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Year 3 Histories/Conditions > Back pain > Flashcards

Back pain Flashcards

1
Q

What would your differentials be if the pain directly overlay the spine?

A

Spinal fracture

Arthritis

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2
Q

What would your differentials be if the pain was paraspinal?

A

Muscle sprain or spasm

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3
Q

What would your differentials be if the pain was lateral to the spine/in the flank?

A

Renal pain

  • pyelonephritis
  • renal colic
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4
Q

What would your differentials be if it was pleuritic back pain?

A

Pulmonary embolism

Pneumonia

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5
Q

Unilateral flank pain?

A

Pyelnephritis/renal colic

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6
Q

What would pain between the scapula suggest?

A

Spinal fracture
Aortic dissection
MI

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7
Q

Dfx for pain that is present at rest and wakes the patient at night

A

Inflammatory arthritis (e.g. rheumatoid arthritis, ankylosing spondylitis)

Malignancy (e.g. spinal metastases)​

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8
Q

Dfx for pain that is described as burning/shooting in nature

A

Neuropathic pain e.g. nerve root compression

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9
Q

Dfx for tearing thoracic back pain

A

Aortic dissection

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10
Q

Dfx for sharp non-specific back pain

A

Spinal fracture
Muscular spasms
PE

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11
Q

Dfx if the pain radiates to the buttocks or legs?

A

Sciatic nerve compression

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12
Q

Dfx for pain in the back that radiates to the ipsilateral groin

A

Renal colic

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13
Q

Dfx for back pain that radiates to the chest

A

MI

Aortic aneurysm

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14
Q

Dfx for back pain that radiates to the epigastrium

A

Peptic ulcer disease

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15
Q

Dfx for back pain that radiates to the abdomen

A

Constipation
Abdominal aortic aneurysm dissection
Ischaemic bowel

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16
Q

Dfx for back pain that radiates to the upper or lower limbs

A

Radiculopathy secondary to spinal nerve root compression

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17
Q

What might be some relieving factors?

A 
Analgesia (e.g. paracetamol)
Muscle relaxants (e.g. diazepam) 
Lying down
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18
Q

What are some associated symptoms to ask about?

A 
Motor or sensory disturbances
Urinary retention or incontinence
Haematuria
Fever
Malaise
Weight loss
Early morning stiffness
Muscular spasms
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19
Q

If back pain is associated with motor or sensory disturbance, what are the differentials?

A

Nerve root compression (i.e. radiculopathy)

Spinal cord compression (e.g. cauda equina syndrome)​

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20
Q

What’s another name for nerve root compression?

A

Radiculopathy

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21
Q

What’s another name for spinal cord compression?

A

Cauda equina syndrome

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22
Q

Causes of cauda equina syndrome

A

Prolapsed intervertebral disc
Displaced vertebral fracture
Haemorrhage
Epidural abscess

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23
Q

What must you specifically ask about if you’re thinking cauda equina syndrome?

A

Saddle anaesthesia - i.e. a loss of sensation in the anal/perianal region

Ask if they can feel when they wipe

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24
Q

Dfx for back pain associated with urinary retention or incontinence

A

Cauda equina syndrome

25
Q

Dfx for back pain associated with haematuria

A

Back trauma
UTI
Renal tract malignancy

26
Q

Dfx for back pain associated with fever

A

UTI
Pneumonia
Discitis

27
Q

Dfx for back pain associated with malaise

A

Discitis

Malignancy

28
Q

Dfx for back pain associated with weight loss

A

Malignancy

29
Q

Dfx for back pain associated with early morning stiffness

A

Inflammatory arthritis

e.g. rheumatoid arthritis/ankylosing spondylitis

30
Q

Dfx for back pain associated with muscular spasms

A

Spinal fracture

Primary muscular injury

31
Q

List some key features of cauda equina syndrome

A 
Bilateral sciatica
Urinary retention
Incontinence
Flaccid paraparesis 
Impaired reflexes
32
Q

What are the four things you want to rule out when asking about red flags?

A

Cauda equina
Spinal fracture
Malignancy
Infection

33
Q

What are the red flags for cauda equina syndrome?

A

Progressive bilateral neurological deficit in the legs ​
Urinary retention/incontinence/ faecal incontinence ​
Saddle anaesthesia

34
Q

What are the red flags for spinal fracture?

A

Sudden onset severe central spinal pain
Relieved by lying down
History of trauma

35
Q

Spinal fracture might be relieved by what position?

A

Lying down

36
Q

What are the red flags for malignancy?

