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OSCE - histories > History of back pain > Flashcards

History of back pain Flashcards

1
Q

What are causes of sudden onset of back pain (seconds to hours)?

A
  1. Mechanical strains
  2. Posterior lumbar disc prolapse
  3. Anterior lumbar disc prolapse
  4. Spondylosis
  5. Central disk profusion
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2
Q

How is a mechanical strain characterised?

A

Recent onset over minutes of pain and restriction of movement in lower back in a young person

History of living a heavy weight or a head-on impact

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3
Q

How would you confirm a mechanical strain?

A

Recovery with minimal loss of function over weeks

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4
Q

How would you manage a mechanical strain?

A

NSAIDs, physiotherapy

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5
Q

How is a posterior lumbar disc prolapse characterised?

A

Onset over seconds of severe back pain on coughing, sneezing or twisting after earlier strain

Radiation to the buttock, thigh or calf if prolapse compresses posterior root

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6
Q

How would you confirm a posterior lumbar disc prolapse?

A

Back flexed and extension restriction

Straight leg raising stopped before 45 degrees because of pain

Loss of sensation of lateral foot

Loss of ankle jerk

DO MRI!!!!

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7
Q

How would you manage a posterior lumbar disc prolapse?

A

Bed rest, analgesia, physiotherapy

If these fail, surgical intervention

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8
Q

How is an anterior lumbar disc prolapse characterised?

A

Onset over seconds of severe back pain on coughing, sneezing or twisting after earlier strain

If large: compression of cauda equine with leg weakness and incontinence and perineum numbness

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9
Q

How would you confirm an anterior lumbar disc prolapse?

A

Flaccid paresis of legs

Loss of knee and ankle and extensor plantar reflex

Loss of vibration sense, touch and pain

MRI shows protrusion

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10
Q

How would you manage an anterior lumbar disc prolapse?

A

Bed rest, analgesia, physiotherapy

If these fail, surgical intervention

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11
Q

How is spondylosis characterised?

A

Positive family history, sudden onset over minutes with or without sciatica in adolescence

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12
Q

How would you confirm spondylosis?

A

Plain back X-RAY shows displacement of vertebrae

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13
Q

How would you manage spondylosis?

A

Analgesics, NSAIDs, avoidance of sports, corset support

Surgical intervention

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14
Q

How is central disc protrusion characterised?

A

Sudden onset over minutes or hours with bilateral sciatica, disturbance of bladder or bowel function. Saddle or perineal anaesthesia

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15
Q

How is a central disc protrusion confirmed?

A

History and MRI

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16
Q

How is central disc protrusion managed?

A

Pain control and neurosurgery

17
Q

What are causes of onset of back pain (days to months)?

A
  1. Lumbar spinal stenosis
  2. Spinal tumours (lung, breast, prostate, thyroid, kidney, myeloma)
  3. Pyogenic spinal infection due to staph, salmonella
  4. Spinal TB with abscesses and cord compression
18
Q

What is lumbar spinal stenosis characterised by?

A

Onset of pain over months, worse on walking with ache and weakness in one leg

19
Q

How is lumbar spinal stenosis confirmed?

A

Pain on extension of back, straight leg raise is normal. Few CNS signs

MRI scan !!

20
Q

How would you manage lumbar spinal stenosis?

A

Spinal decompression if intractable pain

21
Q

How are spinal tumours characterised?

A

Onset of pain over months with progressive pain or paresis in one or both legs

22
Q

How would you confirm spinal tumours?

A

Bone scan with erosion on plan X-ray

Space-occupying lesion on MRI or CT scan and histology on biopsy

23
Q

How would you manage spinal tumours?

A

Analgesia

Radiotherapy, chemotherapy, surgery

24
Q

How are pyogenic spinal infections characterised?

A

Onset of pain over days or weeks

Little or no fever, tenderness or WCC

Background: debilitation, surgery, diabetes

25
Q

How would you confirm pyogenic spinal infections?

A

Bone rarefaction or eeromision with joint space narrowing on back x-ray

Hot spot on isotope bone scan

Space-occupying lesion on MRI or CT scan

26
Q

How would you manage pyogenic spinal infections?

A

Analgesics, NSAIDs, antibiotics

27
Q

How is spinal TB characterised?

A

Onset of weeks or months

Low-grade fever, tenderness, or high WCC and ESR

Background debilitation or diabetes

28
Q

How would you confirm spinal TB?

A

Bone rarefaction or erosion with joint space narrowing, then wedding of vertebrae

Space-occupying lesion on MRI or CT scan

Tubercle bacilli stains or culture on drainage lateral

29
Q

How would you manage spinal TB?

A

Standard anti-tuberculous treatment

30
Q

What are the differential diagnoses for back pain with an onset over years?

A
  1. Kyphotic pan
  2. Scoliotic pain, poliomyelitis, syringomyelia
  3. Idiopathic scoliosis or thoracic or lumbar spine
31
Q

What characterises kyphotic pain?

A

Poor posture with hump appearance of the back

Onset over years, exacerbated over days with wedge fracture

Spinal curvature visible from the side

Associated neuromuscular disease

32
Q

What confirms kyphotic pain?

A

x-ray appearance suggestive of congenital deformity

33
Q

How would you manage kyphotic pain?

A

Analgesics and OBAS (observation, bracing and surgery)

34
Q

What characterises scoliotic pain?

A

Lateral curvature visible from the back and associated rib prominence apparent from the front

Head appears off centre and a hip or shoulder is higher than the other side

Known to have other congenital illnesses

35
Q

How would you confirm scoliotic pain?

A

History and x-ray

36
Q

How would you manage scoliotic pain?

A

Treat underlying cause, otherwise analgesics and OBAS

37
Q

What characterises idiopathic scoliotic pain?

A

Progressive loss over years of horizontal alignment of shoulder and hips with age. Usually more in adolescent girls than boys

38
Q

How would you confirm idiopathic scoliotic pain?

A

X-ray appearance

39
Q

How would you manage idiopathic scoliotic pain?

A

OBAS

OSCE - histories (20 decks)

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