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Diff Di > Low back complaint > Flashcards

Low back complaint Flashcards

1
Q

red flags with low back pain

A

fever or recent infection, saddle anesthesia, severe or progressive neurological complaints, bladder dysfunction, unexplained weight loss, pain that is worse at night

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2
Q

management with signs of cauda equina or progressing neurological deficits

A

refer for neurological evaluation

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3
Q

management for suspected fracture, infection, or cancer

A

do xrays

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4
Q

pts with xrays or labs that show possible tumor, infection, or fracture

A

send for medical eval

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5
Q

pts who appear to have a mechanical cause of pain

A

manage conservatively

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6
Q

most likely diagnosis with urinary retention

A

cauda equina syndrome

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7
Q

pts over the age of 50, previous history of cancer, unexplained weight loss, failure to respond to conservative care, pain that is unrelieved by bedrest

A

possible cancer

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8
Q

pts with history of urinary tract infection, urinary catheter, injection of drugs, fever

A

possible infection (spinal)

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9
Q

older pts with sudden onset of pain with coughing sneezing or sudden flexion, unassociated with radicular complaints

A

possible compression fracture

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10
Q

low back pain with radiation pain below the knee suggests:

A

disc lesion with nerve root irritation

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11
Q

paresthesia or numbness more common with

A

disc lesions

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12
Q

low back pain with rapid onset of bilateral leg weakness

A

immediate medical referral

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13
Q

low back pain with fall on the buttocks or sudden hyperflexion injury

A

xrays to look for fracture

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14
Q

recent onset of associated urinary retention, with associated numbness in perianal or perineal areas, saddle thigh or buttocks sensory loss

A

cauda equina syndrome

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15
Q

recent onset of urinary retention with no numbness in perianal or perineal regoions

A

do UA, DRE and PSA in males

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16
Q

radiating pain into the groin area with associated fever/chills and positive punch test

A

pyelonephritis is likely

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17
Q

pt has posterior or lateral leg pain, paresthesia extending below the knee; SLR positive with hard neurological findings of a single nerve root

A

disc lesion

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18
Q

unilateral or bilateral diffuse leg complaints made worse by walking; pain relieved within 20 minutes of sitting or less severe with bicycling; multiple dermatome involvement; xray shows stenosis

A

neurogenic claudication

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19
Q

unilateral or bilateral diffuse leg complaints made worse by walking; pain not relieved within 20 min of sitting or less severe with walking

A

vascular claudication

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20
Q

leg pain, numbness, paresthesia in anterior thigh region; reproduction with femoral nerve stretch or Lindner’s

A

upper lumbar nerve root pathology

21
Q

pain, numbness, paresthesia above knee; restricted motion or pain produced at SI with compression test, Gaenslen’s, Fabers

A

SI syndrome

22
Q

pain, numbness, paresthesia above knee, positive Kemps and negative SLR

A

facet syndrome

23
Q

pain localized to low back and made worse by movement, pain made worse with active movement in one direction

A

muscle strain likely

24
Q

diffuse sensation of low back pain stiffness; positive 11/18 tender points

A

fibromyalgia likely

25
Q

diffuse sensation of low back pain stiffness; no tender points; restricted ROM associated with SI pain and low back stiffness relieved by rest

A

AS should be considered

26
Q

pt complains of low back and leg pain below the knee after a sudden onset from bending or twisting

A

disc lesion with radiculopathy

27
Q

most disc lesions are at:

A

L4/L5 or L5/S1

28
Q

weakness of dorsiflexion of great toe and numbness on lateral side of lower leg

A

L5 nerve root lesion

29
Q

absent Achilles reflex, numbness on back of calf lateral foot or bottom of foot, weakness on plantar flexion of great toe

A

S1 nerve root lesion

30
Q

in cervical spine, midline disc herniations create

A

myelopathies

31
Q

in cervical spine, lateral disc herniation involves

A

nerve root below

32
Q

in lumbar spine, midline disc herniation involves

A

nerve root below

33
Q

in lumbar spine, foraminal disc herniation involves

A

nerve root at same level

34
Q

disc lesion that affects S1 nerve root, pain projects to S1 area, achilles reflex affected, weak plantar flexion, difficulty with toe walking

A

L5/S1 disc lesion

35
Q

disc lesion that affects L5 nerve root, sensory deficit in anterior lateral lower leg and top of foot, weak dorsiflexion of foot, difficulty with heel walking

A

L4/L5 disc lesion

36
Q

pt leans way from side of disc lesion or pain

A

lateral disc lesion

37
Q

pt leans into side of disc lesion or pain

A

medial disc lesion

38
Q

pt assumes flexed posture with disc lesion

A

central disc lesion

39
Q

pt complains of well localized low back pain with some hip/buttock/leg pain above the knee that has onset after sudden movement or getting up from flexed position

A

facet syndrome

40
Q

pt that is 50 or older, unilateral or bilateral diffuse back and leg pain, onset of complaints with walking and is relieved with rest

A

canal stenosis

41
Q

most common type of spondylo in the young

A

isthmic

42
Q

most common type of spondylo in the old

A

degenerative

43
Q

spondylo usually due to a stress fracture of the pars, most commonly at L5, younger age onset

A

isthmic/spondylolytic

44
Q

spondylo usually associated with facet arthrosis, most commonly at L4, older age onset

A

degenerative

45
Q

pt may have mid abdominal or low back pain, may have leg pain with exertion, may have abdominal mass and/or bruit, may have erosion of anterior vertebral bodies

A

abdominal aneurysm

46
Q

pt has hard neurological evidence of nerve dysfunction, radiation of pain often into leg and foot pain, deficit in correspoinding dermatome myotome and DTR, variable muscle weakness

A

neuritis or radiculitis due to disc

47
Q

primary site of mets in females

A

breast (usually lytic)

48
Q

primary site of mets in males

A

prostate (usually blastic)

49
Q

common tetrad of multiple myeloma (CRAB)

A

calcium, renal failure, anemia, bone lesions

Diff Di (8 decks)

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