Chronic Lower Back Pain Quiz
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Questions and Answers

What is the most common type of back pain, according to the text?

  • Lancinating pain
  • Radicular pain (correct)
  • Referred pain
  • Deep pain

    • What percentage of the population suffers from lower back pain during their lifetime, according to the text?

  • 64%
  • 76%
  • 50%
  • 84% (correct)

    • What is the second most common reason for office visits in the United States, according to the text?

  • Back pain (correct)
  • Fever
  • Headache
  • Stomachache

    • What is the most common type of nerve root affected in radicular pain?

    <p>L5 and S1</p> Signup and view all the answers

    What is the difference between referred pain and radicular pain?

    <p>Referred pain is pain in structures that have the same mesodermal origin, while radicular pain is sharp, stabbing, shooting, or lancinating pain that courses down to the foot, also associated with paresthesia due to the mechanical compression of a nerve root.</p> Signup and view all the answers

    What is the purpose of the straight leg raising test (SLRT) during a physical examination for lower back pain?

    <p>To reproduce radicular symptoms</p> Signup and view all the answers

    At what age does a negative SLRT test lose its reliability in ruling out a herniated disk?

    <p>30</p> Signup and view all the answers

    When is it appropriate to order radiographs or MRI for a patient with lower back pain?

    <p>If the patient is having radicular pain</p> Signup and view all the answers

    What is the most common cause of lower back pain?

    <p>Back strain</p> Signup and view all the answers

    What is the etiology of pain from back strain?

    <p>Inflammation of the paraspinal musculature</p> Signup and view all the answers

    When is a lumbosacral spine radiograph clinically indicated for a patient with back strain?

    <p>If the pain does not subside after 2 weeks of conservative management</p> Signup and view all the answers

    What is the most common level of disk herniation?

    <p>L5-S1</p> Signup and view all the answers

    What is the most likely nerve root to be impinged by a posterolateral herniation?

    <p>The nerve root that traverses the region</p> Signup and view all the answers

    What is the most common presenting symptom of herniated disks?

    <p>Localized back pain</p> Signup and view all the answers

    Which nerve root is compromised with involvement of the L4 nerve root?

    <p>L4</p> Signup and view all the answers

    What is the SLRT maneuver used for?

    <p>To elicit nerve root pain</p> Signup and view all the answers

    When is imaging indicated for a patient with herniated disks?

    <p>If the patient's pain is refractory to conservative therapy</p> Signup and view all the answers

    What percentage of patients with herniated disks will improve with conservative treatment over a period of 5 years?

    <p>80%</p> Signup and view all the answers

    What is the most common cause of spinal stenosis?

    <p>Degenerative pathologies</p> Signup and view all the answers

    What is the typical age range for patients with spinal stenosis?

    <p>50-70 years old</p> Signup and view all the answers

    What are the indications for surgery in patients with spinal stenosis?

    <p>Refractory pain</p> Signup and view all the answers

    What is the recommended imaging technique to visualize the stenotic region in a patient with suspected spinal stenosis?

    <p>X-ray</p> Signup and view all the answers

    What are the indications for surgery in patients with spinal stenosis?

    <p>Inability to cope with functional limitations</p> Signup and view all the answers

    What is the first-line treatment for most patients with spinal stenosis?

    <p>NSAIDs</p> Signup and view all the answers

    Which of the following is the most common cause of spondylolisthesis?

    <p>Degenerative and isthmic conditions</p> Signup and view all the answers

    What is the most commonly affected area in spondylolisthesis?

    <p>L4-L5</p> Signup and view all the answers

    What is the most effective radiographic study to diagnose spondylolisthesis?

    <p>Standing anterior-posterior and lateral X-rays</p> Signup and view all the answers

    What is the most common cause of cauda equina syndrome?

    <p>Herniated disk at L4-L5</p> Signup and view all the answers

    What symptom is necessary for a diagnosis of cauda equina syndrome?

    <p>Urinary symptoms</p> Signup and view all the answers

    What is the recommended timeframe for emergent surgical decompression if cauda equina syndrome is diagnosed?

    <p>Within 24-48 hours</p> Signup and view all the answers

    What is the most common cause of cauda equina syndrome?

    <p>Herniated disk</p> Signup and view all the answers

    What is the most common cause of cauda equina syndrome?

    <p>Herniated disk</p> Signup and view all the answers

    What are the initial urinary symptoms experienced by patients with cauda equina syndrome?

    <p>Urinary retention</p> Signup and view all the answers

    Study Notes

    Types of Back Pain

    • The most common type of back pain is lower back pain.
    • Lower back pain affects approximately 80% of the population during their lifetime.

    Causes of Back Pain

    • The second most common reason for office visits in the United States is lower back pain.
    • The most common cause of lower back pain is back strain.
    • The etiology of pain from back strain is muscle or ligament injury.

    Radicular Pain

    • The most common type of nerve root affected in radicular pain is the L5 nerve root.
    • Radicular pain is a type of pain that radiates from the spine to the extremities, whereas referred pain is a type of pain that is felt in a different area than the source of the pain.

    Physical Examination

    • The straight leg raising test (SLRT) is used to diagnose lower back pain and nerve root compression.
    • The SLRT is used to assess for pain or tightness in the lower back and legs.
    • A negative SLRT test loses its reliability in ruling out a herniated disk after the age of 35.

    Imaging

    • Imaging (radiographs or MRI) is indicated for a patient with lower back pain if they have a history of cancer, infection, or trauma, or if they have a neurological deficit.
    • Imaging is also indicated if the patient's symptoms persist or worsen over time.

    Herniated Disks

    • The most common level of disk herniation is L5-S1.
    • The most likely nerve root to be impinged by a posterolateral herniation is the L5 nerve root.
    • The most common presenting symptom of herniated disks is back pain that radiates to the legs.
    • The L4 nerve root is compromised with involvement of the L4 nerve root, which can cause weakness in the quadriceps muscle.
    • Imaging is indicated for a patient with herniated disks if they have a neurological deficit or if their symptoms persist or worsen over time.
    • Approximately 95% of patients with herniated disks will improve with conservative treatment over a period of 5 years.

    Spinal Stenosis

    • The most common cause of spinal stenosis is degenerative changes in the spine.
    • The typical age range for patients with spinal stenosis is 60-70 years old.
    • Indications for surgery in patients with spinal stenosis include progressive neurological deficit, intractable pain, or bowel or bladder dysfunction.
    • The recommended imaging technique to visualize the stenotic region in a patient with suspected spinal stenosis is MRI.
    • The first-line treatment for most patients with spinal stenosis is conservative therapy.

    Spondylolisthesis

    • The most common cause of spondylolisthesis is degenerative changes in the spine.
    • The most commonly affected area in spondylolisthesis is the L5-S1 level.
    • The most effective radiographic study to diagnose spondylolisthesis is a lateral lumbar spine radiograph.

    Cauda Equina Syndrome

    • The most common cause of cauda equina syndrome is a herniated disk.
    • The necessary symptom for a diagnosis of cauda equina syndrome is bowel or bladder dysfunction.
    • The recommended timeframe for emergent surgical decompression if cauda equina syndrome is diagnosed is within 24-48 hours.
    • The initial urinary symptoms experienced by patients with cauda equina syndrome are urinary retention, incontinence, or decreased urinary sensation.

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    Description

    Test your knowledge on chronic lower back pain with this informative quiz. Discover the unique pathology and treatment options for this common affliction that affects up to 84% of the population. Learn about the various disease entities that fall under this term and how to differentiate them based on location. Enhance your understanding of this prevalent issue and improve your ability to diagnose and treat patients with lower back pain.

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