Acute Low Back Problems in Adults

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Which of the following defines acute back pain?
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a) persists for more than 3 months
b) is often progressive
c) is mechanical in nature
d) cause is difficult to determine

2. What is the most common neurological ailment in the United States?
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a) headache
b) back pain
c) neck pain
d) sciatica

3. In which of he following four regions of the spine is most back pain felt?
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a) the seven cervical vertebrae
b) the twelve thoracic vertebrae
c) the five lumbar vertebrae
d) the sacrum and coccyx

4. What is the most common cause of low back pain?
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a) injury or trauma to the back
b) arthritis
c) osteoporosis
d) viral infection

5. Most low back pain complaints in pre-teen children can be traced to backpacks loaded with schoolbooks.
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a) True
b) False

6. What diagnostic procedure is generally suggested for patients who are considering lumbar surgery?
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a) x-ray imaging
b) discography
c) computerized tomography (CT)
d) magnetic resonance imaging (MRI)
e) bone scan

7. Which of the following is the most effective way to speed recovery from low back pain?
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a) ice and heat
b) bed rest
c) exercise
d) medications

8. Persons who continue their activities without bed rest following onset of low back pain generally do better than those who rest in bed for a week.
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a) True
b) False

9. In the treatment of low back pain which of the following is the last option indicated for the patient?
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a) opioids
b) surgery
c) acupuncture
d) ultrasound

10. The use of wide elastic back belts has been known to reduce job-related injuries.
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a) True
b) False

11. For persons under age 45, one of the following is the most frequent cause of disability:
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a) alcoholism
b) low back problems
c) coronary artery disease
d) mental distress

12. Acute low back problem is generally defined as lasting:
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a) less than 3 days
b) less than 1 week
c) less than 3 months
d) less than one year

13. Assessment and treatment of low back problems is no different in teenagers than it is for adults.
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a) True
b) False

14. Most patients without a serious underlying spinal condition such as fracture, tumor, or infection generally recover spontaneously from their activity limitations within 1 month.
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a) True
b) False

15. Best oral medication to control the discomfort of acute low back problems is:
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a) acetaminophen
b) nonsteroidal anti-inflammatory drugs (NSAIDs)
c) muscle relaxants
d) opioids

16. Patients with low back problems generally benefit from the application of ice, heat, massage, traction and ultra-sound.
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a) True
b) False

17. Serious conditions, such as tumor and cancer, often manifest themselves as low back problems.
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a) True
b) False

18. Although a patient may not show any symptoms of fracture, tumor or infection, recommended practice is to run special tests at the outset of low back problems.
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a) True
b) False

19. For patients presenting with acute low back problems and no limb complaints, a more elaborate neurologic evaluation is usually not necessary.
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a) True
b) False

20. Sciatica almost always leads to the diagnosis of lumbar nerve root compression.
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a) True
b) False

21. For cancer or infection, which of the following is not a red flag?
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a) unexplained weight loss
b) age over 70
c) urinary infection
d) back pain not improved with rest

22. In the straight leg raising procedure, reproduction of the patient's sciatica when the "affected" leg is lifted is evidence of a positive "crossed" straight leg raising test.
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a) True
b) False

23. H-reflex test involves the use of electrodiagnostic equipment to measure motor conduction through nerve roots.

a) True
b) False

24. Which of the following diagnoses may not benefit from surgery?
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a) herniated lumbar disc
b) spinal stenosis
c) myofascitis
d) spondylolisthesis

25. On the road to recovery from most low back problems, one of the following is the last option:
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a) exercise program
b) put up with discomfort
c) change the pace of activities
d) surgery

26. Surgery is not a recommended option for most patients with low back pain alone. Select the least plausible reason for this conclusion:
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a) more than 80 percent of patients eventually recover
b) surgery benefits fewer than 40 percent of patients
c) surgery increases the chance of future procedures with higher complication rates
d) unacceptable degree of infection and bleeding due to surgery

27. The use of trigger point, ligamentous and facet joint injections, needle acupuncture, or dry needling has been found to be of considerable benefit in treating low back problems.

a) True
b) False

28. The best treatment for acute low back problems is prolonged bed rest of two to three weeks.
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a) True
b) False

29. For most patients, aerobic activities, such as walking, hiking or swimming can be started during the first 2 weeks of acute low back problems.
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a) True
b) False

30. For patients limited by sciatica for more than 4 weeks without clear evidence on physical examination of nerve root compromise, following tests may provide evidence of suspected neurologic dysfunction:
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a) electromyography "EMG"
b) H-reflex test of the lower limb
c) sensory evoked potentials "SEPs"
d) all of the above

