Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

LMCC Part II > Chronic Back Pain > Flashcards

Chronic Back Pain Flashcards

1
Q

what are the two most important factors for delineating the source of lower back pain (mechanical vs non mechanical)

A

physical exam and focused neuro-muscular exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 4 broad categories of low back pain

A

mechanical (80-90%)

neurogenic (5-15%)

non mechanical (1%)

visceral disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

list possible causes of mechanical back pain

A
  1. lumbar strain/sprain
  2. degenerative disease
    - -spondylosis (discs)
    - -osteoarthritis
  3. spondylolithesis
  4. osteoporosis
  5. fractures
    - -osteoporotic
    - -traumatic
  6. congenital disease
    - -severe kyphosis
    - -scoliosis
  7. spondylosis
  8. facet joint asymmetry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

list some causes of neurogenic low back pain

A
  1. herniated disc
  2. spinal stenosis
  3. osteophytic nerve root compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the 5 broad categories/types of non mechanical back pain

A
  1. neoplasia
  2. infection
  3. inflammatory arthritis
  4. Scheuermann disease (osteochondrosis)
  5. Pagets disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what types of neoplasm should you be aware of in back pain

A 
multiple myeloma
lymphoma and leukemia
spinal cord tumours
retroperitoneal tumours
metastatic carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what types of infection should you be aware of in back pain

A 
osteomyelitis
septic discitis
paraspinous abscess
epidural abscess
bacterial endocarditis
herpes zoster
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what types of inflammatory arthritis should you be aware of in back pain

A

ankylosing spondylitis
psoriatic spondylitis
reactive arthritis
inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what types of organs/visceral disease can cause back pain

A
  1. pelvic organs
    - -prostatitis
    - -endometriosis
    - -chronic PID
  2. renal disease
    - -nephrolithiasis
    - -pyelonephritis
    - -perinephritic abscess
  3. AAA
  4. GI disease
    - -pancreatitis
    - -cholecystitis
    - -penetrating ulcer
  5. fat herniation of lumbar spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

timelines of acute, subacute, and chronic back pain

A

acute
subacute is less than 12 weeks
chronic is more than 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what does morning stiffness suggest in back pain

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what does constant pain at night suggest back pain

A

neoplasm, infection or inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what to ask about on HPI specifically for back pain

A

associated symptoms like fever, weight loss, bowel/bladder/sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

red flags for back pain

A

cauda equina syndrome

severe worsening pain at night or when lying down (more than 2-6 weeks)

weight loss, hx cancer, fever

use of steroids or IV drugs

patient with first episode above age 50 (malignancy risk)

widespread neurological signs

significant trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is cauda equina syndrome

A

sudden loss of bowel/bladder control, saddle anesthesia, bilateral leg weakness and numbness

*surgical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what to ask specifically on back pain ROS

A

previous history aortic aneurysm

dysuria
frequency/urgency of urination
bladder and bowel retention/incontinence

rash
morning stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

“yellow” flags for back pain (risk factors)

A 
age
smoking
substance use/IVDU
obesity
female gender
psychosocial barriers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

in addition to an MSK and neuro exam, what other exam can be helpful in back pain

A

abdo exam, to rule out visceral disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

describe the inspection portion of the lumbar back exam for back pain

A

check for skin markings, dimples, scars, deformities or swelling

inspect for lordosis, kyphosis, scoliosis

look at gait

look at total spinal posture (inability to walk heel to toe and squat and ride indicates cauda equina or neurological compromise)

20
Q

describe the palpation portion of the lumbar exam for back pain

A

palpate for VERTEBRAL TENDERNESS (mets/infection/fracture)

also check for altered temp, muscle spasms, paravertebral muscles

with patient supine–> palpate umbilicus, inguinal areas, iliac crests, symphysis pubis

with patient prone–> palpate spinous processes, sacrum, SI joints, coccyx, iliac crests, ischial tuberosities

