Back Pain (Rheum) Flashcards

1
Q

Low back pain with paraspinal tenderness + normal neuro exam

A

Mechanical

  • Muscle strain
  • Disc degeneration
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2
Q

Low back pain w/ radiation below knee, +straight leg raise test, neurologic deficits

A

Radiculopathy

(Herniated disc)

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3
Q

Low back pain w/ pseudoclaudication, relieved by leaning forward

A

Spinal stenosis

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4
Q

Low back pain worse w/ rest, improved with activity, with pain in the SI joints

A

Inflammatory

(Spondyloarthropathies; PAIR):

  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis
  • Inflammatory Bowel Disease
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5
Q

Low back pain, worsens w/ activity, relieved with rest

A

Lumbar osteoarthritis

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6
Q

Low back pain >50yo, worse at night, not relieved with rest

A

Metastatic cancer

(Spinal mets)

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7
Q

Low back pain + IVDU or recent infection, fever, focal spine tenderness

A

Infectious

  • Osteomyelitis
  • Discitis
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8
Q

Low back pain + midline tenderness

A

Vertebral fracture

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9
Q

Low back pain that increases w/ standing, walking, or lying on back

A

Vertebral Compression Fracture

(usually 2/2 osteoporosis)

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10
Q

Low back pain that is posture-dependent & persistent when standing

A

Lumbar spinal stenosis

(Neurogenic claudication)

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11
Q

Low back pain that is exertional and goes away within ~30 seconds of sitting

A

Vascular claudication

(PVD)

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12
Q

Low back pain relieved by flexion of the spine

A

Lumbar spinal stenosis

  • Relieved w/ sitting & walking uphill (spinal flexion)
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13
Q

Evaluation for peripheral vascular disease that presents with vascular claudication

A

ABI

(Ankle-Brachial Index)

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14
Q

Gene and age group of ankylosing spondylitis (AS)

A
  • HLA-B27
  • 15-30yo young males
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15
Q

Enthesitis (inflammation/tenderness at tendon insertion sites)

A

Spondyloarthropathies (PAIR):

  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Inflammatory Bowel Disease
  • Reactive arthritis
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16
Q

Low back pain worse at night, improves with rest

A

Spinal osteomyelitis

(if worse @ night but not relieved w/ rest, suspect metastatic cancer)

  • +fever
  • +IVDU or recent infection
  • +focal spine tenderness
17
Q

Low back pain worse in the morning, improves with activity, + diarrhea/abd pain

A

IBD-associated arthritis

(PAIR spondyloarthropathy)

  • Psoriatic/Ankylosing/IBD/Reactive
18
Q

Severe back pain + saddle anesthesia (S3-S5) + hyporeflexia + asymmetric motor weakness

A

Cauda equina syndrome

(LMN only because peripherally located, compared to conus medullaris)

19
Q

Severe back pain + perianal anesthesia + hyperreflexia + BL motor weakness (mild)

A

Conus medullaris syndrome

(UMN & LMN signs because conus medullaris is part of the spinal cord)

20
Q

Low back pain worse at night, worse in recumbent position, gradually worsening & severe, symmetric LE weakness, decreased/absent rectal sphincter tone

A

Spinal cord compression (SCC)

  • Eemrgency MRI
  • IV Glucocorticoids
  • Rad-onc & neurosurgery consults
  • DDx:
    • Spinal injury (MVC)
    • Malignancy (e.g. lung/breast/prostate; myeloma)
    • Infection (e.g. epidural abscess)