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Spinal Disorders Week 1 - Ts versino Terms in this set (146) How much unexpected weight loss on average is enough to be considered a red flag for a patient with LBP? 10lbs or more over 3 months Is no relief from bed rest a more sensitive or more specific€7,84
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Spinal Disorders Week 1 - Ts versino Terms in this set (146) How much unexpected weight loss on average is enough to be considered a red flag for a patient with LBP? 10lbs or more over 3 months Is no relief from bed rest a more sensitive or more specific
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Spinal Disorders Week 1 - Ts versino
Terms in this set (146)
How much unexpected weight loss on average is enough to be considered a red flag for a patient with LBP? 10lbs or more over 3 months
Is no relief from bed rest a more sensitive or more specific sign for cancer as a cause of LBP? High...
Spinal Disorders Week 1 - Ts versino
Jeremiah
Terms in this set (146)
How much unexpected weight loss on 10lbs or more over 3 months
average is enough to be considered a red
flag for a patient with LBP?
Is no relief from bed rest a more sensitive or Highly sensitive (>90%)
more specific sign for cancer as a cause of -meaning is a good cancer screening tool for patients with LBP
LBP?
Decide if the LBP is due to disease or injury
What is the first step in the DDX of a NMS
condition?
Then determine if there is nerve damage or not
Older estimates are about 3%
About what % of LBP patients have a serious
-1% due to local disease, 2% referred pain from GI, reproductive, or urinary systems
condition like cancer or spinal infection?
Later study suggests it may be <1%
Having a prior history of cancer (+LR 16-23)
Which red flag would have the strongest
influence on when the suspect possible Other red flags:
spinal cancer causing LBP? -failure to respond to conservative care for 1 month (+LR 3.1)
-weight loss >10lbs in 3 months (+LR 2.5)
You percuss the SPs of a patient with LBP Spinal infection
and the patient experiences a lingering Cancer
sharp pain. What are the three conditions Fracture
that might do that?
You think your patient may have multiple Serum protein electrophoresis
myeloma. What specific blood test could
you order that would help you confirm that
diagnosis?
What three systems can cause visceral Reproductive (endometriosis)
referred pain to the low back? Give GI (pancreatitis)
examples Urinary (bladder cancer)
What are the first 3 ancillary tests to order if Radiograph
there are sufficient red flags from the history ESR or CRP
Spinal Disorders Week 1 - Ts versino
ESR elevated but <20mm/hr = generally not a concern
ESR >20mm/hr = more concerning that there may be a disease lurking, often you can
treat and monitor carefully if not too high
What are the key elements of LeFebvre's 20-
ESR >50mm/hr = likely a disease process present, after radiograph consider advanced
50 rule for ESRs?
imaging
-the closer you get to 50, the more you want to do more tests
Serum calcium
What 3 tests on a blood chemistry panel
ALP
relate to spinal cancer?
Serum proteins
or physical to make you suspect a disease? CBC
1/9
, 8/10/24, 6:10 AM
Metastatic cancer
-40-50% of pts with metastatic cancer to bone will have elevated calcium
What are the two most common causes of
Hyperparathyroidism
elevated calcium?
Cancer/hyperparathyroidism account for 90% of people with hypercalcemia
What are 3 blood test values that when ESR
elevated suggest an inflammatory disease CRP
(including infections and cancers)? CBC (WBCs)
Nerve involvement
1. Cord lesions (only upper lumbar lesions)
2. Nerve root lesions (include cauda equina)
What are 5 diagnostic possibilities for a
3. Peripheral nerve lesions (sciatica/femoral neuropathy)
patient presenting with leg and back pain?
No nerve involvement
4. Deep referred pain (from SI/lumbar structures)
5. Separate lesions (along the kinetic chain)
History
1. Leg pain (territory? quality? more intense than LBP?)
What are the 5 key clues/tools from the 2. Paresthesia (territory?)
history and physical exam in a patient with Physical exam
LBP and leg pain? 3. Nerve tension tests
4. Neurological deficits/abnormalities (SMRs)
5. Lumbar joint loading procedures that cause immediate leg symptoms
What parts of the nervous system are you Sciatic nerve
tensioning with the SLR? L4, L5, S1
Your patient has weak dorsiflexors. Where in Deep peroneal nerve, L4, or L5
the nervous system could the lesion be?
Urinary retention
Urinary incontinence
What are the signs and symptoms of cauda
Saddle paresthesia
equina syndrome (CES)?
Sexual dysfunction
Rectal sphincter weakness
What are the 2 most common causes of Large midline disc herniation
cauda equina syndrome (CES)? Lumbar spinal stenosis
What ancillary tests would you order to Needle EMG
confirm if there was nervous tissue damage Nerve conduction study (NCV)
and to locate where that lesion might be for
a patient with anterior thigh pain?
Spinal Disorders Week 1 - Ts versino
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