Minor Conditions Flashcards
Why is back pain so important?
It is an extremely common presentation that is often poorly managed
WRT back pain, what is it important to be able to distinguish between?
Self-limiting simple back pain, and more sinister back pain.
What kind of back pain arises fromspinal joints, vertebral or soft tissues, and varies with posture and movement?
Mechanical back pain
What specific causes of mechanical back pain can be identified?
Muscular strain
Intervertebral disc prolapse
Vertebral fracture
Facet joint injury
Can all back pain be atrributed to a cause?
No
What kind of back pain is caused by rheumatoid conditions?
Inflammatory back pain
When is back pain classified as chronic?
After 6 weeks
How common is back pain?
60-80% of people report it to the GP at some int in teir lives (so incidence will be higher still).
What are the social factors that predispose to low back pain?
Physical jobs with heavy or awkward lifting
Prolonged standing
Obesity
Work-related stress
How should a low back pain hx be taken?
As with any pain - SQITARS!
Also, previous pain like this? Occupation and hobbies? PMHx?
Red flags!!!!
How should a patient with low back pain be examined?
Spine exposed, standing up. Inspection Palpation Focused neuro exam Functional assessment
What test can be used O/E of a low back pain patient to assess for nerve root pain?
Straight leg raise
What red flags must we assess for when a patient presents with low back pain?
Any sx of cauda equina - saddle anaesthesia pr parasthesia, bladder dysfunction, faecal incontinence, perianal sensory loss, laxity of anal sphincter, progressive lower limb neurological deficit.
Any sx of spinal fracture - sudden onset central pain, worse on lying down, mjor trauma, minor trauma with hx of osteopoosis, strctural spinal deformity, point tenderness over vertebrae.
Cancer - night time aching, onset over 50 or below 20, hx of cancer esp. those which met to bone or myeloma.
Constitutional sx, immune suppression.
Which cancers ion a patient’s history would put you on alert for bone mets in a hx of back pain?
- Lung esp. bronchus
- Prostate
- Breast
- Thyroid
- Kidney
Why can a hx of TB or exposure to TB be important in a back pain hx?
TB can cause osteomyelitis
When is further investigated indicated for back pain?
If red flags are pesent
Which imaging modality is useful for suspected fractures in a pt with back pain?
Plain x-ray
Which back pathologies does a CT scan show best wrt back pain?
Stress fractures
Spondylolisthesis
Which back pathologies does an MRI scan show best wrt back pain?
Soft tissue injuries e.g. disc prolapse
Nerve compression or lesions
Why ca LFTs be a useful test when investigating suspicious bck pain?
ALP is elevated in Paget’s disease and metastatic disease
What are the main treatment principles of non-suspicious back pain?
Keep active
Analgesia to facilitate this
What conservative management is used for lumbar disc herniation?
Analgesia NSAIDs Manual therapy Acupuncture Epidural corticosteroid injections (short term relief)
Should bed rest be prescribed for simple back pain?
NOOOOOOO
In addition to simple analgesia for back pain, what can be prescribed if the pain is muscular in origin?
Muscle relaxant
Is paracetamol monotherapy enough to manage simple back pain?
No, it should be given alongside an NSAID
Where can a patient with simple back pain be referred? When and why?
To physiotherapist
Earlier rather than later
Help with strengthening exercises, and modification of techniques e.g. lifting that may exacerbate the pain
WRT keeping active, what do most patients need to be specfically told about back pain?
Stay active and work through the pain - if it hurts, you should keep doing it gently so that movement or muscle group doesn’t seize up.
What social probles canback pain lead to?
Social withdrawal
Problems with/dissatisfaction at work/Claims/compensation/time off work
Lack of support from family
An office worked presents with back pain. Which ara should we explore wrt finding a cause?
Seating and posture at work - where is keyboard or screen positioned, what chair or back support is used, how much time is spent sitting down during the day inc. driving.
When should a patient with sciatica be referred to a neurosurgeon or orthopaedics clinic?
If it is still disabling and distressing after 6 weeks or management.
Where is sciatica pain sually felt?
From back/buttocks all the way down the back of the leg
Is reflux more common in men or women?
Men
What % of the adult population experience heartburn every day?
5%
What is the spectrum of disease that GORD forms?
From endoscopy negative GORD to oesophageal mucosal damage
What anatomical structure is often the culprit for GORD?
Lower oesophageal sphincter
Which medications need to be taken with plenty of water so they don’t cause GORD?
Why?
- NSAIDs
- Doxycycline
- Bisphosphonates
They can stick to inside of oesophagus and release contents slwowly, causing oesophagitis.
What are the risk factors for reflux disease?
- Increased intra-abdo pressure (obesity, pregnancy, big meals, tight clothes)
- Poor oesophageal peristalsis (e.g. secondary to stroke or neuro disorder)
