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Self-Assessment Questions

Orthopaedic Surgery

Low Back Pain: Review Questions

Francis H. Shen, MD

Dr. Shen is an assistant professor, Dep[artment of Orthopaedic Surgery, University of Virignia Health System, Charlottesville, VA.

Choose the single best answer for each question.

1. A 63-year-old woman presents with low back pain and cramping in both posterior thighs and numbness radiating into the feet with ambulation. It worsens with standing and walking and improves with sitting and bending forward. She has no bowel or bladder complaints. On examination, she has full strength, normal sensation, reflexes are symmetric, and she has 2+ peripheral pulses. Straight leg raise is negative. What is this patient’s most likely diagnosis?
  1. Cauda equina syndrome
  2. Herniated disc
  3. Internal disc disruption
  4. Spinal stenosis
  5. Vascular claudication
Click here to compare your answer.

2. A 55-year-old woman presents with a 9-month history of moderate low back pain constant in nature and not relieved with rest. The pain has awoken her from sleep on occasion. She has not had fever, chills, or night sweats; however, she has lost 15 lb over the past 3 months. Her medical history is significant for hypertension and breast cancer treated surgically. What is the next step in this patient’s management?

  1. Anti-inflammatory medications
  2. Epidural steroid injections
  3. Magnetic resonance imaging (MRI) of the spine
  4. Physical therapy
  5. Plain radiographs of the lumbar spine
Click here to compare your answer.

3. A 65-year-old rheumatoid patient with a long history of intermittent neck pain is brought to the primary care office because her family notes that she has become progressively less functional and is now wheelchair-bound. Physical examination reveals globally decreased strength in her lower extremities, hyperreflexia in both upper and lower extremities with an upgoing Babinski reflex, and a positive Hoffman’s sign. Hip range of motion is painful. What is the next step in this patient’s management?

  1. Cervical spine radiographs
  2. High-dose prednisone taper
  3. Hip and pelvis radiographs
  4. Lumbar spine radiographs
  5. Physical therapy for strengthening and aquatherapy
Click here to compare your answer.

4. A 33-year-old man presents with a sudden onset of back and left leg pain and weakness after performing heavy squats at the gym. Radiographs are normal, but a MRI reveals a posterolateral left L5-S1 herniated disc. What would a careful neurologic examination likely reveal?
  1. Foot plantar flexion weakness with absent Achilles reflex
  2. Foot plantar flexion weakness with absent patella reflex
  3. Great toe extension weakness with absent Achilles reflex
  4. Great toe extension weakness with absent patella reflex
  5. Quadriceps extension weakness with absent patella reflex
Click here to compare your answer.

5. A 13-year-old gymnast presents with a 2-week history of low back pain that is activity related and relieved by rest. There is no history of trauma. She denies weight loss, night pain, fever, or chills. Physical examination reveals that she is tender to palpation in the lumbosacral region with restricted range of motion and tight hamstrings. She has full strength and normal sensation throughout. Oblique lumbar spine radiographs demonstrate a “Scotty dog” sign suggesting a defect in the pars intra-articularis. What is the best treatment option for this patient at this time?

  1. Activity modification with therapeutic modalities
  2. Computed tomography myelogram
  3. Selective nerve root injection
  4. Surgical decompression
  5. Surgical decompression with spinal fusion
Click here to compare your answer.

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