NR667/ NR 667 VISE (New 2023/ 2024
Update) Guide with Questions and Verified
Answers| 100% Correct- Chamberlain
QUESTION
Etiology: Back
... [Show More] pain
Answer:
-Often unclear
-Can be caused by tearing or stretching of nerves, muscles, tendons, ligaments, discs, or fascia
secondary to trauma or chronic mechanical stress
-Can occur as a symptom of a degenerative disorder (spinal stenosis, DDD, disc herniation)
-Compression or irritation of a nerve root can occur along with back pain, causing radiculopathy
-Most commonly affected discs are L4-L5, and L5-S1
QUESTION
Risk factors: Back pain
Answer:
-Obesity
-Sedentary lifestyle > inadequate conditioning
-Smoking
-Preexisting psychological conditions
-Chronic occupational strain with improper lifting techniques
-Exaggerated lumbar lordosis, chronic poor posture
-Leg length discrepancy
-Age > 65
-Job dissatisfaction
QUESTION
Assessment findings: Back pain
Answer:
-Cauda equina is a surgical emergency that presents with back pain + 1. perineal anesthesia, 2.
loss of bladder/bowel control, 3. loss of rectal sphincter tones with digital exam, 4. bilateral
radicular pain, numbness and weakness
-Back, but, and thighs may be aggravated by movement, rising from seated position, standing,
and flexion; may be relieved by rest, repositioning, or reclining
-Muscle spasm may be present over lumbosacral area due to ligament or muscle involvement
-Pain may radiate down leg below knee with with spinal nerve irritation and radiculopathy
-Motor, sensory, and reflex exams are essential; note asymmetry of findings
-Observe gait, lower extremity strength, and muscle bulk
QUESTION
Differential Diagnosis: Back pain
Answer:
*New onset radicular pain in older patients is often a sign of spinal stenosis
-Low back strain
-Herniated disc
-Multiple myeloma
-Osteomyelitis
-Prostatitis, pyelonephritis
-Vascular occlusion at level of bifurcation; AAA
-Carcinoma if bony metastasis occurs
-Endometriosis, fibromyalgia
-Depression, hysteria
-Malingering (get out of work card)
-Compression fracture, osteoporosis
-Osteoarthritis
-Ankylosing spondylitis
-Cauda equina
-Hip/pelvic pathology
-Drug-seeking
QUESTION
Final diagnosis: Back pain
Answer:
-Routine imaging is nor recommended with new onset mechanical back pain and no red flags
-Red flags: cauda equina, fracture, malignancy, infection
-Lack of improvement over 6-8 weeks warrants AP and lateral x-rays of the spine
-Red flags or severe/progressive neuro deficits, consider MRI, CT, bone scan, CBC, ESR, UA
QUESTION
Prevention: Back pain
Answer:
-Proper lifting technique, body mechanics, and posture
-Conditioning exercises
-Maintenance of appropriate weight for height
-Avoid smoking
QUESTION
Non-pharm management: Back pain
Answer:
-Patient education and reassurance that recovery occurs in 6-8 weeks in 80-90% of patients
-Avoid bed rest; no more than 1-2 days
-PT: for subacute or chronic back pain
-Chiropractics: limited evidence of improvement
-Acupuncture: short-term pain relief
-Hot/cold application for 20-30 mins several times per day
-Gradually resume activities as tolerated
-Shoe insoles recommended for leg length discrepancies
-CBT to reduce disability related to subacute and chronic pain
QUESTION
Pharmacological management: Back pain
Answer:
-Tylenol: common first-line agent
-NSAIDs: effective first-line agent for short-term relief of acute and subacute low back pain; all
are though to have equal efficacy
-Muscle relaxers: to reduce/eliminate muscle spasm
-Opioids: effective but significant concern for abuse, misuse, and addiction
-Tramadol: for acute or chronic back pain; short-term use
-Antidepressants: TCAs can be used for chronic back pain
-Topical agents: little evidence
-Steroid: No evidence supports use in acute non-specific low back pain
QUESTION
Follow-up: Back pain
Answer:
-Return for evaluation in 24-48 hours if pain is severe, or in 7-10 days if pain is moderate [Show Less]