Deck 64: Low Back Pain

Question 1

More than 80% of episodes of low back pain (LBP) will recover spontaneously within 6 weeks.

Answer 1

True

Question 2

It is possible to make a diagnosis of the cause of LBP in the majority of cases if a careful assessment is done.

Answer 2

False

Question 3

The most common causes of LBP are

A) Neurologic
B) Mechanical (muscular)
C) Anatomic (disorders of the vertebrae or discs)

Answer 3

B

Question 4

Which of the following diagnoses represent urgent ("red flag") causes of LBP? (Choose all that apply.)

A) Ankylosing spondylitis
B) Spinal cord compression
C) Herniated disc(s)
D) A compression fracture
E) Cancer

Question 5

Relief with standing or activity is more common with spinal stenosis.

Question 6

Which of the following are reasons to order a lumbar-sacral spine x-ray in patients with new LBP? (Choose all that apply.)

A) Direct trauma to any part of lumbar-sacral area
B) Chronic steroid use
C) Prior diagnosis of cancer
D) Evidence of sciatica on the Straight Leg Raise (SLR) test
E) New fever, elevated sedimentation rate and white blood cell count

Question 7

A positive SLR test always indicates disc herniation.

Question 8

Patients with muscle spasm and new LBP should remain on bed rest until the pain is resolved.

Question 9

Severe leg weakness or sensory loss in lower extremities, urinary retention or incontinence and fecal incontinence, and anesthesia of the perineal area suggest:

A) Ankylosing spondylitis
B) Cauda equina syndrome
C) Metastatic cancer to the spine
D) Osteomyelitis

Question 10

If the SLR test suggests disc herniation in a patient with a new complaint of LBP, you should:

A) Get an x-ray of the area that is most painful
B) Treat with a course of conservative care before further testing
C) Order an MRI
D) Order a C-reactive protein and HLA-B27 to rule out ankylosing spondylitis

Question 11

A patient with a new complaint of nonspecific LBP strongly requests an x-ray after you complete your assessment "to make sure there's nothing serious going on." How should you respond?

A) Order the x-ray because you know there are often unexpected abnormalities that show up on LS spine films that explain the patient's symptoms.
B) Explain to the patient that x-rays are not part of the protocol for initial evaluation of new LBP because most cases resolve on their own.

Question 12

Which are the most common nerve root impingements due to disc herniation as a source of LBP? Choose all that apply.

A) L1-L2
B) L2-L3
C) L3-L4
D) L4-L5
E) L5-S1