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
If patient has any signs and symptoms of prostate involvement and _ _ _ a _ _ they should be?
And HAS NOT HAD A MEDICAL EXAM, they should be REFERRED
Common signs and symptoms of prostate dysfunction could also be _ _, unless they answer yes to joint pain, recurring UTI, recurring urethral discharge, elevated PSA or depression.
Could also be SI DYSFUNCTION
_ _ is a strong predictor of fatal heart ailments. And they were 2X more likely to have _ _ _
ERECTILE DYSFUNCTION
2 X more likely to have PERIPHERAL ARTERY DISEASE
Before getting a patient exercising on the treadmill, what should you ask about? Why?
Viagra use, can cause a sudden drop in BP
There are _ _ systems for prostate cancer, but they all have a _ _
There are DIFFERENT STAGING systems for prostate cancer, but they all have SIMILAR VERBIAGE (confined to prostate, spread to seminal vesicle/ local regions, then spread outside from there, metastasize in other organs/ systems)
What are the 4 most common sites of metastatic for prostate cancer (in descending order)?
LITtR
- lumbar spine
- ileum
- thoracic vertebrae
- ribs (most common)
What is the grading scale that is commonly used for prostate cancer?
Gleason score
Prostate cancer is the most common _ cancer in men, not the most _.
Most common NEW cancer in men, not the most DEADLY
Benign prostatic hyperplasia, prostatitis, recent prostate biopsy, recent ejaculation, digital rectal exam and bicycle riding are all?
Are all non cancerous causes of elevated PSA levels
Normal PSA levels for men: age 40-49, 50-59, 60-69, and 70-79?
40-49: 0-2.5
50-59: 2.6-3.5
60-69: 3.6-4.5
70-79: 4.6-6.5
Prostate cancer risk is _with _, is more common in the _ and _ _, and is more common _, _, and then _ (in descending order).
Risk in INCREASED with AGE
Is more common in the US and NEW ZEALAND
Is more common in Blacks, whites and Hispanics (in descending order)
Men who have prostate cancer and a BMI of more than 25 are _ the _ _ of the disease.
Are DOUBLING the DEATH RISK of the disease
_ _ is the most common type of cancer in men between 15-35 years of age. Although it accounts for about _% of all cancers in men.
TESTICULAR CANCER is the most common . . . .
Although it accounts for about 1% of all cancers in men
What are the risk factors for testicular cancer? (3)
White, Young, Family history
In patients with testicular cancer _ _ usually occurs before _ _ .
BACK PAIN usually occurs before ANTERIOR PAIN
You suspect that your 34 year old male patient has cauda equina compression, what would be the earliest sign? What is the best question to rule in/ out presence of cauda equina syndrome?
Inability to urinate in sitting
Best question to r/I or r/o is: ARE YOU RETAINING URINE?
Cauda equina syndrome red flags: urinary _ or _, _ _, decreased _ _ tone or _ _, bilateral _ _ or _, history of /, and _ deviations.
Urinary INCONTINENCE or RETENTION SADDLE ANESTHESIA Decreased ANAL SPHINCTER tone or FECAL INCONTINENCE Bilateral LE WEAKNESS or NUMBING History of LBP/ SPONDYLOLISTHESIS GAIT deviations
Cauda Equina Syndrome is higher in people with _ _ than _.
Higher in people with DISC HERNIATIONS than LBP
Prognosis for Cauda Equina Syndrome if surgery occurs within 48 hours of symptoms? After 48 hours?
Before 48 hours: 95% change in continence and full recovery w/in 6 months
After 48 hours: 67% change and they will still be catheterized 6 months after surgery
What is the most common symptom of CES? Most consistent? (2) Most common sensory deficit?
Most common symptom: NON-SPECIFIC BACK PAIN( GREATER THAN 90%)
Most consistent: URINARY RETENTION (90%) and DIMINISHED ANAL SPHINCTER TONE (50-75%)
Most common sensory deficit: SADDLE ANESTHESIA (75%)
How do you differentiate between patients with CES and SI pain: SI pain does _ _ _ _ or normally cause _ or _.
SI pain does NOT GO BELOW KNEE or normally cause NUMBNESS or TINGLING
It is rare for a male to have _ _, should be concerned that something else is going on.
Rare for a male to have CHRONIC UTI’S . . .
The _, _ and _ all develop at the same time and are innervated by the same nerve, therefore pain may occur in any of the 3.
The BLADDER, URETER, AND KIDNEY all develop at the same time . . .
_ in _ is the most common symptom of renal disease: _ that is _ or _, _ or _, more or less than _ _, and getting up _ _ to _.
