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Spinal Disorders > 2 Red Flags > Flashcards

2 Red Flags Flashcards

1
Q

Spinal diseases that can cause back pain

A

Metastatic/primary tumors
Spinal infection
Inflammatory diseases

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2
Q

Non-spinal diseases that can cause back pain

A

Viscerosomatic referral/reflexes

Other: AAA, endocrine

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3
Q

Of acute LBP patients, what percent are spinal fractures, cancer, spinal infection, CES or inflammatory disease?

A

<1%

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4
Q

What is the BIGGEST red flags for cancer

A

Previous cancer

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5
Q

What are the red flags of cancer in order of relevance

A
  1. Previous cancer
  2. Unexplained weight loss
  3. Failure of bed rest to relieve//laying down aggravates sx

Other:
4. >50yo

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6
Q

Excruciating pain when supine that is relieved by sitting up, hunched over a table may be what?

A

Malignant retroperitoneal lymphadenopathy

2˚ to lymphomas and testicular cancer

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7
Q

What 3 physical exam findings do you expect with cancer patient? (Not an exhaustive list)

A
  1. Neuro deficits in older pts
  2. Exquisite pain with spinal percussion
  3. Significant restriction at multiple segments in multiple directions
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8
Q

Patient presents with persistent back pain or neurological deficit. What ancillary study will you always do?

A

“X-ray any pt with persistent back pain or neuro deficit”

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9
Q

Spinal percussion is exquisitely painful and lingers. What is your DDX

A
  1. Cancer
  2. Fracture
  3. Spinal infection
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10
Q

Patient presents with severe localized spasm and rigidity of 3 contiguous vertebral segments which may be the result of cord reflex from… (3)

A
  • vascular lesion in cervical spine
  • metastasis in thoracic
  • prostate or uterine cancer in lumbar
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11
Q

What ancillary studies will be your go-to when you suspect disease?

What if you suspect cancer or infection?

What if you suspect arthritis?

What if you suspect urinary problem?

A
  1. Plain film
  2. Order ESR and/or CRP
  3. Order CBC

Consider blood chemistry panel (Ca2+, ALP, protein)

Anti-CCP, RF, ANA, HLA-B27

UA

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12
Q

Metastatic vs primary tumors and which one is more common?

A 
Metastatic = starts elsewhere
Primary = starts in this tissue

2/3 cancers are metastatic

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13
Q

Where do metastatic cancers start from?

A

Breast, lung, prostate, kidney

Sometimes colon, thyroid

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14
Q

What is osteolytic bone cancer? Example?

A

Missing bone

E.g. breast cancer

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15
Q

What is osteoblastic metastatic cancer? Example?

A

White, bone build up.

E.g. prostate cancer

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16
Q

For NMS case, what is your general blood work up?

A

erythrocytes sedimentation rate (ESR)

C-reactive protein (CRP)

17
Q

What is ESR normal range?

A

Normal 0-18 mm/hr

18
Q

What is LeFebvre’s 20-50 rule about ESR range?

A

<20mm/hr is abnormal but not clinically meaningful

> 50mm/hr is probably a significant disease the requires further testing and advanced imaging

19
Q

If ESR > 100 what are your top 3 DDX?

A

Multiple myeloma
Temporal arteritis
Polymylagia rheumatica

20
Q

Your patient has anemia plus back pain, what might it be?

A

Anemia is present in 50% of cancer cases (compared to 14% of all other patients)

21
Q

You ordered a CBC for your patient who has LBP.

  • HgB is low
  • White count is increased
  • Increased immature white cells
A

Anemia (more common with cancer patients)

Increased WBC suggests infection, cancer, or inflammation

Increased immature white cells suggests leukemia

22
Q

If your CBC shows depressed white cells, what might that suggest?

A

Multiple myeloma or other cancers

23
Q

What is normal serum calcium?

A

10.2 mg/dL

Anything over this number is a big problem!

24
Q

2 most common causes elevated calcium

A
  1. Metastatic cancer

2. Hyperparathyroidism

25
Q

Increased ALP suggests what disease state?

What is normal values?

A

50-75% of osteoblastic cancer pts have elevated ALP

Normal values: 0-50. So anything >150 is a big deal

26
Q

What 3 parts of the viscera refer pain to the low back?

A

Reproductive
Urinary
Gastrointestinal

27
Q

4 types of back pain from viscera

A
  • Menstrual cycle
  • Periodic pain unassociated with movement or activity
  • Colicky or cramping pain
  • Writhing pain
28
Q

Your patient has LBP plus, in the history and physical exam, you notice three things that are red flags:

A
  • no muscle spasm
  • no tenderness
  • no impaired segmental mobility
29
Q

What is a pathognomic position for thoracolumbar pain?

A

Knees drawn up and in forward flexion (cross legged and hunched over)

30
Q

Colon referral is where?

A

Mid lumbar spine (not sigmoid)

31
Q

Gynecological disorders rarely refer above what spinal segment?

A

L4

32
Q

Sigmoid colon, rectum, and pelvic referral is where?

A

Sacral

33
Q

What might pelvic pain be for a woman?

A

Endometriosis
Fallopian tube pain
Ruptured ovarian cyst

34
Q

If you suspect arthritic conditions, what blood work will you order?

A

Anti-CCP: RA
RF:
ANA: lupus, sjogren’s, scleroderma, RA, polymyositis
HLA-B27: ankylosing spondylitis

Spinal Disorders (5 decks)

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