Red Flags Flashcards
Cancer red flags:
Persistent pain at night Constant pain anywhere in the body Unexplained weight loss Loss of appetite Unusual bumps or growths Unwarranted fatigue
Cardiovascular Red Flags
Shortness of breath
Dizziness
Pain or a feeling of heaviness in the chest
Pulsating pain anywhere in the body
Constant and severe pain in lower leg (calf) or arm
Discolored or painful feet
Swelling (no history of injury)
Gastrointestinal/genitourinary
Frequent or severe abdominal pain Frequent heartburn or indigestion Frequent nausea or vomiting Change in or problems with bladder function Unusual menstrual irregularities
Miscellaneous
Fever or night sweats
Recent severe emotion disturbances
Swelling or redness of any joint without history of injury
Pregnancy
Neurological
Changes in hearing
Frequent or severe headaches without history of injury
Problem with swallowing or changes in speech
Changes in vision (blurriness or loss of sight)
Problem with balance, coordination, or falling
Fainting spells (drop attacks)
Sudden weakness
Back-related tumor
Age over 50 years
History of cancer
Unexplained weight loss
Failure of conservative therapy
Back-related infection (spinal osteomyelitis)
Recent infection (urinary tract or skin infection)
Intravenous drug user/abuser
Concurrent immunosuppressive disorder
Back-related infection findings:
Deep constant pain, increases with weight bearing
Fever, malaise, and swelling
Spine rigidity, accessory mobility may be limited
Back related tumor findings:
Constant pain not affected by position or activity
Worse at night
Cauda equina syndrome
History of spinal stenosis or degenerative disk disease
Urine retention or incontinence
Fecal incontinence
Saddle anesthesia
Global or progressive weakness in the lower extremities
Sensory deficits in the feet (L4, L5, S1 areas
Ankle dorsiflexion, toe extension, and ankle plantarflexion weakness
Spinal Fracture
History of trauma (including minor falls or heavy lifts for individuals with osteoporosis or elderly individuals)
Prolonged use of steroids
Age over 70 years
Physical exam spinal fracture findings:
Exquisitely tender with palpation over fracture site
Increased pain with weight bearing
Edema in local area
Abdominal Aneurysm
Back, abdominal or groin pain
Presence of peripheral vascular disease or coronary artery disease and associated risk factors (age >50, smoker, HTN, DM
Symptoms not related to movement stresses associated with somatic LBP
Abdominal Aneurysm physical exam findings:
Abnormal width of aortic or iliac arterial pulses
Presence of a bruit in the central epigastric region upon auscultation
Colon Cancer
Age of 50 years
Bowel disturbances (rectal bleeding or black stools)
Unexplained weight loss
History of colon cancer in the immediate family
Pain unchanged by positions or movement
Physical Exam findings for colon cancer
Possible tenderness to palpation of abdomen in area of cancer
May have ascites
May have hypoactive or hyperactive bowel sounds in the later stages
Pathological fractures of the femoral neck
Older women (>70 years) with hip, groin, or thigh pain History of a fall from a standing position
Physical Exam findings for pathological fractures of femoral neck
Severe, constant pain that is worse with movement
A shortened and externally rotated lower extremity
Osteonecrosis of the femoral head (avascular necrosis)
History of long-term corticosteroid use (patients with rheumatoid arthritis, systemic lupus erythematosus, or asthma)
History of avascular necrosis of the contralateral hip
Trauma
Physical Exam findings for Osteonecrosis of the femoral head (avascular necrosis)
Gradual onset of pain; may refer to groin, thigh, or medial knee that is worse with weightbearing
Stiff hip joint; restrictions primarily in IR and flexion
Legg-Calve-Perthes disease
Boys age 5 to 8 with groin or hip pain
Antalgic gait
Pain complaints aggravated with hip movement, especially hip flexion and internal rotation
Slipped capital femoral epiphysis
Overweight adolescents
History of a recent growth spurt or trauma
Groin aching exacerbated with weight bearing
Involved leg held in external rotation
Range of motion limitations of hip internal rotation
Peripheral arterial occlusive disease
Age > 60 yrs History of type 2 diabetes History of ischemic heart disease Smoking history Sedentary lifestyle Concurrent intermittent claudication
Physical Exam findings for Peripheral arterial occlusive disease
Unilaterally cool extremity (bilateral if aorta is involved)
Prolonged capillary refill time (>2 sec)
Decreased pulses in arteries below level of the occlusion
Prolonged vascular filling time
Deep vein thrombosis
Recent surgery, malignancy, pregnancy, trauma or leg immobilization
