Disease Abdominal Traumatic back Traumatic back Cauda equina Multiple Prosta

Back pain Plab 2 Revision

Aortic Notes By Ali Munawar
pain pain Syndrome Myeloma te CA
(spinal cord
Aneurysm (sprain) (disc prolapse) compression)
Presentation 72M-ED 30M-ED 25M-ED 35M-ED 70W-GP F/U 1W Writte
Back pain Back pain Back Pain Back pain Back pain, n in
HTN on aspirin 1D Collision while Lifted heavy Tiredness for 3M Cancer
and amlodipine playing rugby object Pathw
ay
Presenting Lower Back Para spinal Acute back pain for Acute back pain for 2 Chest infections
Complaint: pain(gradual/dull/ tenderness 6 hours 2 days in last 8 months
1D/6/10/getting (while playing Now pain (severe,8/10,radiates treated with abx
Pain squash/golf >back
worse/non- (Severe,8/10,lower to right leg+ leg HTN on Amlodipine
twisting>pain weakness+ sensations
radiating/not- back, non-radiating, Pain effecting ADL
immediately>6/10>t lost, PCM not helping)
relieving with ook ibuprofen(non- for 6H)
-Urine not passed-9H,
PCM) radiating) Feeling sick
-Numbness around
back passage -Sick
Time Acute(1D) Acute(1D) Acute(6H) Acute(2D) Chronic (3month)
Rule out Shock: Cauda Equina Cauda Equina Cauda Equina FLAWS
Fainting/dizzy/light No urinary /bowel No urinary /bowel
FLAWS Multiple
headedness /numbness symptoms
symptoms/no loss of myeloma Q
FLAWS sensation around FLAWS
back passage/legs
Risk Factor Young age Traumatic Lifting heavy Lifting heavy Family hx of
HTN Fall weight /Trauma weight /Trauma cancer
Accident (soft cushion between (soft cushion between (BBN-Bone cancer
your backbone shift) your backbone slipped
Sports injury and press on nerve) affecting bones
Twisting motion
Examination OBS OBS OBS OBS OBS
BACK BACK BACK BACK BACK
Tummy Tummy Tummy Tummy Tummy(hepato-
Back passage Back passage Back passage Back passage spleenomegaly)
SLRT SLRT SLRT SLRT SLRT
Radio-femoral delay Leg Neuro
Investigation 1.Routine Routine Routine Routine (Already done)
2.BG and cross X-ray Back X-ray Back X-ray Back HB 10.1,MCV69
match US tummy US tummy MRI spine (ortho) CRP 60 ESR 85
3.ECG MRI spine (by MRI spine (ortho) Cretinine 60
4.USG tummy ortho team) Urine (nitrates
5.CT+ Doppler +proteins(Benze
scan of tummy jones proteins)
Management 1.Admit in ER 1.Supportive 1.Supportive 1.Immediate 1.Not treatable
2.Senior +Inv Pain killer Pain killer referral to 2.Admit(1.High cacium
levels(>3.4)2.confused3.
3.Vascular surgeon (NSAID>Codeine) (NSAID>Codeine) Orthopedic and unable to cope at home)
review (reassess+ Diazepam 2mg Diazepam 2mg neurosurgeon. 3.Senior +inv (Calcium
scan to see leak+ (muscle relaxant) (muscle relaxant) levels
(may need
1.open aneurysm for 5 days for 5 days 4.Supportive
repair and graft
operation to
2. Physiotherapist 2. Physiotherapist Pain killer
2.endovascular relieve
(spine exercise) (spine exercise) (PCM/Morphine)
compression)
 Plab 2 Revision Notes By Ali Munawar

repair through Occupational Occupational 2. Pain killer IV fluids to correct

groin vein therapist therapist (NSAID>Codeine) Ca levels
4.Supportive: 3.Sick note for rest. Refer to ortho if pain Diazepam 5.Refer to
4.Advice: not settle after 6Weeks
Wide bore Catheter hematologist (BM
3.Sick note for rest.
cannulas in both 1.Rest 3.PT/OT. biopsy+ MRI+ Meds
2.Avoid lifting 4.Advice: like chemo/steroids)
arms
heavy object 1.Rest MDT:
IV Fluids
3.Avoid playing 2.Avoid lifting (Psychiatrist Physio
IV morphine
golf till settled. heavy object OT, Dietician,
Anti-emetics
3.Avoid playing Palliative physician)
rugby till settled.
Safety Net DESA Advice Cauda Equina Cauda Equina Cauda Equina
Red flag(Shock) Follow-up in GP Follow-up in GP FLAWS
after 1 Week after 1 Week

AAA Questions:
1.Abdominal pain radiating to back
2.Pulsatile mass in the abdomen
3.Have you ever had a scan on your tummy where you were told that you have abnormal blood vessel in your
tummy?

Cauda Equina
1.Any urinary /bowel symptoms (loss of control over urine/bowel)
2.Any numbness around back passage/legs?

Disk prolapse Questions:

1.Pain radiating to back of legs?
2.Started after lifting heaving weight/trauma?

Multiple myeloma Q:
1.Calcium
(poly urea- poly dypsia- weight loss)
Bone pains/ psychyic moans/abdominal groans/kidney stones/ sitting on the king throne
2. Blood components:
(RBCS: anemia: tiredness/ SOB/ Heart racing/ abdominal pain) +
Symptoms of decrease WBCS (repeated sore throat/ fever/ cough) +
Symptoms of decrease platelet (bleeding easily and bruises)
Plab 2 Revision Notes By Ali Munawar

Back pain Scheme

I) Any back-pain stations if it is not acute then: Start with 2 questions first: upper or lower
back? How about your upper / lower back? + psychosocial (acute pain, no psychosocial)
II) DDS of back pain:
1-AAA: any abdominal pain? Do you feel something pulsating in your tummy?
2- Cauda Equina syndrome: any numbness around your back passage? Can you take
control over your urination? When was the last time you pass urine? Can you take control over
your bowel? When was the last time you pass stool?
3- Multiple Myeloma: DM (polyuria, polydipsia, weight loss) dt increase Ca Decrease blood
(RBCs: anemia/ platelets: bleeding, bruises/ WBCs: repeated infections) 4- trauma / fall /
accident
5- disc prolapse: any numbness, weakness in your legs? Before that pain start, have you felt
a clicking? Have you left up or pushed something heavy?
6- Female: by any chance are you pregnant?
7.Kidney Stone: loin to groin pain + Hematuria
III) Always Ask FLAWS (to exclude cancer)
IV) If it is a male & old age, back pain ask about prostration: do you go to the loo
more often? Do you rush to the loo? Do you have any difficulties starting urination? Can you
maintain good stream during urination? Can you notice any dribbling after voiding? Are you
able to completely emptying your bladder?
V) In examination: Observation + Back + Back passage (PR)/ prostate+ Tummy (AAA) + SLRT
)Patient will be lying down on his back on an examination table, examine you lift the patient leg
while knee is straight between 30-70 pain ((disc prolapse)
VI) In management: Don’t forget pain killers.
In investigations: (x-ray back)
Safety netting always (Cauda equina): if unable to control urine/ bowel/ pain around the
anus come back