Back Pain Essentials Of Back Pain 4 — Questions and Answers
Question 1: A patient with back pain has a fever of 101.5°F, recent IV drug use, and focal spinal tenderness. Which diagnosis must be ruled out first?
- Lumbar strain
- Spondylolisthesis
- Vertebral osteomyelitis or epidural abscess (Correct answer)
- Osteoarthritis
Correct answer: Vertebral osteomyelitis or epidural abscess
Fever with focal spinal tenderness in an IV drug user is a classic red flag triad for spinal infection.
Question 2: Which activity recommendation is most appropriate for a patient during the first days of acute nonspecific low back pain?
- Strict bed rest for one week
- Staying active and continuing normal activities as tolerated (Correct answer)
- Wearing a rigid back brace continuously
- Complete avoidance of all walking
Correct answer: Staying active and continuing normal activities as tolerated
Evidence shows that staying active leads to faster recovery than bed rest for acute nonspecific back pain.
Question 3: Loss of the Achilles (ankle) reflex during examination most suggests compression of which nerve root?
- S1 (Correct answer)
- L4
- L2
- L5
Correct answer: S1
The Achilles reflex is mediated primarily by the S1 nerve root, commonly affected by L5-S1 disc herniation.
Question 4: A 68-year-old woman with osteoporosis develops sudden mid-back pain after a minor cough. What is the most likely cause?
- Disc herniation
- Vertebral compression fracture (Correct answer)
- Sciatica
- Spinal stenosis
Correct answer: Vertebral compression fracture
In osteoporotic patients, even trivial forces like coughing can cause vertebral compression fractures.
Question 5: Which nonpharmacologic therapy has the strongest evidence for managing chronic low back pain?
- Exercise therapy (Correct answer)
- Continuous ultrasound alone
- Prolonged bed rest
- Rigid lumbar bracing
Correct answer: Exercise therapy
Structured exercise therapy is consistently supported by evidence as a core treatment for chronic low back pain.
Question 6: Spondylolisthesis refers to which spinal abnormality?
- Inflammation of the sacroiliac joint
- Forward slippage of one vertebra over another (Correct answer)
- Rupture of the annulus fibrosus
- Lateral curvature of the spine
Correct answer: Forward slippage of one vertebra over another
Spondylolisthesis is the anterior displacement of a vertebra relative to the one below it.
Question 7: Which ergonomic adjustment best reduces low back strain for someone working at a desk all day?
- Using a chair with no back support
- Positioning the monitor below waist level
- Sitting with hips and knees near 90 degrees with lumbar support (Correct answer)
- Perching on the front edge of the seat
Correct answer: Sitting with hips and knees near 90 degrees with lumbar support
Neutral hip and knee angles with lumbar support maintain the natural lordosis and minimize disc pressure.
Back Pain Essentials Of Back Pain 4
A patient with back pain has a fever of 101.5°F, recent IV drug use, and focal spinal tenderness.
Which diagnosis must be ruled out first?