Minor Conditions

Question 1

Why is back pain so important?

Answer 1

It is an extremely common presentation that is often poorly managed

Question 2

WRT back pain, what is it important to be able to distinguish between?

Answer 2

Self-limiting simple back pain, and more sinister back pain.

Question 3

What kind of back pain arises fromspinal joints, vertebral or soft tissues, and varies with posture and movement?

Answer 3

Mechanical back pain

Question 4

What specific causes of mechanical back pain can be identified?

Answer 4

Muscular strain
Intervertebral disc prolapse
Vertebral fracture
Facet joint injury

Question 5

Can all back pain be atrributed to a cause?

Answer 5

No

Question 6

What kind of back pain is caused by rheumatoid conditions?

Answer 6

Inflammatory back pain

Question 7

When is back pain classified as chronic?

Answer 7

After 6 weeks

Question 8

How common is back pain?

Answer 8

60-80% of people report it to the GP at some int in teir lives (so incidence will be higher still).

Question 9

What are the social factors that predispose to low back pain?

Answer 9

Physical jobs with heavy or awkward lifting
Prolonged standing
Obesity
Work-related stress

Question 10

How should a low back pain hx be taken?

Answer 10

As with any pain - SQITARS!
Also, previous pain like this? Occupation and hobbies? PMHx?

Red flags!!!!

Question 11

How should a patient with low back pain be examined?

Answer 11

Spine exposed, standing up.
Inspection
Palpation
Focused neuro exam
Functional assessment

Question 12

What test can be used O/E of a low back pain patient to assess for nerve root pain?

Answer 12

Straight leg raise

Question 13

What red flags must we assess for when a patient presents with low back pain?

Answer 13

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.

Question 14

Which cancers ion a patient’s history would put you on alert for bone mets in a hx of back pain?

Answer 14

• Lung esp. bronchus
• Prostate
• Breast
• Thyroid
• Kidney

Question 15

Why can a hx of TB or exposure to TB be important in a back pain hx?

Answer 15

TB can cause osteomyelitis

Question 16

When is further investigated indicated for back pain?

Answer 16

If red flags are pesent

Question 17

Which imaging modality is useful for suspected fractures in a pt with back pain?

Answer 17

Plain x-ray

Question 18

Which back pathologies does a CT scan show best wrt back pain?

Answer 18

Stress fractures

Spondylolisthesis

Question 19

Which back pathologies does an MRI scan show best wrt back pain?

Answer 19

Soft tissue injuries e.g. disc prolapse

Nerve compression or lesions

Question 20

Why ca LFTs be a useful test when investigating suspicious bck pain?

Answer 20

ALP is elevated in Paget’s disease and metastatic disease

Question 21

What are the main treatment principles of non-suspicious back pain?

Answer 21

Keep active

Analgesia to facilitate this

Question 22

What conservative management is used for lumbar disc herniation?

Answer 22

Analgesia
NSAIDs
Manual therapy
Acupuncture
Epidural corticosteroid injections (short term relief)

Question 23

Should bed rest be prescribed for simple back pain?

Answer 23

NOOOOOOO

Question 24

In addition to simple analgesia for back pain, what can be prescribed if the pain is muscular in origin?

Answer 24

Muscle relaxant

Question 25

Is paracetamol monotherapy enough to manage simple back pain?

Answer 25

No, it should be given alongside an NSAID

Question 26

Where can a patient with simple back pain be referred? When and why?

Answer 26

To physiotherapist

Earlier rather than later

Help with strengthening exercises, and modification of techniques e.g. lifting that may exacerbate the pain

Question 27

WRT keeping active, what do most patients need to be specfically told about back pain?

Answer 27

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.

Question 28

What social probles canback pain lead to?

Answer 28

Social withdrawal
Problems with/dissatisfaction at work/Claims/compensation/time off work
Lack of support from family

Question 29

An office worked presents with back pain. Which ara should we explore wrt finding a cause?

Answer 29

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.

Question 30

When should a patient with sciatica be referred to a neurosurgeon or orthopaedics clinic?

Answer 30

If it is still disabling and distressing after 6 weeks or management.

Question 31

Where is sciatica pain sually felt?

Answer 31

From back/buttocks all the way down the back of the leg

Question 32

Is reflux more common in men or women?

Answer 32

Men

Question 33

What % of the adult population experience heartburn every day?

Answer 33

5%

Question 34

What is the spectrum of disease that GORD forms?

Answer 34

From endoscopy negative GORD to oesophageal mucosal damage

Question 35

What anatomical structure is often the culprit for GORD?

Answer 35

Lower oesophageal sphincter

Question 36

Which medications need to be taken with plenty of water so they don’t cause GORD?

Why?

Answer 36

• NSAIDs
• Doxycycline
• Bisphosphonates

They can stick to inside of oesophagus and release contents slwowly, causing oesophagitis.

Question 37

What are the risk factors for reflux disease?

Answer 37

• Increased intra-abdo pressure (obesity, pregnancy, big meals, tight clothes)
• Poor oesophageal peristalsis (e.g. secondary to stroke or neuro disorder)