Back Pain Essentials Of Back Pain 2 — Questions and Answers
Question 1: A 45-year-old office worker reports low back pain that worsens with prolonged sitting and improves with walking. Which structure is most likely contributing to this pattern?
- Intervertebral disc (Correct answer)
- Facet joints
- Sacroiliac ligament
- Spinous process
Correct answer: Intervertebral disc
Discogenic pain classically worsens with sitting and flexion because sitting increases intradiscal pressure.
Question 2: Which of the following is considered a 'red flag' symptom requiring urgent evaluation in a patient with back pain?
- Pain lasting more than two weeks
- New urinary retention with saddle anesthesia (Correct answer)
- Pain that improves with rest
- Morning stiffness lasting ten minutes
Correct answer: New urinary retention with saddle anesthesia
Urinary retention with saddle anesthesia suggests cauda equina syndrome, a surgical emergency.
Question 3: The straight leg raise test is primarily used to assess irritation of which nerve roots?
- L1-L2
- L2-L3
- L4-S1 (Correct answer)
- S3-S4
Correct answer: L4-S1
A positive straight leg raise between 30 and 70 degrees suggests L4-S1 nerve root irritation, commonly from disc herniation.
Question 4: Which imaging approach is recommended for a patient with acute nonspecific low back pain of one week's duration and no red flags?
- Immediate MRI
- Plain radiographs
- CT with contrast
- No imaging (Correct answer)
Correct answer: No imaging
Guidelines recommend against imaging for acute nonspecific back pain without red flags because it does not improve outcomes.
Question 5: Which muscle group is a primary stabilizer of the lumbar spine and a common focus of core-strengthening rehabilitation?
- Transversus abdominis (Correct answer)
- Biceps femoris
- Gastrocnemius
- Deltoid
Correct answer: Transversus abdominis
The transversus abdominis provides deep segmental stabilization of the lumbar spine and is targeted in core rehabilitation programs.
Question 6: Back pain accompanied by morning stiffness lasting over an hour that improves with exercise in a 24-year-old man most suggests which condition?
- Lumbar strain
- Ankylosing spondylitis (Correct answer)
- Herniated disc
- Spinal stenosis
Correct answer: Ankylosing spondylitis
Inflammatory back pain in a young adult with prolonged morning stiffness relieved by activity is characteristic of ankylosing spondylitis.
Question 7: Which sleeping position is generally recommended to reduce strain on the lower back?
- Prone with head turned to one side
- Supine with legs fully extended on a soft mattress
- Side-lying with a pillow between the knees (Correct answer)
- Sitting upright in a chair
Correct answer: Side-lying with a pillow between the knees
Side-lying with a pillow between the knees keeps the spine and pelvis in neutral alignment, reducing lumbar strain.
Back Pain Essentials Of Back Pain 2
A 45-year-old office worker reports low back pain that worsens with prolonged sitting and improves with walking.
Which structure is most likely contributing to this pattern?