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BACK PAIN

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tomi1's version from 2017-02-17 11:06

Section 1

Question Answer
pain worse on coughing and walkingsciatic
intermittent leg pain, worse on walking ,relieved by leaning forward lumbar spinal stenosis
pain in knees onlyfacet joint OA
back pain and leg painsciatica, hip OA, cauda equina
pain and stiffness morning, SOB, relived by exerciseankylosing spondylosis
persitant back pain in kidsspondylolithesis
unsteady, clumsy hands pain in neckcervical spinal stenosis
constant leg and back painprolapse disc (buldging disc impinging nerve root)
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Section 2

Question Answer
associated with HLA-DR4PMR
symmetrical shoulder weaknessPMR
balance and neck/arm paincervical spinal stenosis
LBP sudden onset in a person with HIVpsoas abscess
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Section 3

Question Answer
sciatic nerve rootsL4-S4
sciatic branchescommon peroneal and tibial nerve
sciatic nerve functiondorsiflex + evert foot + sensory to back leg
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Section 4

Question Answer
explain SLRlie flat + relax - raise affected leg 30-60 degrees
indication for crossed leg raiseif SLR positive - confirms nerve root irritation (radiculopathy)
define sciaticlumbar plexus region
positive SLRpain leg raised between 30-60 degrees
loss achilles reflexsciatica
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Section 5

Question Answer
causes of back pain *NM PRIM*neoplasm,metabolic,psychosocial, refferred, inflammatory, mechanical
red flags back pain *BACK P*bladder or bowel/cancer/night sweats/persistant pain/saddle anaesthesia
cauda equina treatment laminectomy for surgical decompression to prevent permanent neurological damage
psychosocial causes back painanxiety,depression, obesity, inactivity
reffered pain backaortic anuersym, pancreatitis, kidney stones, gallstones
MUST ASK ABOUT IV DRUG USEPSOAS ABSCESS = LUMBAR TB
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Section 6

Question Answer
spinal stenosis presentsspinal claudication
identifying spinal tumour XRowl sign - looking for missing pedicle (connects vertebral body to lamina)
Define lamina: vertebral archprotects SC posteriorly
identifying spondylolysis XRscottie dog collar (fracture at interarticularis)
On lateral spine XR parts of Scottie doghead/neck(collar)/ear/leg/bodytransverse process/interarticularis/superior facet/inferior facet/lamina
syndesmophytesbony growth from vertebral ligaments, seen in AS
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Section 7

Question Answer
conus medullaris differs from cauda equinano weakness or sensory loss
features shared by conus medulllaris and cauda equinusbladder bowel dysfunction - LBP- SCIATICA
no 1 cause cauda equinaprolapsed intervertebral disc
other causes cauda equinaTrauma/pregnancy
define cauda equina syndromecompression nerve roots l2 onwards
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Section 8

Question Answer
5 classes of back pain by incidence acute-chronic(85%)-prolapsed disc-spinal stenosis - rare (OM,SPA,cauda equina,cancer)
managment mechanical back pain4 step approach: ice/heat-positional advice-exercise - meds (nsaids,paracetamol)
management inflammatory back painMDT:physio, nsaids/tnf inhibitors/MTX/sulfasalazine
tnf inhibitors infliximab, adalimumab, etancerpt
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Section 9

Question Answer
where is back pain managed largelyprimary care - most cases are mechanical non-specific
what is radicular painnerve root pain
when is radicular pain feltspinal stenosis or PID
what needs to be assessed in chronic back painpsychosocial factors: anxiety, depression,substance abuse, obesity
how is psychosocial managedcounselling, cbt, antidepressants
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