red flags Flashcards
what are signs of infection? (vitals - temp, BP, pulse, respiratory rate)
- Temp > 100.4 F
- BP > 160/95 mmHg
- Resting Pulse > 100/min
- Resting Respiration > 25/min
for patients with nonspecific low back pain - diagnostic imaging (Should or Should Not) be obtained?
Should Not
for patients with low back pain with severe or progressive neurologic deficits - diagnostic imaging (Should or Should Not)be obtained?
Should
for patients with low back pain when serious underlying conditions are suspected on basis of history and physical exam - diagnostic imaging (Should or Should Not) be obtained?
Should
Red flag symptom: Pain is (intermittent or constant)?
and (related or unrelated) to position or movement
constant, unrelated to movement
Red flag symptom: Severe (day or night) pain (related or unrelated) to movement
night, unrelated to movement
Red flag symptom: Recent unexplained weight loss (or gain) > # lb
10 lb
Red flag symptom: History of (direct blunt or indirect) trauma
direct blunt
Red flag symptom: Appearance?
acutely ill, generalized weakness or malaise
Red flag symptom: Abdominal pain – especially radiation into…
groin, hematuria
Red flag symptom: Bowel or Bladder…
dysfunction/Saddle anesthesia
Red flag symptom: nvolving genitals
Sexual dysfunction, Recent menstrual irregularities
These symptoms refer (from or to) low back:
cancer
compression fracture
sacral stress fracture
from
These symptoms refer (from or to) low back:
acute spondylolisthesis
ankylosing spondylitis
central sensitization
from
These symptoms refer (from or to) low back:
vertebral infection
cauda equina
from
These symptoms refer (from or to) low back:
aneurysm
vascular claudication
to
These symptoms refer (from or to) low back:
kidney stone
gastrointestinal
genital pathologies
to
key features & recommended imaging: new onset low back pain with history of cancer
cancer, MRI
key features & recommended imaging:
age >50yr
unexplained weight loss
failure to improve after 1 month
cancer, lumbosacral plain radiography
key features & recommended imaging:
older age
history of osteoporosis
use of corticosteroids
compression fracture, lumbosacral plain radiography
key features of compression fracture
older age, history of osteoporosis, use of corticosteroids
key features of cancer
age >50yr, unexplained weight loss, failure to improve after 1 month, history of cancer
key features:
Fever
IV drug use
Recent infection
Vertebral infection, MRI
key features: Vertebral infection
Fever
IV drug use
Recent infection
key features: Cauda equina syndrome
Urinary retention
motor deficits at multiple levels
fecal incontinence
saddle anesthesia
key features: Urinary retention motor deficits at multiple levels fecal incontinence saddle anesthesia LMN and/or UMN signs unilateral or bilateral
Cauda equina syndrome, MRI
key features:
Younger age <40yo (typically young adult male, hunched posture)
Morning stiffness
Improved with exercise
Alternating buttock pain
Awakening due to back pain during second half of night
Ankylosing spondylitis (form of arthritis, inflame spinal joints, bones are fusing), AP pelvis plain radiography
key features: Ankylosing spondylitis
Younger age <40yo (typically young adult male 20-30s, hunched posture)
Reduced lateral mobility
Morning stiffness
Improved with exercise
Alternating buttock pain
Awakening due to back pain during second half of night
key features: progressive motor weakness
Severe progressive neurological deficits, MRI
key features: Severe progressive neurological deficits
progressive motor weakness
5 types of cancer that commonly metastasize to the spine
Prostrate, Thyroid, Breast, Lung, Kidney
“PT Barnum Loves Kids” or PB Lead Kills The
Key features: • Injection drug use • Urinary infection • Indwelling urinary catheter • Skin infection • Fever Percussion tenderness
Infective spondylitis
Key features:
• Age > 50
• Trauma
Corticosteroid use
Compression fracture
Risk factors: recent infection recent surgery of injections immunocompromised - prolonged oral steroid use drug use sexual contact diabetes
spinal infection
Presentation: fever nigh sweats, pain worsening despite care tenderness over spinous process (not sensitive or specific)
spinal infection