31. Anatomic abnormalities of the lumbar spine are often noted on imaging tests in subjects with no symptoms of back problems.

a) True
b) False

32. A referral for surgical consultation is reasonable for patients with sciatic symptoms who have:
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a) activity limitations for more than one month without improvement
b) clear clinical or electrophysiological evidence of nerve root compromise
c) collaborative findings on imaging studies
d) all of the above

33. At any given time, the percent of the U.S. population that is chronically disabled because of back problems is:

a) 1 percent
b) 10 percent
c) 20 percent
d) 50 percent

34. Although as many as 50 percent of working-age people complain of back symptoms, they are not the most common reason for office visits to orthopedic surgeons, neuro surgeons and occupational medicine physicians.
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a) True
b) False

35. In looking for red flags during physical examination, range of motion measurements of the back are of considerable value.

a) True
b) False

36. The patient's inability to toe walk, heel walk, or do a single squat and rise, may indicate muscle weakness.
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a) True
b) False

37. Difference of as little as one cm in measurement of the two limbs at the same level may indicate muscle atrophy.
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a) True
b) False

38. Back-specific exercise machines and stretching of the back are effective for treating acute low back problems.
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a) True
b) False

39. Surgery for acute low back problems is considered when:
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a) serious spinal acology is detected
b) nerve root dysfunction due to a herniated lumbar disc is detected
c) the patient has had no improvement over 1 - 3 months
d) A and B above

40. Direct methods of nerve root decompression include:
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a) laminotomy
b) microdiscectomy
c) laminectomy
d) all of the above

41. Best method for indirect root decompression is:
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a) chemonucleolysis
b) microdiscectomy
c) percutaneous dyscectomy
d) none of the above

42. Spinal stenosis typically has a gradual onset and begins in older patients.
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a) True
b) False

43. Elderly patients with spinal stenosis who tolerate their daily activities usually need no surgery unless they develop new signs of bowel or bladder dysfunction.
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a) True
b) False

44. Symptoms of low back problems include:
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a) pain or numbness that moves down the leg
b) pain that worsens when supine
c) severe night time pain
d) major motor weakness, such as knee extension weakness

45. The following categories of people are at greater risk for low back problems:
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a) people in poor physical condition
b) those whose work includes heavy labor
c) those who are sitting or standing for long periods of time
d) all of the above

46. Decision about back surgery should be made right away so as to not make the condition worse.
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a) True
b) False

47. Back surgery has been found to be helpful in a majority of cases with low back problems.
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a) True
b) False

48. There is no credible evidence to either support or refute the evidence that back belts reduce back injuries.
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a) True
b) False

49. Back belts are generally recommended to prevent injuries among workers who have never been injured.
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a) True
b) False

50. Back belts have been proved to:
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a) reduce internal forces on the spine during forceful exertions of
b) the back
c) stiffen the spine, which may decrease forces on the spine
d) restrict bending motions
e) none of the above

51. Straight leg raising (SLR) test is recommended in the assessment of sciatica in older patients with spinal stenosis.
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a) True
b) False

52. Pain radiated to the posterior thigh is more likely to indicate a true radiculopathy than pain radiating below the knee.
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a) True
b) False

53. For spinal fracture, one of the following is a red flag that suggests the possibility of a serious underlying condition as the cause of acute low back problem.

a) history of cancer
b) intravenous drug use
c) back pain not improved with rest
d) none of the above

54. For most back problems patient education where an adequate explanation is provided with positive assurance is more important than any actual treatment for speedy recovery.
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a) True
b) False

55. Muscle relaxants have been shown to be more effective than NSAIDs in the treatment of patients with acute low back problems.
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a) True
b) False

56. Opioids appear to be more effective in relieving low back symptoms than analgesics, such as acetaminophen, or aspirin or other NSAIDs.
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a) True
b) False

57. Oral steroids have been found to be effective in the treatment of acute low back problems.
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a) True
b) False

58. If acute low back problems persist after the first month, spinal manipulation would be an effective treatment.
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a) True
b) False

59. Electroacupuncture is an effective method of treatment for patients with low back pain of less than 3 years of duration.
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a) True
b) False

60. Shoe insoles may be effective for patients with acute low back problems who stand for long periods of time.
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a) True
b) False

61. Prolonged use of lumbar corsets and support belts may lead to a decrease in strength of abdominal and back muscles.

a) True
b) False

62. Spinal traction which elongates the spine by either mechanical or manual means is effective in the treatment of patients with acute low back problems.

a) True
b) False

63. Biofeedback may be more effective for treating patients with chronic low back problems than those with acute low back problems.
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a) True
b) False

