Presentation
Workup
Ddx
Red Flags
Management
100
Most low back pain resolves on its own in this amount of time
2-4 weeks
100
LBP without red flag symptoms typically needs this kind of imaging
None!
100
This is by far the most common etiology of LBP
mechanical lumbar strain
100
persistent pain at night may indicate this etiology of LBP
malignancy
100
These are the three components of conservative management of uncomplicated LBP
NSAIDs or muscle relaxants
Heat
PT
200
Pain that is worth at rest most often suggests this dx
lumbar strain
200
This is the preferred mode of imaging for persistent radiculopathy
MRI
200
bony point tenderness on back exam suggests this dx
focal fracture
200
abdominal bruit indicates this uncommon, highly morbid cause of acute back pain
abdominal aortic aneurysm
200
This is the mainstay of tx for cauda equina syndrome
Surgical decompression
300
Name at least three symptoms of cauda equina syndrome
Saddle anesthesia
Fecal incontinence
Urinary incontinence
Bilateral LE weakness or numbness
Progressive focal neuro deficits
300
normal UA would help rule out this cause of LBP
pyelonephritis
300
these are the second and third most common dx's for LBP
degenerative joint disease
herniated disc
300
You might worry about these two dxs in a patient whose LBP is associated with fever and recent endocarditis
-epidural abscess
-osteomyelitis
300
This class of drugs can reduce the incidence of vertebral fracture in elderly patients
bisphosphonates (eg alendronate)
400
if a standing bend to the side provokes contralateral pain, you should consider this dx
lumbar muscle strain
400
This is how to perform and interpret a FABER test
abduct hip, flex knee, place foot on opposite knee and apply pressure to knee. + if pain at hip or SI joint
400
This non-malignant etiology usually has an insidious onset and is often apparent on X-ray
Degenerative arthritis
400
Prolonged use of methylprednisolone for an autoimmune condition would make you more concerned for this etiology of LBP
vertebral fx
400
Three contraindications to using NSAIDs in LBP
Pregnancy post 20 weeks
CKD
PUD500
What is the "shopping cart sign" and what dx does it suggest?
leaning forward to decompress spine; Spinal stenosis
500
This is how to differentiate tight hamstrings from lumbar radiculopathy on supine straight leg raise test
if dorsiflexion provokes pain, indicates stretching of S5 or L1; if no pain, likely just tight hamstrings
500
one symptom associated with this finding, and its dx
worse with bending, +posterior thigh pain
spondylolisthesis
500
18yo p/w chronic morning stiffness and LBP, found to have CRP=70mg/L : most likely dx?
ankylosing spondylitis
500
These are some best practices for prescribing opiates for LBP
-Try non-opiate tx first
-Rx short course
-Lowest dose possible
-If rx'ing an opiate co-formulated with acetaminophen (eg Tylenol w/ codeine), counsel on avoiding other acetaminophen-containing products
-Co-rx naloxone