Back Pain Back Pain Diagnosis and Imaging 3

Question 1

Which reflex is associated with the L5 nerve root?

Accepted Answer

No consistent deep tendon reflex

Answer

The L5 nerve root has no consistently testable deep tendon reflex, unlike L4 (patellar) and S1 (Achilles).

Question 2

A bone scan (scintigraphy) is particularly useful for detecting which back pain cause?

Accepted Answer

Metastatic bone disease or stress fractures

Answer

Bone scans detect areas of increased bone turnover, making them sensitive for metastases, infections, and stress fractures.

Question 3

Which clinical feature distinguishes referred pain from radicular (nerve root) pain in the back?

Accepted Answer

Radicular pain is dermatomal and often includes neurological signs; referred pain is diffuse

Answer

Radicular pain follows a dermatomal distribution and can include sensory, motor, and reflex changes, unlike diffuse referred pain.

Question 4

Which provocative test reproduces lumbar radiculopathy symptoms by applying axial compression to the spine?

Accepted Answer

Kemp's test (quadrant test)

Answer

Kemp's test (lumbar quadrant test) combines extension, rotation, and lateral flexion to provoke facet or nerve root pain.

Question 5

CT myelography is preferred over standard MRI in which clinical scenario?

Accepted Answer

Patients with MRI-incompatible implants needing detailed neural evaluation

Answer

CT myelography uses contrast injected into the thecal sac and is used when MRI is contraindicated (e.g., pacemakers, certain implants).

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