Chapter 6: Red Flag Identifications

Question 1

reversed

(Red flags Low Back Pain) Age 50 years History of cancer Unexplained weight loss Failure of conservative therapy

Answer 1

Back-related tumor

Question 2

reversed

(Red flags Low Back Pain) Recent infection (e.g., urinary tract orskin infection Intravenous drug user/abuser Concurrent immunosuppressive disorder

Answer 2

Back-related infection(spinal osteomyelitis

Question 3

reversed

(Red flags Low Back Pain) Urine retention or incontinence Fecal incontinence Saddle anesthesia Global or progressive weakness in the lower extremities Sensory deficits in the feet (i.e., L4, L5, S1 areas) Ankle dorsiflexion, toe extension, and ankle plantarflexion weakness

Answer 3

Cauda equina syndrome

Question 4

reversed

(Red flags Low Back Pain) History of trauma (including minor falls or heavy lifts for osteoporotic or elderly individuals) Prolonged use of steroids Age 70 years

Answer 4

Spinal fracture

Question 5

reversed

(Red Flags for the Pelvis, Hip, and Thigh Region) Age 50 years Bowel disturbances (e.g., rectal bleeding, black stools) Unexplained weight loss History of this type of cancer in immediate family, Pain unchanged by positions or movement

Answer 5

Colon cancer

Question 6

reversed

(Red Flags for the Pelvis, Hip, and Thigh Region) Older females (70 years) with hip, groin, or thigh pain History of a fall from a standing position Severe, constant pain, worse with movement A shortened and externally rotated lower extremity

Answer 6

Pathologic fractures of the femoral neck

Question 7

reversed

(Red Flags for the Pelvis, Hip, and Thigh Region) History of long-term corticosteroid use (e.g., in patients with RA, SLE, asthma) History of this condition of the contralateral hip, trauma

Answer 7

Osteonecrosis of the femoral head (also known as avascular necrosis)

Question 8

reversed

(Red Flags for the Pelvis, Hip, and Thigh Region) 5- to 8-year-old boys with groin/thigh pain Antalgic gait Pain symptoms aggravated with hip movement, especially hip abduction and internal rotation

Answer 8

Legg-Calvé-Perthes disease

Question 9

reversed

(Red Flags for the Pelvis, Hip, and Thigh Region) Overweight adolescent History of a recent growth spurt or trauma Groin aching exacerbated with weightbearing Involved leg held in external rotation ROM limitations of hip IR and abduction

Answer 9

Slipped capital femoral epiphysis

Question 10

reversed

(Red Flags for the Knee, Leg, Ankle, or Foot) RegionAge 60 years old History of type II diabetes History of ischemic heart disease Smoking history Sedentary lifestyle Concurrent intermittent claudication Unilaterally cool extremity Decreased pedal pulses: posterior tibial artery, dorsalis pedis artery Prolonged venous filling time Abnormal ankle-to-arm systolic pressure

Answer 10

Peripheral arterial occulisive disease

Question 11

reversed

(Red Flags for the Knee, Leg, Ankle, or Foot) Calf pain, edema, tenderness, warmth Calf pain that is intensified with standing or walking and relieved by rest and elevation Recent surgery, malignancy, pregnancy, trauma, or leg immobilization

Answer 11

Deep vein thrombosis

Question 12

reversed

(Red Flags for the Knee, Leg, Ankle, or Foot) History of blunt trauma, crush injury, or unaccustomed exercise Severe, persistent leg pain that is intensified with stretch applied to involved muscles Swelling, exquisite tenderness, and palpable tension (hardness) of involved area Paresthesia, paresis, and pulselessness

Answer 12

Compartment syndrome

Question 13

reversed

(Red Flags for the Knee, Leg, Ankle, or Foot) Constant aching and/or throbbing pain, joint swelling, tenderness, warmth History of recent infection, surgery, or injection Coexisting immunosuppressive disorder

Answer 13

Septic arthritis

Question 14

reversed

(Red Flags for the Knee, Leg, Ankle, or Foot) Pain, skin swelling, warmth, and an advancing, irregular margin of erythema/reddish streaks Fever, chills, malaise, and weakness History of recent skin ulceration or abrasion, venous insufficiency, CHF, or cirrhosis

