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goatMaster goatMaster
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6 years ago
A 60-year-old male office worker presents to a clinic complaining of new onset of lower back pain that has been worsening over the last 6 weeks.
 
  The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)?
  A)
  His pain is relieved by extended bed rest.
  B)
  When supine, passive rising of his leg to 90 degrees results in hamstring pain.
  C)
  He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in recent weeks.
  D)
  His onset of pain has been gradual, and he has no prior history of lower back problems.
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6 years ago
Ans:
D

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The gradual onset of back pain unrelated to injury and initial presentation after age 50 are considered red flags for more serious pathologies such as aortic aneurysm, malignancy, or compression fracture. Pain that is aggravated by lying down is a red flag for malignancy or infection. The onset of hamstring pain at 90 degrees of hip flexion is a normal finding. The need for and use of NSAIDs for lower back pain relief are not indicative of a serious pathology in and of itself.
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