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Neurology > Back Pain & Sciatica > Flashcards

Back Pain & Sciatica Flashcards

1
Q

List 3 general red flags in back pain

A

Failure to improve after 4-6 weeks conservative therapy,
Night pain/pain at rest
Progressive motor/sensory deficit

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2
Q

List 5 cancer red flags of back pain

A 
Age >50, 
Unintended weight loss,
Hx cancer,
Night pain 
Pain lying down
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3
Q

List 6 red flags for infection in back pain

A 
Fever/chills, 
Recent infection, 
Immunosuppression, 
IV drug use,
Dental status, 
Foreign travel
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4
Q

List 4 red flags for fracture in back pain

A

Age >50,
osteoporosis,
Significant trauma,
Chronic steroid use

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5
Q

List 5 red flags for Cauda Equina Syndrome in back pain

A 
Bilateral sciatica, 
Urinary incontinence, 
Decreased anal tone, 
Loss of perianal sensation,
Leg weakness (not always)
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6
Q

List 3 red flags for AAA in back pain

A

Age >60,
abdo pulsating mass,
Pain at rest

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7
Q

What does the Straight leg raise test assess?

A

Hip is flexed until pain is noted which stretches hamstrings and sciatic nerve. Patients with herniated disc often experience back pain radiating to lower leg

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8
Q

Weak leg flexion is problem with what nerve roots

A

L2,3

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9
Q

Weak leg extension is problem with what nerve roots

A

L4,5

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10
Q

Weak knee extension is problem with what nerve roots

A

L3,4

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11
Q

Weak knee flexion is problem with what nerve roots

A

L5,S1

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12
Q

Weak ankle dorsiflexion is problem with what nerve roots

A

L4,5

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13
Q

Weak ankle plantar flexion is problem with what nerve roots

A

S1,2

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14
Q

Weak ankle inversion is problem with what nerve roots

A

L4

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15
Q

Weak ankle eversion is problem with what nerve roots

A

L5,S1

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16
Q

MRC is used to grade muscle power. Outline meaning of Grade 0-5

A

0 - complete paralysis
1 - flicker of contraction possible
2 - movement possible if gravity eliminated
3 - movement against gravity but not resistance
4 - movement possible against some resistance
5 - power normal

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17
Q

Outline the common presentation of pain, numbness, motor weakness, screening exam and reflexes for L4 nerve root problem

A 
Pain: felt along outside of leg and down front of knee and shine 
Numbness: felt on and above knee
Motor weakness: quads extension 
Screening exam: squat and rise
Reflexes: knee jerk diminished
18
Q

Outline the common presentation of pain, numbness, motor weakness, screening exam and reflexes for L5 nerve root problem

A

Pain: bum and then down along outer edge of whole leg
Numbness: outer calf and side of leg
Motor weakness: dorsiflexion of great toe and foot
Screening exam: heel walking
Reflexes: none reliable

19
Q

Outline the common presentation of pain, numbness, motor weakness, screening exam and reflexes for S1 nerve root problem

A

Pain: bum and then down along middle of the back of the whole leg
Numbness: back of calf and bottom of foot
Motor weakness: plantar flexion of great toe and foot
Screening exam: walking on toes
Reflexes: ankle jerk diminished

20
Q

Triceps reflexes tests what nerve roots?

A

C7,C8

21
Q

Biceps reflexes tests what nerve roots?

A

C5, C6

22
Q

Patellar reflexes tests what nerve roots?

A

L2, L3, L4

23
Q

Achilles reflexes tests what nerve roots

A

S1

24
Q

70-90% of LBP will resolve within a month. True/false?

A

True

25
Q

X-rays are not very useful for back pain as do not show soft tissue. What are two exceptions where x-rays should be used for back pain?

A

Young men: SI-joint to exclude ank spond

Elderly: to exclude vertebral collapse, fractures, malignancy

26
Q

What are EOS scans and what are they used for?

A

EOS are full spinal xrays with 10% of femur, useful for deformity and surgical planning

27
Q

What are CTs useful for and what are they not useful for?

A

Show bony pathology, foreign bodies, implants, spinal fusion planning and if MRI contra-indicated.
Not very useful in acute LBP with no red flags

28
Q

Gold standard for lower back pain and why?

A

MRI - good for soft tissue and bone oedema and microfractures

29
Q

What are two presentations you should definitely investigate MRI?

A

Red flags or neurological signs/symptoms

30
Q

What are radionuclide bone scans useful for? (4)

A

Increased bone turnover (fractures, osteomyelitis, Paget’s, ank spond),
Metastases,
Tumours, osteoid osteoma

31
Q

Use of SPECT and PET scan for LBP?

A

Increased uptake in high turnover areas e.g. infection, malignancy

32
Q

When are laboratory tests indicated?

A

Any red flags, malignancy, infection, metabolic causes

33
Q

List 3 malignancy markers for LBP and what they test for

A

PSA and acid phosphatase - prostate cancer

Monoclonal bands - paraneoplastic syndrome

34
Q

List 4 metabolic lab tests for LBP?

A

Alk phos, Ca2+ (e.g. bony mets), PO4, HLA B-27

35
Q

What medication is good for relieving spasm?

A

Diazepam

36
Q

Pharmacological conservative treatment for LBP?

A

NSAIDS, opiates, gabapentin, TCAs, injections + physio

37
Q

What is the most effective prevention of back pain?

A

Physical activity

38
Q

What is management plan for sciatica?

A

Initially conservative unless red flags, may be for surgical intervention.
Conservative because usually body resorbs disc material from disc bulge within 3 months

39
Q

What are 4 potential differentials for sciatica that are caused by root compression outside the spine?

A

Piriformis syndrome,
Endometriosis,
PID,
Peroneal compression

40
Q

What are 4 potential differentials for radiculopathy symptoms that is not caused by root compression?

A

Arachnoiditis e.g. from previous haemorrhage, peripheral neuropathies, IIH can cause cervical compression symptoms, SI joint dysfunction

Neurology (34 decks)

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