Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CDM2 - Midterm > Jaynstein - Lower Back Pain > Flashcards

Jaynstein - Lower Back Pain Flashcards

1
Q

what diagnosis should you use for the 85% of patients who have lbp that can not be attributed to a specific dz

A

nonspecific lbp

do not give specific dx until it is absolutely proven

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

7 rare conditions that must be ruled out with lbp

A

ankylosing spondylitis
compression fx
cancer
cauda equina
symptomatic herniated disc
spinal infxn
spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2 red flag conditions for lbp that providers mc get sued over

A

cauda equina
spinal infxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

lbp peaks at __ ages

A

55-64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

mc cause of activity limitation in persons < 45 yo

A

lbp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 primary goals for lbp in primary care setting

A

prevention of disability
identify red flags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

definitions of lbp from acute to chronic

A

acute: < 4 weeks
subacute: 4-12 weeks
chronic: > 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

7 rf for lbp

A

psychological
congenital
smoking
occupation
prior episode
physical unfitness
increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

strongest rf for developing lbp

A

psychosocial factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

8 red flags w. lbp

A

trauma
unexplained wt loss
neuro sx
age > 50
fever
IVDU
steroids
hx cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

lbp w. recent chiropractor manipulation is concerning for

A

vertebral dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when is lbp considered metastatic dz until proven otherwise

A

pt w. hx of ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 cancers that mc metastasize to spine/bone

A

breast
lung
prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 characteristics of lbp related to ca

A

unexplained wt loss
pain > 1 mo
failure to improve w. conservative tx
night time pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

work up for suspected lbp related to ca (2)

A

CBC
plain films

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 mc causes of spinal infxn

A

urinary infxn
indwelling catheter
skin infxn
IVDU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

t/f: fever is a sensitive indicator of spinal infxn

A

f!!

only 40% sensitive overall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PE finding that is relatively sensitive/specific for lbp related to spinal infxn

A

spinal tenderness -> specific focal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

lab work up for spinal infxn (5)

A

UA
CBC
blood cultures
lactate
ESR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

most sensitive lab to detect spinal infxn

A

ESR!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

imaging of choice if you suspect spinal infxn and ESR is positive

A

MRI w. and w.o contrast

if negative -> high rule out sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

compression fx mc occur in what pt pop

A

osteoporosis -> caucasian > 70 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what pt population w. lbp is a compression fx until proven otherwise

A

pt’s on longterm steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

order of imaging for compression fx

A
  1. plain films -> first line
  2. if negative, CT w.o contrast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

2 surgical procedures used for compression fx

A

kyphoplasty
vertebroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

5 screening factors for ankylosing spondylitis

A

morning stiffness
improvement w. exercise
onset of pain at age < 40 yo
slow pain progression
pain > 3 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

t/f: screening for ankylosing spondylitis is specific

A

f!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

cornerstone characteristic of lbp related to ankylosing spondylitis

A

reduced flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

work up for ankylosing spondylitis (3)

A

HLA B27
pelvic xray
lumbar spine xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

pelvic xray finding of ankylosing spondylitis

A

bilateral, symmetric sacroilitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

lumbar spine xray finding of ankylosing spondylitis

A

bony sclerosis
bamboo spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

95% of pt’s w. symptomatic disc herniation have __

A

sciatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

with an acute herniation, __ often overshadows back pain

A

leg pain

34
Q

what age does does lumbar disc herniation peak

A

30-55 yo

35
Q

2 bedside screening PE tools for disc herniation

A

SLR
crossed SLR

36
Q

w. SLR, pt has increased pain between __ angles

A

30-60

after 60 degrees, the pain should remain constant and is negligible

37
Q

what is the crossed SLR

A

raise straight leg 30-60 degrees -> positive if elicits pain on opposite side

38
Q

what increases specificity of SLR, and also indicates larger disc protrusion

A

lower degree of pain onset

39
Q

SLR is most sensitive for disc herniation at which vertebrae

A

L5/S1

40
Q

most sensitive AND specific PE findings for disc herniation

A

positive SLR
AND
positive crossed SLR

41
Q

4 signs of neuro compromise and need for surgical intervention w. lumbar disc herniation

