Differential & Work-up: Low Back Pain

Question 1

45 yo F presents with low back pain that radiates to the lateral aspect of her left foot. The straight leg raise is positive. The patient is unable to tiptoe.

Answer 1

1. Disk herniation
2. Lumbar muscle strain
3. Tumor in the vertebral canal

Question 2

WORK UP FOR:

1. Disk herniation
2. Lumbar muscle strain
3. Tumor in the vertebral canal

Answer 2

1. XR-L,spine
2. MRI-L,spine

Question 3

45 yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, and there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted.

Answer 3

1. Lumbar muscle strain
2. Disk herniation
3. Vertebral compression fracture

Question 4

WORK UP FOR:

1. Lumbar muscle strain
2. Disk herniation
3. Vertebral compression fracture

Answer 4

1. XR-L,spine
2. MRI -L,spine

Question 5

45 yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward ( eg, pushing a grocery cart).

Answer 5

1. Lumbar spinal stenosis
2. Lumbar muscle strain
3. Tumor in the vertebral canal
4. Peripheral vascular disease

Question 6

WORK UP FOR:

1. Lumbar spinal stenosis
2. Lumbar muscle strain
3. Tumor in the vertebral canal
4. Peripheral vascular disease

Answer 6

1. MRI-L,spine(preferred)
2. XR-L-spine
3. CT-L-spine
4. Ankle-brachial index

Question 7

17 yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not match any known distribution. He insists on requesting a week off from school because of his injury.

Answer 7

1. Malingering
2. Lumbar muscle strain
3. Disk herniation
4. Knee or leg fracture
5. Ankylosing spondylitis

Question 8

WORK UP FOR:

1. Malingering
2. Lumbar muscle strain
3. Disk herniation
4. Knee or leg fracture
5. Ankylosing spondylitis

Answer 8

1. XR-L-spine/knee
2. MRI-L-spine
3. ESR, CRP