21
Q

what you do look for on ROM testing for back pain

A

pain with forward flexion–> mechanical etiology

pain with extension–> spinal stenosis

also look at side flexion, rotation, chest expansion

22
Q

list the special tests for lumbar pain/back pain

A

Schober’s test (lumbar flexion)

straight leg raise

cross straight leg

Bragard’s test

Prone straight leg

Patrick test

23
Q

what is Schober’s test

A

looks at lumbar flexion

mark 10 cm above and 5 cm below dimples of Venus

should increase to 20 cm or more during flexion

get limited flexion in ankylosing spondylitis

24
Q

what is straight leg raise test

A

raise leg until radicular pain felt

positive if pain in sciatic L4-S3 at 30-70 degrees passive flexion (indicates radiculopathy)

25
what is the cross straight leg test
raise asymptomatic extremity in similar fashion to straight leg test positive if pain occurs on contralateral side (indicates radiculopathy)
26
what is Bragard's test
if pain is generated with a straight leg raise, lower the symptomatic extremity until the pain disappears. then, dorsiflex the ankle at the point when the pain disappears to reproduce pain this test is positive in cases of lesions in lumbosacral, SI joint or hamstring regions (L4-S1)
27
what is the prone straight leg raise test
with extension of extremity, if pain moves more anteriorly in the thigh, its likely L2, L3
28
what is patrick test
SI joint pain FABER--> flexion, abduction, external rotation
29
what neuro exam should be done in low back pain
full neuro exam of the lower limbs, including sensation, strength, reflexes
30
if the lesion is in L1, how do the following aspects present: 1. pain 2. sensory loss 3. weakness 4. stretch reflex loss
pain--inguinal sensory loss--inguinal weakness--rarely hip flexion stretch reflex loss--none
31
if the lesion is in L2-4, how do the following aspects present: 1. pain 2. sensory loss 3. weakness 4. stretch reflex loss
pain--back, radiating into anterior thigh or medial lower leg sensory loss--anterior thigh, occasionally medial lower leg weakness--hip flexion and adduction, and knee extension stretch reflex loss--patellar tendon
32
if the lesion is in L5, how do the following aspects present: 1. pain 2. sensory loss 3. weakness 4. stretch reflex loss
pain--back, radiating into buttock, lateral thigh, lateral calf, dirsum foot, great toe sensory loss--lateral calf, dorsum foot, web space between first and second toe weakness--hip abduction, knee flexion, foot dorsiflexion, toe extension/flexion, foot inversion/eversion stretch reflex loss--internal hamstrings tendon
33
if the lesion is in S1, how do the following aspects present: 1. pain 2. sensory loss 3. weakness 4. stretch reflex loss
pain--back, radiating into buttock, lateral/posterior thigh, posterior calf, lateral/plantar foot sensory loss--posterior calf, lateral/plantar aspects of foot weakness--hip extension, knee flexion, plantar flexion of foot stretch reflex loss--achilles
34
if the lesion is in S2-4, how do the following aspects present: 1. pain 2. sensory loss 3. weakness 4. stretch reflex loss
pain--sacral or buttock pain radiating into posterior aspect of leg/perineum sensory loss--medial buttock, perineal, perianal weakness--possible urinary and fecal incontinence, sexual dysfunction stretch reflex loss--bulbocavernosus, anal wink
35
what blood tests should you order if thinking of Pagets disease
calcium and phosphate
36
what should you order if suspect multiple myeloma
albumin serum or urine electrophoresis (SPEP/UPEP)
37
when should you order a lumbar spine XR in back pain
pain more than 6 weeks or red flags
38
when would you consider a bone scan in back pain
if considering infection or malignancy
39
when would you order a skeletal survey in back pain
multiple myeloma
40
what blood tests should be done to workup possible PMR
rheumatoid factor and/or anti-CCP antibodies CRP or ESR bone profile including calcium and ALP
41
first line pain management for acute and subacute back pain
acetaminophen alternating cold and heat physiotherapy and exercise
42
second line pain management for acute and subacute back pain
NSAIDs can also add cyclobenzaprine for muscle spasms can consider controlled release opioid
43
in what time frame should mechanical back pain resolve
less than 6 weeks
44
third line management for chronic back pain
first and second line is same as acute third line is TCA 4th--tramadol 5th--strong, controlled release opioids
45
in what situations should you consider XRAY immediately
``` constitutional sx risk of infection cancer history hx traumatic onset less than 18 or older than 50 years osteoporosis focal neuro deficit progressive or disabling symptoms duration longer than 6 wks ```
46
should patients without radicular symptoms be offered steroid injections
no

LMCC Part II (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions