Sectional 1 Flashcards
Sexual dysfunction, urinary frequency changes, and dyspraxia are all category _ _ _, meaning they are not _ _, but they need to be _.
Are all category II RED FLAGS, meaning they are not LIFE THREATENING, but they need to be MONITORED.
A decreased _ level is common among conditions including: chronic/ recent acute blood loss, some cancers, kidney and liver disease, malnutrition, vitamin deficiencies (B12, folic acid, iron), pregnancy, lupus, RA and peptic ulcer disease. A level of _ than _% is considered a red flag.
A decreased HEMATOCRIT LEVEL is common among . . . .
A level of LESS THAN 30% is considered a RED FLAG
According to the San Francisco Syncope Rule any of which 5 measures is considered at high risk of a serious outcome?
SPASM
- stroke
- pulmonary embolism (PE)
- arrhythmias
- subarachnoid hemorrhage (SAH)
- myocardial infarction (MI)
Of the 5 measures outlined as a high risk for serious outcome by the San Fran Syncope Rules they make up -% of ER visits and _% of those patients are _.
Make up 3-6% of ER visits
50% of those patients become HOSPITALIZED
If a patient’s pain is _ at _, and they can’t find a _ of _- it is a red flag. If _ in a recliner relieves pain what 3 things should you look at?
If patients pain is WORSE AT NIGHT, and they can’t find a POSITION OF COMFORT- it is a red flag
If SLEEPING in a recliner relieves pain, you should check:
-gall bladder, kidney or urogenital system dsyfunctions
Less than _% of _ thoroughly screen for Red Flags.
Less than 5% OF PHYSICIANS thoroughly screen for Red flags.
Category 1 red flags: factors that require _ _ _
Factors that require IMMEDIATE MEDICAL ATTENTION
What category of Red flag is being described: factors that require subjective questioning and precautionary examination and treatment procedures before referral. Requires _ _.
Category II
Requires FURTHER TESTING
Category III Red flag: factors that require _ _ _ and _ _ (perhaps ‘_ treatment’)
Factors that require FURTHER PHYSICAL TESTING and DIFFERENTIATION ANALYSIS. (Perhaps ‘TRIAL treatment’)
In a study on documentation of Red flags for patients with LBP PT’s flagged presence of _ of the _ red flag items and were documented _% of the time. _ have a better screening _ than _.
PT’s flagged presence of 7 of the 11 red flag items and were documented 98% of the time
PT’s have better screening PERCENTAGE than PHYSICIAN
Military PT are the primary care providers for musculoskeletal disorders since 1971 and has resulted in: _% reduction in _ _ for patients.
Resulted in a 300% reduction in WAIT TIME for patients
In a survey of family practice physicians _% felt they had insufficient training in orthopedics, _% claimed that med school was their only source of formal musculoskeletal training.
51% felt they had insufficient Ortho training
56% said med school was their only source of formal MSK training
When did direct access go into effect in CA?
January 1, 2014
External myths in medical screening by physicians: PT _ _ _ since they don’t _; PT don’t have the _ or _ to _; how can PTs have direct access if they cannot perform _.
PT’s CAN NOT SCREEN since they don’t DIAGNOSE
PT’s don’t have the TRAINING or EXPERTISE TO SCREEN
How can PT’s have direct access if they can’t perform X-RAYS?
X-RAYS have been found to be _ when screening for a variety of medical conditions.
Found to be INEFFICIENT when screening for a variety of medical conditions.
Testing strategies for detecting underlying cancer in patients with LBP: history of _, _ _, failure to _ to _ _, erythrocyte sedimentation rate of _ than _ _/ hour, Positive findings on a _; and older than _ years of age.
- history of CANCER
- WEIGHT LOSS
- failure to RESPOND to CONSERVATIVE THERAPY
- erythrocyte sedimentation rate of LESS THAN 50 mm/ hour
- positive findings on an X-RAY
- older than 50 YEARS of age.
Of the 6 factors looked at to screen LBP for cancer, a PT can screen/ perform _ _.
Can screen/ perform 4 FACTORS (out of 6)
Fatigue, weight loss, fever, frequent pain, and sores that don’t heal are all _ _ for _.
Are all RED FLAGS for CANCER
LBP that is initially mild, diffuse, dull ache, and is intermittent or constant but variable is?
NOT A RED FLAG FOR CANCER
LBP that gradually progresses or has 3 months of localized, sharp, intense, unrelenting or incapacitating pain, and is accompanied by weight loss, nausea, fever, night sweats, or night pain are?
Are RED FLAGS FOR CANCER
If you have 1-2 weeks of localized, intense, unrelenting LBP that is constant and possibly accompanied by weight loss, nausea, fever, night sweats and malaise these are _ _ for _.
These are RED FLAGS for INFECTION
_ _ are defined as anything that comes between our patient and the correct diagnosis.
YELLOW FLAGS
According to study by Jarvik _ do not predict success/ non-success in rehabilitation or future disability. _ lead to higher rates of _ _.
MRI’S do not predict success . . .
MRI’S lead to higher rates of SURGICAL INTERVENTIONS
Flynn study found MRI’s result in more _ and more _ without _ _.
More SURGERIES and more COMPLICATIONS without BETTER OUTCOMES.
