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CDM Ex 2 > Eval of Back Pain in PC > Flashcards

Eval of Back Pain in PC Flashcards

1
Q

When patients come in with LBP that cannot be attributed to a specific disease or spinal pathology, we should label it as what?

A

Non-specific lbp

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2
Q

What are major conditions that need to be ruled out for LBP?

A
  • ankylosing spondylitis
  • compression fracture
  • symptomatic herniated disc
  • spinal stenosis
  • cancer
  • cauda equina
  • spinal infection
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3
Q

What is the timeframe considered for acute LBP?

A

< 4 wks

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4
Q

What is the timeframe considered for subacute LBP?

A

4-12 wks

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5
Q

What is the timeframe considered for chronic LBP?

A

> 12 wks (only 20% will move into chronic)

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6
Q

Name the red flags of back pain (TUNAFISH)

A 
Trauma 
Unexplained weight loss 
Neurologic symptoms 
Age > 50 
Fever 
IV Drug Use 
Steroid Use 
Hx of Cancer
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7
Q

T/F: a patient with a hx CA who presents with LBP is metastatic disease until proven otherwise

A

True

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8
Q

What are the mc cancer metastasis that spread to spine/bone?

A

breast, lung, prostate

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9
Q

What are these sxs of?

A

unexplained weight loss, pain >1 mo, failure to improve with conservative therapy, and night time pain

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10
Q

Fever + back pain = what?

A

spinal abscess until proven otherwise

(even if RF for spinal abscess but NO FEVER) = spinal abscess until proven otherwise

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11
Q

In a spinal infection, what is the most sensitive and specific lab choice?

A

ESR

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12
Q

In a spinal infection, what is the DOC?

A

MRI with and without

with con looks for abscess and without looks at the bone

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13
Q

In longterm steroid use, what should we be concerned about with patient?

A

compression fracture

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14
Q

If we are concerned for a compression fracture, what is the DOC?

A

plain films (tells you % of height loss)

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15
Q

These are signs of what disease?

  • morining stiffness
  • improvement with exercise
  • onset of pain age <40
  • pain progression, slow
  • pain > 3 mo
A

ankylosing spondylitis

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16
Q

what is the cornerstone for ankylosing spondylitis?

A

reduced flexion AND HLAB-27

17
Q

What is the DOC in ankylosing spondylitis?

A
  • Pelvic xray (shows bilateral and symmetric sacrolitis)

- xray lumbar spine shows bony sclerosis and bamboo sign

18
Q

How to dx a lumbar disc herniation?

A

-SLR (80% sensitive and 40% specific) and with the addition of the crossed straight leg raise it is 90% specific

19
Q

The SLR will ilicit pain on the same/opposite side whereas CRSLR will ilicit pain on the same/opposite side?

A

SLR- same

CRSLR- opposite

20
Q

What are two common findings found in patients with impaired ankle reflex + weak dorsiflexion?

A

surgical lumbar herniation

21
Q

What is the TOC for lumbar disc herniarion and at how many weeks is it ordered?

A

MRI with and without contrast and >6 weeks

22
Q

Spinal stenosis can sometimes prevent like PVD so it is important to check what?

A

pulses

23
Q

An interesting finding in spinal stenosis is that pain is not provoked by what exercise?

A

bike riding

24
Q

What is the TOC in spinal stenosis?

A

First do xray and if it shows degenerative changes then you should do MRI

25
Q

Don’t forget to check ______ in patients with cauda equina

A

rectal tone (they will have decreased rectal tone)

26
Q

What is the TOC for cauda equina?

A

emergent MRI and emergent neurosurg consult

27
Q

T/F: no imaging or other diagnostic tests are needed initially in a patient with nonspecific low back pain

A

TRUE

28
Q

If patients have no improvement in LBP in >6wks, what TOC?

A

MRI

29
Q

Are any labs helpful in the eval of LBP?

A

**ESR, CBC, lactate, blood cultures

Plain film xray and ESR is sufficient workup in the majority of patients.

30
Q

First line meds for LBP

A

Nsaid or APAP (neither is superior)

31
Q

Second line for LBP

A

muscle relaxants but greatest benefits if startd in 1-2 wks of onset of LBP

32
Q

When should you d/c muscle relaxants if they are not working?

A

within 2-4 wks

33
Q

Third line tx of LBP

A

antidepressants (SNRI)

34
Q

Are corticosteroids generally recommended for LBP?

A

No

35
Q

What is a good f/u for patients with LBP?

A

4 wks sooner if pain progresses

CDM Ex 2 (6 decks)

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