Back Pain :: PLAB 2 Symptomatic Differential Stations

• Spinal cord compression

  • Other presenting symptoms 

    • Severe progressive bilateral pain in lower limbs

    • Recent onset urinary retention and/or incontinence

    • Recent onset of fecal incontinence

    • Saddle paraesthesia

  • Past history and PMAFTOSA

  • Social DVLA, work for time off

  • Exam and Invs

    • GPE, vitals, 

    • Back exam

    • Straight leg raise test

    • Neurological exam

    • PR exam

    • Supine Xray

    • MRI

  • Referral Orthopedics

  • Treatment 

    • Catheter for urine, 

    • Diazepam for muscle spasms, 

    • Strong painkiller

    • Surgery

  • Warning signs 

• Spinal metastasis/ Multiple myeloma

  • Other presenting symptoms 

    • FLAWS

  • Past history and PMAFTOSA

  • Social DVLA, work for time off

  • Exam and Invs

    • GPE, vitals, 

    • Back exam

    • Straight leg raise test

    • Neurological exam

    • PR exam

    • Lymph node examination

    • Xray spine

  • Referral 2-week cancer referral

  • Treatment 

  • Warning signs: Any blood in stools or urine, hemoptysis, SOB, chest pain

• Pyelonephritis:

• Ankylosing spondylitis

  • Other presenting symptoms 

    • Worse in the morning and after rest

    • Better after moving

    • Stiffness

    • Anterior uveitis

  • Past history and PMAFTOSA: Other autoimmune diseases, Eye problems

  • Social DVLA, work for time off

  • Exam and Invs

    • GPE, vitals 

    • Back exam

    • Straight leg raise test

    • Neurological exam

    • PR exam

    • Xray spine

    • ESR, CRP

  • Referral Rheumatologist

  • Treatment 

    • NSAIDs in GP

    • DMARDs in specialist

    • Physiotherapy

    • Regular osteoporosis assessment

  • Warning signs: Eye symptoms: redness, blurry vision, eye pain

• Intervertebral disc prolapse

  • Other presenting symptoms 

    • After big trauma or lifting heavy weights.

  • Past history and PMAFTOSA

  • Social DVLA, work for time off

  • Exam and Invs

    • GPE, vitals, 

    • Back exam

    • Straight leg raise test

    • Neurological exam

    • PR exam

    • Spine Xray

  • Referral Orthopedics

  • Treatment 

    • Moderate painkiller

    • Diazepam for muscle spasms

    • Physiotherapy

  • Warning signs

    • Weakness, tingling sensation, or sensory loss in your legs

    • Bowel problems

    • Urinary problems

• AAA

  • Other presenting symptoms 

    • Tearing abdominal pain, dizziness, fainting, pain in leg

  • Past history and PMAFTOSA: hypercholesterolaemia, smoking, family history, high blood pressure

  • Social DVLA, work for time off

  • Exam and Invs

    • GPE, vitals, 

    • Back exam

    • Straight leg raise test

    • Neurological exam

    • PR exam

    • Radiofemoral delay

  • Referral Vascular surgery

  • Treatment 

    • Moderate painkiller

    • Depends on the size of the aneurysm

  • Warning signs

    • Dizziness, fainting

• Renal colic:

• Sprain

  • Other presenting symptoms 

    • Small trauma history

  • Past history and PMAFTOSA

  • Social DVLA, work for time off

  • Exam and Invs

    • GPE, vitals, 

    • Back exam

    • Straight leg raise test

    • Neurological exam

    • PR exam

  • Referral Orthopedics if doesn’t respond to treatment 

  • Treatment 

    • Moderate painkiller

    • Do PRICE, Avoid HARM

  • Warning signs

    • Weakness, tingling sensation, or sensory loss in your legs

    • Bowel problems

    • Urinary problems