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1. 80% if the back pain is lumbar strain, mostly seen in ages 30-60, associated with overuse.
If shooting down the leg, consider pinch nerve due to herniated disc (3-4%);
If >70 yr female with osteoporosis, consider compression fracture (3-4%);
If worse walking upright, consider spinal stenosis (3%);
If in ages 20-30 and better with activity, consider spondyloarthritis (<1%);
If losing weight with history of cancer, consider cancer;
If developing fever in immunocompromised patient, consider infection/abcess.
2. Red Flags: Age>50, history of cancer, fever, pain worse at night or lying down, morning stiffness, urinary symptoms, bilateral sciatica, numbness in the pelvis, steroid use, injection drug use.
3. Localizing lesion based on symptoms
L3 - anterior thigh and knee;
L4 - anterior shin;
L5 - dorsum of the foot;
L5/S1 - lateral and posterior calf
S1 - heel.
4. Localizing lesion based on physcial exam
L4 nerve root - decreased patellar reflex, weak rising from squat
L5 nerve root - weak great toe dorsiflexion, weak heel walk
S1 nerve root - decreased ankle reflex, weak toe walk
1. The acid helps to digest food, but it may go in the wrong direction, causing acid reflex and burning
2. Eat: a low-fat diet
3. Do not eat: chocolate, tomatoes, tomato sauces, oranges, pineapple and grapefruit, mint, coffee, alcohol, carbonated beverages, and black pepper
4. Mild: try Tums or Pepcid
5. Moderate: try omeprazole
6. Severe: see your family doctor
1. Female much easier to get infected
2. Typical symptoms: lower belly pain, burning pain when peeing, urinary urgency, and frequency
3. Watch for fever and flank pain for a complication of kidney infection (pyelonephritis)
4. Usually improving fast with appropriate antibiotics
1. Flank pain, radiating to the groin area
2. Adequate hydration
RUQ belly pain
RLQ belly pain
Lower belly, can be bilateral
No gas or bowel movement
Diarrhea
others
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