Answer 14

Cellulitis

Question 15

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Chest pain Pallor, sweating, dyspnea, nausea, palpitations Presence of risk factors: previous history of coronary artery disease, hypertension, smoking, diabetes, elevated blood serum cholesterol (240 mg/dL) Men over age 40, women over age 50 Symptoms lasting longer than 30 minutes and not relieved with sublingual nitroglycerin

Answer 15

Myocardial infarction

Question 16

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Chest pain that occurs outside of a predictable pattern Not responsive to nitroglycerin

Answer 16

Unstable angina pectoris

Question 17

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Chest pain/pressure that occurs with predictable levels of exertion Symptoms are predictably alleviated with rest or sublingual nitroglycerin

Answer 17

Stable angina pectoris

Question 18

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Sharp/stabbing chest pain that may be referred to the lateral neck or either shoulder Increased pain with left-side lying Relieved with forward lean while sitting (supporting arms on knees or a table)

Answer 18

Pericarditis

Question 19

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Chest, shoulder, or upper abdominal pain Dyspnea History of, or risk factors for developing, a deep vein thrombosis

Answer 19

Pulmonary embolus

Question 20

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Severe, sharp, “knife-like” pain with inspiration Dyspnea, decreased chest wall excursion History of a recent or concurrent respiratory disorder (e.g., infection, pneumonia, tumor, tuberculosis)

Answer 20

Pleurisy

Question 21

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Chest pain, intensified with inspiration Difficulty ventilating or expanding rib cage Recent bout of coughing or strenuous exercise or trauma Hyperresonance on percussion Decreased breath sounds

Answer 21

Pneumothorax

Question 22

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Pleuritic pain, may be referred to shoulder Fever, chills, headaches, malaise, nausea Productive cough

Answer 22

Pneumonia

Question 23

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Colicky pain in right upper abdominal quadrant with accompanying right scapular pain Symptoms may worsen with ingestion of fatty foods Symptoms not increased by activity nor relieved by rest

Answer 23

Cholecystitis

Question 24

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Dull or gnawing pain or “burning” sensation in the epigastrium, midback, or supraclavicular regions Symptoms relieved with food Localized tenderness at the right epigastrium Constipation, bleeding, vomiting, tarry-colored stools, coffee ground emesis

Answer 24

Peptic ulcer

Question 25

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Recent or coexisting urinary tract infection Enlarged prostate Kidney stone or past episode of kidney stone

Answer 25

Pyelonephritis

Question 26

reversed

(Red Flags for the Thoracic Spine and Rib Cage Region) Sudden, severe back or flank pain Chills, fever, nausea, or vomiting Renal colic Symptoms of urinary tract infection Residence in hot and humid environment Past episodes of kidney stone; 50% of patients experience a recurrence

Answer 26

Nephrolithiasis (kidney stones)

Question 27

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Chest pain Pallor, sweating, dyspnea, nausea, palpitations Presence of risk factors: previous history of coronary artery disease, hypertension, smoking, diabetes, elevated blood serum cholesterol (240 mg/dL) Men over age 40, women over age 50 Symptoms lasting longer than 30 minutes and not relieved with sublingual nitroglycerin

Answer 27

Myocardial infarction

Question 28

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Major trauma such as a motor-vehicle accident or a fall from a height Rheumatoid arthritis or ankylosing spondylitis Oral contraceptive use Long track neurologic signs, especially present in more than one extremity, dizziness, nystagmus, vertigo with head/neck movements/positions, clonus, positive Babinski sign

Answer 28

Cervical ligamentous instabilities with possible cord compromise

Question 29

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Paresthesias Pain present at rest and possibly with a retrograde distribution Muscles innervated can be tender to palpate Muscles and sensory distribution follow specific nerve pattern

Answer 29

Cervical and shoulder girdle peripheral entrapment neuropathies

Question 30

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Weakness of shoulder abduction Inability to shrug the shoulders Dull pain, weakness, and drooping of the shoulder Lack of scapular stabilization

Answer 30

Spinal accessory nerve

Question 31

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Weakness of shoulder abduction and flexion Lack of sensation of the lateral aspect of the upper arm

