Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spinal Disorders > Low Back Pain Red Flags > Flashcards

Low Back Pain Red Flags Flashcards

1
Q

Multiple Myeloma General

A

Most common bone cancer. But still less than 1% of all cancers
Consider in: >50 with chronic LBP and anemia of chronic disease
Order: serum protein electrophoresis for >50 with LBP that don’t respond to care.
MRI is positive. Bone scans are normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A patient with back pain and recurrent infections in patients over 50. Consider…

A

Multiple Myeloma OR Spinal Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Recognition of red flags and symptoms

A

Prevention of complications of chiropractic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First step in differential diagnosis of NMS condition

A

Figure out if it is an injury or disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Muscloskeletal pain from disease (spine)

A 
Metastatic/primary tumors
Spinal Infection
Inflammatory diseases (RA, AS, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Muscloskeletal pain from disease (non-spinal)

A

Viscerosomatic referral/reflexes (eg, From GI, reproductive, urinary systems)
AAA, endocrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

First step in DDX

A

Rule out disease
3% of LBP is from serious disease
1% = local cancer or spinal infection
2% = referred pain (usually GI, reproductive system or urinary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Test characteristics of cancer

A

Previous cancer: 16-23x

Failure to improve with a month of therapy: 3x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Weight Loss as a Red Flag

A

Weight Loss (>10 lbs over 3 months)
Sensitivity 15%
Specificity 94%
Better at ruling in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Failure of bed rest to relieve as a Red Flag

A

Very common in cancer (>90% sensitivity)

Reported in over 1/2 of non-cancer patients - low sensitivity for cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lying down aggravation

A

Excruciating pain when lying supine, relieved by sitting up or hunched over a table

Possibly from malignant retroperitoneal lymphadenopathy
Secondary to lymphomas and testicular cancer - both are responsive to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Age with LBP as a Red Flag

A

77-10% of patients were 50 years old or older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Deyo’s study

A

No patient was found to have cancer and LBP under 50 unless they had:
Prior history of cancer
Unexplained weight loss
Failure of conservative therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Night Pain

A

No longer considered a large concern unless pain is severe, progressive, or unabated by position

42% of pts had night pain and 20% with pain every night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Best questions

A

Have you ever had cancer?
Yes, think possible recurrence

Have you lost weight recently?
Yes, think cancer

Does bed rest give you any pain relief?
Yes is evidence against cancer.
If pain gets worse then think cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When leg symptoms are present

A

Be more careful especially if:

Female, pediatric, or geriatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bone tumors

A

Cancer associated with older age and hogher incidence of neurological deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Neurological deficits

A

Primary neoplasm - 55% had objective neurological deficits at the initial visit
20% of patients with spinal malignancy present with neurological deficits
8% with metastatic malignancy have cord compression as the first symptom

Almost 1/3 of prostrate cancer patients have neurological deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical strategy for X-Ray

A

X-Ray any patient with persistent back pain or a neurological deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Spinal Percussion for cancer, fracture, spinal infection

A

Cancer - poor sens and spec
Fracture - poor sens and spec
Spinal infection - 86% sens and 60% spec

21
Q

Clinical Pearl

A

Severe localized spasm and rigidity of 3 continuous vertebral segments

May be the result of:
Vascular lesion of cervical spine
Metastasis in thoracic
Prostate or uterine cancer in lumbar

22
Q

Ancillary Studies: BW and urinalysis

A 
ESR and CRP 
CBC
Blood chemistry panel
UA
Special blood/urine tests
23
Q

Ancillary Studies: Imaging

A

Radiographs
CT/MR
Bone scan/SPECT
Ultrasound

24
Q

Clinical Strategy for suspicion of disease

A

Plane film radiograph (if suspicion remians high -MRI, CT or bone scan)
Order ESR
Order CBC

25
Q

Should you X-Ray a patient for a routine evaluation?

A

NO

Not recommended for accute LBP w/in first month unless there is a red flag

26
Q

Metastatic cancer: factoids

A

2/3 of cancers are metastatic
Usually from breast, lung, prostate, or kidney
Maybe from colon or thyroid

Most metastatic bone cancers are osteolytic

27
Q

Metastatic bone cancer appearance on x-ray at first visit?

A

If present it is 68% likely to appear

28
Q

MRI - Cancer and Infection

A

Cancer: Sense (83-93%), Spec (90-97%)
Infection: Sense 96%, Spec 92%

29
Q

Bone Scan: Cancer

A

Sens - 74-98%

30
Q

X-ray: cancer

A

Spec - 95-99%

31
Q

Initial Blood Work

A

For NMS cases, start with erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP)

These are sensitive but not specific.
Good for screening but with false positives

32
Q

ESR range

A

Erythrocyte Sedimentation Rate
Normal: 0-18mm
20-50 rule

33
Q

20-50 rule

A

20mm/hr - 50mm/hr
Below 20 is abnormal but not clinically meaningful
Above 50 is probably a significant disease requireing further testing and advanced imaging

34
Q

ESR > 100

A

Multiple myeloma
Temporal arteritis
Polymyalgia rheumatica

35
Q

Combination of normal ESR and x-rays constitutes…

A

A very sensitive screem for serious malignancies or infections

36
Q

Complete Blood Count

A

Anemia plus back pain is a red flag
Anemia is present in about 50% of caseswith cancer
14% in all other patients

37
Q

Red Flags for Cancer in LBP

A 
Prior history of cancer: (LR-23.7) large post-test change
Reduced Hct (anemia): (LR-18.2) large post-test change
Elevated ESR: (LR-18)large post-test change
Clinical judgement: (LR-12.1) large post-test change
38
Q

Combination of age _____, prior _____, unexplained _______, failure to improve in ______ had 100% sensitivity

A

Age > 50, history of cancer, weight loss, 1 month

39
Q

CBC red flags

A

Altered white count
Increased white count can signal infection, cancer, or inflammatory disease
Increased immature can suggest leukemia
Depressed white cells can suggest multiple myeloma or other cancers

40
Q

Two most common causes of elevated calcium

A

Metastatic cancer: 40-50% of patients with metastatic cancer to bone will have elevated calcium
Hyperparathyroidism

Not usually caused by osteoporosis

41
Q

Alkaline Phosphatase (from bone)

A

50-75% of cancer patients will have elevated ALP
Normal value is 0-50
Values increase above 150
Paget’s disease, healing fracture, growing bones, pregnancy and liver disease
Prostate cancer

42
Q

Viscerosomatic referral and LBP may be due to

A

Reproductive
Urinary
GI

43
Q

Causes of back pain from viscera

A

Menstrual cycle
Periodic pain unassociated with movement or activity
Colicky or cramping pain
Writhing pain

44
Q

Red Flag in the spine

A

LBP plus:
Little muscle spasm
Little tenderness
Little impaired segmental mobility

45
Q

Pancreatic cancer

A

Associated with nausea or vomiting
May be made worse by recumbency
Relieved by knees drawn up and forward flexion (100% specificity)

46
Q

Urinary bladder referred pain patterns

A

Upper gluteal crease
Inner thighs and cross gluteal folds

Pain may be present on the opposite side
because visceral nerves crisscross midline

47
Q

Kidney referred pain patterns

A

Low back, lateral back, lateral thighs

Pain may be present on the opposite side

48
Q

Low back pain referrals

A

Colon (not sigmoid) referral is often to mid lumbar spine
Gynecological disorders rarely refer above L4
Sigmoid colon, rectum, pelvic referral is usually sacral

Spinal Disorders (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions