Red Flags

Question 1

What is a red flag?

Answer 1

A sign or a symptom that suggests a serious condition that can cause death and disability

Question 2

What should be done about red flags?

Answer 2

Clinical reasoning as to whether the patient is immediately referred, treated then referred, etc.

Question 3

What are the signs of cauda equina?

Answer 3

Sensory deficit in saddle to light touch and pinprick
Abnormal lower-limb neurology

Question 4

What are the symptoms of cauda equina?

Answer 4

Sensory change (LL)
Motor weakness (LL)
Saddle sensory disturbances
Change in ability to achieve an erection or ejaculate
Loss of sensation in genitals
Change in urinary function and/or habits
UL/BL leg P
LBP

Question 5

What are the risk factors for cauda equina?

Answer 5

Herniated intervertebral disc
Lumbar spinal stenosis
Spinal surgery

Question 6

What are the signs of fracture?

Answer 6

Bone tenderness
Neurological signs
Spinal or limb deformity
Contusion or abrasion

Question 7

What are the symptoms of fracture?

Answer 7

Thoracic pain (crush fracture)
Severe pain
Neurological symptoms

Question 8

What are the risk factors of cancer?

Answer 8

Previous history of cancer
History of osteoporosis
Corticosteroid use
Severe trauma
Female sex
Previous spinal fractures
History of falls

Question 9

What are signs of malignancy?

Answer 9

Altered sensation from trunk down
Neurological signs
Bony tenderness

Question 10

What are symptoms of malignancy?

Answer 10

Severe pain that may become progressive and constant
Unremitting night or non-mechanical pain
Systematically unwell
Thoracic pain
Neurological symptoms
Unexplained weight loss
Unfamiliar back pain

Question 11

What are the risk factors of cancer?

Answer 11

Previous history

Question 12

What are the signs of infection?

Answer 12

Neurological signs
Radiculopathy
Bony tenderness

Question 13

What are the symptoms of infection?

Answer 13

Spinal pain
Neurological symptoms
Fatigue
Fever
Unexplained weight loss

Question 14

What are the risk factors of infection?

Answer 14

Immunosuppression
Invasive surgery
Intravenous drug use
Social and environmental factors (occupational exposure)
History of tuberculosis
Recent pre-existing infection

Question 15

What are the signs of cervical region dissection events?

Answer 15

Unsteadiness/ataxia
Dysphagia/dysarthria/aphasia
Weakness (UL and/or LL)
Nausea/vomiting
Facial palsy
Ptosis
Dysphagia
Loss of consciousness
Confusion
Dizziness/disequilebrium

Question 16

What are the symptoms of cervical region dissection?

Answer 16

Drowsiness
Headache
Neck paon
Visual pain
Parasthesia (UL, LL, face)
Dizziness

Question 17

What are the risk factors for cervical artery dissection?

Answer 17

Recent trauma
Vascular anaomaly
Current or past smoker
Migraine
High total cholesterol
Recent infection
Hypertension
Oral contraception
Family history of stroke

Question 18

What are the signs of a cervical region non-dissection event?

Answer 18

Unsteadiness/ataxia
Dysphagia/dysarthria/aphasia
Weakness (UL and/or LL)
Nausea/vomiting
Facial palsy
Ptosis
Dysphagia
Loss of consciousness
Confusion
Dizziness/disequilebrium

Question 19

What are the risk factors of cervical non-dissection events?

Answer 19

Current or past smoker
Hypertension
High total cholesterol
Migraine
Vascular anomaly
Family history of stroke
Oral contraception
Recent infection
Recent trauma (mild -moderate, which include recent OMT)

Question 20

What are the symptoms of cervical region non-dissection?

Answer 20

Headache
Parasthesia (UL, LL, face)
Visual disturbance
Neck pain
Dizziness

Question 21

What are the risk factors of cervical non-dissection events?

