MS 4

Question 1

LBP

Answer 1

1/5 people affected, most cases resolve w/o intervention within several weeks

Question 2

LBP - consider what
5

Answer 2

1. trauma
2. infection
3. malignancy
4. psychosocial factors
5. comorbid conditions

Question 3

LBP - red flag symptoms
3

Answer 3

1. significant trauma
2. neurologic complaints - deficits, bladder or bowel dysfunction, saddle anesthesia, loss of rectal tone, sexual dysfunction
3. history - malignancy, current/recent IV drug use, recent back sx or procedure, fever associated w/ back pain, unintentional weight loss

Question 4

LBP physical exam - evaluate for underlying what

Answer 4

conditions and neuro deficits as well as causes of back pain not r/t the spine i.e. renal colic, aortic dissection

Question 5

LBP PE - MS
2

Answer 5

1. exam is typically unremarkable
2. may be associated w/ paraspinal muscle strain/spasm

Question 6

LBP PE - radiculopathy/sciatica
3

Answer 6

1. pain radiating to lower extremity, usually unilateral
2. weakness
3. sensory changes along spinal nerve root distrubtion

Question 7

LBP PE - cauda equina syndrome
5

Answer 7

1. decreased perineal sensation
2. +/- diminished rectal tone
3. lower extremity reflexes diminished
4. bladder/bowel dysfunction
5. great toe dorsiflex diminished

Question 8

LBP PE - epidural abscess
3

Answer 8

1. fever
2. neuro deficits
3. percussive tenderness of the spine

Question 9

LBP - img/testing

Answer 9

none usually needed except in the presence of red flag sx

Question 10

LBP - x rays when

Answer 10

setting of trauma

Question 11

nonspecific LBP - non pharm tx
6

Answer 11

1. prognosis is usually favorable
2. advise pts to remain active, avoid bed rest
3. heating pads
4. yoga
5. massage
6. PT

Question 12

nonspecific LBP - pharm tx
4

Answer 12

1. NSAIDs
2. tylenol
3. muscle relaxors
4. steroids not typically rec

Question 13

nonspec LBP - f/u

Answer 13

in 4 weeks or sooner if persistent/worsening sx; refer to PCP for minor injuries/symptoms and f/u care

Question 14

nursemaid’s elbow

Answer 14

subluxation of the radial head d/t a tear of annular ligament

Question 15

subluxation of the radial head d/t a tear of annular ligament

Answer 15

nursemaid’s elbow

Question 16

nursemaid’s elbow - most common in what area

Answer 16

upper extremity injury in children younger than 6 years old

Question 17

nursemaid’s elbow - peak age

Answer 17

2-3 years old; can occur as young as 6 months

Question 18

nursemaid’s elbow - predilection for who

Answer 18

girls and left arm

Question 19

nursemaid’s elbow - caregiver reports a history of

Answer 19

pulling up, swinging child, or a fall on an outstretched hand followed by pain and child refusing to use the affected arm

Question 20

nursemaid’s elbow -child might c/o

Answer 20

pain at the elbow or wrist or may not complain of pain at all

Question 21

nursemaid’s elbow - physical exam findings
4

Answer 21

1. affected arm held against the body w/ elbow slightly flexed and arm pronated
2. refusal to move arm
3. might have mild tenderness to palpation of radial head
4. examine entire arm for additional injury

Question 22

nursemaid’s elbow - PE findings should be free of what symptoms
4

Answer 22

1. swelling
2. erythema
3. ecchymosis
4. deformity to the elbow and forearm

Question 23

nursemaid’s elbow - x ray typically not needed unless
4

Answer 23

1. hx inconsistent w/ the mechanism to cause nursemaid’s elbow
2. physical exam shows overt signs of trauma, swelling, bruising, or significant point tenderness
3. concern for fx on exma
4. reduction is unsuccessful after 2 attempts AND child is not using affected arm after 30 minutes

Question 24

nursemaid’s elbow - when should child’s arm be working

Answer 24

5-30 mins after reduction

Question 25

nursemaid’s elbow - DD
1

Answer 25

fractures

Question 26

nursemaid’s elbow - tx
2

Answer 26

1. hyperpronation reduction
2. supination and flexion reduction

Question 27

nursemaid’s elbow - when to apply a splint

Answer 27

unable to reduce or fracture suspected

Question 28

nursemaid’s elbow - when to send to ER

Answer 28

1. suspicion for non accidental trauma
2. need ortho eval

Question 29

When to get back x ray for pain - weeks

Answer 29

If it’s been 6 weeks or more of pain unless red flag signs are there