Lower Back Pain

A frequently tested topic in the OSCE part of the MCEM Examinations

History taking
Examination

Remember if the station involves history, go about in these steps:

Hi, My name is Dr.                                , one of the emergency department registrars. May I know your name please? How old are you? And What do you do for your living?

I understand that you have back pain.... I would like to give you some medications for your pain. Well,... I have been asked to take a history about your pain, Is that Okay with you?

Ask SOCRATES of pain, Past similar complaints, Allergies, Past Medical & Surgical History, Medications, Urinary and GI habits, Social history.

Remember to look for REDFLAGS: TUNA FISH

T     Trauma, Tuberculosis
U     Unexplained loss of weight, Night sweats
N     Neurological Deficits, Bowel & Bladder incontinence
A     <20 and="">55
F     Fever
I      IVDU
S     Steroid use or immunosuppressed
H    History of Cancer, early morning stiffness

Ask for Physical examination to be performed, and certain tests like FBC, U & E, CRP, X ray and/or MRI

Thank the patient and Examiner

1. For OSCEs asking for physical examination, remember the following things:

Hi, My name is Dr.                                , one of the emergency department registrars. I understand that you have back pain.... I would like to give you some medications for your pain. Also, I would like to do a physical examination on you. Is that Okay with you?

Before I begin, I would like to know/obtain the vital signs of my patient.

The examination of spine consists of:

1. Range of movements of spine
2. Neurological examination of the lower limb
3. Nerve Stretch tests: SLR, Femoral Stretch tests
4. Gait

Read the question carefully, as they may just ask you to perform specific components. Look for the following videos for further idea about the examination.

(Video Credits: Dr Claire B. & Dr Simon C.)