8.22 Symptom Investigation 2 (Red Flags)

Question 1

Low back region: What could be going on?

Answer 1

• back related tumor
• abdominal aneurysm
• back related infection
• cauda equina syndrome
• spinal fx

Question 2

low back region: risk factors for cancer

Answer 2

• age over 50
• hx of cancer
• weight loss
• failure of conservative care

Question 3

low back region: abdominal aneurysm clues

Answer 3

• PVD

- symptoms not related to movement

Question 4

low back region: back related infection clues

Answer 4

• recent infection (UTI/skin)
• IV drugs
• immunosuppressive disorder

Question 5

low back region: cauda equina syndrome clues

Answer 5

• b/b
• saddle paresthesia
• weakness
• myotomes/dermatomes

Question 6

low back region: spinal fx clues

Answer 6

• trauma
• age over 70
• prolonged steroid use

Question 7

What are some potential nonmusculoskeletal conditions of the pelvis, hip, and thigh region?

Answer 7

• colon cancer
• pathological fx of femoral neck
• AVN
• Legg-Calve-Perthes disease
• slipped capital femoral epiphysis

Question 8

pelvis, hip, and thigh region: colon cancer clues

Answer 8

• age over 50
• rectal bleeding/black stool
• weight loss
• pain unchanged by position
• hx cancer in immediate family

Question 9

pelvis, hip, and thigh region: pathological fx of femoral neck clues

Answer 9

• age over 70
• falls
• severe/constant pain
• LE is externally rotated

Question 10

pelvis, hip, and thigh region: AVN clues

Answer 10

• long term corticosteroid use
• trauma
• hx of AVN on contralateral side

Question 11

pelvis, hip, and thigh region: Legg-Calve-Perthes clues

Answer 11

• boys age 5-8 with groin or thigh pain

- antalgic gait

Question 12

pelvis, hip, and thigh region: slipped capital femoral epiphysis

Who tends to get this?

Answer 12

• overweight adolescents

- hx of recent growth spurt or trauma

Question 13

LE red flags - conditions

Answer 13

• peripheral arterial occlusive disease
• DVT
• compartment syndrome
• septic arthritis

Question 14

LE red flags: peripheral arterial occlusive disease

clues on pt’s lifestyle

Answer 14

• age over 60
• Type II DM
• heart disease
• smoker
• sedentary

Question 15

LE red flags: peripheral arterial occlusive disease

What are some of the signs that would clue you in?

Answer 15

• intermittent claudication
• cool extremity
• decreased pedal pulses
• prolonged venous filling time

Question 16

DVT clues

Answer 16

• recently immobilized
• pain worse with moving
• less pain with elevation
• TTP
• warm
• swollen

Question 17

Homans’ sign is present in ___% of pts with thrombosis and ___% in those without

Answer 17

33

21

Question 18

Reliability of Homans’ sign

Answer 18

• unreliable
• insensitive
• nonspecific

Question 19

What are the other criteria for dx of a DVT?

Answer 19

• Wells criteria for DVT

- Padua CPR for hospitalized pts

Question 20

LE red flags: What would clue you in to compartment syndrome as a possible dx?

Answer 20

• recent trauma
• unaccustomed exercise
• paresthesia
• decreased pulses

Question 21

LE red flags: What would clue you in to septic arthritis as a possible dx?

Answer 21

• recent infection, surgery, or injection
• constant aching/throbbing pain
• tenderness
• warmth
• immunosuppressive disorder