Answer 21

Current or past smoker
Hypertension
High total cholesterol
Migraine
Vascular anomaly
Family history of stroke
Oral contraception
Recent infection
Recent trauma (mild -moderate, which include recent OMT)

Question 22

What are the signs and symptoms of cervical instability?

Answer 22

Overt loss of balance in relation to head movements
Facial lip parasthesia, reproduced by active or passive neck movements
Bilateral or quadrilateral limb parasthesia either constant or reproduced by neck movements
Nystagmus produced by active or passive neck movements
Production or aggravation of symptoms due to movement of the head and neck (e.g. neck flexion, rotation or side bending)

Question 23

What are the risk factors for cervical ligamentous isntability?

Answer 23

Trauma (e.g. whiplash)
Rheumatoid arthritis
Down’s syndrome

Question 24

What are the signs and symptoms of secondary headache disorders?

Answer 24

Systemic symptoms (including fever)
Neoplasm in history
Neurologic deficit or dysfunction
Onset of headache is sudden or abrupt (thunderclap headache)
Older age (after 50 years)
Pattern change or recent onset of headache
Positional headache
Precipitated by sneezing, coughing or exercise
Papilledema
Progressive headache and atypical presentation
Pregnancy or puerperium
Painful eye with autonomic features
Posttraumatic onset of headache
Pathology of immune system such as HIV
Pain killer overuse or new drug at onset of headache

Question 25

What are the risk factors for secondary headaches?

Answer 25

Numerous, depending on if primary or secondary headache

Question 26

What are the signs of vascular (non-cervical) and cardiac events?

Answer 26

Often, no noticeable signs in early stages
Advanced stage (over 5.5cm in diameter) abdominal pain, pulsating abdominal mass
Rupture: sudden onset of instense abdominal pain, drop in BP, ssx of shock

Question 27

What are the symptoms of vascular (non-cervical) and cardiac events?

Answer 27

Often, no noticeable symptoms in early stages
Persistent back pain
Rupture: sudden onset of intense abdominal pain, drop in BP, ssx of shock

Question 28

What are the risk factors for vascular (non-cervical) and cardiac events?

Answer 28

Advancing age (over 65)
Male
Smoking
Family history
Atherosclerosis
HypertensionHIgh total cholesterol
Other vascular aneurysm

Question 29

What are the signs of acute cardiac events?

Answer 29

Sweating, pallor
Bradycardia, tachycardia

Question 30

What are the symptoms of acute cardiac events?

Answer 30

Shortness of breath
Fatigue
Chest pain/discomfort (tightness, squeezing)
Pain radiating to shoulder, arm, or jaw
Upper abdominal discomfort
Nausea
Vomiting
Dizziness/light-headedness
Palpitations

Question 31

What are risk factors for acute cardiac events?

Answer 31

Age over 50
Aboriginal and/or torres strait islander person (age >35)
Family history of CVD
Type 2 diabetes
High blood pressure
High total cholesterol
Smoker
Diet high in saturated fat, sugar, salt, alcohol

Question 32

What are contraindications to treatment/spinal manipulation?

Answer 32

Trauma/instability
- Severe recent trauma, fracture, dislocation, and gross instability
Bone weakening
- Pathologies (osteoporosis), long-term corticosteroid use
Serious neurological pathology
- Acutemyelopathy, spinal cord damage, upper motor neuron lesions, multi-level nerve root pathology, worsening neurological function
Clinical features of serious illness
- Unremitting night pain, unremitting non-mechanical pain or active cancer, serious viseral pathology
Inability to establish working diagnosis
Excessive pain and/or alarmng physical signs or symptoms
Informed consent for managment not (or not able to be) given by patient

Question 33

What are some precautions?

Answer 33

Age
Pregnancy (first trimester)
Intervertebral disc herniation
Gross degenerative change (severe osteoarthritis)
Osteoporosis
Hypermobility syndrome or connective tissue disorders
Active inflammatory disease (rheumatoid arthritis, gout)
Previous malignancy