Low Back Pain & Sciatica: Red Flags, Diagnosis & Rehab MCQs

Low Back Pain (LBP) & Sciatica

Low Back Pain is the second most common reason for visiting a doctor (after the common cold). The primary goal in assessment is not just to diagnose the tissue, but to rule out dangerous pathology.

1. Diagnostic Triage

We classify LBP into three categories:

• Non-Specific LBP (Mechanical): 90% of cases. Strain, sprain, degenerative changes. Pain varies with posture/activity.
• Nerve Root Pain (Radicular): Sciatica (Disc herniation, Stenosis). Leg pain > Back pain.
• Serious Pathology (Red Flags): Fracture, Tumor, Infection, Cauda Equina.

2. The Flag System

RED FLAGS (Medical Emergency/Referral):
- Age < 20 or > 55 (onset).
- History of Cancer, Trauma, Steroid use.
- Weight loss, Fever, Night pain.
- Cauda Equina signs (Saddle anesthesia, incontinence).

YELLOW FLAGS (Chronicity Risk):
- Psychosocial factors: Fear-avoidance beliefs, anxiety, depression, "passive" coping style.

3. Management Principles

• Acute: Stay active (Bed rest < 2 days), NSAIDs, reassurance.
• Chronic: Multidisciplinary rehab. Address Yellow Flags (Cognitive Behavioral Therapy). Core strengthening.

25 Practice MCQs

Q1. The most common cause of Low Back Pain is:

Answer: A). 90% of cases have no identifiable specific pathology.

Q2. "Red Flags" are signs of:

Answer: B). Requiring immediate investigation.

Q3. "Yellow Flags" indicate:

Answer: A). Fear-avoidance, catastrophizing, etc.

Q4. Saddle anesthesia is a Red Flag for:

Answer: A). Surgical emergency.

Q5. Sciatica is typically defined as pain radiating:

Answer: A). Following the L5 or S1 dermatome.

Q6. Prolonged bed rest (> 2 days) for acute LBP is:

Answer: A). Keeping active prevents deconditioning and stiffness.

Q7. Night pain that wakes a patient from sleep is a Red Flag for:

Answer: A). Mechanical pain usually improves with rest.

Q8. Spondylogenic Back Pain originates from:

Answer: A). Primary back pain.

Q9. Piriformis Syndrome mimics Sciatica by compressing the nerve at the:

Answer: A). Non-spinal cause of sciatic pain.

Q10. Unexplained weight loss in a back pain patient suggests:

Answer: A). A major Red Flag.

Q11. "Fear-Avoidance Beliefs" leads to:

Answer: A). Patients stop moving because they think "Hurt = Harm".

Q12. Meralgia Paresthetica involves compression of:

Answer: A). Causes thigh numbness, often confused with L3 radiculopathy.

Q13. Which visceral organ pathology commonly refers pain to the back?

Answer: A). Always check costovertebral angle tenderness.

Q14. Ankylosing Spondylitis typically presents as:

Answer: A). Inflammatory back pain.

Q15. FABER test (Patrick's test) assesses:

Answer: A). Flexion, Abduction, External Rotation.

Q16. Long-term steroid use is a risk factor for:

Answer: A). Red flag requiring X-ray.

Q17. Core stability involves which "local" muscle system?

Answer: A). Stabilizers of the lumbar segments.

Q18. "Blue Flags" refer to:

Answer: A). Occupational barriers to recovery.

Q19. The "Centralization Phenomenon" (McKenzie) is a sign of:

Answer: A). Indicates the disc is reducing.

Q20. Discogenic pain is often aggravated by:

Answer: A). While Facet/Stenosis pain is worse with Extension/Walking.

Q21. Is X-ray required for acute LBP (< 4 weeks) without Red Flags?

Answer: B). Clinical guidelines advise against early imaging.

Q22. Hoover's Test helps identify:

Answer: A). Lack of downward pressure in the "good" heel when lifting the "bad" leg.

Q23. Coccydynia is pain in the:

Answer: A). Use a donut cushion.

Q24. Lasegue's Test is a variation of:

Answer: A). Adds sciatic stretch.

Q25. 90% of acute low back pain resolves within:

Answer: A). Prognosis is generally good.