CHIR%20878%20workbook%202009%20weeks%201-7%20answers -...

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1 CASES FOR TUTORIALS …… answers to medical questions
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WEEK 1 CASE – MR APIS QUESTION 1 What are the causes of low back pain in older patients? Classified by pathologies: ± traumatic e.g. muscle strain, joint damage, fractures, ligamentous sprains ± structural alterations ± inflammatory e.g. pancreatitis, acute pyelonephritis, arthritides ± infections e.g. osteomyelitis, spinal abscesses, pelvic infection, renal infections ± degenerative e.g. osteoarthritis ± hormonal e.g. dysmenorrhoea, pre-menstrual syndrome ± metabolic alterations e.g. osteoporosis, osteomalacia, Paget’s disease ± activity related o following prolonged periods of recumbency or inactivity o prolonged periods of activity ± neoplastic: primary and secondary ± psychogenic e.g. stress related muscle contraction ± malingering ± idiopathic ± iatrogenic Classified by anatomy ± disorders of the vertebral column o disc protrusion o fractures o spondylosis o spondylolisthesis o intervertebral disc disease o spinal stenosis o inadequacies of vertebral column supporting structures e.g. ligaments, bone o bony tumours: primaries (e.g. multiple myeloma) and metastases o Scheuermann’s disease o ankylosing spondylitis o infections e.g. osteomyelitis, tuberculosis o facet joint disorders o other arthritides e.g. osteoarthritis, rheumatoid arthritis, osteitis condensans ilii o disorders of sacrum e.g. sacroiliitis o disorders of the coccyx e.g. coccydynia ± disorders of paravertebral muscle and/or myofascial tissue: strain or sprain, muscle spasm, myositis, inflammation of fascial attachments ± disorders of anterolateral abdominal wall eg trauma, post surgical, ± disorders of digestive system: pancreatic diseases, some intestinal diseases (eg irritable bowel syndrome), severe constipation, faecal impaction, following prolonged vomiting or diarrhoea ± disorders of reproductive system: endometriosis, uterine fibroids, uterine prolapse, dysmenorrhoea, pelvic inflammatory disease, malignancies (e.g. prostate, uterine, ovarian), ovarian cysts, adenomyosis ± disorders of urinary system: renal or ureteric calculi, renal neoplasms, acute pyelonephritis and other urinary tract infections ± disorders of cardiovascular system: e.g. dissecting aortic aneurysms ± disorder of nervous system e.g. herpes zoster, spinal abscess or spinal cord tumour (if pain sensitive structures irritated) ± functional somatic syndromes: fibromyalgia, chronic fatigue syndrome ± others: osteoporosis, lymphomas, Cushing’s syndrome, expanding dermatological growths, Paget’s disease, some connective tissue disorders, pregnancy QUESTION 2 What specific information do we need (if any) from Mr. Apis in order to clarify our thinking? Ask about the Pain
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CHIR%20878%20workbook%202009%20weeks%201-7%20answers -...

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