Approach to the Patient with Back Pain

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Approach to patient with back pain Chronic pain syndrome - Case 1

Approach to patient with back pain Chronic pain syndrome - Case 2

Approach to the Patient with Back Pain - Basic Level Case Study

Approach to the Patient with Back Pain - Intermediate Level Case Study

Approach to the Patient with Back Pain - Advanced Level Case Study
1. What is the most appropriate next step in the management of a patient suspected of having cauda equina syndrome?
Select only 1 answer.
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A. Start oral corticosteroids
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B. Perform an urgent MRI of the lumbar spine
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C. Refer to physical therapy
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D. Prescribe nonsteroidal anti-inflammatory drugs (NSAIDs)
2. Which of the following questions is most important to ask a patient presenting with low back pain of 3 months’ duration to help determine the underlying cause?
Select only 1 answer.
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A. Have you experienced any recent weight gain?
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B. Do you have any history of trauma or injury to your back?
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C. How many hours do you sleep each night?
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D. Do you have any allergies to medications?
3. Which of the following features is most indicative of inflammatory back pain rather than noninflammatory (mechanical) back pain?
Select only 1 answer.
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A. Pain that improves with rest
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B. Pain that worsens with activity
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C. Morning stiffness lasting more than 30 minutes
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D. Pain that radiates to the legs
4. Which of the following is considered a mechanical cause of low back pain?
Select only 1 answer.
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A. Spinal stenosis
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B. Osteomyelitis
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C. Acute pancreatitis
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D. Endometriosis
5. Which of the following imaging modalities is most appropriate for diagnosing suspected inflammatory back pain?
Select only 1 answer.
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A. X-ray
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B. Ultrasound
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C. Magnetic Resonance Imaging (MRI)
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D. Computed Tomography (CT)
6. What is the role of HLA-B27 in inflammatory back pain?
Select only 1 answer.
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A. It directly causes inflammation in the spine and sacroiliac joints.
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B. It is a genetic marker that increases the risk of developing certain inflammatory conditions.
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C. It is a diagnostic marker that definitively confirms ankylosing spondylitis.
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D. It is a protein that reduces the risk of developing inflammatory back pain.
7. Which of the following best describes the pathophysiological mechanisms underlying inflammatory back pain in conditions such as ankylosing spondylitis?
Select only 1 answer.
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A. Degeneration of intervertebral discs leading to nerve root compression
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B. Chronic inflammation of the entheses and axial skeleton with subsequent bone remodeling and ankylosis
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C. Mechanical stress on the lumbar spine causing muscle strain and ligament sprain
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D. Osteophyte formation and facet joint hypertrophy resulting in spinal stenosis
8. Which of the following statements best describes the incidence and prevalence of vertebral compression fractures (VCFs) in people with osteoporosis?
Select only 1 answer.
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A. VCFs are rare in people with osteoporosis, affecting less than 5% of this population annually
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B. VCFs are the most common complication of osteoporosis, affecting more than 700,000 Americans annually.
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C. VCFs primarily occur in young adults with osteoporosis.
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D. VCFs are equally common in men and women with osteoporosis.
9. During a reflex examination of a patient with back pain, which of the following findings would most likely indicate nerve root compression, and what would this suggest in terms of diagnosis?
Select only 1 answer.
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A. Hyperactive reflexes, suggesting a central nervous system lesion
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B. Absent or diminished reflexes, suggesting nerve root compression
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C. Normal reflexes, suggesting no neurological involvement
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D. Clonus, suggesting upper motor neuron involvement
10. Which of the following findings would most likely be observed during the physical examination and radiologic evaluation of a patient with lumbar spinal stenosis?
Select only 1 answer.
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A. Hyperreflexia and normal MRI findings
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B. Positive straight leg raise test and disc herniation on MRI
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C. Decreased lower extremity reflexes and central canal narrowing on MRI
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D. Normal reflexes and osteophyte formation on X-ray
11. Which of the following symptoms and pathophysiological mechanisms are most commonly associated with spinal metastases?
Select only 1 answer.
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A. Chronic muscle spasms and inflammation of the intervertebral discs
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B. Severe back pain, neurological deficits, and compression of the spinal cord by metastatic tumors
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C. Intermittent back pain and degeneration of the vertebral bodies
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D. Localized back pain and hypertrophy of the spinal ligaments
12. What is the most appropriate test when a compression fracture is suspected, and why?
Select only 1 answer.
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A. Bone density test (DEXA)
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B. Ultrasound
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C. X-ray
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D. Electromyography (EMG)
13. Which of the following combinations of symptoms and clinical findings is most indicative of “text neck,” a condition resulting from prolonged use of electronic devices?
Select only 1 answer.
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A. Persistent lower back pain, radiating leg pain, and positive straight leg raise test
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B. Chronic neck pain, upper back discomfort, tension headaches, and forward head posture
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C. Episodic abdominal pain, nausea, and positive Murphy’s sign
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D. Intermittent hip pain, knee pain, and reduced hip range of motion
14. What is a positive straight leg raise test, and which conditions can it indicate?
Select only 1 answer.
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A. Pain localized to the upper back, indicating thoracic spine issues
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B. Pain in the hip, indicating hip joint pathology
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C. Pain radiating below the knee, indicating lumbar disc herniation or nerve root compression
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D. Pain in the abdomen, indicating gastrointestinal issues
15. Which of the following exam findings is most indicative of shoulder impingement syndrome, considering the results of the Neer test and Hawkins-Kennedy test?
Select only 1 answer.
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A. Pain during the Neer test and Hawkins-Kennedy test
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B. Hyperreflexia in the upper extremities
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C. Positive Spurling’s test
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D. Decreased sensation in the fingers