Low Back Pain Flashcards
A 62-year-old female presents with low back pain which radiates down the back of both legs. She is also having problems urinating. On examination, there is saddle anesthesia present, and her ankle reflexes are nonexistent. CT scan shows a space-occupying lesion in the spinal canal at L4.
Cauda equina syndrome
A 35-year-old male presents with low back pain for the past five years. There is decreased lumbar motion in all planes, with SI joint tenderness. HLA-B27 is positive and x-ray shows blurring of both SI joints and shiny corners of the lumbar vertebrae.
Ankylosing spondylitis
A 53-year-old male complains of right lumbar pain which radiates into the back of the right leg. Coughing and straining make the pain worse. On examination, the SLR is positive on the right at 60 degrees of hip flexion. WLR test is also positive. MRI shows a posterior lateral disc herniation of L4/5 disc.
Sciatica secondary to lumbar disc herniation
An overweight 67-year-old male hypertensive smoker presents with LBP. He also complains of left leg cramps and pain after walking. The leg pain is better hen he stops and rests. On examination of the abdomen, a midline pulsatile mass is felt above the umbilicus. The left posterior tibial pulse is decreased. Ultrasound of the abdomen shows an abdominal aorta with a diameter of 4 cm.
Abdominal aortic aneurysm
A 46-year-old male presents with LBP which is worse on left lateral bending. On examination, Kemps test results in localized pain in the L4 region. Lumbar x-ray shows imbrication of the left L4/5 facet joint. No tests done otherwise.
Lumbar facet syndrome
A 63-year-old male presents with fatigue and back pain. There is some hearing loss as well. On examination, there is anterior bowing of his tibia. He has a bounding pulse. CMP shows an elevated alkaline phosphatase with normal calcium levels. X-ray of the skull shows a cotton wool appearance and there is a brim sign in the pelvic x-ray.
Paget’s disease
A 60-year-old male presents with LBP and unexplained weight loss. On examination, there is tenderness on percussion of the spinous process of L2. CBC shows a mild normochromic normocytic anemia. There is Bence-Jones proteinuria and serum electrophoresis shows an M spike of monoclonal IgG. Multiple lytic lesions in the spine observed on x-ray.
Multiple Myeloma
A 21-year-old female presents with LBP, fever, chills, vomiting and dysuria. On examination, there is tenderness on percussing the left costovertebral angle. CBC shows leukocytosis with elevated neutrophils. Urinalysis shows bacteria, nitrites and WBC casts.
Pyelonephritis
A 67-year-old female presents with LBP. The pain radiates into the legs and is worse when she walks for more than a quarter mile. It gets better when she sits down or if she leans forward on her shopping cart if she is in the store. On examination, the peripheral pulses in the lower limbs are strong and equal. Bicycle test is positive. Lumbar CT and MRI show the narrowing of the diameter of the lumbar spinal canal.
Spinal canal stenosis (or central canal stenosis)
A 55-year-old black man presents with LBP that gets worse at night. On examination, there is a hard irregular mass in the posterior lobe of his prostate. CMP shows an elevated alkaline phosphatase. His PSA is 24 pg/dL and lumbar x-ray shows an ivory vertebra at L2.
Prostatic metastasis
A 24-year-old male athlete presents with intermittent LBP especially after exercising. On examination, there is a step sign between L5 and S1. Lateral lumbosacral x-ray shows a grade II anterolisthesis of L5 on S1.
Spondylolisthesis