A 
50 years+ ​
Severe unremitting pain despite position ​
Disturbance of sleep ​
Localised spinal tenderness​
Unexplained weight loss ​
History of cancer
37
Q

What are the red flags for infective causes of back pain?

A 
Fever ​
Tuberculosis or recent UTI ​
Diabetes ​
History of IV drug use​
HIV infection ​
Use of immunosuppressant medication​

​

38
Q

What are the red flags for epidural abscess?

A

Fever ​
Back/ neck pain ​
Neuro deficits ​
IV drug use

39
Q

What are the red flags for acute pancreatitis?

A 
Epigastric or LUQ pain radiating to the back ​
Relieved when lean forward​
N+V, fever, tachycardia ​
Gallstones​
XS alcohol intake
40
Q

What are the red flags for ruptured AAA?

A

Abdo/back pain ​
Pulsatile abdo mass ​
Hypotension ​

41
Q

Cauda equina causes LMN symptoms or upper motor neuron symptoms? What are these?

A 
LMN symptoms: 
Flaccid paralysis - asymmetrical 
Decreased or absent reflexes
Saddle anaesthesia - asymmetrical 
Faecal incontinence/urinary retention
42
Q

Cauda equina causes UMN symptoms or upper motor neuron symptoms? What are these?

A 
UMN
Spastic paralysis - symmetrical 
Increased reflexes 
Specific anatomical level symmetrical sensory changes 
Faecal incontinence/urinary retention
43
Q

Which gene is associated with ankylosing spondylitis?

A

HLA B27

44
Q

Which test is used to diagnose ankylosing spondylitis? Explain this test

A

Schober’s test
- place two fingers on patient’s back, ten cm apart, and ask them to bend
Fingers should move more than 15 cm, if not then it’s suggestive of spondylitis

45
Q

What kind of position do patients with ankylosing spondylitis have?

A

Question mark position

46
Q

What kind of appearance is the spine on xray for ankylosing spond? What is this caused by?

A

Calcification of ligaments with ankyloses leads to bamboo spine appearance on X-ray

47
Q

What are the 5As of extra articular disease for ankylosing spond?

A 
Anterior uveitis ​
Apical lung fibrosis ​
Achilles tendinitis ​
Amyloidosis - mucosal and skin lesions​
Aortic regurgitation ​
(IBD and cauda equine syndrome)​
48
Q 
What systems review questions would you ask for:
Systemic
CV
Resp
Gastro
GU
Neuro
MSK
Derm
A

Systemic: fevers (e.g. discitis), weight change (e.g. malignancy)​

Cardiovascular: chest pain (e.g. aortic dissection)​

Respiratory: dyspnoea, cough (e.g. pneumonia), pleuritic chest pain (e.g. pulmonary embolism)​

Gastrointestinal: abdominal pain (e.g. constipation)​

Genitourinary: loin pain, haematuria, dysuria (e.g. pyelonephritis)​

Neurological: headache (e.g. cervicogenic headache), motor or sensory disturbances (e.g. spinal cord compression)​

Musculoskeletal: trauma​

Dermatological: rashes (e.g. psoriasis)​

49
Q

Relevant pre-existing conditions?

A

Previous history of back pain ​

Previous back pain treatments​

Osteoporosis​

Trauma ​

Congenital spine problems (scoliosis) ​

Malignancy ​

Recent infections/ immunosuppression ​

CVD ​

Gallstones

50
Q

What medications might you particularly ask about that might increase risk of fractures?

A

Corticosteroids

51
Q

What do you call TB-related bone disease?

A

Pott’s disease

52
Q

Relevant family history

A 
Back problems ​
Inflammatory arthritis ​
Malignancy ​
CVD​
Osteoporosis
53
Q

Key social history factors - how do these relate to back pain?

A

Smoking is an important risk factor for malignancy, osteoporosis, bone fractures and aortic aneurysms.​

Chronic excessive alcohol use is a risk factor for osteoporosis and trauma.​

Intravenous drug use is a risk factor for discitis

54
Q

Why might travel/sexual history be relevant?

A

Travel - TB/musc strain

Sexual history - muscular strain, prengancy

55
Q

Why would you ask about hobbies?

A

To identify any risk factors e.g. contact sport

56
Q

Why does diet and CVD relate to back pain?

A

Aortic dissection

57
Q

What else do you need to ask about?

A

Occupation/housing

58
Q

What are some differentials for muscular strain?

A

Prolapsed intervertebral disc​
Muscular strain​
Vertebral fracture

Year 3 Histories/Conditions (20 decks)

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