Lower Back Pain

Question 1

What is seen in cauda equina syndrome?

Answer 1

Bilateral sciatica
Urinary incontinence
Decreased anal tone
Loss of perianal sensation

Question 2

What is seen in abdominal aortic aneurysm?

Answer 2

Age over 60
Pulsating abdominal mass
Pain in back when at rest

Question 3

What are red-flags for a spinal malignancy?

Answer 3

Pain worsening at night/rest
Over 50yo
Unintentional weight loss
History of malignancy

Question 4

What are red-flag symptoms of spinal infection?

Answer 4

Fever/Chills
Recent infection
Immunosuppression
IV drug use
Dental status
History of foreign travel

Question 5

In which timeframe do most cases of back pain resolve?

Answer 5

4-6 weeks.

Question 6

Is x-ray useful in back pain?

Answer 6

No, as it does not rule out any serious pathology.

Question 7

What tests are performed in back pain that does not resolve after 4-6 weeks?

Answer 7

Imaging
FBC
Inflammatory markers

Question 8

Which form of imaging is gold standard in those with red-flag symptoms?

Answer 8

MRI scan

Question 9

Is bed rest advised in those with back pain?

Answer 9

No, advise exercise instead.

Question 10

How is back pain treated?

Answer 10

Give NSAIDs.

In severe cases, opiates may be needed.

Question 11

What is the most effective prevention method for lower back pain?

Answer 11

Physical activity.

Question 12

What can nerve root compression result from?

Answer 12

Disc prolapse

Question 13

Which muscle is closely linked to the sciatic nerve?

Answer 13

The piriformis muscle.

Question 14

Name 3 spinal tracts

Answer 14

DCML
Corticospinal
Spinothalamic

Question 15

What are potential causes of an acute spinal cord compression?

Answer 15

Trauma
Infection
Abscess
Haemorrhage

Question 16

What are potential causes of a chronic spinal cord compression?

Answer 16

Degenerative disease

Tumour

Question 17

Does cord transection affect sensory or motor function?

Answer 17

It affects both.

It is the most severe spinal injury.

Question 18

What paralysis is seen in those with a cord transection?

Answer 18

Flaccid areflexic paralysis

Question 19

What sort of injury is responsible for Brown-Sequard syndrome?

Answer 19

Hemisection of the spinal cord.

Question 20

What is central cord syndrome?

Answer 20

Incomplete spinal cord injury, characterised by the impairment of the limbs.

Question 21

What is the cause of central cord syndrome?

Answer 21

Hyperflexion/extension injury of an already stenotic neck.

It is more common in the upper limbs.

Question 22

Do UMN signs or LMN signs predominate in chronic spinal cord compression?

Answer 22

UMN signs predominate.

Question 23

In early spinal cord metastasis, what is given to reduce oedema?

Answer 23

Dexamethasone

Question 24

What is suspected if the disc is intact but bone is destroyed?

Answer 24

Malignancy

Question 25

What is suspected if the disc is destroyed but bone is intact?

Answer 25

Infection

Question 26

Does spinal cord decompression reverse injury?

Answer 26

No, it only prevents further worsening of symptoms.