Back Pain Back Pain 3 — Questions and Answers
Question 1: A 25-year-old man has low back pain and stiffness that is worst in the morning, lasts over an hour, and improves with exercise. Which condition should be suspected?
- Lumbar disc herniation
- Ankylosing spondylitis (Correct answer)
- Muscle strain
- Osteoporotic fracture
Correct answer: Ankylosing spondylitis
Inflammatory back pain in a young adult with prolonged morning stiffness that improves with activity is classic for ankylosing spondylitis.
Question 2: Which imaging study is the preferred choice for evaluating suspected lumbar disc herniation with neurological deficits?
- Plain X-ray
- MRI (Correct answer)
- Ultrasound
- Bone scan
Correct answer: MRI
MRI provides the best visualization of soft tissues, including discs and nerve roots.
Question 3: Neurogenic claudication from lumbar spinal stenosis typically improves with which position or activity?
- Leaning forward or sitting (Correct answer)
- Standing upright
- Walking downhill
- Lying face down
Correct answer: Leaning forward or sitting
Flexion widens the spinal canal, relieving nerve compression in lumbar stenosis.
Question 4: An elderly woman with osteoporosis develops sudden mid-back pain after a minor fall. What is the most likely diagnosis?
- Sciatica
- Ankylosing spondylitis
- Piriformis syndrome
- Vertebral compression fracture (Correct answer)
Correct answer: Vertebral compression fracture
Osteoporotic bone can fracture under minimal trauma, most often causing vertebral compression fractures.
Question 5: Which muscle group, when weak, is most associated with increased risk of low back pain?
- Forearm flexors
- Calf muscles
- Neck extensors
- Core abdominal and trunk muscles (Correct answer)
Correct answer: Core abdominal and trunk muscles
Weak core muscles reduce spinal stability and increase load on passive spinal structures.
Question 6: The straight leg raise test is used to assess for which condition?
- Hip arthritis
- Lumbar nerve root irritation (Correct answer)
- Knee ligament injury
- Sacroiliac infection
Correct answer: Lumbar nerve root irritation
Reproduction of radiating leg pain between 30 and 70 degrees of elevation suggests lumbar nerve root tension, often from disc herniation.
Question 7: Which of the following psychosocial factors is a known predictor of back pain becoming chronic?
- Fear-avoidance beliefs and catastrophizing (Correct answer)
- High job satisfaction
- Regular aerobic exercise
- Strong social support
Correct answer: Fear-avoidance beliefs and catastrophizing
Fear of movement and catastrophizing thoughts are strong 'yellow flag' predictors of chronicity and disability.
Back Pain Back Pain 3
A 25-year-old man has low back pain and stiffness that is worst in the morning, lasts over an hour, and improves with exercise.
Which condition should be suspected?