CCS FINAL EXAM LATEST EXAM ACTUAL EXAM 200 QUESTIONS AND ANSWERS

CCS FINAL EXAM LATEST EXAM ACTUAL EXAM 200 QUESTIONS AND ANSWERS Acute LBP - CORRECT ANSWERS Characterized by pain or discomfort in the lumbar region, irradiating to the buttocks and lasting no more than a month. Acute LBP - CORRECT ANSWERS It affects more than 80% of the population and has a year prevalence of up to 30% Acute LBP - CORRECT ANSWERS Over 90% of these cases resolve in less than 30 days 30-50 years old Women>Men Sedentary Lifestyle Obesity Pregnancy Physically Demanding Job Familial Hx of Arthritis Psychological Conditions - CORRECT ANSWERS What are the risk factors for LBP LBP - CORRECT ANSWERS Frequently, this disease is cause by d/o of the intervertebral disk Matrix Metalloproteinases Phospholipase A2 Nitric oxide Tumor necrosis factor-a - CORRECT ANSWERS Which cytokines are thought to contribute to the development of LBP? Pinched nerve People with DM related to neuropathy - CORRECT ANSWERS Occasionally, low back pain may indicate a more serious medical problem such as: Acute - up to 4 wks Subacute - 2-6 wks Chronic - over 6 mos - CORRECT ANSWERS Universal classification of LBP Compression Fracture - CORRECT ANSWERS History of trauma Point of tenderness at spine level Pain worsens with flexion, and while pulling up from a supine to sitting position and from a sitting to standing position Herniated Nucleus Pulposus - CORRECT ANSWERS DDx for ALBP - Leg pain is greater than pack pain and worsens when sitting - Pain from L1-L3 nerve roots radiates to hip and/or anterior thigh, pain from L4-S1 nerve roots radiates to below the knee Lumbar Strain/Sprain - CORRECT ANSWERS DDx for ALBP - Diffuse back pain with or without buttock pain - Pain worsens with movement and improves with rest Spinal Stenosis - CORRECT ANSWERS DDx for ALBP - Leg pain is greater than back pain - Pain worsens with standing and walking, and improves with rest or when the spine is flexed - Pain may be unilateral (foraminal stenosis) or bilateral (central or bilateral foraminal stenosis) Spondylolisthesis - CORRECT ANSWERS DDx for ALBP - Leg pain is greater than back pain - Pain worsens with standing and walking, and improves with rest or when the spine is flexed - Pain may be unilateral or bilateral Spondylolysis - CORRECT ANSWERS DDx for ALBP - Can cause back pain in adolescents - Unclear whether it causes back pain in adults - Pain worsens with spine extension and activity Spondylosis (degenerative disk or face joint arthropathy) - CORRECT ANSWERS Similar to lumbar strain Disk pain often worsens with flexion activity or sitting Facet pain often worsens with extension activity, standing Connective tissue disease - CORRECT ANSWERS DDx for ALBP Multiple joint arthralgias, fever, weight loss, fatigue, spinous process tenderness, other joint tenderness Inflammatory spondyloarthropathy - CORRECT ANSWERS Intermittent pain at night, morning pain and stiffness, inability to reverse from lumbar lordosis to lumbar flexion Malignancy - CORRECT ANSWERS Pain worsens in prone position, spinous process tenderness, recent weight loss, fatigue Vertebral diskitis/osteomyelitis - CORRECT ANSWERS Constant pain, spinous process tenderness, often no fever, normal CBC, elevated erythrocyte sedimentation rate and/or C-reactive protein level Abdominal aortic aneurysm - CORRECT ANSWERS Abdominal discomfort, pulsatile abdominal mass Gastrointestinal conditions: pancreatitis, peptic ulcer disease, cholecystitis - CORRECT ANSWERS DDx for ALBP Abdominal discomfort, nausea/vomiting, symptoms often associated with eating Herpes zoster - CORRECT ANSWERS Unilateral dermatomal pain, often allodynia, vesicular rash Pelvic conditions: endometriosis, pelvic inflammatory disease, prostatitis - CORRECT ANSWERS Discomfort in lower abdomen, pelvis, or hip Retroperitoneal conditions: renal colic, pyelonephritis - CORRECT ANSWERS DDx for ALBP Costovertebral angle pain, abnormal urinalysis results, possible fever Reassurance and Patient Education Back Schools Exercise (Aerobic Exercise + Strengthening and Stretching Exercise) Aquatic Exercise Medications (NSAIDs and Muscle Relaxants) - CORRECT ANSWERS Management for ALBP Benzodiazepines Nonbenzodiazepines (Antispasmodic and Anti-spasticity) Herbal Medicine - CORRECT ANSWERS Three drug classes for LBP treatment Cyclobenzaprine Carisoprodol Carbamol - CORRECT ANSWERS Antispasmodic Nonbenzodiazepines Baclofen Dantrolene Tizanidine - CORRECT ANSWERS Anti-spasticity Nonbenzodiazepines Two key recommendations: 1. To remain as active as possible 2. To avoid bed rest Manipulation and Exercises - CORRECT ANSWERS Rehabilitation Approach for LBP Avoid chronicity and regaining fitness - CORRECT ANSWERS Two important factors