I. Symptom: Low back pain, 42 y/o

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I. Symptom: Low back pain, 42 y/o. Consider: Metabolic x Infection Autoimmune/Inflammatory Neoplasm Degenerative Trauma Congenital x Vascular x. Infection. 1. UTI- ask for other GU symptoms, dysuria , discharge
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I. Symptom: Low back pain, 42 y/oConsider:
  • Metabolic x
  • Infection
  • Autoimmune/Inflammatory
  • Neoplasm
  • Degenerative
  • Trauma
  • Congenital x
  • Vascular x
  • Infection1. UTI- ask for other GU symptoms, dysuria, discharge2. Pelvic Inflammatory Disease- ask for sexual history, other GU symptoms, vaginal discharge3. Endometriosis - ask for timing of pain, history of heavy menstrual bleeding, other symptoms fatigue, pain with intercourse, diarrhea, constipation, painful bowel movements during the menstrual period, rectal bleeding or blood in urine only during the menstrual period, and irregular bleeding or spotting between periods4. Osteomyelitis - ask for tenderness, swelling and warmth in the affected area; avoidance of use in the affected part; malaise, loss of appetite, fever, nausea, fatigue, irritability5. spinal infection- ask for fever, night sweats, and recent weight loss; check for elevated erythrocyte sedimentation rate and, spinous tenderness on percussion.Degenerative1. Osteoporosis- patient its over 40 years of age; ask thoroughly focusing on risk factors2. Lumbar disc herniation- a slowly progressive degenerative process; ask for distribution of pain in the body 3. Acquired spinal stenosis- a consequence of degenerative joint disease that has been present for many years; ask for insidious pain at lower back and buttocks radiating to the legs; burning sensation in the buttocks and posterior thighs; pain typically increases with walking and is relieved by rest. The patient may also feel better when he or she bends at the waist, because the diameter of the spinal canal is increased with flexion and decreased with extension; patient with spinal stenosis feels worse with hyperextension.4. Spondylolisthesis- ask for progressive neurological deficit, caudaequina syndrome, or unremitting leg pain; affects women more than menInflammatory1. AnkylosingSpondylitis- ask for pattern of pain (usually worse in the morning and improving through the day) and stiffness experienced over 3 months; ask for pain in sacrum, lumbar spine and thoracic spine and other peripheral joints; family history2. Rheumatoid Arthritis- consider the criteria (presence of four of the following): (1) morning stiffness in and around joints that lasts for longer than one hour (2) arthritis (pain and inflammation) with swelling of three or more joints simultaneously (3) at least one of the joints referred to in (2) must be in the hand (4) symmetric arthritis with simultaneous involvement of the same joint bilaterally (5) rheumatoid nodules over bony prominences or near joints (6) positive serum rheumatoid factor (RF) (7) x-ray changes typical of RA.Neoplasm1. spinal tumor (Primary)- severe and progressive pain, which commonly occurs during the night; slow and progressive neurological loss2. OsteoidOsteoma- back pain that becomes worse at night, but is relieved by taking aspirin; look for visible bone loss on x-ray studies.3. Metastatic spinal tumors- history of breast ca; unexplained weight loss; ask for other non- spinal symptom; ask for relief of pain: Degenerative Joint Disease is typically relieved by rest while metastatic bone pain is not 4. Multiple MyelomaTrauma1. Spinal Fracture- ask for any history of major and minor trauma e.g. falls; ask for neurologic deficits and paralysis2. CaudaEquina syndrome- ask for bilateral leg pain, numbness, and/or weakness, as well as bowel and bladder incontinence, saddle anesthesia around the anus and buttocks; may be due to spinal stenosis, a spinal cord lesion, a very large posterior disc herniation, an inflammatory reaction, or a combination of all of these pathologiesII. Signs and Symptoms : low back pain mostly in the evening for 6 mos., temporarily relieved by Mefenamic acid; progression of pain slightly relieved by another pain killer (unrecalled); weight loss; previously diagnosed to have Invasive Ductal Carcinoma Stage III-B(-) hx of trauma(-) signs of infection, fever(-) asthma, allergy(-) Cardiorespiratory symptoms except for dyspnea on exertion(-) GU symptoms(-) Abdominal symptoms(-) Neurologic problemsII. Symptoms: low back pain mostly in the evening for 6 mos., temporarily relieved by Mefenamic acid; progression of pain slightly relieved by another pain killer (unrecalled); weight loss; previously diagnosed to have Invasive Ductal Carcinoma Stage III-BConsider:Neoplastic 1. Spinal tumor (Primary)- (+) severe and progressive pain, which commonly occurs during the night; ask if there is slow and progressive neurological loss 2. OsteoidOsteoma- (+) back pain that becomes worse at night, but should be relieved by taking aspirin; look for visible bone loss on x-ray studies. 3. Metastatic spinal tumors- (+) history of breast cancer, weight loss; soft palpable liver, 10 cm liver span which may indicate metastasis to the liver; ask for relief of pain: Degenerative Joint Disease is typically relieved by rest while metastatic bone pain is not III. Symptoms: above signs and symptoms plus labsInsert lab results III. Symptoms: above signs and symptoms plus labsHypercalcemia- may indicate cancer especially in the ff cases:
  • Multiple myeloma
  • Breast cancer
  • Squamous Cell Lung cancer
  • Renal cancer
  • These have high propensity to spread to the bones and release calcium into the blood. Some tumors secrete parathyroid-related peptide which acts like PTH.III. Symptoms: above signs and symptoms plus labsConsider:
  • Neoplasm- Metastatic spinal tumor
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