64. Injection therapy is not recommended in the treatment of patients with acute low back problems. Select the least plausible reason.
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a) it is invasive
b) it may damage nerves or other tissues
c) it is found ineffective
d) it has to be repeated every six months making the patient dependent on it

65. Invasive needle acupuncture is now an acceptable mode of treatment for patients with acute low back problems.
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a) True
b) False

66. Patients with acute low back problems should be advised to limit temporarily any heavy lifting, prolonged sitting, and bending or twisting the back since these activities have been shown to increase mechanical stress on the spine.
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a) True
b) False

67. Bed rest for more than four days is worse for patients than a gradual return to normal levels of activity.
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a) True
b) False

68. The best advice for patients with low acute back problems is:
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a) avoid exercises such as walking, biking or swimming
b) use back-specific exercise machines to strengthen back muscles
c) participate in and gradually increase aerobic exercises
d) stop exercising if the pain occurs

69. Electrophysiologic tests are sometimes used to evaluate physiologic functioning of:
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a) three lower leg muscles
b) stomach muscles
c) spinal cord and nerve roots
d) thigh posterior

70. Electrophysiologic tests include:
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a) electromyography (EMG)
b) H-reflex
c) F-wave response
d) all of the above

71. For most patients potential harms and costs of electrophysiologic tests are fairly negligible.
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a) True
b) False

72. EMG and H-reflex tests appear to be useful
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a) to document presence or absence of radiculopathy or neuropathy as the cause of symptoms in the lower extremities
b) to provide more information on specific nerve roots that may be compromised
c) to help differentiate between acute and chronic nerve root dysfunction
d) all of the above

73. Needam-EMG testing should be done on patients with lower limb symptoms within their first week.
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a) True
b) False

74. Studies have proven that bone scans are perfectly safe for pregnant women.
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a) True
b) False

75. Thermography refers to
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a) treatment of lower back problems with heat
b) injections of radioisotope in the spine to assess any damage
c) measuring small temperature differences between sides of the body and evaluating the patterns on infrared thermographic images
d) treatment of low back problems with higher doses of radiation

76. Anatomic studies such as MRI, CT -myelography and discography
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a) are misleading
b) do not show any defects in many patients
c) do not show that an anatomic defect is actually the cause of symptoms
d) all of the above

77. Plain x-rays are recommended for routine evaluation of patients with acute low back problems in the following situations:
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a) for all patients
b) patients having suffered a recent trauma
c) patients over the age of 70
d) all except (a)

78. X-rays reveal degenerative changes of the spine which cause back pain.
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a) True
b) False

79. For obese patients CT and MRI scanners are more suitable than myelography.
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a) True
b) False

80. Plain x-rays are useful in:

a) detecting or defining spinal fractures
b) diagnosing lumbar nerve root impingement of herniated disc
c) diagnosing spinal stenosis
d) all of the above

81. Routine spinal imaging tests are generally recommended for 90 percent of patients with acute low back pain.
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a) True
b) False

82. CT-myelography and myelography have a higher risk of complications than CT or MRI.
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a) True
b) False

83. Discography is a useful diagnostic test for various reasons. Select the least plausible reason.
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a) it can help select patients who ,would benefit from spinal fusions
b) it promotes better treatment outcomes in patients with acute low back problems
c) it is non-invasive
d) it is less expensive that CT, myelography or MRI

84. Surgical consultation for herniated disc is recommended under certain conditions. Which one of the following is not such a condition?
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a) sciatica is severe and disabling
b) symptoms of sciatica persist
c) there is clinical evidence of nerve root compromise
d) one of the "red flags" is present

85. Microscopic discectomy yields significantly better results than standard discectomy in herniated disc surgery.
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a) True
b) False

86. Spinal stenosis is associated with:
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a) nerve root compression
b) unrelieved sciatic pain
c) degenerative condition affecting patients over age 60
d) positive "red flags"

87. Surgery for lumbar spinal stenosis is generally done if symptoms:
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a) persist for 3 months
b) persist for at least one year
c) recur intermittently
d) appear in a young adult

88. When all else has failed, spinal fusion is the ultimate treatment for acute low back problems.
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a) True
b) False

89. Psychosocial factors are more important than physical factors in affecting the symptoms and response to treatment of patients with chronic low back problems.
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a) True
b) False

90. Exercise is recommended in overcoming the back problem for all of the following reasons except:
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a) trains the muscles that protects the back
b) reduces employee absence and cost of disability insurance
c) conditions the whole body
d) stimulates the body to make its own powerful pain killers