Routine Imaging and other diagnostic tests are _ _ in patients with generalized LBP
Are NOT RECOMMENDED/ USEFUL in patients with generalized LBP
Diagnostic imaging and testing for patients with LBP should be performed if there is _ or _ _ _ present or when _ _ _ are suspected on the basis of _ and _ _
If there is SEVERE or PROGRESSIVE NEUROLOGICAL DEFICITS present or when SERIOUS UNDERLYING CONDITIONS are suspected on the basis of HISTORY and PHYSICAL EXAM.
Patients with persistent LBP and sign/ symptoms of radiculopathy or spinal stenosis should be evaluated with MRI (preferred) or CT scan only if they are _ _ for _ or _ _.
Only if they are POTENTIAL CANDIDATES for SURGERY or EPIDURAL INJECTION
Of Asymptomatic individuals 60 years or older: _ had HNP, _ had spinal stenosis, and approximately _ had degenerative or bulging discs.
36% had HNP
21% had spinal stenosis
Approx. 90% had degenerative or bulging discs
A diagnosis based on _, in the absence of _ _ may not be the source of patients pain.
Diagnosis based on MRI in absence of CLINICAL FINDINGS may not be the source of the patients pain
What are the 3 diagnosis of LBP that can scare patients?
DiSH
- degenerated disc
- slipped disc
- herniated disc
Lumbar _ _ are on the rise in the US. Patients should be informed that the _ of _ following lumbar spine _ is _.
Lumbar FUSION OPERATIONS are on the rise in the US
Patients should be informed that the LIKELIHOOD OF REOPERATION following lumbar spine OPERATION IS SUBSTANTIAL
What is the greatest predictor that you will have LBP surgery in the US?
Zip code
If a patient _ _ to _ _ than surgery may be necessary.
If a patient DOESN’T RESPOND to CONSERVATIVE THERAPY (Actual PT tx- not just modalities) than surgery may be necessary
Signs and symptoms found in the patients _ and _ _ that may tie a _ to a _ _ is a red flag.
Signs and symptoms found in the patients HISTORY AND CLINICAL EXAM that ma tie a DISORDER to a SERIOUS PATHOLOGY is a red flag.
Any patient with _ and/or _ with _ _ with _ on the spinous process _ a _ _. Performed with? Possible?
Any patient with FEVER and/or CHILLS with CONCURRENT PAIN with TAPPING on the spinous process MANDATES a MEDICAL REFERRAL
Tapping performed with hammer or finger tips
Possible SPINAL INFECTION
What are the 6 lumbosacral specific category I red flags?
UP SCAN
- Upper lumbar disc herniation in younger patients
- progressive neurological deficits
- sacral fracture
- cauda equina dsyfunction
- abdominal pulsating mass
- non-mechanical pain distribution (doesn’t follow recognized patterns)
Red Flag category I: new findings of ‘Back ache’ while _ _. May suggest?
New findings of ‘back ache’ while TAKING COUMADIN (or other anticoagulant)
May suggest INTERNAL BLEEDING
Blood in the peritoneum causes _ _ that is sometimes difficult to _.
Causes INTENSE PAIN that is sometimes difficult to LOCALIZE
Bruising of the flank due to internal bleeding is known as _ _ sign. Around or near the umbilicus?
Bruising of flank- GREY-TURNER’S SIGN
Around/ near umbilicus- CULLEN’S SIGN
Very few symptoms by themselves are indicative of a _ _ _, more clinically relevant is an exam that _ a _ or _ of _ _ findings.
Very few symptoms by themselves are indicative of a SERIOUS MEDICAL CONDITION, more clinically relevant is an exam that REVEALS A PATTERN OR CLUSTER of RED FLAG findings.
What are the 3 relationships between diagnosis and presentation that could be zebra’s?
Common diagnosis/ UNCOMMON PRESENTATION
UNCOMMON DIAGNOSIS/ common presentation
UNCOMMON DIAGNOSIS/ UNCOMMON PRESENTATION
Patient with LBP following a bending/ lifting injury: during resisted tests of the patients myotomes of her LE, you note that while testing her right dorsi flexors she is pain free but extremely week. Using Cyriax differentiation what would the test finding suggest?
Neurological lesion- painless and weak
- of L4, can cause foot drop
If you are treating/ examining a patient and it is not evident that there is an emergent (serious) condition you should see a _ or _ within - _.
You should see a CHANGE OR PROGRESS within 1-2 WEEKS
3 referral options: _ referral to an MD, determine _ _ MD _ and call to address concerns, or ask patients to _ _ next _ _.
IMMEDIATE referral to an MD
Determine NEXT SCHEDULED doctors VISIT and call to address concerns
Ask patient (or directly ask patients Doctor) to MOVE UP NEXT MD VISIT
Fever, night sweats, weight loss/ gain (unexplained), night pain and malaise are all _ _ _ that should raise the index of _ (aka _ _)
Are all GENERAL HEALTH QUESTIONS that should raise the index of SUSPICION (aka CATEGORY II)
Night pain is _ a _ isolated red flag. If there is?
Night pain is NOT A STRONG isolated red flag.
If there is ADDITIONAL FLAGS THEN IT INCREASES THE IMPROTANCE.
Which of the following is the best predictor of severe OA in the hip: positive FABER’S/ SCOUR test, ZIP CODE, or NIGHT PAIN?
NIGHT PAIN
Frequent urge to urinate, blood in urine or semen, painful/ burning during urination, difficulty urinating, erectile dsyfunction, painful ejaculation, frequent pain/ stiffness in the LB/ hips/ thighs, inability to urinate and slow urine/ dribbling are all?
All SIGNS AND SYMPTOMS OF PROSTATE INVOLVEMENT