Calf pain, edema, tenderness, warmth
Calf pain that is intensified with standing or walking and relieved by rest and elevation
Possible pallor and loss of dorsalis pedis pulse
Compartment syndrome
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 compartment
Paresthesia, paresis, pallor, pulselessness
Septic Arthritis
History of recent infection, surgery, or injection
Coexisting immunosuppressive disorder
Constant aching or throbbing pain, joint swelling, tenderness, warmth
May have elevated body temperature
Cellulitis
History of recent skin ulceration or abrasion, venous insufficiency, congestive heart failure, or cirrhosis
Pain; skin swelling; warmth; advancing, irregular margin of erythema/reddish streaks
Fever, chills, malaise, and weakness
Myocardial infarction
Presence of risk factors: previous history of coronary artery disease, HTN, smoking, DM, elevated cholesterol
Men over age 40 years; women over age 50 years
Physical Exam findings for MI:
Chest pain
Pallor, sweating, dyspnea, nausea, palpatations
Symptoms lasting > 30 mins and not relieved with sublingual nitroglycerin
Unstable angina pectoris
History of coronary artery disease
Physical exam findings
Chest pain that occurs outside of a predictable pattern
Not responsive to nitrogylcerin
Stable angina pectoris
Common in people > 65 years
More common in men
History of coronary artery disease
Chest pain/pressure that occurs with predictable levels of exertion
Symptoms predictably alleviated with rest of nitroglycerin
Pericarditis
Often associated with autoimmune diseases (systemic lupus erythematosus, RA)
History of MI
History of renal failure, open heart surgery, or radiation therapy
Exam findings for Pericarditis
Sharp/stabbing chest pain that may be referred to the lateral neck or either shoulder
Increased pain with left sidelying
Relieved with forward leaning while sitting (supporting arms on knees or a table.
Pulmonary embolus
History of, or risk factors for developing, deep vein thrombosis
Immobility
Trauma
Cancer
Physical Exam findings for PE
Chest, shoulder, or upper abdominal pain
Dyspnea
Tachypnea
Tachycardia
Pleurisy
History of a recent or concurrent respiratory disorder (infection, pneumonia, tumor, TB)
Physical exam findings
Severe, sharp, knifelike pain with inspiration
Dyspnea, decreased chest wall expansion
Pneumothorax
Recent bout of coughing or strenuous exercise or trauma
Chest pain, intensified with inspiration
Difficulty ventilating or expanding rib cage
Hyperresonance on percussion
Decreased breath sounds
Pneumonia
History of bactierial, viral, fungal, or mycoplasmal infection
Often follows influenza
History of inhalation of toxic or caustic chemicals, smoke, dusts, or gases (smoking)
Exam findings for Pneumonia:
Pleuritic pain, may be referred to the shoulder
Fever, chills, headaches, malaise, nausea
Productive cough
Cholecystitis
Most common in middle age (particularly in women)
WBC count may be elevated (12,000-15,000/mL)
Exam findings for cholecystitis
Colicky pain in right upper quadrant with accompaning right scapular pain
Symptoms may worsen with ingestion of fatty foods
Symptoms not increased by activity or relieved by rest
Peptic ulcer
Dull or gnawing pain or burning sensation in the epigastrium, mid-back, or supraclavicular regions
Symptoms relieved with food
History of infection (H. pylori)
History of multiple stressors, poor coping skills, persistent anxiety, and depression
Exam findings for peptic ulcer
Localized tenderness at right epigastrim
Constipation, bleeding, vomiting, tarry-colored stools, coffee-ground emesis
Pyelonephritis (kidney infection)
More common in women
Recent or coexisting UTI
Kidney stone or past episode of kidney stone
Physical Exam findings for Pyelonephritis (kidney infection)
Fever, chills, malaise, headache, flank pain
Enlarged prostate
Tenderness over the costovertebral angle (Murphy’s sign)
Nephrolithiasis (kidney stones)
Reside in hot and humid environment Past episodes of kidney stones Sudden, severe back or flank pain Chills, fever, nausea, or vomiting Renal colic Symptoms of UTI
Spinal Fracture
History of fall or motor vehicle crash History of osteoporosis Prolonged use of steroids Age over 70 years Loss of function of mobility
Physical exam findings for spinal fracture:
Midline tenderness at level of fracture Most common levels are T11-L1 Bruising Lower extremity neurologic deficits Evidence of increased thoracic kyphosis
Cervical ligamentous instabilities
Major trauma such as MVA or fall from a height
History of RA or ankylosing spondylitis
Oral contraceptive use
Long tract neurologic signs especially present in more than one extremity; dizziness; nystagmus; vertigo with head/neck movements/positions; clonus; positive Babinski’s sign
