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NEUROLOGY > Low Back Pain > Flashcards

Low Back Pain Flashcards

1
Q

What does lower back pain radiation to the buttocks mean>

A
  • muscle pain
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2
Q

What does lower back pain to the knees mean>

A

possible slip disc

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3
Q

What associated symptoms should you ask for, if pc is Lower back pain?

A
  • stiffness of back
  • numbness/ tingling
  • urinary symptoms
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4
Q

What non-pharmacological measures can be taken for lower back pain?

A
  • massage
  • chiropactor
  • osteopath
  • acupuncture
  • PT
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5
Q

Name major/ dangerous ddx for lower back pain.

A
  1. CANCER
  2. INFECTION
  3. #
  4. Other general things
  5. CES
  6. AAA (abdominal aortic aneurysm)
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6
Q

What things should be considered to mark lower back pain as a definite concern?

A
  1. failure to improve after 4-6 weeks of conservative therapy
  2. UNRELENTING night pain/ at rest
  3. progressive motor/ sensory deficit
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7
Q

When is cancer a considered a red flag in a pt?

A
  • if pt is >50 y.o
  • had unintended weight loss
  • hx of CANCER
  • pain at NIGHT and when lying
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8
Q

When is infection of the spine considered a red flag?

A
  • fever/chills
  • recent infection
  • IMMUNOSUPPRESSION
  • iv drug use
  • poor DENTAL status
  • foreign travel
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9
Q

When to suspect Cauda-Equina syndrome,as a red flag?

A
  • bilateral sciatica
  • urinary incontinence
  • leg weakness
  • decr. ANAL tone
  • loss of perianal sensation
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10
Q

When is a fracture of a spine esp. considered as a red flag?

A
  • IF pt is >50y.o
  • has osteoporosis
  • hx of signif. trauma
  • chronic STEROID use
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11
Q

Why may AAA cause lower back?

A
  • the aneurysm becomes so big, it may just erode the vertebra
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12
Q

When to suspect AAA as a red flag?

A
  • age >60y.o
  • presence of an abdominal pulsating MASS
  • pain at REST
  • cardiac syncope more than pain
  • pain could be at abdominal/ flank/ groin
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13
Q

What special tests at the bedside that could be performed for lower back pain?

A
  • Straight leg raise
  • muscle strength
  • sensation
  • deep tendon reflex
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14
Q

What does SLR test?

A
  • the test stretches the sciatic nerve and the hamstrings
  • pain radiate to the lower extremity with compression of the saccral nerve roots
  • —sign of disc herniation
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15
Q

Patient comes in with pain running straight down the leg from the mid-butt. She is unable to walk on her toes. What nerve root is involved?

A
  • weakness on plantar flexion of great toe and foot, suggests ..
  • S1 nerve root compression
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16
Q

Pt is has pain shooting down the lateral aspect of her right leg (starting at the lower back).
- he is unable to walk on his HEELs. What nerve root is involved?

A
  • L5

- –INABILITY TO dorsiflex great toe and foot

17
Q

Pt comes in complaining of pain shooting down the lateral thigh and shifting to the medial aspect of the calf. There is diminished knee reflex.. What nerve root is involved, and which muscle is affected?

State another screening test in this nerve root compression.

A
  • nerve root L4 is compressed
  • weakness of the Quadriceps
  • screening test for L4= SQUAT and RISE
18
Q

What nerves are tested in the biceps reflex?

A

C5 and C6

19
Q

What nerve roots are tested with the triceps reflex?

A

C7 and C8

20
Q

What nerve roots are tested with the patellar reflex?

A

L2,L3 and L4

21
Q

What nerve root is tested with the achilles reflex?

A

S 1

22
Q

Do pts with acute onset Lower back pain need investigating?

A

NO

70-90% of LBP WILL resolve within a month

23
Q

What invx to be performed if LBP has not resolved?

A
  • CT
  • MRI
  • XRay
  • BONE SCAN
  • PET/SPECT
24
Q

What labs to be performed with chronic LBP?

A
  • FBC
  • U&Es
  • inflammatory markers
  • check for metabolic causes (Ca2+, PO4, HLA B-27, alk phos.)
  • malignancy (PSA, acid phosphatase, monoclonal bands)
25
Q

Should x-rays be performed routinely?

A

NO!

  • not sensitive
  • does NOT show soft tissues
  • does not r.o serious conditions!
26
Q

What are the exceptions, where XRAY is asked for?

A
  1. YOUNG men: S-I joint to exclude Ankylosing spondylitis
  2. Elderly: to exclude vertebral collapse (other #s/MALIGNANCY)
  3. when there is evident spinal deformity
27
Q

How effective is CT scan for pathology screening?

A
  • limited IF no RED FLAGS…

- BONY pathology (TRAUMA, TUMORS, INFECTION)

28
Q

What is CT scan good for screening?

A
  • implants and foreign bodies

- for spinal fusion planning

29
Q

When is CT scan performed?

A
  • when MRI is c.i

-

30
Q

What can MRI pick up on, specifically in the SPINE?

A
  • details in soft tissues (tumors/infections)
  • new fractures
  • bone EDEMA and MICROFRACTURES
31
Q

What does the PET scan pick up on?

A
  • areas of HIGH turnover rates
32
Q

Why is a radionuclide bone scan performed?

A
  • to check for incr. bone turnover (#s/ Osteomyelitis/ Paget’s/ Ankylos. Spondylitis)
  • metastases
  • tumors, osteoid osteoma
33
Q

What pharmacological rx for LBP??

A
  • regular analgesia (incl. NSAIDs) —helps exercise/ aids mobility
  • OPIATES for severe pain (SHORT term/ breakthrough only)—TCAs
  • injections
34
Q

What other conditions results in spinal nerve root compression?

A
  • degenerative disease (bones spurs/ canal stenosis/ spondylolisthesis/ facet arthropathy)
  • sinister causes (tumor/ TB/ #)
  • extrinsic factors (outside the spine)—-piriformis syndrome/ endometriosis/ peroneal compression
  • no root compression (peripheral neuropathies/ arachnoiditis)
35
Q

What is spinal fusion?

A
  • surgical procedure of fusing together 2 or more vertebrae, so that they form a single solid bone
  • helps to restore stability or painful motion
36
Q

If a pt is clearly presenting with red flags, as well as neurological deficits. WHat must be done?

A

MRI

NEUROLOGY (36 decks)

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