Comprehensive Flashcards on Clinical Reasoning for Low Back Pain in Medicine

Ivory Vertebra Sign

increased opacity of vertebral body that retains its size/contour; adjacent discs/verterbae are unchanged

osteoblastic metastases --> prostate/breast cancer

lymphoma

hemangioma

paget disease of the bone

causes of ivory vertebra sign

spondylosis

facet joints (osteoarthritis)

herniated disc

spinal stenosis

spondylolysis

spondylolisthesis

what are some degenerative diseases that can cause mechanical low back pain?

kyphosis

lordosis

scoliosis

transitional vertebra

what are some congenital diseases that can cause mechanical low back pain?

compression fracture

how does osteoporosis cause mechanical low back pain?

multiple myloma

lymphoma/leukemia

metastatic carcinoma

spinal cord tumors

retroperitoineal tumors

neoplastic causes of non-mechanical low back pain

osteomyelitis

septic discitis

paraspinous abscess

epidural abscess

infectious causes of non-mechanical low back pain

ankylosing spondylitis

psoriatic spondylitis

reactive arthritis

paget disease

inflammatory causes of non-mechanical low back pain

prostatitis

endometriosis

PMDD

chronic PID

fat herniation of lumbar space

what are some pelvic origins of visceral low back pain

nephrolithiasis

pyelonephritis

perinephric abscess

what are some renal origins of visceral low back pain

aortic anerysm

aortic dissection

IBD

pancreatitis

cholecystitis

penetrating ulcer

misc causes of visceral low back pain

age <16 or >50 with new onset pain

prior malignancy, especially those that have predisposition to bone metastasis

Major trauma in young, minor trauma in elderly

Osteoporosis

long term corticosteroid use

serious recent infection/illness

current/hx of IVDU

PMHx red flags in low back pain

P.T. Barnum Loves Kids

Prostate

Thyroid

Breast

Lungs

Kidneys

what are the cancer that have predisposition to bone metastasis

Peripheral/central line

Surgically implanted catheter

previous back surgery or spinal procedures

recent GI/GU procedure

what PSHx are red flags when it comes to bone pain?

fever, chills, night sweats, unintentional weight loss

constitutional symptoms that are red flags in low back pain

major/progressive motor/sensory deficits (hip/knee weakness, foot drop, generalized neurologic deficit)

change in bowel or bladder function (new urinary retention or fecal incontinence, reduced rectal tone, saddle anesthesia)

Worrisome patterns of pain (thoracic, progressively worsening, sudden severe worsening, worsens when supine/at rest, wakes patient up in second half of night, unresponsiveness to previous therapies)

other symptoms that are red flags in low back pain

worse with standing, better with flexion

spinal stenosis is characterized by what pain pattern?

worse with extension

spondylosis is characterized by what pain pattern?

worse in morning, better with exercise

ankylosing spondylitis is characterized by what pain pattern?

metastatic disease and ankylosing spondylitis

night low back pain is characteristic of....