DSA: Low Back Pain Flashcards
Acute vs. sub-acute vs. chronic
Acute = LBP lasting up to 6 weeks
Sub-acute = LBP lasting 7-12 weeks
Chronic = LBP lasting over 12 weeks
Subjective red flags for LBP
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
Objective red flags for LBP
Muscle atrophy
Increased muscle tone (CP)
Decreased DTR’s (muscle stretch)
Signs of inflammation
Tests used to evaluate LBP
Prostate specific antigen Rheumatoid factor Ultrasound Urinalysis X-ray CBC C-reactive protein CT ESR HLA-B27 MRI
Categories for LBP differential diagnoses
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
Mechanical differential diagnoses and work-ups for pts without radiation below the knee
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]
Mechanical differential diagnoses and work-ups for pts with radiation below the knee
Radiculopathy (MRI)
Spinal stenosis (MRI)
Cauda equina syndrome (MRI)
Which of the following is EMERGENT?
A. Radiculopathy
B. Spinal stenosis
C. Cauda equina syndrome
D. Spondylolisthesis
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
Organ systems most likely to cause viscerogenic LBP
Kidney
Gastrointestinal
Reproductive organs
Viscerogenic differential diagnoses associated with the kidneys and their associated work-ups
Nephrolithiasis (US, CT, UA)
Pyelonephritis (UA, CBC, US)
Viscerogenic differential diagnoses associated with the GI system and their associated work-ups
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)
Viscerogenic differential diagnoses associated with the reproductive organs and their associated work-ups
Endometriosis (US, laparoscopy)
Menstrual (based on clinical findings)
Prostatitis (UA, possible US or CT)
Vasculogenic differential diagnoses for LBP and their associated work-ups
Aortic aneurysm (US, CT, CT angiogram)
Ischemic spinal claudication (CT angiogram, MRI)
Infection-related differential diagnoses for LBP and their associated work-ups
Discitis (CBC, blood cultures, MRI)
Herpes zoster (no workup needed)
Osteomyelitis (CBC, blood cultures, MRI)
Metabolic-associated differential diagnoses for LBP and their associated work-ups
Osteoporosis (DEXA, compression fracture w/u = XR)
Paget disease (XR, bone scane)
Primary tumor-associated differential diagnoses for LBP and their associated work-ups
Myeloma
Sarcoma
Osteoid osteoma
Neural tumor (neurofibroma, schwannoma, meningioma)
[w/u = XR, CT, MRI, blood work]
Secondary (metastatic) tumor-related differential diagnoses for LBP and their associated work-ups
Prostate lesions
Lung lesions
Breast lesions
Kidney lesions
[same w/u for all: XR to start, then may need CT, MRI, blood work]
Rheumatologic differential diagnoses for LBP and their associated work-ups
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)
Congenital differential diagnoses for LBP and their associated work-ups
Genetic malformations d/t congenital scoliosis, spina bifida, menigocele, meningomyelocele (maternal US)
Achondroplasia (maternal US)
Collagen disorders like Marfan’s or ED (H&P)
Psychological differential diagnoses for LBP
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)
Would you expect facet arthritis to be worse in spinal flexion or extension?
Extension
Which differential diagnosis category do the following fit into?
Radiculopathy
Spinal stenosis
Cauda equina syndrome
Mechanical - with radiation below the knee
Which differential diagnosis category do the following fit into?
Nephrolithiasis Pyelonephritis IBD Diverticulitis Pancreatitis Endometriosis Menstrual Prostatitis
Viscerogenic
Which differential diagnosis category do the following fit into?
Discitis
Herpes zoster
Osteomyelitis
Infection
