Doorway Information About Patient

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The Answer is Approach to the patient
Most patients with acute (<4-6 weeks), uncomplicated low back pain have a benign etiology and will have spontaneous resolution. However, patients with chronic or atypical symptoms are more likely to require diagnostic and therapeutic intervention. For this reason, the evaluation of patients with back pain should give careful attention to duration of symptoms and other features that might suggest a poor prognosis.
In addition, patients with possible infection, malignancy, or bony injury (eg, compression fracture) may require more aggressive evaluation. These red flag features include:
Age >50
History of cancer
Constitutional symptoms (eg, fever, weight loss)
Nocturnal pain
No response to appropriate treatment
Significant neurologic deficits
Differential diagnosis
$Approach to the patient Most patients with acute (<4-6 weeks), uncomplicated low back pain have a benign etiology and will have spontaneous resolution. However, patients with chronic or atypical symptoms are more likely to require diagnostic and therapeutic intervention. For this reason, the evaluation of patients with back pain should give careful attention to duration of symptoms and other features that might suggest a poor prognosis. In addition, patients with possible infection, malignancy, or bony injury (eg, compression fracture) may require more aggressive evaluation. These red flag features include: Age >50 History of cancer Constitutional symptoms (eg, fever, weight loss) Nocturnal pain No response to appropriate treatment Significant neurologic deficits Differential diagnosis The differential diagnosis is heavily dependent on age, comorbid and historical conditions (eg, history of malignancy), and risk factors (eg, intravenous drug use for infectious causes, menopausal state for osteoporosis). The most common causes of back pain and the major clinical clues are listed in the table. History and physical examination In addition to the standard medical history and physical examination, the following sections include most common items that should be included in the evaluation of a patient with back pain. Closing the encounter Treatment is not tested as part of Step 2 CS, but diagnostic testing for patients with back pain is oriented toward identifying which patients can be managed conservatively with simple analgesics and which will need more aggressive treatment. In light of this, discuss the factors in the history and physical examination that are most relevant in guiding subsequent testing and treatment: Patients with acute, uncomplicated back pain are managed conservatively, without additional testing. Advise the patient to maintain moderate activity. Patients with prolonged or recalcitrant pain may require more complex interventions (eg, physical therapy). Patients with red flag features warrant specific imaging tests. Patients with severe or worsening neurologic deficits may require surgical intervention and will need imaging and/or electrodiagnostic studies. Diagnostic studies Imaging for uncomplicated low back pain is not recommended. If no additional testing is required, write No studies indicated in the Diagnostic Studies section of the patient notes. Diagnostic tests that can be considered for patients with back pain include: X-rays: Reduced range of motion, suspected malignancy, compression fracture Inflammatory markers (eg, ESR or C-reactive protein): Suspected malignancy or infection MRI: Neurologic deficits, cauda equina syndrome Radionuclide bone scan: Patients unable to undergo MRI Electrodiagnostics (eg, nerve conduction studies): Radicular pain likely to require surgery Urinalysis: Kidney stones, pyelonephritis CBC: Infection, hematologic malignancy BUN, creatinine: Kidney stones, urinary obstruction$
The differential diagnosis is heavily dependent on age, comorbid and historical conditions (eg, history of malignancy), and risk factors (eg, intravenous drug use for infectious causes, menopausal state for osteoporosis). The most common causes of back pain and the major clinical clues are listed in the table.
History and physical examination
In addition to the standard medical history and physical examination, the following sections include most common items that should be included in the evaluation of a patient with back pain.
$Approach to the patient Most patients with acute (<4-6 weeks), uncomplicated low back pain have a benign etiology and will have spontaneous resolution. However, patients with chronic or atypical symptoms are more likely to require diagnostic and therapeutic intervention. For this reason, the evaluation of patients with back pain should give careful attention to duration of symptoms and other features that might suggest a poor prognosis. In addition, patients with possible infection, malignancy, or bony injury (eg, compression fracture) may require more aggressive evaluation. These red flag features include: Age >50 History of cancer Constitutional symptoms (eg, fever, weight loss) Nocturnal pain No response to appropriate treatment Significant neurologic deficits Differential diagnosis The differential diagnosis is heavily dependent on age, comorbid and historical conditions (eg, history of malignancy), and risk factors (eg, intravenous drug use for infectious causes, menopausal state for osteoporosis). The most common causes of back pain and the major clinical clues are listed in the table. History and physical examination In addition to the standard medical history and physical examination, the following sections include most common items that should be included in the evaluation of a patient with back pain. Closing the encounter Treatment is not tested as part of Step 2 CS, but diagnostic testing for patients with back pain is oriented toward identifying which patients can be managed conservatively with simple analgesics and which will need more aggressive treatment. In light of this, discuss the factors in the history and physical examination that are