A

ankle dorsiflexion weakness
great toe extensor weakness
decreased pinprick sensation
impaired ankle reflex

42
Q

what 2 PE findings are found in 90% of pt’s who need surgical intervention for lumbar disc herniation

A

impaired ankle reflex
weak ankle dorsiflexion

43
Q

imaging of choice for lumbar disc herniation

A

MRI

44
Q

who should get MRI for lumbar disc herniation (2)

A

significant PE findings
PLUS
pain or sx > 6 mo

45
Q

pain in the legs, and sometimes neuro deficits, that occurs after standing or walking

A

neurogenic claudication

46
Q

what does neurogenic claudication make you think of

A

spinal stenosis

47
Q

neurogenic claudication is always __lateral

A

bi

48
Q

how do you differentiate spinal stenosis/neurogenic claudication from PVD

A

check pulses

49
Q

what do you think when you see: lbp that slowly progresses to constant pain w. leg stiffness or pain

A

spinal stenosis

50
Q

what do you think when you see a pt w. lb who tells you that the pain is NOT aggravated by bike riding

A

spinal stenosis

51
Q

spinal stenosis pain is aggravated by __

A

spine extension

usually it’s flexion w. other causes

52
Q

order of imaging for spinal stenosis

A
  1. lumbar xray -> high r.o value
  2. if positive -> MRI or CT w.o contrast
53
Q

gs diagnostic imaging for spinal stenosis

A

MRI w.o contrast

54
Q

xray finding of spinal stenosis

A

degenerative changes

55
Q

history finding of pt w. cauda equina

A

herniated disc

56
Q

what sx is seen in 90% of pt’s w. early cauda equina

A

urinary retention (not incontinence)

57
Q

2 late findings of cauda equina

A

bowel incontinence
urinary incontinence

58
Q

what type of anesthesia is seen in 75% of pt’s w. cauda equina

A

perianal (saddle)

59
Q

decreased __ tone is seen in 60-80% of pt’s w. cauda equina

A

rectal

60
Q

3 PE findings of cauda equina

A

sciatica
positive SLR
sensory/motor deficits

61
Q

management of cauda equina

A

MRI
emergent neuro consult

62
Q

mainstay of diagnosis for all lbp conditions

A

good h&p

63
Q

2 things that should NOT be considered first line for any lbp conditions

A

labs
imaging

64
Q

5 indications to obtain spinal imaging for lbp

A
  1. high risk for compression fx
  2. suspected infxn, cauda equina, progressive/severe neuro deficits
  3. risk factors for ca (unless age is only rf)
  4. suspected radiculopathy or spinal stenosis
  5. no improvement after > 6 weeks
65
Q

what imaging should you order if a pt has lbp with no improvement > 6 mo

A

MRI

66
Q

3 labs that are useful for eval of lbp (in order of usefulness)

A
  1. ESR
  2. CBC
  3. lactate/cultures
67
Q

work up including __ (2) is sufficient in the majority of lbp patients w. red flags

A

xray
ESR

68
Q

t/f: patient’s pain level correlates w. the severity of injury

A

f!

69
Q

what is pain level useful for in eval of lbp

A

to guide activity modification

70
Q

4 first line tx for lbp

A

PT
massage
acupuncture
manipulation

71
Q

__ has less favorable outcomes for lbp

A

bed rest

72
Q

first line pharm for lbp (2)

A

NSAIDs
APAP

73
Q

2nd line pharm for lbp (2)

A

gabapentin
antidepressants

74
Q

topical meds for lbp (2)

A

voltaren gel
lidocaine patches

75
Q

procedure for lbp

A

trigger point injxns

76
Q

tx for nerve pain (2)

A

gabapentin
lyrica

77
Q

what can be used to break the pain cycle for lbp

A

vicodin

but a very small amt (2-3 days)

78
Q

pt with lbp should aim to get back to baseline activity w.in __ weeks

A

4

79
Q

walking recs for lbp

A

20 min 3-4 x/week

80
Q

f/u for lbp

A

4 weeks

sooner if progressive sx

CDM2 - Midterm (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions