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OS1 Exam 2 > Low Back Pain DSA > Flashcards

Low Back Pain DSA Flashcards

1
Q

Acute back pain

A

back pain lasting up to 6 weeks

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2
Q

Sub-acute back pain

A

back pain lasting 7-12 weeks

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3
Q

chronic back pain

A

back pain lasting >12 weeks

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4
Q

red flags for back pain

A 
major trauma
age>50
persistent fever
history of cancer
saddle anesthesia
history of osteoporosis
progressive neurologic systems
bowel/bladder dysfunction
history of corticosteroid use
decreased anal sphincter tone
unrelenting night pain
major muscle weakness
rheumatoid arthritis, Down's syndrome, Marfan's, Ehler-Danlos syndrome
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5
Q

Objective physical exam red flags

A

muscle atrophy
increased muscle tone (cerebral palsy)
decreased deep tendon (muscle stretch)
signs of inflammation (red, hot, swollen)

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6
Q

DDx for low back pain

A

mechanical: with(out) radiation below the knee
viscerogenic: pain from organs
vasculogenic: pain from vascular structures
infection
metablic
tumor: primary/secondary
rheumatologic
congenital
psychological

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7
Q

mechanical low back pain without radiation below the knee causes

A

SD (TART), spinal arthritis, DDD, facet arthritis, fracture, spondylolysis, spondylolisthesis, scoliosis

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8
Q

mechanical low back pain without radiation below the knee caused by somatic dysfunction

A

TART
may be chronic or acute
resolves with OMT
typically no further work up

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9
Q

mechanical low back pain without radiation below the knee spinal arthritis

A 
typically chronic
localized to low back and buttocks
better with lying down and change of position
worse with prolonged standing or sitting
Work up: AP and lateral XR
MRI
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10
Q

mechanical low back pain without radiation below the knee DDD

A 
localized to low back and buttocks
better with lying down and change of position
worse with prolonged standing or sitting
typically chronic
Work up: AP and lateral XR and MRI
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11
Q

mechanical low back pain without radiation below the knee facet arthritis

A 
localized to low back and buttocks
better with lying down and change of position
worse with spinal extension
typically chronic
Work up: AP and lateral plain films, MRI
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12
Q

mechanical low back pain without radiation below the knee fracture

A

compression fracture: history of trauma or osteoporosis
usually acute
work up: AP and lateral XR

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13
Q

mechanical low back pain without radiation below the knee spondylolysis

A

fracture of the pars interarticularis
new-onset LBP in athletically active adolescent or history of trauma
work up: AP, lateral and oblique film (scottie dog), CT

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14
Q

mechanical low back pain without radiation below the knee spondylolisthesis

A

leg pain numbness or weakness, stiff back, changes in posture or gait
grades I & II stable, grades III-V surgery
step off when palpating lumbar spine
usually chronic
work up AP and lateral XR

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15
Q

mechanical low back pain without radiation below the knee scoliosis

A

typically chronic
rib hump
Work up AP and lateral

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16
Q

mechanical low back pain with radiation below the knee DDx

A

radiculopathy
spinal stenosis
cauda equina syndrome

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17
Q

viscerogenic LBP DDx

A

kidney, GI, pancreatitis, reproductive organs

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18
Q

viscerogenic LBP from nephrolithiasis “kidney stones”

A 
LBP and abdominal pain
intermittent (renal colic)
hematuria
acute, may become chronic
Work up: US, CT, UA
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19
Q

viscerogenic LBP from pyelonephritis

A 
kidney infection
low back and abdominal pain
fever
pyuria (pus in urine)
typically acute, may become chronic
unilateral
Work up: UA, CBC, US
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20
Q

viscerogenic LBP from IBD: crohn’s disease and UC

A

abdominal pain, tenderness, and distension
bloody diarrhea
typically chronic with acute flares
Work up: abd XR, US, CT, CBC, amylase/lipase

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21
Q

viscerogenic LBP from diverticulitis

A

abd pain (especially LLQ) , tenderness, possibly fever
typically acute flares
work up: XR, CT, CBC

22
Q

viscerogenic LBP from pancreatitis

A

back pain with abdominal pain, tenderness, and distension, nausea and vomiting
typically acute but can progress to chronic
work up: abd XR, US, CT, CBC, amylase/lipase

23
Q

viscerogenic LBP from endometriosis

A

pelvic pain
typically chronic
work up: US, laproscopic diagnosis

24
Q

viscerogenic LBP from menstrual

A

intermittent, cramping pelvic pain, may have nausea/vomiting/diarrhea
cyclic pain
work up: based on clinical findings

25
Q

viscerogenic LBP from prostatitis

A

painful, frequent, urgent urination; pain with ejaculation; difficulty sitting
typically actue but may become chronic
work up: UA (possibly after prostate massage), possible US or CT

26
Q

vasculogenic LBP DDx

A

aortic aneurysm

ischemic spinal claudation

27
Q

vasculogenic LBP from aortic aneurysm

A

“ripping” or “tearing” abdominal pain
pulsatile abdominal mass
work up: US, CT, CTA

