Rheum - Low Back Pain Flashcards

0
Q

Sciatica?

A

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

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1
Q

Cauda equina syndrome - Symptoms? Cause? Treatment?

A
  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

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2
Q

Spondylolisthesis?

A

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

Caused by spondylolysis or from degenerative disk disease

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3
Q

Sciatica can because by herniation what disks?

A

L4-L5 or L5-S1 level

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4
Q

A true radiculopathy radiates where?

A

Below the knee

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5
Q

Red flag symptoms in patients with low back pain?

A
  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
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6
Q

Primary cancers which metastasize to spine?

A

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

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7
Q

Patient with red flag symptoms or signs – workup?

If no red flags?

A
  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

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8
Q

Test for radicular pain?

A
  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)
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9
Q

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

A

Perform usual activity (superior to bed rest)

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10
Q

Bedrest is only appropriate for?

A

Patients without severe pain or neurologic deficits

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11
Q

Natural history of disc herniation with radiculopathy?

A

Resolve spontaneously within 4 to 6 weeks

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12
Q

Treatment for lumbosacral sprain?

A
  1. NSAIDs on a fixed schedule
  2. Analgesics
  3. Muscle relaxants
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13
Q

Surgery referral for lower back pain if?

A

Does not resolve within 4 to 6 weeks

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14
Q

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

  1. Cancer history
  2. High ESR and fever
  3. Erectile dysfunction
A
  1. Cord compression - STEROIDS first, then surgery
  2. Epidural abscess - vanc and culture
  3. Cauda equina - surgery
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15
Q

Only image pts if present with back pain and?

A

Focal neurological findings

16
Q

Typical patient for lumbar spine stenosis?

A
#Over 60
#Worse with walking downhill
#Pain radiates to bilateral butt/thighs
 #pulses and ABI normal 
#less pain when leaning forward
17
Q

Test for Lumbar spinal stenosis? Treatment?

A

MRI

#Weight-loss and pain meds 
#then PT and steroids
# then surgery
18
Q

Treatment for fibromyalgia?

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