Low Back Pain questions well done 2023/2024.

Risk factors for Low Back Pain - answers• Increasing age • Congenital spine abnormalities • Smoking • Occupation • Prior episode of LBP • Physical fitness Alarming symptoms for back pain caused by cancer include - answersunexplained weight loss, failure to improve with treatment, pain for more than 6 weeks, and pain at night or rest. History of cancer and age > 50 years are other risk factors for malignancy. Alarming symptoms for back pain caused by infection include - answersfever, rest pain, recent infection (urinary tract infection, cellulitis, pneumonia), or history of immunocompromise or injection drug use. cauda equina syndrome is suggested by - answersurinary retention or incontinence, saddle anesthesia, decreased anal sphincter tone or fecal incontinence, bilateral lower extremity weakness, and progressive neurologic deficits. Diagnostic Imaging for Low Back pain - answersNot recommend until 6 weeks, unless red flags are present Tx. for Low back Pain - answersConservative - Nonpharmacologic treatments are key in the management of low back pain. Education alone improves patient satisfaction with recovery and recurrence. PT, and NSAIDs in needed When to Refer a Low back pain patient - answers• Patients with the cauda equina syndrome. • Patients with cancer, infection, or severe spinal deformity. • Patients who have not responded to conservative treatment. CMDT pg. 1635 Sx of Disk Herniation - answersLow back pain radiating down the buttocks and below the knee suggests a herniated disk causing nerve root irritation Define Sciatica - answerscauses electric shock-like pain radiating down the posterior aspect of the leg often to below the knee. Symptoms usually worsen with back flexion such as bending or sitting for long periods (eg, driving). A significant disk herniation can cause numbness and weakness, including weakness with plantar flexion of the foot (L5/S1) or dorsiflexion of the toes (L4/L5). PE finding of herniation/nerve root impigement - answersA positive straight leg raising test indicates nerve root irritation. It has a specificity of 40% but is 95% sensitive in patients with herniation at the L4-5 or L5-S1 level (the sites of 95% of disk herniations). Tx for lumbar disk herniation - answersfirst-line treatments include modified activities; NSAIDs and other analgesics; and physical therapy, Referral is worsens Sx of Lumbar Stenosis - answersPatients report pain that worsens with extension. They describe reproducible single or bilateral leg symptoms that are worse after walking several minutes and that are relieved by sitting (termed "neurogenic claudication"). PE of Lumbar Stenosis - answerspatients often exhibit limited extension of the lumbar spine, which may reproduce the symptoms radiating down the legs. A thorough neurovascular examination is recommended. Best imaging choice for Lumbar stenosis - answersThe diagnosis of spinal stenosis in a patient with symptoms is best confirmed by MRI Patient Complaints of Lumbar Stenosis - answersMost patients with lumbar spinal stenosis are over 60 years old and complain of either leg pain or trouble walking. The pain may originate in the low back but will extend below the buttock into the thigh in nearly 90% of patients. The pain is often a combination of aching and numbness, which characteristically worsens with walking, prolonged standing. Troubled by poor balance, unsteadiness of gait, or leg weakness that develops as they walk. Some describe these neuroclaudication symptoms as developing "spaghetti legs" or "walking like a drunk sailor." Red Flags of Spine Malignancy - answersLow back pain at night, unrelieved by rest or the supine position, suggests the possibility of malignancy, either vertebral body metastasis (chiefly from prostate, breast, lung, multiple myeloma, or lymphoma) or cauda equina tumor. Cauda Equina - Why should we worry? - answersSymptoms of bilateral leg weakness (from multiple nerve root compressions) or of saddle area anesthesia, bowel or bladder incontinence, or impotence (indicating multiple sacral nerve root compressions) indicate a cauda equiana process. Deficit of multiple nerve roots suggest cauda equine tumor or an epidural abscess, both requiring urgent evaluation and treatment. Do you pawn off your patient with chornic low back pain? - answersNo, othropedist, and neurosurgeons cant do anything different than you can. So suck it up...80% the population experience low back pain at some time.