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Neurol > Neurol - MedEd - Back pain > Flashcards

Neurol - MedEd - Back pain Flashcards

1
Q

What are alarm symptoms of back pain?

A

Bowel/bladder incontinence
Saddle anesthesia
New focal neurologic deficit - new/rapidly progressive

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2
Q

What are you thinking of when someone has alarm symptoms of back pain

A

Cord compression - surgical/medical emerg

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3
Q

Cord compression - what do you give them

A

Steroid IV
(methylpred, dexamethasone IV) - more likely to have recovery
After give steroids, do MRI

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4
Q

What imaging to do with alarm symptoms of back pain?

A

X-rays

May jump to MRI

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5
Q

Treatment of cord compression

A

Decompression

  • Drain hematoma
  • Incision and drainage/antibiotics for abscess
  • Irradiation for cancer
  • Surgery
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6
Q

What other things to ask for on history of low back pain?

A

Cancer - constitutional symptoms

Drug use - abscess

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7
Q

Most complaints of low back pain are…

A

Nonspecific/MSK

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8
Q

What is treatment for MSK low back pain?

A 
OTC NSAIDs/Tylenol 
Exercise
No bedrest necessary 
-Not bedrest
-Duration for 4 weeks, then reassess
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9
Q

What happens after 4 weeks of treatment of nonspecifc, MSK low back pain?

A

Better - good, MSK, encourage good lifestyle

Not better - consider other diagnoses –> may need X-ray MRI imaging

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10
Q

MSK back pain - pathophys

A

Muscles spasm
Young, usually male
Heavy lifting
Belt-like pain

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11
Q

Disc herniation - pathophys

A

Nucleus pulposus pinching nerve

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12
Q

Signs and symptoms of disc herniation

A

Patient: 30-50 year old male, heavylifting
Complain of sciatica pain - lightening-shock sensation down leg
Will have positive straight leg test
Neurologic complaints associated with nerve impingement

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13
Q

Disc herniation - imaging

A

X-ray negative

MRI is imaging of choice

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14
Q

Disc herniation - treatment

A

Neurosurgery better than conservative management at 6 months
Neurosurgery is = to conservative at 1 year
So based on severity and lifestyle choices
Also treatment depends on patient… young and active might want surgery, while older might opt for conservative

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15
Q

Osteophyte formation back symptoms - pathophys

A

Bony spur into canal and pinches nerve

Asymmetric and unilateral

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16
Q

Osteophyte formation - signs and symptoms

A 
Older male
No heavy lifting involved
Sciatica symptoms
Neurologic impairment
Postive straight leg raise
17
Q

Osteophyte imaging

A

Negative X-rays

MRI is better

18
Q

Treatment of osteophyte

A

Needs surgery

19
Q

Compression fracture - pathophys

A

Osteoporosis

20
Q

Compression fracture - signs and symptoms

A

Older female - osteoporosis
Falls on backside
Symptoms of fracture - vertebral step-off, pinpoint tenderness
No sciatica symptoms

21
Q

Compression fracture - imaging

A

Diagnosis by x-ray - usually sufficient

MRI is better

22
Q

Treatment of compression fracture

A

Surgery

Follow-up - dexa scan, osteoporosis treatment

23
Q

Spinal stenosis - pathophys

A

Narrowing of canal

24
Q

Spinal stenosis - signs/symptoms

A

Pinching of nerve
Old patient
Present with pseudo-claudication in bottom and thighs
(so might think about femoral artery stenosis, but why not in lower legs)
Pseudo-claudication is positional - so upright and walking; but better with hunching over!*
So might present as peripheral vascular disease

25
Q

Spinal stenosis - diagnosis

A

X-ray - not great

MRI better

26
Q

Treatment of spinal stenosis

A

Laminectomy

27
Q

Female, back pain in menstrual cycle - what?

A

Dysmeonrrhea

28
Q

Geriatric patient and back pain - what?

A

Constipation

29
Q

Back pain with pulsatile mass

A

AAA

30
Q

What are other causes of low back pain other than MSK and cord compression?

A

1) Spinal stenosis
2) Compression fracture
3) Osteophyte
4) Disc herniation

Neurol (7 decks)

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