HYHO Lumbar Strain + Nephrolithiasis

Question 1

What features lead you to think systemic disease with LBP presentation?

Answer 1

cancer hx

50+

unexplained wt loss

duration of pain > 1 mo

pain at night

unresponsiveness to previous therapies

Question 2

What are the time frames for LBP?

Answer 2

less than 4 weeks - acute

4 to 12 weeks - subacute

12 weeks + - chronic

Question 3

PT presents with extreme LBP with motor and sensory abnormalities. What is the most likely cause?

Answer 3

herniation of a disc causing spinal cord or cauda equina

bowel/bladder dysfunction is a late finding

Question 4

If a pt has damage to L4, where will they experience pain, numbness, motor weakness? L5? S1?

Answer 4

Question 5

Which pts get an immediate MRI?

Answer 5

sx of SC or cauda equina compression

or progressive and/or severe neuro deficits

ex of sx: new urinary retention, urinary incontinence from bladder overflow, new fecal incontinence, saddle anesthesia, and significant motor deficits not localized to a single nerve root

Question 6

When do pts with radiculopathy of a single nerve root or who are stable need imaging?

Answer 6

when there is risk of metastatic cancer or moderate to high risk of infection

if either are +, they need immediate MRI

Question 7

What imaging is preferred for suspected nephrolithiasis?

Answer 7

CT of the abd and pelvis without contrast

if CT unavailable, US of kidneys adn bladder (sometimes with abdominopelvic radiography)

Question 8

What are the key sx to dx of cauda equina?

Answer 8

urinary retention

saddle anesthesia

b/l leg weakness

b/l sciatica

Question 9

What are the key sx to dx of infection causing LBP?

Answer 9

fever

recent skin infection or UTI

immunosuppression

injection drug use

Question 10

What are the key sx to dx of malignancy causign LBP?

Answer 10

cancer hx (esp active cancer)

unexplained wt loss

50+

duration > 1 mo

Question 11

What are the key sx to dx of compression fracture?

Answer 11

70+

female

corticosteroid use

hx of osteoporosis

trauma

Question 12

What are the key sx to dx of lumbar radiculopathy?

Answer 12

sciatica

abnormal neuro exam

Question 13

If pt’s LBP is not tx sufficiently with NSAIDs, what is the next step?

Answer 13

add a nonbenzodiazepine muscle relaxant

Question 14

What are predictors of developing chronic LBP?

Answer 14

maladaptive pain coping behaviors

functional impairment

poor general health status

presence of psychiatric comorbidities

nonorganic signs