Cardinal Presentations/Back Pain

Question 1

List the at risk population for Vertebral Osteomyelitis and spinal epidural abscess

Answer 1

1- DM
2- IVDU
3- CKD
4- EtOH Abuse
5-Malignancy
6-Recent surgery
7-Trauma

Question 2

Major cause of spinal epidural abscess

Answer 2

S.aureus

Question 3

State 7 red flag features in the history for back pain

Answer 3

Recent significant trauma
History of cancer
Anticoagulant use
Intravenous drug use
History of prolonged glucocorticoid use
History of osteoporosis
History of abdominal aortic aneurysm
Patient > 50 yr
Unrelenting night or rest pain
Unexplained weight loss
Recent bacterial infection
Immunocompromised status
Failure to improve after 6 wk of conservative therapy

Question 4

List 7 red flag signs of concern for back pain

Answer 4

Abnormal vital signs—hypotension, hypertension, tachycardia, fever
Unequal blood pressure readings in the upper extremities
Murmur of aortic insufficiency
Pulse deficit or circulatory compromise of the lower extremities
Pulsatile abdominal mass
Urinary retention
Urinary or stool incontinence
Loss of rectal sphincter tone
Severe or progressive neurologic deficit
Focal lower extremity weakness
New ataxia or difficulty walking

Question 5

How would you define non-specific back pain

Answer 5

The World Health Organization (WHO) defines nonspecific back pain as back pain having
*no known underlying identifiable pathology and
*no apparent relative tissue damage.
Nonspecific back pain may arise in almost any patient, but has increased likelihood in patients who smoke or are obese, sedentary, or of advanced age

Question 6

Main disease processes causing back pain

Answer 6

Back pain may be caused by a 
vascular, 
visceral,
 infectious, 
mechanical, 
or rheumatologic process

Question 7

List 7 spinal causes of acute low back pain

Answer 7

Cauda equina syndrome,
 spinal epidural abscess or hematoma, 
spinal fracture, 
transverse myelitis, 
traumatic fracture, 
pathologic fracture, 
vertebral osteomyelitis,
 infectious diskitis, 
ankylosing spondylitis,
 spondylolysis or spondylolisthesis, 
disc herniation, 
degenerative disease (discs, facet joints),
 isolated sciatica, spinal stenosis

Question 8

Four important variables associated with serious outcomes for low back pain

Answer 8

(1) pain worse at night,
(2) decreased lower extremity sensation,
(3) use of anticoagulants,
and (4) pain persisting despite appropriate treatment.

Question 9

List the three most common locations for disc herniation

Answer 9

L4
L5
S1

Question 10

List the examination findings that help distinguish true pathologic backpain from non pathologic causes

Answer 10

distraction, 
overreaction,
 regional disturbances, 
simulation tests,
 tenderness

Question 11

Safety net advise for back pain

Answer 11

1 New or progressive leg weakness
2 Bowel or bladder dysfunction
3 Saddle anaesthesia