Post Tutorial 4 - Back Problem ( Datin Vasanthie )

A 52-year-old man presents with left-sided leg pain radiating from the lower back to the lateral aspect of the foot. On examination, he has reduced ankle reflex and weakness in plantarflexion. Which nerve root is most likely affected?

• L4

• L5

• S1

• S2

A 47-year-old man presents with severe lower back pain which has been progressively worsening over the last 6 days. On examination, there is tenderness over the lumbar region, and has persistent pyrexia. Imaging shows evidence of discitis in the region of L4. What is the most likely causative organism?

• Staphylococcus aureus

• Mycobacterium tuberculosis

• Staphylococcus epidermidis

• Haemophilus influenzae

A 70-year-old man complains of leg pain and numbness when walking, which improves on sitting or leaning forward. He walks bent over his trolley for relief. What is the most likely diagnosis?

• Peripheral vascular disease

• Lumbar disc herniation

• Spinal stenosis

• Ankylosing spondylitis

A 16-year-old gymnast complains of low back pain after training. Imaging reveals a pars interarticularis defect with forward slippage of L5 over S1. What is the most likely diagnosis?

• Epidural Abscess

• Compression fracture

• Spondylolysis

• Spondylolisthesis

A 13-year-old boy is referred for spinal asymmetry seen during a sports physical. He has a right thoracic prominence on forward bend test. He is otherwise asymptomatic. What is the next best step?

• Reassure and discharge

• Refer for MRI of spine

• Order standing spinal X-rays

• Prescribe physiotherapy

A 49-year-old man presents with lower back pain, numbness in the perineal area, and new-onset urinary retention. What is the most appropriate next step?

• MRI spine and urgent spinal decompression

• Analgesia and discharge with safety netting

• CT scan

• Refer for physiotherapy

A 42-year-old woman presents with neck pain, unsteady gait, and clumsiness in her hands. Reflexes are brisk and Hoffmann’s sign is positive. What is the most likely diagnosis?

• Cervical myelopathy

• Brachial neuritis

• Carpal tunnel syndrome

• Motor neuron disease

A 70-year-old female with long-standing rheumatoid arthritis complains of increasing back pain and height loss. What is the gold standard investigation to confirm osteoporosis?

• CT spine

• DEXA scan

• MRI spine

• Serum calcium and phosphate

A 57-year-old man with chronic back pain has restricted forward flexion and palpable lumbar paraspinal tenderness. There is no leg radiation. What examination would best assess lumbar function?

• Modified Schober’s test

• Spurling’s test

• Lhermitte’s sign

• Gower’s test

A 37-year-old man presents with chronic back pain associated with cough, low-grade fever, and weight loss. X-ray shows destruction of vertebral endplates and anterior wedging of vertebrae. What is the most likely diagnosis?

• Vertebral metastasis

• Pyogenic osteomyelitis

• Pott’s disease

• Multiple myeloma