Orthopedics - Disorders of the Back/Spine
1. What is suspected when pain is leg dominant, rather than back dominant?: -
nerve root impingement
2. What are red flag symptoms related to low back pain?: - unexplained weight loss
- failure to improve with treatment
- severe pain for more than 6 weeks
- night or rest pain
3. How does cauda equina syndrome typically present?: - usually presents with urinary
retention, bowel or bladder incontinence
- it is an emergency
4. Why is cauda equina syndrome an emergency?: - because if it does not get properly
diagnosed and surgically decompressed, the patient can become permanently incontinent
5. What are some symptoms of cauda equina syndrome?: - MC symptom is urinary
retention
- saddle anesthesia
- lower motor neuron symptoms
,- loss of DTRs
- increased flaccidity of lower extremities
- decreased anal sphincter tone or fecal incontinence
- B lower extremity weakness
- progressive neurologic deficits
6. What can cauda equina syndrome be caused by?: - surgery
- possibly trauma
7. What is the only treatment for cauda equina syndrome?: Call neurosurgery
- surgical decompression
8. What should chronic management of low back pain include?: - physical, emotional,
cognitive, and behavioral aspects of back pain
9. What is the MCC of disability in patients under 45 y/o and the 2nd MCC for
primary care visits?: - low back pain
10. How long does it take for the majority of low back pain cases to resolve?: - 6
weeks
11. What are RFs for low back pain?: - back pain/fracture form corticosteroid use
,- age > 70
, - history of osteoporosis
- severe trauma
- presence of contusion or abrasion
12. What is low back pain often the presenting symptom for?: - abdominal aortic
aneurysm
- kidney stones
- peptic ulcer disease
- pancreatitis
13. What does the knee reflex test?: - femoral nerve, L2-L4
14. What does the ankle reflex test?: - deep peroneal nerve, L4-L5
15. What does the babinski reflex test?: - sciatic nerve, L5-S1
16. If a patient is supine and has a positive sitting SLR test, what can it suggest?: -
L5-S1 radiculopathy
17. What can a positive femoral stretch test suggest?: - L2-L4 radiculopathy
18. When would you test rectal reflexes?: - if cauda equina syndrome is suspected
1. What is suspected when pain is leg dominant, rather than back dominant?: -
nerve root impingement
2. What are red flag symptoms related to low back pain?: - unexplained weight loss
- failure to improve with treatment
- severe pain for more than 6 weeks
- night or rest pain
3. How does cauda equina syndrome typically present?: - usually presents with urinary
retention, bowel or bladder incontinence
- it is an emergency
4. Why is cauda equina syndrome an emergency?: - because if it does not get properly
diagnosed and surgically decompressed, the patient can become permanently incontinent
5. What are some symptoms of cauda equina syndrome?: - MC symptom is urinary
retention
- saddle anesthesia
- lower motor neuron symptoms
,- loss of DTRs
- increased flaccidity of lower extremities
- decreased anal sphincter tone or fecal incontinence
- B lower extremity weakness
- progressive neurologic deficits
6. What can cauda equina syndrome be caused by?: - surgery
- possibly trauma
7. What is the only treatment for cauda equina syndrome?: Call neurosurgery
- surgical decompression
8. What should chronic management of low back pain include?: - physical, emotional,
cognitive, and behavioral aspects of back pain
9. What is the MCC of disability in patients under 45 y/o and the 2nd MCC for
primary care visits?: - low back pain
10. How long does it take for the majority of low back pain cases to resolve?: - 6
weeks
11. What are RFs for low back pain?: - back pain/fracture form corticosteroid use
,- age > 70
, - history of osteoporosis
- severe trauma
- presence of contusion or abrasion
12. What is low back pain often the presenting symptom for?: - abdominal aortic
aneurysm
- kidney stones
- peptic ulcer disease
- pancreatitis
13. What does the knee reflex test?: - femoral nerve, L2-L4
14. What does the ankle reflex test?: - deep peroneal nerve, L4-L5
15. What does the babinski reflex test?: - sciatic nerve, L5-S1
16. If a patient is supine and has a positive sitting SLR test, what can it suggest?: -
L5-S1 radiculopathy
17. What can a positive femoral stretch test suggest?: - L2-L4 radiculopathy
18. When would you test rectal reflexes?: - if cauda equina syndrome is suspected
