back pain

Practice targeted AMC-style multiple-choice questions on back pain.

A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm

Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 70-year-old male presents to his general practitioner complaining of mild, chronic lower back pain that has been present for several months. He describes the pain as a dull ache, worse with prolonged standing. He has a significant past medical history including hypertension, hyperlipidemia, and a 50-pack-year smoking history, all of which are currently managed with medications. He denies any acute abdominal pain, pulsatile sensation, or leg symptoms. On physical examination, his vital signs are stable: blood pressure 135/85 mmHg, heart rate 72 bpm, respiratory rate 14 breaths/min, and oxygen saturation 99% on room air. Abdominal examination is soft, non-tender, with no palpable masses. Peripheral pulses are symmetric and strong. As part of the investigation into his chronic back pain, a contrast-enhanced CT scan of the abdomen and pelvis is performed. An axial view from the scan is shown. Based on the clinical presentation and the findings demonstrated in the provided image, which of the following is the MOST appropriate next step in management?

A. Refer urgently to a vascular surgeon for consideration of immediate endovascular repair.

B. Initiate a program of regular surveillance imaging with ultrasound and aggressively manage cardiovascular risk factors.

C. Reassure the patient that the finding is incidental and benign, and focus solely on managing his chronic back pain.

D. Arrange for immediate admission to hospital for observation and further investigation.

E. Schedule a repeat CT scan with contrast within 3 months to assess for rapid expansion.

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A 70-year-old male presents to the emergency department with severe abdominal and back pain. He has a history of hypertension and smoking. On examination, he is hypotensive and tachycardic. Palpation reveals a pulsatile abdominal mass. What is the most likely diagnosis?

A. Ruptured abdominal aortic aneurysm

B. Renal colic

C. Acute pancreatitis

D. Myocardial infarction

E. Diverticulitis

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Image by RadsWiki — CC BY-SA 3.0 · Source

A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?

A. Elevated urine homogentisic acid

B. Elevated urine vanillylmandelic acid (VMA)

C. Elevated serum lactate dehydrogenase (LDH)

D. Elevated serum amylase

E. Elevated serum alpha-fetoprotein (AFP)

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A 60-year-old woman with a history of breast cancer, treated with surgery and radiation 5 years ago, presents with new-onset back pain. Imaging reveals lytic lesions in the spine. What is the most likely diagnosis?

A. Multiple myeloma

B. Degenerative disc disease

C. Spinal tuberculosis

D. Metastatic breast cancer

E. Osteoporosis

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 72-year-old male presents with new onset back pain. His CT is shown. What is the most appropriate initial management?

A. Lifestyle modification advice

B. Commence beta-blocker therapy

C. Repeat imaging in 12 months

D. Prescribe a statin

E. Referral to vascular surgery

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 72-year-old man presents to his GP with a 3-month history of intermittent lower back pain, which is worse with activity. He has a history of hypertension, hyperlipidaemia, and is a former smoker. Physical examination reveals normal vital signs and no abdominal tenderness or pulsatile mass. Routine blood tests are normal. An abdominal CT scan is performed as part of the workup. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Prescribe analgesia and review in 3 months.

B. Advise no further imaging is necessary.

C. Schedule surveillance ultrasound in 12 months.

D. Refer for urgent vascular surgical consultation.

E. Arrange a repeat CT scan in 6 months.

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He is otherwise asymptomatic with stable vital signs. The image provided is an axial view from this scan. Based on this finding, what is the most appropriate next step in the patient's management according to current guidelines?

A. Schedule elective endovascular aneurysm repair (EVAR).

B. Arrange for urgent surgical consultation.

C. No further follow-up is required.

D. Repeat CT angiography in 6 months.

E. Arrange for surveillance ultrasound in 12 months.

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Image by RadsWiki — CC BY-SA 3.0 · Source

A. Elevated urine vanillylmandelic acid (VMA)

B. Elevated serum lactate dehydrogenase (LDH)

C. Elevated alpha-fetoprotein (AFP)

D. Elevated urine urobilinogen

E. Elevated serum amylase

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He has no history of abdominal pain or pulsatile mass. His blood pressure is 130/80 mmHg. The image provided is an axial view from this scan. Based on this finding and the patient's clinical status, what is the most appropriate next step in management according to current guidelines?

A. Schedule elective endovascular aneurysm repair (EVAR).

B. Arrange for surveillance ultrasound in 12 months.

C. Arrange for urgent surgical consultation.

D. Repeat CT angiography in 6 months.

E. No further follow-up is required.

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

An 80-year-old male with a history of smoking and hypertension presents to his GP with mild, intermittent lower back pain. Physical examination is unremarkable. Routine blood tests are normal. A CT scan of the abdomen is performed to investigate the back pain. Considering the findings demonstrated in the provided image in the context of this patient's presentation, what is the most appropriate next step in management?

A. Refer immediately for surgical consultation for elective repair.

B. Initiate aggressive blood pressure control and repeat imaging in 5 years.

C. Schedule regular surveillance imaging.

D. Perform urgent angiography to assess for rupture risk.

E. Discharge with advice to return if pain worsens significantly.

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He denies abdominal pain or pulsatile mass. His blood pressure is 130/80 mmHg. The provided image is an axial view from this scan. Based on this finding and the patient's clinical status, what is the most appropriate next step in management according to Australian guidelines?

A. Arrange for surveillance ultrasound in 12 months

B. Repeat CT angiography in 6 months

C. Arrange for urgent surgical consultation

D. No further follow-up is required

E. Schedule elective endovascular aneurysm repair (EVAR)

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back pain

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