Back Pain Essentials Of Back Pain 3 — Questions and Answers
Question 1: A 70-year-old reports leg pain when walking that is relieved by sitting or leaning forward on a shopping cart. What is the most likely diagnosis?
- Lumbar spinal stenosis (Correct answer)
- Acute disc herniation
- Muscle strain
- Sacroiliitis
Correct answer: Lumbar spinal stenosis
Neurogenic claudication relieved by flexion is the hallmark presentation of lumbar spinal stenosis.
Question 2: Which vertebral level is the most common site of lumbar disc herniation?
- L1-L2
- L2-L3
- L3-L4
- L4-L5 (Correct answer)
Correct answer: L4-L5
The L4-L5 level bears the greatest mechanical load and is the most frequent site of disc herniation along with L5-S1.
Question 3: Which of the following medications is recommended as a first-line pharmacologic option for acute low back pain?
- Long-term opioids
- NSAIDs such as ibuprofen (Correct answer)
- Oral corticosteroids
- Antibiotics
Correct answer: NSAIDs such as ibuprofen
NSAIDs are first-line for acute low back pain, while opioids and systemic steroids are not recommended initially.
Question 4: Weakness in great toe extension during a back pain exam most suggests involvement of which nerve root?
- L3
- L4
- L5 (Correct answer)
- S2
Correct answer: L5
The L5 nerve root innervates the extensor hallucis longus, so its compression weakens great toe extension.
Question 5: A construction worker lifts a heavy box by bending at the waist with straight legs and feels sudden low back pain. Which lifting error most contributed?
- Keeping the load close to the body
- Flexing the spine instead of the hips and knees (Correct answer)
- Lifting with a wide stance
- Exhaling during the lift
Correct answer: Flexing the spine instead of the hips and knees
Lifting with a flexed spine rather than bending the hips and knees dramatically increases stress on lumbar discs.
Question 6: In a patient with back pain, unexplained weight loss, night pain, and a history of breast cancer should raise suspicion for which cause?
- Spinal metastasis (Correct answer)
- Muscle spasm
- Facet arthropathy
- Piriformis syndrome
Correct answer: Spinal metastasis
A cancer history with constitutional symptoms and night pain is a red flag combination for spinal metastasis.
Question 7: Which psychological factor is most strongly associated with the transition from acute to chronic low back pain?
- High job satisfaction
- Fear-avoidance beliefs (Correct answer)
- Regular aerobic exercise
- Strong social support
Correct answer: Fear-avoidance beliefs
Fear-avoidance beliefs lead to activity restriction and deconditioning, strongly predicting chronicity of back pain.
Back Pain Essentials Of Back Pain 3
A 70-year-old reports leg pain when walking that is relieved by sitting or leaning forward on a shopping cart.
What is the most likely diagnosis?