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OS Exam II > DSA: Low Back Pain > Flashcards

DSA: Low Back Pain Flashcards

1
Q

Acute vs. sub-acute vs. chronic

A

Acute = LBP lasting up to 6 weeks

Sub-acute = LBP lasting 7-12 weeks

Chronic = LBP lasting over 12 weeks

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2
Q

Subjective red flags for LBP

A 
Major trauma
Age >50
Persistent fever
Hx of cancer
Saddle anesthesia
Hx of osteoporosis
Progressive neuro symptoms
Bowel/bladder dysfunction
Hx of corticosteroid use
Decreased anal sphincter tone
Unrelenting night pain
Major muscle weakness
RA, Down's syndrome, Marfan's, Ehler Danlos
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3
Q

Objective red flags for LBP

A

Muscle atrophy
Increased muscle tone (CP)
Decreased DTR’s (muscle stretch)
Signs of inflammation

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4
Q

Tests used to evaluate LBP

A 
Prostate specific antigen
Rheumatoid factor
Ultrasound
Urinalysis
X-ray
CBC
C-reactive protein
CT
ESR
HLA-B27
MRI
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5
Q

Categories for LBP differential diagnoses

A

Mechanical (with or without radiation below knee)

Viscerogenic (pain from organs)

Vasculogenic (pain from vascular structures)

Infection

Metabolic

Tumor (primary or secondary=metastatic)

Rheumatologic

Congenital

Psychological

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6
Q

Mechanical differential diagnoses and work-ups for pts without radiation below the knee

A 
Somatic dysfunction (no further w/u needed)
Spinal arthritis (x-ray, MRI)
DDD (x-ray, MRI)
Facet arthritis (x-ray, MRI)
Fracture (x-ray)
Spondylosis (x-ray+oblique films, CT)
Spondylolisthesis (x-ray)
Scoliosis (x-ray)

[x-rays = AP and lateral films]

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7
Q

Mechanical differential diagnoses and work-ups for pts with radiation below the knee

A

Radiculopathy (MRI)
Spinal stenosis (MRI)
Cauda equina syndrome (MRI)

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8
Q

Which of the following is EMERGENT?

A. Radiculopathy
B. Spinal stenosis
C. Cauda equina syndrome
D. Spondylolisthesis

A

C. Cauda equina syndrome

Presents with impaired neurological function including saddle anesthesia, lower extremity weakness, diminished reflexes, and urinary retention. Usually occurs d/t trauma

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9
Q

Organ systems most likely to cause viscerogenic LBP

A

Kidney
Gastrointestinal
Reproductive organs

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10
Q

Viscerogenic differential diagnoses associated with the kidneys and their associated work-ups

A

Nephrolithiasis (US, CT, UA)

Pyelonephritis (UA, CBC, US)

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11
Q

Viscerogenic differential diagnoses associated with the GI system and their associated work-ups

A

IBD d/t Crohn’s or ulcerative colitis (abdominal XR, US, CT, CBC, amylase/lipase)

Diverticulitis (XR, CT, CBC)

Pancreatitis (abdominal XR, US, CT, CBC, amylase/lipase)

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12
Q

Viscerogenic differential diagnoses associated with the reproductive organs and their associated work-ups

A

Endometriosis (US, laparoscopy)

Menstrual (based on clinical findings)

Prostatitis (UA, possible US or CT)

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13
Q

Vasculogenic differential diagnoses for LBP and their associated work-ups

A

Aortic aneurysm (US, CT, CT angiogram)

Ischemic spinal claudication (CT angiogram, MRI)

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14
Q

Infection-related differential diagnoses for LBP and their associated work-ups

A

Discitis (CBC, blood cultures, MRI)

Herpes zoster (no workup needed)

Osteomyelitis (CBC, blood cultures, MRI)

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15
Q

Metabolic-associated differential diagnoses for LBP and their associated work-ups

A

Osteoporosis (DEXA, compression fracture w/u = XR)

Paget disease (XR, bone scane)

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16
Q

Primary tumor-associated differential diagnoses for LBP and their associated work-ups

A

Myeloma
Sarcoma
Osteoid osteoma
Neural tumor (neurofibroma, schwannoma, meningioma)

[w/u = XR, CT, MRI, blood work]

17
Q

Secondary (metastatic) tumor-related differential diagnoses for LBP and their associated work-ups

A

Prostate lesions
Lung lesions
Breast lesions
Kidney lesions

[same w/u for all: XR to start, then may need CT, MRI, blood work]

18
Q

Rheumatologic differential diagnoses for LBP and their associated work-ups

A

Seronegative spondyloarthropathy relating to psoriatic arthritis, ankylosing spondylitis, IBD-enteropathic arthritis, Reiter syndrome (HLA-B27, XR)

Fibromyalgia (Dx of exclusion)

Rheumatoid arthritis (Rheumatoid factor, XR)

19
Q

Congenital differential diagnoses for LBP and their associated work-ups

A

Genetic malformations d/t congenital scoliosis, spina bifida, menigocele, meningomyelocele (maternal US)

Achondroplasia (maternal US)

Collagen disorders like Marfan’s or ED (H&P)

20
Q

Psychological differential diagnoses for LBP

A

Somatoform disorder (physical symptoms cannot be explained by underlying medical condition)

Malingering (exaggerate/feign illness to avoid duty/work)

Central sensitization/chronic pain syndrome (nervous system gets into regulated persistent state of high reactivity)

21
Q

Would you expect facet arthritis to be worse in spinal flexion or extension?

A

Extension

22
Q

Which differential diagnosis category do the following fit into?

Radiculopathy
Spinal stenosis
Cauda equina syndrome

A

Mechanical - with radiation below the knee

23
Q

Which differential diagnosis category do the following fit into?

Nephrolithiasis
Pyelonephritis
IBD
Diverticulitis
Pancreatitis
Endometriosis
Menstrual
Prostatitis
A

Viscerogenic

24
Q

Which differential diagnosis category do the following fit into?

Discitis
Herpes zoster
Osteomyelitis

A

Infection

25
Q

Which differential diagnosis category do the following fit into?

Osteoporosis
Paget disease

A

Metabolic

26
Q

Which differential diagnosis category do the following fit into?

Myeloma
Sarcoma
Osteoid osteoma
Neurofibroma
Schwannoma
Meningioma
A

Tumor-primary

27
Q

Which differential diagnosis category do the following fit into?

Lesions in prostate, lung, breast, or kidney

A

Secondary metastatic tumor

28
Q

Which differential diagnosis category do the following fit into?

Seronegative spondyloarthropathy (psoriatic arthritis, ankylosing spondylitis, IBD, Reiter syndrome)
Fibromyalgia
Rheumatoid arthritis

A

Rheumatologic

29
Q

Which differential diagnosis category do the following fit into?

Spina bifida
Meningocele
Myelomeningocele
Achondroplasia
Collagen disorders
A

Congenital

30
Q

Which differential diagnosis category do the following fit into?

Somatoform disorder
Malingering
Central sensitization/chronic pain syndrome

A

Psychological

31
Q

Which differential diagnosis category do the following fit into?

Somatic dysfunction
Spinal arthritis
DDD
Facet arthritis
Fracture
Spondylolysis
Spondylolisthesis
Scoliosis
A

Mechanical - without radiation below the knee

32
Q

Which differential diagnosis category do the following fit into?

Aortic aneurysm
Ischemic spinal claudication

A

Vasculogenic

OS Exam II (10 decks)

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