Back Pain - Referred, Infectious and Malignant

Question 1

What can cause referred back pain? (4)

Answer 1

Aortic aneurysm
Acute pancreatitis
Duodenal peptic ulcer disease
Acute pyelonephritis/renal colic

Question 2

How can you identify referred back pain? (1)

Answer 2

Other features of the underlying condition present

Question 3

Which features may be present in referred back pain caused by aortic aneurysm? (3)

Answer 3

Cardiovascular risk factors
Collapse
Pulsating abdominal mass

Question 4

Which features may be present in referred back pain caused by acute pancreatitis? (3)

Answer 4

Epigastric pain
Relief when leaning forwards
Generally unwell patient

Question 5

Which features may be present in referred back pain caused by duodenal peptic ulcer disease? (4)

Answer 5

Epigastric pain
History of PUD
Vomiting
Blood in stools (melaena)

Question 6

Which features may be present in referred back pain caused by acute pyelonephritis/renal colic? (5)

Answer 6

History of UTI/kidney stones
Generally unwell patient
Radiation of pain
Haematuria
Increased urination frequency

Question 7

What are the 3 types of systemic disease which can cause back pain?

Answer 7

Infection
Malignancy
Inflammatory conditions

Question 8

List 3 types of infection which can cause back pain.

Answer 8

Discitis
Osteomyelitis
Epidural abscess

Question 9

Describe the clinical features of infectious discitis. (4)

Answer 9

Fever
Weight loss
Back pain, which is:
-Constant
-Night pain

Question 10

What is the most common causative organ in infectious discitis?

Answer 10

Staph. aureus

Question 11

Which investigations would you do for infectious discitis? (4)

Answer 11

Bloods, e.g.

• FBC
• CRP/ESR
• Blood cultures

MRI

X-ray

Joint aspiration

Question 12

In infectious discitis, which features would you see on an x-ray? (5)

Answer 12

End-plate bone destruction
Vertebral destruction
Soft tissue swelling
Soft tissue extension (paravertebral abscess)
Damage on BOTH sides of the disk

Question 13

How would you manage infectious discitis? (3)

Answer 13

IV antibiotics
Surgical debridement
Treatment of source

Question 14

List 5 types of malignancy which commonly cause back pain.

Which pnemonic is used to remember these?

Answer 14

Lung cancer
Prostate cancer
Follicular Thyroid cancer
Kidney cancer
Breast cancer

“LP Thomas Knows Best”

Question 15

Describe the clinical features of back pain caused by malignancy. (4)

Answer 15

Pain, which is:

• Constant
• Worse at night

Systemic symptoms, e.g.

• Primary tumour symptoms
• Weight loss

Question 16

Which investigations would you do for back pain that you suspect is caused by malignancy? (3)

Answer 16

X-ray
MRI
DEXA scan

Question 17

In back pain caused by malignancy, what features would you see on an x-ray? (2)

What about MRI? (1)

Answer 17

X-RAY:
Lytic lesions
Bone destruction

MRI:
Primary tumour

Question 18

List 12 red flag symptoms for back pain.

Answer 18

New onset at age <16 or 50+
Following significant trauma
Previous malignancy
Systemic symptoms
Previous steroid use
IV drug abuse
HIV/other immunosuppression
Recent infection
Non-mechanical pain
Thoracic spine pain
Cauda equina symptoms