Approach to the patient with back pain

Hopefully this is a nice question to ease you in. Cauda equina syndrome is where the caudal equina bundle of spinal nerves become compressed and requires emergency MRI and may require urgent surgical decompression. This must be excluded in all patients presenting with back pain. The main signs are saddle area anaesthesia, incontinence or retention of urine or faeces, reduced anal tone, paralysis and or sensory loss.

The ligamentum flavum extends between the lamina of adjacent vertebrae. The intertranserve ligament extends between the transverse processes, interspinous and supraspinous ligaments attach between the spinous processes. The nucleus pulposus is the jelly like component of the vertebral disc.

The question tests your understanding of examination findings in back pain differentials. Walking with a forward flexed gait accompanied with diminished pulses and skin changes such as mottling, thinning and shininess indicating vascular claudication in lumbar spine stenosis. Lumbar spine stenos is a degenerative condition of the lumbar spine that results in narrowing of the spinal canal. BMJ best practice has great resources on examination findings in back pain on the website.

Prednisolone is a glucocorticoid steroid that is used to reduce inflammation. Atropine is a antimuscarinic. Fomoterol is a beta 2 adrenergic agonist, Tolcapone is a COMT inhibitor, ketorolac is an intravenous NSAID.

Edith has a number of risk factors for a vertebral fracture: increasing age and high likelihood of osteoporosis (remember that post-menopausal people are at high risk of osteoporosis due to the drop in oestrogen). Therefore the most appropriate initial investigation would be a plan x-ray of the spine.

Although smoking is a risk factor for many diseases, it is not a recognised risk factor for osteomyelitis. All the other answer options are risk factors for osteomyelitis.

Codeine is a weak opioid analgesic meaning it stimulates the opioid receptors and can result in sedative effects. Both codeine and sedatives have depressive effects on the central nervous system meaning there is more likely to result in impaired consciousness. The British National Formulary is a greta resource to look at for drug interactions

Ahh SocPop returns! There are a number of models of disability: Medical, Social and Interactional. The Social Model explains that individuals may have an impairment (answer option 1), but that disability is the inability to take part in society on an equal basis, an example of this is a lack of widen doorways and ramps in a building.

Cancers of the brain are less likely to metastasise to the spinal column whereas lung, prostate, breast, thyroid and renal cancers are most likely to metastasise to the spinal column

England in May 2020 moved to an Opt out system of organ donation. This means to be in favour of organ donation is the default, but people are still free to opt out of that choice.