American Board of Internal Medicine (ABIM) Certification Practice Exam

What should clinicians consider when evaluating patients with chronic low back pain?

1. The presence of red flags

2. Previous treatment failures

3. Family history of back pain

4. Employment status

The correct answer is: The presence of red flags

When evaluating patients with chronic low back pain, it is crucial for clinicians to consider the presence of red flags. Red flags are indicators that suggest the possibility of serious underlying conditions that may require further investigation or intervention. These can include signs of systemic disease (such as fever or unexplained weight loss), neurological deficits (like weakness or numbness), and histories of trauma or malignancy. Identifying red flags is essential because they help clinicians distinguish between typical mechanical low back pain and more serious conditions, such as fractures, infections, or tumors, which could have significant implications for patient management and outcomes. While the other factors—previous treatment failures, family history of back pain, and employment status—are also relevant in the overall assessment and management of chronic low back pain, they do not carry the same immediate weight in alerting clinicians to potentially severe or life-threatening conditions as the presence of red flags does. Previous treatment failures can inform treatment decisions, family history may provide context for genetic predispositions to certain conditions, and understanding a patient's employment status can impact recovery strategies. However, addressing red flags is the foremost priority in ensuring patient safety and appropriate care.