NR667 VISE II 2026 TEST PAPER SOLVED
QUESTIONS AND SOLUTIONS
◉ Risk factors: Back pain. Answer: -Obesity
-Sedentary lifestyle > inadequate conditioning
-Smoking
-Preexisting psychological conditions
-Chronic occupational strain with improper lifting techniques
-Exaggerated lumbar lordosis, chronic poor posture
-Leg length discrepancy
-Age > 65
-Job dissatisfaction
◉ Assessment findings: Back pain. Answer: -Cauda equina is a
surgical emergency that presents with back pain + 1. perineal
anesthesia, 2. loss of bladder/bowel control, 3. loss of rectal
sphincter tones with digital exam, 4. bilateral radicular pain,
numbness and weakness
-Back, but, and thighs may be aggravated by movement, rising from
seated position, standing, and flexion; may be relieved by rest,
repositioning, or reclining
-Muscle spasm may be present over lumbosacral area due to
ligament or muscle involvement
,-Pain may radiate down leg below knee with with spinal nerve
irritation and radiculopathy
-Motor, sensory, and reflex exams are essential; note asymmetry of
findings
-Observe gait, lower extremity strength, and muscle bulk
◉ Differential Diagnosis: Back pain. Answer: *New onset radicular
pain in older patients is often a sign of spinal stenosis
-Low back strain
-Herniated disc
-Multiple myeloma
-Osteomyelitis
-Prostatitis, pyelonephritis
-Vascular occlusion at level of bifurcation; AAA
-Carcinoma if bony metastasis occurs
-Endometriosis, fibromyalgia
-Depression, hysteria
-Malingering (get out of work card)
-Compression fracture, osteoporosis
-Osteoarthritis
-Ankylosing spondylitis
-Cauda equina
,-Hip/pelvic pathology
-Drug-seeking
◉ Final diagnosis: Back pain. Answer: -Routine imaging is nor
recommended with new onset mechanical back pain and no red
flags
-Red flags: cauda equina, fracture, malignancy, infection
-Lack of improvement over 6-8 weeks warrants AP and lateral x-rays
of the spine
-Red flags or severe/progressive neuro deficits, consider MRI, CT,
bone scan, CBC, ESR, UA
◉ Prevention: Back pain. Answer: -Proper lifting technique, body
mechanics, and posture
-Conditioning exercises
-Maintenance of appropriate weight for height
-Avoid smoking
◉ Non-pharm management: Back pain. Answer: -Patient education
and reassurance that recovery occurs in 6-8 weeks in 80-90% of
patients
-Avoid bed rest; no more than 1-2 days
-PT: for subacute or chronic back pain
-Chiropractics: limited evidence of improvement
, -Acupuncture: short-term pain relief
-Hot/cold application for 20-30 mins several times per day
-Gradually resume activities as tolerated
-Shoe insoles recommended for leg length discrepancies
-CBT to reduce disability related to subacute and chronic pain
◉ Pharmacological management: Back pain. Answer: -Tylenol:
common first-line agent
-NSAIDs: effective first-line agent for short-term relief of acute and
subacute low back pain; all are though to have equal efficacy
-Muscle relaxers: to reduce/eliminate muscle spasm
-Opioids: effective but significant concern for abuse, misuse, and
addiction
-Tramadol: for acute or chronic back pain; short-term use
-Antidepressants: TCAs can be used for chronic back pain
-Topical agents: little evidence
-Steroid: No evidence supports use in acute non-specific low back
pain
◉ Follow-up: Back pain. Answer: -Return for evaluation in 24-48
hours if pain is severe, or in 7-10 days if pain is moderate
-F/u ever 2 weeks until able to resume lifestyle
QUESTIONS AND SOLUTIONS
◉ Risk factors: Back pain. Answer: -Obesity
-Sedentary lifestyle > inadequate conditioning
-Smoking
-Preexisting psychological conditions
-Chronic occupational strain with improper lifting techniques
-Exaggerated lumbar lordosis, chronic poor posture
-Leg length discrepancy
-Age > 65
-Job dissatisfaction
◉ Assessment findings: Back pain. Answer: -Cauda equina is a
surgical emergency that presents with back pain + 1. perineal
anesthesia, 2. loss of bladder/bowel control, 3. loss of rectal
sphincter tones with digital exam, 4. bilateral radicular pain,
numbness and weakness
-Back, but, and thighs may be aggravated by movement, rising from
seated position, standing, and flexion; may be relieved by rest,
repositioning, or reclining
-Muscle spasm may be present over lumbosacral area due to
ligament or muscle involvement
,-Pain may radiate down leg below knee with with spinal nerve
irritation and radiculopathy
-Motor, sensory, and reflex exams are essential; note asymmetry of
findings
-Observe gait, lower extremity strength, and muscle bulk
◉ Differential Diagnosis: Back pain. Answer: *New onset radicular
pain in older patients is often a sign of spinal stenosis
-Low back strain
-Herniated disc
-Multiple myeloma
-Osteomyelitis
-Prostatitis, pyelonephritis
-Vascular occlusion at level of bifurcation; AAA
-Carcinoma if bony metastasis occurs
-Endometriosis, fibromyalgia
-Depression, hysteria
-Malingering (get out of work card)
-Compression fracture, osteoporosis
-Osteoarthritis
-Ankylosing spondylitis
-Cauda equina
,-Hip/pelvic pathology
-Drug-seeking
◉ Final diagnosis: Back pain. Answer: -Routine imaging is nor
recommended with new onset mechanical back pain and no red
flags
-Red flags: cauda equina, fracture, malignancy, infection
-Lack of improvement over 6-8 weeks warrants AP and lateral x-rays
of the spine
-Red flags or severe/progressive neuro deficits, consider MRI, CT,
bone scan, CBC, ESR, UA
◉ Prevention: Back pain. Answer: -Proper lifting technique, body
mechanics, and posture
-Conditioning exercises
-Maintenance of appropriate weight for height
-Avoid smoking
◉ Non-pharm management: Back pain. Answer: -Patient education
and reassurance that recovery occurs in 6-8 weeks in 80-90% of
patients
-Avoid bed rest; no more than 1-2 days
-PT: for subacute or chronic back pain
-Chiropractics: limited evidence of improvement
, -Acupuncture: short-term pain relief
-Hot/cold application for 20-30 mins several times per day
-Gradually resume activities as tolerated
-Shoe insoles recommended for leg length discrepancies
-CBT to reduce disability related to subacute and chronic pain
◉ Pharmacological management: Back pain. Answer: -Tylenol:
common first-line agent
-NSAIDs: effective first-line agent for short-term relief of acute and
subacute low back pain; all are though to have equal efficacy
-Muscle relaxers: to reduce/eliminate muscle spasm
-Opioids: effective but significant concern for abuse, misuse, and
addiction
-Tramadol: for acute or chronic back pain; short-term use
-Antidepressants: TCAs can be used for chronic back pain
-Topical agents: little evidence
-Steroid: No evidence supports use in acute non-specific low back
pain
◉ Follow-up: Back pain. Answer: -Return for evaluation in 24-48
hours if pain is severe, or in 7-10 days if pain is moderate
-F/u ever 2 weeks until able to resume lifestyle