most relevant in guiding subsequent testing and treatment: Patients with acute, uncomplicated back pain are managed conservatively, without additional testing. Advise the patient to maintain moderate activity. Patients with prolonged or recalcitrant pain may require more complex interventions (eg, physical therapy). Patients with red flag features warrant specific imaging tests. Patients with severe or worsening neurologic deficits may require surgical intervention and will need imaging and/or electrodiagnostic studies. Diagnostic studies Imaging for uncomplicated low back pain is not recommended. If no additional testing is required, write No studies indicated in the Diagnostic Studies section of the patient notes. Diagnostic tests that can be considered for patients with back pain include: X-rays: Reduced range of motion, suspected malignancy, compression fracture Inflammatory markers (eg, ESR or C-reactive protein): Suspected malignancy or infection MRI: Neurologic deficits, cauda equina syndrome Radionuclide bone scan: Patients unable to undergo MRI Electrodiagnostics (eg, nerve conduction studies): Radicular pain likely to require surgery Urinalysis: Kidney stones, pyelonephritis CBC: Infection, hematologic malignancy BUN, creatinine: Kidney stones, urinary obstruction$ $Approach to the patient Most patients with acute (<4-6 weeks), uncomplicated low back pain have a benign etiology and will have spontaneous resolution. However, patients with chronic or atypical symptoms are more likely to require diagnostic and therapeutic intervention. For this reason, the evaluation of patients with back pain should give careful attention to duration of symptoms and other features that might suggest a poor prognosis. In addition, patients with possible infection, malignancy, or bony injury (eg, compression fracture) may require more aggressive evaluation. These red flag features include: Age >50 History of cancer Constitutional symptoms (eg, fever, weight loss) Nocturnal pain No response to appropriate treatment Significant neurologic deficits Differential diagnosis The differential diagnosis is heavily dependent on age, comorbid and historical conditions (eg, history of malignancy), and risk factors (eg, intravenous drug use for infectious causes, menopausal state for osteoporosis). The most common causes of back pain and the major clinical clues are listed in the table. History and physical examination In addition to the standard medical history and physical examination, the following sections include most common items that should be included in the evaluation of a patient with back pain. Closing the encounter Treatment is not tested as part of Step 2 CS, but diagnostic testing for patients with back pain is oriented toward identifying which patients can be managed conservatively with simple analgesics and which will need more aggressive treatment. In light of this, discuss the factors in the history and physical examination that are most relevant in guiding subsequent testing and treatment: Patients with acute, uncomplicated back pain are managed conservatively, without additional testing. Advise the patient to maintain moderate activity. Patients with prolonged or recalcitrant pain may require more complex interventions (eg, physical therapy). Patients with red flag features warrant specific imaging tests. Patients with severe or worsening neurologic deficits may require surgical intervention and will need imaging and/or electrodiagnostic studies. Diagnostic studies Imaging for uncomplicated low back pain is not recommended. If no additional testing is required, write No studies indicated in the Diagnostic Studies section of the patient notes. Diagnostic tests that can be considered for patients with back pain include: X-rays: Reduced range of motion, suspected malignancy, compression fracture Inflammatory markers (eg, ESR or C-reactive protein): Suspected malignancy or infection MRI: Neurologic deficits, cauda equina syndrome Radionuclide bone scan: Patients unable to undergo MRI Electrodiagnostics (eg, nerve conduction studies): Radicular pain likely to require surgery Urinalysis: Kidney stones, pyelonephritis CBC: Infection, hematologic malignancy BUN, creatinine: Kidney stones, urinary obstruction$ Closing the encounter
Treatment is not tested as part of Step 2 CS, but diagnostic testing for patients with back pain is oriented toward identifying which patients can be managed conservatively with simple analgesics and which will need more aggressive treatment. In light of this, discuss the factors in the history and physical examination that are most relevant in guiding subsequent testing and treatment:
Patients with acute, uncomplicated back pain are managed conservatively, without additional testing. Advise the patient to maintain moderate activity.
Patients with prolonged or recalcitrant pain may require more complex interventions (eg, physical therapy).
Patients with "red flag" features warrant specific imaging tests.
Patients with severe or worsening neurologic deficits may require surgical intervention and will need imaging and/or electrodiagnostic studies.
Diagnostic studies
Imaging for uncomplicated low back pain is not recommended. If no additional testing is required, write "No studies indicated" in the Diagnostic Studies section of the patient notes.
Diagnostic tests that can be considered for patients with back pain include:
X-rays: Reduced range of motion, suspected malignancy, compression fracture
Inflammatory markers (eg, ESR or C-reactive protein): Suspected malignancy or infection
MRI: Neurologic deficits, cauda equina syndrome
Radionuclide bone scan: Patients unable to undergo MRI
Electrodiagnostics (eg, nerve conduction studies): Radicular pain likely to require surgery
Urinalysis: Kidney stones, pyelonephritis
CBC: Infection, hematologic malignancy
BUN, creatinine: Kidney stones, urinary obstruction

Doorway Information About Patient

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Doorway Information About Patient

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