoporotic collapse

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4
Q

Malignancies that commonly metastasise to spine

A

Breast

Thyroid

Kidney

Prostate

Lung

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5
Q

Investigations for myeloma

A

Ca raised

Renal f(x) impaired

Anaemia (normocytic normochromic, rouleaux)

Bone: Pain, collapse fracture

Electrophoresis: Serum/urine, looking for paraproteinemia (monoclonal band)

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6
Q

Signs of cauda equina - history

A

History:

  • Saddle anaesthesia (wiping bottom)
  • Loss of bladder/bowel function or continence
  • Progressive leg weakness
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7
Q

Red flags for back pain

A

The patient:

  • <20 or >55 yo
  • IVDU
  • PMHx cancer, immunosuppression, HIV
  • Weight loss
  • Constitutional symptoms

The pain:

  • Night-time pain
  • Worse on lying down
  • Structural deformity
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8
Q

Yellow flags for back pain

A

Indicate psychosocial barriers to recovery

Belief that pain/activity is harmful

Sickness behaviour

Overprotective family OR lack of support

Emotional problems

Social withdrawal

Work issues

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9
Q

Serious spinal pathology to rule out in LBP

A

Spinal infection - travel, immunosuppression

Fracture - Trauma, osteoporosis

Malignancy - red flags

Cauda equina - neuro signs

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10
Q

Management of mechanical LBP

A

NSAIDs PRN

Consider muscle relaxant, amitryptilline

Advise on activity + self-help exercises

Challenge yellow flag symptoms

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11
Q

Management of nerve root compression/pain

A

R/V in 4w

PRN analgesia

Likely self-limiting, consider referral if not improving in 4w

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12
Q

Management of malignant cord compression

A

16mg oral dexamethasone

Urgent neurosurg referral

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13
Q

Features suggesting inflammatory back pain

A

Worse in morning (>30 min)

Improves with activity

Raised inflammatory markers

Age <45

Insidious onset

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14
Q

L2 nerve root

A

Sensory: Front of thigh

Motor: Hip flexion

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15
Q

L3 nerve root

A

Sensory: Medial thigh/knee

Motor: Knee extension

Reflex: Knee jerk

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16
Q

L4 nerve root

A

Sensory: Medial leg/ankle

Motor: Foot dorsiflexion

Reflex: Knee jerk

17
Q

L5 nerve root

A

Sensory: Lateral shin/dorsum of foot

Motor: Foot inversion (c.f. eversion peroneal), knee flexion

18
Q

S1 nerve root

A

Sensory: Sole of foot

Motor: Knee flexion, foot plantarflexion

Reflex: Ankle

19
Q

Signs of cauda equina - examination

A

Loss of anal tone

Hypo or hyperreflexia (mixed UMN/LMN signs)

Progressive lower limb motor/neuro deficit

Perianal/perineal sensory loss

Primary care (8 decks)

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