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History taking > Common orthorpaedic/gynaecological history - Lower back pain > Flashcards

Common orthorpaedic/gynaecological history - Lower back pain Flashcards

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1
Q

What would you ask about lower bac pain?

A
  • SOCRATES
  • Assocaitions - sciatica, stiffness/deformity, incontinence, neurological symptoms
  • Reg Flags
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2
Q

What conditions would you want to check for in a low back pain history?

A
  • Cauda equina
  • Infection/cancer
  • Fracture
  • Spondyloarthropathy
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3
Q

What features assocaited with back pain would you want to check for when thinking about cauda equina as a cause?

A
  • Urinary incontinence/retention
  • Contipation/faecal incontinence
  • Bilateral leg pain
  • WEakness
  • Saddle anaesthesia
  • Sexual dysfunction
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4
Q

What features associated with back pain would you want to ask about when checking for red flag features of malignancy/infection?

A
  • Age < 20/>55 at onset
  • Cancer history
  • Night pain
  • Weight loss
  • Fever
  • Injecting drugs
  • Immunosuppression
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5
Q

What red flag features associated with low back pain would you check for when checking for fracture as a cause?

A
  • Trauma
  • Severe central spinal pain
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6
Q

What red flag features assocaited with low back pain would you want to check for when checking for spondyloarthropathy?

A
  • Early morning stiffness
  • Worse with rest
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7
Q

What would you want to ask about on systemic enquiry in someone with low back pain?

A
  • Fever, night sweats, weight loss
  • Neuro - weakness, paraesthesiae, muscle wasting, pain numbness
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8
Q

What features of low back pain suggest a muscular cause?

A
  • Acute onset
  • Paraspinal muscles affects, not central
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9
Q

What features of low back pain suggest lumbar sponlylosis/facet joint problems as a ccause?

A
  • Chronic episode mechanical back pain
  • Backache related to standing/walking a lot/sitting in one place
  • Progressive stiffening
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10
Q

What features assocaited with low back pain would suggest lumbar disc prolapse as a cause?

A
  • Acute onset while lifting/bending/sneezing/coughing
  • Severe pain
  • SCiatica, leg pain often worse than back pain
  • Neurological symtpoms - weakness, numbness - L4/5/S1 distribution
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11
Q

What features of low back pain would suggest discitis as a cause?

A
  • Fever
  • Systemic upset
  • Risk factors - injecting drug user
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12
Q

What features of low back pain would suggest spinal fracture as a cause?

A
  • History of trauma
  • Sudden onset
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13
Q

What features of low back pain suggest ankylosing spondylitis as a cause?

A
  • Morning stiffness > 30 minutes
  • Pain worse on rest
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14
Q

What are orthopaedic causes of back pain?

A
  • Muscular
  • Lumbar spondylosis and facet joint syndrome
  • Lumbar disc prolapse
  • Discitis
  • Cauda equina syndrome
  • Ankylosing spondylitis
  • Paget’s disease
  • Spondylolisthesis
  • Osteoporotic bone fracture
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15
Q

What are haematological causes of back pain?

A

Myeloma

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16
Q

What are non-orthopaedic/rheumatological causes of low back pain?

A
  • Pyelonephritis
  • PID
  • Pancreatitis
  • AAA
17
Q

What rheumatological conditions would you consider as a cause of lower back pain?

A

Ankylosing spondylitis

18
Q

What features of low back pain would suggest Spinal tumour as a cause of back pain?

A
  • Pain over months
  • Progressive pain/paresis in one or both legs
  • Focal neuro signs - depending on location
19
Q

What features assocaited with low back pain would suggest spinal TB with abscess/psoas abscess?

A
  • Pain onset over weeks/months
  • Low-grade fever, tenderness
  • Increased WCC/ESR
  • Background debilitation/diabetes/IVDU
20
Q

What features on examination would suggest posterolateral disc herniation as a cause of low back pain?

A
  • Back flexed and extension restricted
  • Straight leg raise stopped at 45o
  • Loss of sensation in lateral foot (L4/L5)
  • Loss of ankle jerk and sensation in sole of foot (S1)
21
Q

What are features of low back pain on examination suggest anterior disc prolapse?

A
  • Flaccid paresis of leg/s
  • Loss of knee/ankle jerk
  • Extensor plantar
  • Loss of vibration sense, touch and pain with sensory

History taking (53 decks)

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