28
Q

vasculogenic LBP from ischemic spinal claudication

A

ischemia - restriction of blood supply to tissues
claudication - pain caused by too little blood flow
myelopathy - any neurological deficit related to the spinal cord
acute myelopathy
work up: CTA, MRI

29
Q

infection LBP DDx

A

discitis
herpes zoster
osteomyelitis

30
Q

infection LBP from discitis

A 
recent skin infection, UTI, or IVDA; consider in immunocompromised individuals
pain at rest or at night
localized pain
typically acute
work up: CBC, blood cultures, MRI
31
Q

infection LBP from herpes zoster

A

pain proceeds rash
typically acute, pain may become chronic
work up: none (viral cultures available but rarely done)

32
Q

infection LBP from osteomyelitis

A 
recent skin infection, UTI, IVDA; consider immunocompromised individuals
pain at rest or at night, fever
localized pain
typically acute
work up: CBC, blood cultures, MRI
33
Q

metabolic LBP DDx

A

osteoporosis, Paget disease

34
Q

metabolic LBP from osteoporosis

A

chronic pain may be acute with compression fracture
work up: DEXA scan
compression fracture work up: XR

35
Q

metabolic LBP from Paget disease

A

bone cells don’t function properly, resulting in deformed, enlarged, and fragile bones
dull, persistent, worse at night
neurologic symptoms like tingling, numbness, difficulty walking, wor bowel and bladder problems
typically chronic, acute with fracture
work up: XR, bone scan

36
Q

bone scan

A

nuclear medicine test which uses a very small amount of a radioactive substance injected into a vein. abnormal absorption by the body may indicate disease.

37
Q

LBP from tumor - primary DDx

A

myeloma
sarcoma
osteoid osteoma
neural tumor: neurofibroma (chr 17), schwannoma, meningioma

38
Q

LBP from primary tumor - myeloma, sarcoma, osteoid osteoma

A

bone tumors
pain at rest, at night, night sweats, weight loss
chronic/starts insidiously
work up: XR to start, then may need CT, MRI, blood work

39
Q

LBP from primary tumor - neural neurofibroma, schwannoma, meningioma

A

pain at rest, at night
chronic
work up: XR to start, then may need CT, MRI, blood work

40
Q

LBP from secondary (metastatic) tumors of the prostate, lung, breast, or kidney

A

usually multiple lesions
pain at rest, at night, night sweats, weight loss
chronic/starts insidiously
work up: XR to start, then may need CT, MRI, blood work

41
Q

rheumatologic LBP DDx

A

seronegative spondyloarthropathy: psoriatic arthritis, ankylosing spondylitis, IBD (enteropathic arthritis), Reiter syndrome
Bechet syndrome
Fibromyalgia
Rhematoid arthritis

42
Q

rheumatologic LBP from seronegative spondyloarthropathy: psoriatic arthritis, ankylosing spondylitis, IBD (enteropathic arthritis), Reither syndrome

A

psoriatic arthritis: pencil in cup
ankylosing spondylitis: calcification of ligaments at lumbar spine - “bamboo” spine limits flexion, extension, sidebending
enteropathic colitis: inflammation within back causing chronic LBP associated with viscera
Reiter syndrome: lateral calcification
back and joint pain
typically chronic
work up: HLA-B27, XR

43
Q

rheumatologic LBP from fibromyalgia

A

11 of 18 tender points
many symptoms
chronic
work up: diagnosis of exclusion

44
Q

rheumatologic LBP from rheumatoid arthritis

A

morning stiffness > 1 hour, fatigue, joint arthritis

work up: RF (rheumatoid factor), XR

45
Q

Congenital LBP DDx

A

genetic malformations: congenital scoliosis, spinal bifida, meningocele, menigomylocele
achondroplasia
collagen disorders: Marfan’s syndrome, Ehler-Danlos syndrome

46
Q

congenital LBP from genetic malformations: congenital scoliosis, spina bifida, meningocele, meningomylocele

A

work up: maternal US
scoliosis: failure of formation and/or segmentation
spina bifida: bifid spinous process, meningocele: protrusion of meninges, meningomyelocele: nerve tissue

47
Q

congenital LBP from achondroplasia

A

pain usually due to spinal stenosis or increased lordosis

work up: maternal US

48
Q

congenital LBP from collagen disorders (Marfan’s syndrome and Ehler Danlos syndrome)

A

work up: history and physical exam (maybe genetic)

49
Q

psychological LBP DDx

A

somatoform disorder
malingering
central sensitization/chronic pain syndrome

50
Q

psychological LBP somatoform disorder

A

group of psychological disorders in which a pt experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition

51
Q

psychological LBP from malingering

A

exaggerate or feign illness in order to escape duty or work

52
Q

psychological LBP from central sensitization/chronic pain syndrome

A

condition of the NS that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the NS goes through a process called wind-up and gets regulated in a persistent state of high reactivity

OS1 Exam 2 (8 decks)

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