Rheum - Low Back Pain

Question 0

Sciatica?

Answer 0

Pain in the distribution of lumbar sacral nerve roots, with or without motor/sensory deficits

Question 1

Cauda equina syndrome - Symptoms? Cause? Treatment?

Answer 1

1. Lower back pain
2. saddle esthesia
3. bowel/bladder dysfunction
4. lower Extremity weakness
5. loss of reflexes.

Caused by compression multiple sacral nerve roots. Surgical emergency

Question 2

Spondylolisthesis?

Answer 2

Anterior displacement of the upper vertebral body on the lower body – causes symptoms of spinal stenosis

Caused by spondylolysis or from degenerative disk disease

Question 3

Sciatica can because by herniation what disks?

Answer 3

L4-L5 or L5-S1 level

Question 4

A true radiculopathy radiates where?

Answer 4

Below the knee

Question 5

Red flag symptoms in patients with low back pain?

Answer 5

1. Fever, unintentional weight loss, history of cancer, nighttime pain, pain that is worse in supine position (Cancer)
2. Major, motor weakness
3. Bowel or bladder incontinence, Saddle paresthesia
4. Immunosuppression

Question 6

Primary cancers which metastasize to spine?

Answer 6

Lung, breast, prostate, lymphoma, G.I., melanoma

Question 7

Patient with red flag symptoms or signs – workup?

If no red flags?

Answer 7

1. X-rays
2. ESR
3. CBC

MRI should be reserved for patients for whom surgery is being considered.

If patient has no red flags start on nonnarcotic analgesic

Question 8

Test for radicular pain?

Answer 8

1. Straight leg raise testing (however, not very sensitive or specific)
2. Patrick maneuver (Patient lies with his ankle over opposite knee while examiner presses down on the knee)

Question 9

In treating idiopathic back pain, one should encourage the patient to?

Answer 9

Perform usual activity (superior to bed rest)

Question 10

Bedrest is only appropriate for?

Answer 10

Patients without severe pain or neurologic deficits

Question 11

Natural history of disc herniation with radiculopathy?

Answer 11

Resolve spontaneously within 4 to 6 weeks

Question 12

Treatment for lumbosacral sprain?

Answer 12

1. NSAIDs on a fixed schedule
2. Analgesics
3. Muscle relaxants

Question 13

Surgery referral for lower back pain if?

Answer 13

Does not resolve within 4 to 6 weeks

Question 14

Most likely diagnosis (and treatment) if patient presents with back pain and:

1. Cancer history
2. High ESR and fever
3. Erectile dysfunction

Answer 14

1. Cord compression - STEROIDS first, then surgery
2. Epidural abscess - vanc and culture
3. Cauda equina - surgery

Question 15

Only image pts if present with back pain and?

Answer 15

Focal neurological findings

Question 16

Typical patient for lumbar spine stenosis?

Answer 16

#Over 60
#Worse with walking downhill
#Pain radiates to bilateral butt/thighs
 #pulses and ABI normal 
#less pain when leaning forward

Question 17

Test for Lumbar spinal stenosis? Treatment?

Answer 17

MRI

#Weight-loss and pain meds 
#then PT and steroids
# then surgery

Question 18

Treatment for fibromyalgia?

Answer 18

#Amitriptyline 
#milnacipran (Reuptake inhibitor of serotonin/epinephrine specifically used for fibromyalgia)