Cervical central cord lesion
Older age or post trauma
Incontinence
Gait disturbances due to hyperreflexic lower extremities
Upper extremity (especially hand) atrophy and paresis
Cervical and shoulder girdle peripheral entrapment neuropathies
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
Spinal accessory nerve injury
History of a penetrating injury, such as stab or GSW
Direct blow or stretching of the nerve during a fall or MVA
Surgical history of radical neck dissection for tumor or cervical lymph node biopsy
Spinal accessory nerve injury exam findings:
Assymmetry of the neck line and drooping of the shoulder
Inability to shrug
Lack of scapular stabilization
Weakness of shoulder abduction
Axillary nerve injury
Patients > 40 with shoulder dislocation
History of traction force or blunt trauma to the shoulder
History of brachial neuritis or quadrilateral space syndrome
Weakness of shoulder abduction and flexion
Lack of sensation of lateral aspect of the upper arms
Long thoracic nerve injury
Identified in players of many sports, including tennis, volleyball, archery, golf, fymnastics, bowling, weight lifting, soccer, hockey, and rifle shooting
Recent chest surgery or trauma to the thoracic cage
Serratus anterior weakness with scapular winging
Loss of scapulohumeral rhythm
Suprascapular nerve injury
Deep, poorly localized pain
History of fracture of the scapula with involvement of the notch and blade of the scapula
Traction injury mechanism
Suprascapular nerve injury physical exam findings:
Similar presentation 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
Pancoast Tumor
Men over age 50 years with history of cigarette smoking
Nagging-type pain in the shoulder and along the vertebral border of the scapula
Pain that progressed from nagging to burning in nature, often extending down the arm and into the ulnar nerve distribution
Vertebrobasilar artery insufficiency
Dizziness Vertigo that lasts for minutes Headaches Visual disturbances Nausea Loss of consciousness Apprehension with end range neck movements
Meningitis
History of recent bacterial or viral infection (influenza) History of skull fracture Positive slump sign Headache Fever GI signs of vomiting and symptoms of nausea Photophobia Confusion Seizures Sleepiness
Primary brain tumor
age 20-64 Ataxia Speech deficits Sensory abnormalities Headache GI signs of vomiting and symptoms of nausea Visual changes Altered mental status Seizures
Subarachnoid hemorrage
History of smoking, HTN, and alcohol abuse
Headache of sudden onset (worse HA of life)
Brief loss of consiousness
Brain tumor signs (neurologic dysfunction, nausea and vomiting)
Meningeal irritation (nuchal rigidity, fever, photophobia, nausea and vomiting)
Fractures
Recent fall or trauma
History of osteoporosis
Extended use of steroids (e.g. respiratory problems)
Pathologies with improper bone remodeling
Pain, tenderness, swelling, ecchymosis
Radial head fracture
Fall onto an outstretched arm that is supinate (FOOSH injury)
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
Distal radius (Colles’) fracture
Fall onto an outstretched arm with forceful wrist extension Age > 40 Women affected more than men History of osteoporosis Wrist held in neutral resting position Wrist swelling Movements into extension are painful
Scaphoid fracture
Wrist swelling
Wrist held in neutral position
Pain in the “anatomic snuff box”
FOOSH
Triangular fibrocartilaginous complex tear
Traumatic fall on outstretched hand with forearm pronated
Commonly associated with Colles’ fractures
Ulnar-sided wrist pain
Tenderness and clicking with passive ulnar deviation
Weakness with grip strength
Dorsal ulnar head subluxation
Space Infection of the Hand
Recent puncture of skin
Recent insect bite
Presence of an abscess
Purulent tenosynovitis of tendons that go through that space
Physical Exam findings Space Infection of the Hand:
Typical signs of inflammation: swelling in palm, dorsum of hand, or fingertips
Pain, tenderness, warmth, erythema
Signs of long-standing infection: high fever, chills, weakness, malaise
Raynaud’s phenomenon/disease
Paist medical history of RA, occlusive vascular disease, smoking, or use of beta blockers
Hands or feet that blanch, go cyanotic and then red with exposed to cold or emotional stress
Pain and tingling in hands or feet when they turn red
Complex regional pain syndrome (CRPS) – formerly RSD – reflex sympathetic dystrophy)
Trauma including fracture, dislocation, or surgery
Pain does not respond to typical analgesics
Severe aching, stinging, cutting, or boring pain that is not typical of injury; hypersensitivity
Area swollen (pitting edema), warm, and erythematous
