Print Friendly, PDF & Email

Common Lower Back Pain exam questions for medical finals, OSCEs and MRCP PACES


Question 1.

What are the features of inflammatory back disease?

  • Insidious onset
  • Onset at young age
  • Worse in the morning
  • Improves with exercise

Question 2.

What are the red flag symptoms in lower back pain?

  • Patient factors
    • Age <20 or >55
    • Current or recent infection (especially TB, but staph and others will infect the spine)
    • Immunosuppression (infection)
    • Abdominal mass (malignancy)
  • Symptoms
    • Acute onset in elderly (think osteoporotic fracture)
    • Constant or progressive pain
    • Pain at night
    • Pain when supine (pain usually improves on lying flat in mechanical back problems)
    • Morning stiffness
    • Fever, high sweats, weight loss (malignancy)
    • Thoracic back pain
    • Bilateral or alternating symptoms
    • Neurological abnormalities (weakness, numbness)
    • Sphincter disturbance (incontinence of urine and faeces)
    • Leg ‘claudication’ (? Spinal stenosis)


Question 3.

What are the indications for an MRI in lower back pain?

  • If you are suspecting:
  • Cord compression
  • Cauda equina
  • Infection
  • Malignancy
  • Acute fracture
  • Inflammatory back disease


Question 4.

What are the common causes of cauda equina and cord compression?

  • Large, central disc protrusion
  • Cancer
    • Bone metastases
    • Myeloma
    • Cord or paraspinal tumour
  • Infection
    • TB
    • Abscess