Week 2.03

Question 1

Immediate imaging is required for patients with acute low back pain who have:

Answer 1

Major risk factors for cancer

Question 2

Clinical practice guidelines endorse the following diagnostic categories for patients with acute low back pain:

Answer 2

Non-specific low back pain, red flag conditions, sciatica/spinal stenosis

Question 3

What is the prevalence of non-specific low back pain in patients presenting to primary care with acute low back pain?

Answer 3

85%

Question 4

To assist treatment decision making, patients with non-specific low back pain can be staged into subgroups based upon:

Answer 4

Risk of developing chronic low back pain

Question 5

First line care for acute low back pain includes:

Answer 5

Advice, simple analgesics and review in 1-2 weeks.

Question 6

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?

Answer 6

An initial trial of conservative care

Question 7

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?

Answer 7

Referral to a physiotherapist.

Question 8

The StarT back approach triages back pain patients with different categories:

Answer 8

To help guide management decisions

Question 9

Which of the following best describes Multidisciplinary Biopsychosocial rehabilitation?

Answer 9

An intervention that targets various physical, psychological and social components and is delivered by clinicians with several different professional backgrounds.

Question 10

An overall pooled effect estimate on a forest plot represented by a wide diamond shows:

Answer 10

That we are unsure of how large the effect size

Question 11

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:

Answer 11

Patient preference, cost effectiveness, the size of the likely effect

Question 12

The most common cause of radiculopathy is:

Answer 12

Herniation of the intervertebral disc

Question 13

Most people experience a single episode of back pain their life

Answer 13

False

Question 14

The poor relationship between pathology and clinical signs makes diagnosis of the specific anatomical cause of LBP difficult

Answer 14

True

Question 15

The nucleus pulposus in intervertebral disc is a neural and so pathology in this tissue cannot contribute to LBP

Answer 15

False

Question 16

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.

Answer 16

Research this

Question 17

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?

Answer 17

Where the workplace makes demands on the worker beyond their capacity.

Question 18

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:

Answer 18

Employer factors

Question 19

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:

Answer 19

Negative health impact on the worker

Question 20

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?

Answer 20

Malignancy

Question 21

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?

Answer 21

Osteoporosis

Question 22

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?

Answer 22

MRI spine

Question 23

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?

Answer 23

Aspirate of L3/4 for culture.

Question 24

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?

Answer 24

Surgical decompression.

Question 25

A 35 year old man presents with a long history of low back pain and stiffness. He has known psoriasis. Examination reveals of lumbar lordosis and decreased lumbar flexion. You suspect ankylosing spondylitis. What investigation would confirm your diagnosis?

Answer 25

X-ray pelvis.

Question 26

A 49 year old man presents with a 6 month history of back pain and stiffness. He wakes at night with stiffness and has early morning stiffness in his back which lasts for 2 hours. Examination reveals decreased lumbar spine flexion and pain on stressing his sacroiliac joints. His CRP is 12 (N<6) and ESR 28 (N<25). X-ray of his pelvis shows sacroiliitis. He has been taking Panadol. Which of the following is the treatment of choice?

Answer 26

Non-steroidal anti-inflammatory drug.

Question 27

A 25 year old man presents with pain and stiffness in his back as well as his ankles and knees. He has known ulcerative colitis and has been treated with corticosteroids and sulfasalazine. He is tender over the posterior aspect of the calcaneus. What process is likely to cause this tenderness.

Answer 27

Achilles enthesitis.