Week 2.03 Flashcards
Immediate imaging is required for patients with acute low back pain who have:
Major risk factors for cancer
Clinical practice guidelines endorse the following diagnostic categories for patients with acute low back pain:
Non-specific low back pain, red flag conditions, sciatica/spinal stenosis
What is the prevalence of non-specific low back pain in patients presenting to primary care with acute low back pain?
85%
To assist treatment decision making, patients with non-specific low back pain can be staged into subgroups based upon:
Risk of developing chronic low back pain
First line care for acute low back pain includes:
Advice, simple analgesics and review in 1-2 weeks.
You have examined a new low back pain patient to your practice and your clinical diagnosis is spinal canal stenosis. What should be your next step?
An initial trial of conservative care
Your patient with persistent non-specific low back pain has not responded to the course of simple analgesics you prescribed. What would be your next step?
Referral to a physiotherapist.
The StarT back approach triages back pain patients with different categories:
To help guide management decisions
Which of the following best describes Multidisciplinary Biopsychosocial rehabilitation?
An intervention that targets various physical, psychological and social components and is delivered by clinicians with several different professional backgrounds.
An overall pooled effect estimate on a forest plot represented by a wide diamond shows:
That we are unsure of how large the effect size
Which of the following considerations should be taken into account when deciding whether the multidisciplinary rehabilitation should be offered to a patient with chronic low back pain:
Patient preference, cost effectiveness, the size of the likely effect
The most common cause of radiculopathy is:
Herniation of the intervertebral disc
Most people experience a single episode of back pain their life
False
The poor relationship between pathology and clinical signs makes diagnosis of the specific anatomical cause of LBP difficult
True
The nucleus pulposus in intervertebral disc is a neural and so pathology in this tissue cannot contribute to LBP
False
The ‘functional spinal unit’ (FSU) describes the inter relationship between two adjacent vertebral bodies, their end plates and intervening, intervertebral discs, the peri-discal ligaments, the spinal cord and spinal nerves, the vertebral facet joints and the spinal muscles. Describe briefly how the concept of the FSU may help explain the relationship between pathology in different spine tissue and low back pain, and the rate of recurrence of back pain episodes.
Research this
It is broadly accepted that work is good for health. What would be a situation when work was not likely to be good for health?
Where the workplace makes demands on the worker beyond their capacity.
For a female worker aged 65, with neck pain that had its onset at work, who believes that she will have a prolonged recovery due to osteoarthritis of the cervical spine, but has a supportive employer, and a general practitioner who provides appropriate treatment and has ruled out ‘red flag’ factors, the major relevant prognostic factor is:
Employer factors
For a worker who has back pain with onset at work recovery is varied. What is the most important reason for concern at the relatively small percentage (5% to 10%) of workers who have not returned to work by one year after injury:
Negative health impact on the worker
A 72 year old man presents to his GP with low back pain. This has been present over the last 3 months and is getting worse. There is no radicular radiation and the pain is keeping him awake at night. He has lost 3 kegs in weight over this period of time. The most likely cause of his pain is?
Malignancy
A 58 year old woman presents to accident and emergency with severe low thoracic back pain. She has a known history of asthma and has had intermittent courses of oral cortico-steroids. An X-ray demonstrates loss of height of T12 vertebra. What is the most likely cause of this finding?
Osteoporosis
A 32 year old female, ex IV drug user, presents to accident and emergency with a 3 day history of severe low back pain. She is afebrile and has localised tenderness around L3. Her neurological examination is normal. Investigations reveal an ESR 40mm/hr (Normal <25) and C-reactive protein of 55 (Normal < 6). The investigation of choice for diagnosis is which of the following?
MRI spine
A 68 year old female, on haemodialysis, presents with a 2 week history of severe low back pain. She is afebrile and has localised tenderness around L2/3. She has chronic ulcer on her lower leg. Her neurological examination is normal. Investigations reveal an ESR 80 mm/hr (Normal <25) and C-reactive protein of 150 (Normal <6). An MRI demonstrates L3/4 disciitis. The investigation of choice is to make a definitive diagnosis is?
Aspirate of L3/4 for culture.
An 82 year old woman presents with severe pain in her back, extending into both lower limbs to the ankles. She has had some urinary incontinence. Examination reveals patchy numbness on her lower limbs and weakness of knee extension and ankle dorsiflexion. She has absent knee and ankle reflexes. An MRI shows a large disc protrusion compressing the cauda equine. The management of choice is?
Surgical decompression.
