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1. Which of the following statements is/are TRUE regarding lumbar disk disease?
A. Symptoms may be unilateral or bilateral
B. Fever accompanies lumbar disk disease
C. Lumbar disk disease is most likely to occur at the L4-L5 and L5-S1 levels
D. A and C
2. True or False. MRI is the optimal imaging method for soft tissue structures while CT myelography is effective for imaging of the lateral recess of the spinal canal.
3. Which of the following conditions is/are possibly present in a patient who is asymptomatic for back pain?
A. Lumbar spinal stenosis (LSS)
B. Compression fractures
C. Ruptured disk
D. All of the above
4. True or False. Disk protrusions are critical signs to look for on MRI imaging when making management decisions for back pain.
5. Upper abdominal diseases usually refer pain to the __________ region of the spine, while lower abdominal diseases usually refer pain to the __________ region.
B. Lower thoracic; sacral
C. Lower thoracic or upper lumbar; midlumbar
D. Midlumbar; sacral
1. D. A and C - According to the 19th edition of Harrison’s Principles of Internal Medicine, lumbar disk disease is most likely to occur at the L4-L5 or L5-S1 levels, although upper lumbar levels can also be involved at times, and symptoms can be bilateral, though they are usually unilateral. Patient symptoms such as fever, constant pain that is unconnected to position, and sphincter abnormalities are more suggestive of disease other than lumbar disk disease.
2. A. True
3. D. All of the above - LSS refers to a narrowed lumbar spinal canal and is often asymptomatic. A ruptured disk may be asymptomatic, and up to two-thirds of compression fractures detected on radiologic imaging are asymptomatic.
4. B. False - Disk protrusions and contrast-enhancing tears in the annulus fibrosus are common sources of back pain but they can also be present in patients who are asymptomatic. According to the 19th edition of Harrison’s Principles of Internal Medicine, such phenomena “are common incidental findings that, by themselves, should not dictate management decisions for patients with back pain.”
5. C. Lower thoracic or upper lumbar; midlumbar - Upper abdominal diseases typically refer pain to the spine’s lower thoracic or upper lumbar region, while lower abdominal diseases refer to the midlumbar region.
For full information :
Engstrom JW, Deyo RA. Chapter 22: Back and neck pain. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine; vol. I. 19th edition. New York: McGraw-Hill Education; 2015: 111-123.