What studies do you initially order when you see a patient with back pain?
None
100
Most Back pain is:
A) Mechanical
B) Visceral
C) Non-Mechanical
Mechanical
100
A red flag for Cauda Equina Syndrome is.
a) Fever
b) Weight Loss
c) I punched you in the kidney and now it hurts
d) Difficulty urinating and fecal incontinence
d) Difficulty urinating and fecal incontinence
200
What do you need to ask about the pain to get a good HX for the patient?
Pain characteristics
Does Pain Radiate?
Is the Pain Constant?
What Exacerbates it? (active vs. passive motion, day vs. night)
What Makes it Better? (medication, positioning-sitting, lying, standing)
Intensity of the pain
History of similar problem?
200
How many weeks do you wait until you consider further imaging modalities?
4 to 6 weeks
200
What is the Hypothesis of back pain? (What causes it)
Most Back Pain is Idiopathic
Hypothesis is that it is caused by chronic flexion injury.
200
Name two out of the five red flags that I presented for cancer causing back pain/
Unrelenting night pain
Pain Pain at rest
UNEXPLAINED WEIGHT LOSS!
Patients >50 and <17
HX of Cancer
300
What would you be concerned about if the patient has had unexplained weight loss?
Malignancy
300
What is usually the first imaging modality chosen in patients with back pain and why?
A plain radiograph is usually the first imaging test performed:
Inexpensive
Easily accessible
Quick turnaround
A 23 year old patient comes in with severe back pain. He tells you that he is an IV drug user, is on chronic steroids, and had a UTI last week, you would suspect that his back pain is caused by...
AN INFECTION
400
Name every possible cause of back pain in alphabetical order.
Joking
400
Why is imaging not the first thing done in patients with back pain?
CT or MRI is no associated with improved patient outcomes, but can identify abnormalities not associated with the patient’s back pain. This can cause anxiety and further unnecessary interventions.
400
What is the Systems Approach to back pain and what does it stand for?
CT Mind V
Congenital, Traumatic, Metabolic, Infectious, Inflammatory, Neoplastic, Degenerative, Vascular
400
Minor Trauma can be an indication for back pain in what what population of patients?