Low back complaint

Question 1

red flags with low back pain

Answer 1

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

Question 2

management with signs of cauda equina or progressing neurological deficits

Answer 2

refer for neurological evaluation

Question 3

management for suspected fracture, infection, or cancer

Answer 3

do xrays

Question 4

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

Answer 4

send for medical eval

Question 5

pts who appear to have a mechanical cause of pain

Answer 5

manage conservatively

Question 6

most likely diagnosis with urinary retention

Answer 6

cauda equina syndrome

Question 7

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

Answer 7

possible cancer

Question 8

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

Answer 8

possible infection (spinal)

Question 9

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

Answer 9

possible compression fracture

Question 10

low back pain with radiation pain below the knee suggests:

Answer 10

disc lesion with nerve root irritation

Question 11

paresthesia or numbness more common with

Answer 11

disc lesions

Question 12

low back pain with rapid onset of bilateral leg weakness

Answer 12

immediate medical referral

Question 13

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

Answer 13

xrays to look for fracture

Question 14

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

Answer 14

cauda equina syndrome

Question 15

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

Answer 15

do UA, DRE and PSA in males

Question 16

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

Answer 16

pyelonephritis is likely

Question 17

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

Answer 17

disc lesion

Question 18

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

Answer 18

neurogenic claudication

Question 19

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

Answer 19

vascular claudication

Question 20

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

Answer 20

upper lumbar nerve root pathology

Question 21

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

Answer 21

SI syndrome

Question 22

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

Answer 22

facet syndrome

Question 23

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

Answer 23

muscle strain likely

Question 24

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

Answer 24

fibromyalgia likely

Question 25

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

Answer 25

AS should be considered

Question 26

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

Answer 26

disc lesion with radiculopathy

Question 27

most disc lesions are at:

Answer 27

L4/L5 or L5/S1

Question 28

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

Answer 28

L5 nerve root lesion

Question 29

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

Answer 29

S1 nerve root lesion

Question 30

in cervical spine, midline disc herniations create

Answer 30

myelopathies

Question 31

in cervical spine, lateral disc herniation involves

Answer 31

nerve root below

Question 32

in lumbar spine, midline disc herniation involves

Answer 32

nerve root below

Question 33

in lumbar spine, foraminal disc herniation involves

Answer 33

nerve root at same level

Question 34

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

Answer 34

L5/S1 disc lesion

Question 35

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

Answer 35

L4/L5 disc lesion

Question 36

pt leans way from side of disc lesion or pain

Answer 36

lateral disc lesion

Question 37

pt leans into side of disc lesion or pain

Answer 37

medial disc lesion

Question 38

pt assumes flexed posture with disc lesion

Answer 38

central disc lesion

Question 39

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

Answer 39

facet syndrome

Question 40

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

Answer 40

canal stenosis

Question 41

most common type of spondylo in the young

Answer 41

isthmic

Question 42

most common type of spondylo in the old

Answer 42

degenerative

Question 43

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

Answer 43

isthmic/spondylolytic

Question 44

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

Answer 44

degenerative

Question 45

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

Answer 45

abdominal aneurysm

Question 46

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

Answer 46

neuritis or radiculitis due to disc

Question 47

primary site of mets in females

Answer 47

breast (usually lytic)

Question 48

primary site of mets in males

Answer 48

prostate (usually blastic)

Question 49

common tetrad of multiple myeloma (CRAB)

Answer 49

calcium, renal failure, anemia, bone lesions