Chapter 9 Back Pain

Question 1

Disk herniation is responsible for 95% of cases of nrve root impingement. the most common site of disk herniation is the ___ level, followed by ___ .

Answer 1

L5-S1 level

followed by L4-L5

Question 2

presence of sciatica, which is

Answer 2

a sharp pain that radiates down the back or side of the leg past the knee, is often a sign of disk herniation with nerve root irritation.

Question 3

as a general rule, pain from spondylolysis, spondylolisthesis, Scheuermann disease, muscle disease, and over use problems improves with rest

Answer 3

true.
in contrast, tumor, infection, or inflammatory diseases can cause nighttime wakening due to pain and DO NOT improve with bedrest.

Question 4

testing straight leg raising (SLR)

+ if sciatica is reproduced with elevation of legg <60 degrees.

Answer 4

true

Question 5

ipsilateral SLR is more sensitive for a herniated disk.

whereas;

contralateral SLR( with symptoms of sciatica in leg opposite to examined leg) is…

Answer 5

is more specific for herniated disk.

Question 6

for most patients, x-rays are not recommended unless the pain persists beyond 6 weeks

Answer 6

true

Question 7

magnetic resonance imaging (MRI) and computed tomography CT are more sensitive than plain films for detecting spinal infections, cancers, herniated disks, and spinal stenosis. t

Answer 7

true

Question 8

blood tests are not necessary for most patients with back pain.

Answer 8

true

Question 9

cbc, UA, calcium, phosphorus, erythrocyte sedimentation rate (ESR), and alkaline phosphatase may be considered in pts with suspected systemic disease

Answer 9

true

Question 10

CBC screens for

Answer 10

infection, anemia associated with multiple myeloma, or occult malignancy.

Question 11

ESR may be elevated in patients with

Answer 11

malignancy, infection, or connective tissue disease.

Question 12

patients who require long term NSAIDS may require baseline

Answer 12

renal and liver function tests.

Question 13

treatment: mechanical low back pain will get better with conservative treatment consisting of

Answer 13

1. pain control
2. education
   3reassurance
3. appropriate activity.

Question 14

approx 80-90% will recover within

Answer 14

6 weeks (1 1/2 months)

Question 15

avoid heavy lifting, >25lbs, twisting, prolonged sitting, driving for long periods, and heavy vibration.

Answer 15

true

Question 16

medications:

Answer 16

1. acetaminophen with or without NSAIDS.
2. NSAIDs - can have pain relieft and have anti-inflammatory effective. (use in caution in patients with hx of gastritis, ulcers, hypertension, chronic renal failure, or CHF.

Question 17

for younger pts and those at low risk for cardiovascular disease who cannot tolerate traditional NSAIDS, cyclooxygenase-2 (COX-2) inhibitors have fewer gastrointestinal side effects, although they still have the same adverse effects on the kidneys and on fluid balance.

Answer 17

true

Question 18

cox-2 inhibitors increase risk of heart attack and stroke

Answer 18

true