Back Pain / Focused H&P Flashcards
Top two symptomatic reasons for Dr. visit?
- URI
2. Back pain
3 basic questions of back pain?
- Is there systemic disease?
- Neurologic compromise requiring surgical eval?
- Social / psychological stress?
* **Can be answered in history and very few ptns. will need imaging
Most common systemic disease impacting spine?
- Malignant neoplasm
- Only 1% of low back pain episodes
- Normal > 50 y/o
- History or cancer highly specific
Findings in back pain from cancer?
- **UNRELIEVED BY BED REST
- Weight loss
- Pain > 1 mo.
- Failure to improve w/ therapy
Main source of spinal infections?
Bloodborne from other sites
What is spine tenderness in response to percussion indicative of?
Bacterial infection
Who is at risk for compression factors?
- Osteoporitis
What is person on LT corticosteroids with back pain likely to have?
Compression fracture
Questions to diagnose Spondylitis?
- Morning stiffness?
- Improvement in pain w/ exercise
- Onset before 40 yo
- Slow onset?
- Pain > 3 months
What occurs in spondylitis?
Reduces spinal mobility from fusion of adjacent vertebrae
What is reduced chest expansion specific for?
Spondylitis
What is the first sign of nerve root irritation re. back pain?
- Sciatica: sharp burning pain radiating down leg
- Often associated with numbness and paresthesia
What is presence of sciatica sensitive for?
- Lumbar disk herniation
- Without sciatica this is very unlikely
What is pain from straight leg raise in supine position indicative of?
Sciatica
What are weakness in ankle, great toe, and sensory loss in feet indicative of?
Lumbar disk herniation
