Back Pain Back Pain Diagnosis and Assessment 1 — Questions and Answers
Question 1: Which red flag symptom in back pain patients requires immediate evaluation for cauda equina syndrome?
- Morning stiffness
- Bilateral leg pain
- Bladder or bowel dysfunction (Correct answer)
- Pain radiating to the knee
Correct answer: Bladder or bowel dysfunction
Bladder/bowel dysfunction alongside back pain suggests cauda equina compression, which is a surgical emergency requiring immediate imaging.
Question 2: What does a positive straight leg raise (SLR) test indicate?
- Sacroiliac joint dysfunction
- Lumbar nerve root irritation (Correct answer)
- Piriformis syndrome
- Facet joint pathology
Correct answer: Lumbar nerve root irritation
A positive SLR at 30-70° of hip flexion reproduces radicular pain and suggests nerve root irritation, typically from disc herniation.
Question 3: Which imaging modality is the gold standard for diagnosing lumbar disc herniation and nerve root compression?
- Plain X-ray
- CT scan
- MRI (Correct answer)
- Bone scan
Correct answer: MRI
MRI provides the best soft tissue contrast for visualizing disc herniations, nerve root compression, and spinal cord pathology without radiation.
Question 4: The Oswestry Disability Index measures which aspect of back pain?
- Pain intensity only
- Functional disability and quality of life (Correct answer)
- Neurological deficit severity
- Imaging findings
Correct answer: Functional disability and quality of life
The Oswestry Disability Index is a validated questionnaire assessing how back pain affects activities of daily living and functional capacity.
Question 5: Pain that worsens with prolonged standing and improves with sitting or forward flexion is characteristic of which condition?
- Lumbar disc herniation
- Lumbar spinal stenosis (Correct answer)
- Sacroiliac joint dysfunction
- Muscle strain
Correct answer: Lumbar spinal stenosis
Neurogenic claudication from spinal stenosis classically worsens with extension (standing) and relieves with flexion (sitting/forward lean) due to increased canal space.
Question 6: Which clinical test is used to assess sacroiliac joint pain?
- FABER test (Correct answer)
- Spurling test
- Hoffman test
- Romberg test
Correct answer: FABER test
The FABER test (Flexion, ABduction, External Rotation) stresses the sacroiliac joint and hip; reproduction of posterior pelvic pain suggests SI joint involvement.
Back Pain Back Pain Diagnosis and Assessment 1
Which red flag symptom in back pain patients requires immediate evaluation for cauda equina syndrome?