Back Pain Back Pain Diagnosis and Imaging 1 — Questions and Answers
Question 1: Which imaging modality is considered the gold standard for evaluating soft tissue structures in back pain?
- Plain X-ray
- CT scan
- MRI (Correct answer)
- Bone scan
Correct answer: MRI
MRI provides superior soft tissue contrast and is the preferred modality for evaluating discs, nerves, and spinal cord.
Question 2: A positive straight leg raise (SLR) test at less than 60° is most suggestive of which condition?
- Facet joint arthropathy
- Lumbar nerve root compression (Correct answer)
- Sacroiliac joint dysfunction
- Muscle strain
Correct answer: Lumbar nerve root compression
A positive SLR at <60° indicates tension or compression of a lumbar nerve root, most often from disc herniation.
Question 3: Which red flag symptom in back pain warrants immediate evaluation for cauda equina syndrome?
- Morning stiffness
- Unilateral leg pain
- Bladder or bowel dysfunction (Correct answer)
- Pain with prolonged sitting
Correct answer: Bladder or bowel dysfunction
Bladder or bowel dysfunction is a red flag for cauda equina syndrome, a surgical emergency requiring urgent MRI.
Question 4: When is plain X-ray most useful in the workup of low back pain?
- Detecting disc herniations
- Ruling out fracture, tumor, or infection (Correct answer)
- Evaluating nerve root compression
- Assessing muscle tears
Correct answer: Ruling out fracture, tumor, or infection
Plain X-rays are best for detecting bony abnormalities such as vertebral fractures, lytic lesions, or signs of infection.
Question 5: The Patrick (FABER) test is used to assess pain arising from which structure?
- Lumbar disc
- Hip joint or sacroiliac joint (Correct answer)
- Piriformis muscle only
- Posterior longitudinal ligament
Correct answer: Hip joint or sacroiliac joint
The FABER test (Flexion, Abduction, External Rotation) provokes pain from the hip joint or SI joint when positive.
Question 6: Electromyography (EMG) and nerve conduction studies (NCS) are most useful for evaluating which aspect of back pain?
- Disc degeneration severity
- Vertebral alignment
- Nerve root or peripheral nerve dysfunction (Correct answer)
- Facet joint inflammation
Correct answer: Nerve root or peripheral nerve dysfunction
EMG/NCS assess the electrical activity of muscles and nerves to identify radiculopathy or peripheral neuropathy.
Back Pain Back Pain Diagnosis and Imaging 1
Which imaging modality is considered the gold standard for evaluating soft tissue structures in back pain?