Answer 31

Axillary nerve

Question 32

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Serratus anterior weakness with scapular winging Loss of scapulohumeral rhythm

Answer 32

Long thoracic nerve

Question 33

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Presentation similar to rotator cuff tear because of wasting of the supraspinatus and/or infraspinatus muscles Loss of strength in abduction and external rotation of the shoulder Pain is deep and poorly localized

Answer 33

Suprascapular nerve

Question 34

reversed

(Red Flags for the Cervical Spine and Shoulder Region) Men older than 50 years with a history of cigarette smoking “Nagging”-type pain in the shoulder and along the vertebral border of the scapula Pain that has progressed from nagging to burning in nature, often extending down the arm and into the ulnar nerve distribution

Answer 34

Pancoas’s tumor (superior sulcus lung tumor)

Question 35

reversed

(Red Flags for the Head, Face, and Temporomandibular Joint Regions) Positive slump sign Headache Fever Gastrointestinal signs of vomiting and symptoms of nausea Photophobia Confusion Seizures Sleepiness

Answer 35

Meningitis

Question 36

reversed

(Red Flags for the Head, Face, and Temporomandibular Joint Regions) Ataxia Speech deficits Sensory abnormalities Headache Gastrointestinal signs of vomiting and symptoms of nausea Visual changes Altered mental status Seizures

Answer 36

Primary brain tumor

Question 37

reversed

(Red Flags for the Head, Face, and Temporomandibular Joint Regions) Headache of sudden onset (the worst headache of his or her life) A brief loss of consciousness Brain tumor signs (neurologic dysfunction, nausea and vomiting) Meningeal irritation signs (nuchal rigidity, fever, photophobia, nausea and vomiting)

Answer 37

Subarachnoid hemorrhage

Question 38

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Recent fall or trauma Pain, tenderness, swelling and ecchymosis History of osteoporosis Extended use of steroids (e.g., respiratory problems) Pathologies with improper bone remodeling

Answer 38

Fracture (elbow, wrist, hand)

Question 39

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Fall onto an outstretched arm that is supinated Anterolateral pain and tenderness at the elbow Inability to supinate and pronate the forearm Elbow held against the side with 70 degrees of flexion and slightly supinated

Answer 39

Radial head fracture

Question 40

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Fall onto outstretched arm with forceful wrist extension Wrist held in neutral resting position Wrist swelling Movements into wrist extension are painful

Answer 40

Distal radius (Colles’) fracture

Question 41

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Fall onto outstretched arm Wrist swelling Wrist held in neutral position Pain in the “anatomical snuff box

Answer 41

Scaphoid fracture

Question 42

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Diffuse synovitis Generalized wrist swelling and pain Decreased motion Decreased grip strength (Rule out capitate fracture)

Answer 42

Lunate fracture or dislocation

Question 43

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Grade I and II muscle tear: local tenderness, swelling,muscle spasms, hematoma, pain with motion and with passive stretch Grade III muscle rupture: total loss of motion and palpable defect in the muscle, swelling, tenderness, ecchymosis of the overlying skin

Answer 43

Long flexor tendon rupture

Question 44

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Recent puncture of skin Presence of an abscess Purulent tenosynovitis of tendons that go through a space Typical signs of inflammation: swelling in palm, dorsum of hand, or finger tips Pain, tenderness, warmth, and erythema Signs of longstanding infection: high fever, chills, weakness, and malaise

Answer 44

Space infection of the hand

Question 45

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Hands or feet that blanch, go cyanotic and then red when exposed to cold or emotional stress Pain and tingling in hands or feet when they turn red Past medical history significant for rheumatoid arthritis, occlusive vascular disease, smoking, or use of beta-blockers

Answer 45

Raynaud’s phenomenon or Raynaud’s disease

Question 46

reversed

(Red Flags for the Elbow, Wrist, and Hand Regions) Trauma including fracture, dislocation, or surgery Severe aching, stinging, cutting, or boring pain that is not typical of injury; hypersensitivity Area swollen (pitting edema), warm, and erythematous Pain does not respond to typical analgesics

Answer 46

Complex regional pain syndrome (reflex sympathetic dystrophy)