History
Physical Exam
Labs and Studies
What's the Diagnosis
Management
100

What are the three major categories of back pain?

Mechanical

Visceral

Non-mechanical

100

What are the three components of the back exam?

Standing 

Sitting

Supine

100

Are labs needed in evaluation of acute low back pain?

NO

100

Can cause referred LBP in men?

Prostatitis

100
What are the first line medications for treatment of lower back pain

NSAIDS, tylenol, muscle relaxants

200

What are the three most common causes of Back Pain and what category do they fall under?

Degenerative Joint Disease

Disc Herniation

Lumbar strain

All mechanical

200

What are the components of standing portion of the PE

Inspection

Palpation

Range of motion

Gait

Stoop Test

200

when should a CBC be ordered?

if tumor or infection is suspected

200

Occurs when a large mass effect (such as an acute disc herniation or a tumor) compresses a portion of the spine, causing pain radiating down the leg and can be accompanied by weakness and numbness of the leg.

cauda equina syndrome

200

What is included in the conservative therapy for acute low back pain?

Pharmacologic therapy (Aspirin/NSAIDS/Muscle relaxants)

Local therapy (heat/cold compress)

Activity

300

What are three risk factors for low back pain

Prolonged sitting

Deconditioning

Sub-optimal lifting and carrying habits

Repetitive bending and lifting

Spondylolysis

Obesity

Prolonged use of steroids

Intravenous drug use

Psycho-social factors

300

What are the components of testing the sensation

Test for sharp and light touch along dermatomal distribution, great toe (L5), lateral malleolus, and posteriolateral foot (S1)

300

When do you order an X-ray?

History of trauma

Strenuous lifting in patient with osteoporosis

Prolonged steroid use

Osteoporosis Age <20 and >70

History of cancer

Fever/chills/weight loss

Pain worse when supine or severe at night

Spinal fracture, tumor, or infection

300

Has an insidious onset and is increasingly common with advancing age

Disc Herniation

300

When should you refer to a surgeon or for advanced imaging?

If pain has not improved after four to six weeks or if progression of neurologic deficits is demonstrated

400

Name three Red flags when encountering back pain

Fever

Unexplained weight loss

Pain at night

Bowel or bladder incontinence

Urinary retention

Neurologic symptoms

Saddle anesthesia

Trauma

400

The test is performed by flexing the hip and placing the foot of the tested leg on the opposite knee. Pressure is then placed on the tested knee while stabilizing the opposite hip

FABER test

400

When is an MRI indicated?

Worsening or unremitting neurologic deficit or radiculopathy

Progressive major motor weakness

Cauda equina compression (sudden bowel/bladder disturbance)

Suspected systemic disorder (metastatic or infectious disease)

Failed six weeks of conservative care

400

Typically has an acute or sub-acute onset after an injury or precipitating activity.

Lumbar strain

400

Compared to control, patients with LBP who had PT showed what level of improvement in a 100 point disability score?

10 point improvement

500

Mechanical lower back pain involves what three anatomical strucutres

Bones of the spine

Muscles and ligaments surrounding the spine

Nerves

500

At what degree can the normal leg be raised?

80 degrees

500

what test is useful to confirm the existence of radiculopathy (level of nerve involvement) and to exclude the presence of other peripheral nerve disorders

Electrodiagnostic/electromyographic tests

500

Associated with HLA-B27 gene

Ankylosing spondylitis

500

When should you use cold compress versus hot compress

When your back pain is acute (less than a 4-week duration) and/or occurs due to a direct injury, use cold therapy first. Lowering the body temperature will help constrict the blood vessels, reduce swelling, decrease inflammation, and cause a numbing effect. Once the inflammation has subsided, use heat therapy 

-spine-health.com