Chapter 6: Red Flag Identifications Flashcards
reversed
(Red flags Low Back Pain) Age 50 years History of cancer Unexplained weight loss Failure of conservative therapy
Back-related tumor
reversed
(Red flags Low Back Pain) Recent infection (e.g., urinary tract orskin infection Intravenous drug user/abuser Concurrent immunosuppressive disorder
Back-related infection(spinal osteomyelitis
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
Cauda equina syndrome
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
Spinal fracture
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
Colon cancer
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
Pathologic fractures of the femoral neck
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
Osteonecrosis of the femoral head (also known as avascular necrosis)
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
Legg-Calvé-Perthes disease
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
Slipped capital femoral epiphysis
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
Peripheral arterial occulisive disease
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
Deep vein thrombosis
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
Compartment syndrome
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
Septic arthritis
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
Cellulitis
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
Myocardial infarction
reversed
(Red Flags for the Thoracic Spine and Rib Cage Region) Chest pain that occurs outside of a predictable pattern Not responsive to nitroglycerin
Unstable angina pectoris
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
Stable angina pectoris
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)
Pericarditis
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
Pulmonary embolus
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)
Pleurisy
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
Pneumothorax
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
Pneumonia
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
Cholecystitis
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
Peptic ulcer
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
Pyelonephritis
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
Nephrolithiasis (kidney stones)
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
Myocardial infarction
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
Cervical ligamentous instabilities with possible cord compromise
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
Cervical and shoulder girdle peripheral entrapment neuropathies
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
Spinal accessory nerve
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
Axillary nerve
reversed
(Red Flags for the Cervical Spine and Shoulder Region) Serratus anterior weakness with scapular winging Loss of scapulohumeral rhythm
Long thoracic nerve
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
Suprascapular nerve
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
Pancoas’s tumor (superior sulcus lung tumor)
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
Meningitis
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
Primary brain tumor
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)
Subarachnoid hemorrhage
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
Fracture (elbow, wrist, hand)
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
Radial head fracture
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
Distal radius (Colles’) fracture
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
Scaphoid fracture
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)
Lunate fracture or dislocation
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
Long flexor tendon rupture
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
Space infection of the hand
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
Raynaud’s phenomenon or Raynaud’s disease
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
Complex regional pain syndrome (reflex sympathetic dystrophy)