CHANGES IN URINATION is the most common symptom of renal disease: URINE that is FOAMY OR BUBBLY, RED or PINK, more or less than USUAL AMOUNT, and getting up AT NIGHT to URINATE.
_ _ _ can cause pain due to renal dysfunction because the kidneys are near the _ _.
PASSIVE HIP EXTENSION can cause pain due to renal dysfunction because the kidneys are near the PSOAS MUSCLE
All retroperitoneal organs will cause _ _ _ before _ pain.
Will cause THORACOLUMBAR JUNCTION PAIN before ABDOMINAL pain
What is the chief complaint associated with kidney problems? How do you differentiate from cord compression?
Chief complaint of kidney problems: LOW BACK PAIN
How do you differentiate:
- KIDNEY: FREQUENT URINATION (earlier sign)
- CORD COMPRESSION: will be a PAIN-MOVEMENT RELATIONSHIP
_/ _ stool is common with an upper GI bleed. _/ _ _is common with a lower GI bleed.
BLACK/ TARRY stool- upper GI
RED/ SWIRL STOOL- lower GI
Gall bladder dsyfunction/ gall stones can result in _ _ _. _ and _ dsyfunction can result in brown urine/ pale fecal matter. Pancreatic cancer can result in _ stool.
Gall bladder dysfunction/ stones: PALE COLORED STOOL
KIDNEY AND LIVER dysfunction can result in brown urine/ pale stool
Pancreatic cancer: SILVERY STOOL
What is the fecal shape associated with: tumor/ hemorrhoid? Distal colon cancer/ anal cancer/ space occupying lesion?
Tumor/ hemorrhoids: RIBBON SHAPED STOOL
Distal colon and anal cancer/ space occupying lesion: PENCIL THIN
_ _ is the 3rd most common malignant neoplasm, and the 3rd most common cause of cancer of cancer deaths.
COLORECTAL CANCER
When auscultating your _ _ you should be able to hear ‘gut sounds’
Auscultating your ASCENDING COLON
Impaction/ constipation in both the young and elderly can result in _ _
Can result in MENTAL CONFUSION
_ _/ _ is one of the most common causes of constipation. Binds to _ _ in gut which stops peristalsis.
OPIOD USE/ ADDICTION is one of the most common causes of constipation.
Binds to the MU RECEPTORS in the gut stopping peristalsis
_% of the population is taking opioids, -% use chronically, and -% develop constipation.
17% is taking opioids
3-5% use chronically
41-62% develop constipation
_ _ is known as the carpal tunnel of the pelvic floor. Symptoms can include _ and other _. Can also cause difficulty emptying _ and _, and pelvic floor _.
PUDENDAL NEURALGIA is known as carpal tunnel of pelvic floor
Symptoms can include TINGLING and other SENSATIONS (like saddle anesthesia).
Can also cause difficulty emptying BLADDER AND BOWEL, and pelvic floor DYSFUNCTION
_ _, _ delivery, weight/ power lifting, _/ surgery, and entrapment can all be MOI for pudendal neuralgia.
BIKE RIDING, VAGINAL delivery, weight/ power lifting, HEMORRHOIDS/ surgery and entrapment . . .
What are the nerve roots for the pudendal nerve? Common entrapment site?
S2-S4
Alcock’s canal
Differential Dx: Men with pain during urination and an enlarged prostate will most commonly have _ with _.
Commonly have PAIN WITH URINATION
Differential dx: Men with urinary retention and saddle anesthesia can have _ _ or _ _ _
Can have ENLARGED PROSTATE or CAUDA EQUINA SYNDROME
Differential Dx: pain with sitting and possible tingling is most likely caused by?
PUDENDAL NERVE ENTRAPMENT
_ significantly slows the healing rate, decreases bony healing and soft tissue healing
SMOKING
What is the minimum of smoking cessation to see improvements for surgical site infection?
Minimum of 4 weeks
_ _ typically affects the right apex of the lung. Will see majority of symptoms in the _, will mimic subacromial bursitis, TOS and ulnar nerve neuropathy. How do you differentiate?
PANCOAST’S TUMOR
Will see majority of the symptoms in the SHOULDER
Should be able to provoke symptoms of bursitis/ TOS/ ulnar nerve neuropathy
_ and _ refer pain to the neck. _ only get stressed unless deep/ prolonged breathing from sustained exercise.
LUNGS AND LIVER refer pain to the neck
LUNGS only get stressed unless deep/ prolonged breathing from sustained exercise.
_ _ can refer pain to the right upper quadrant, right shoulder, right scapula.
GALL STONES
_ _ will refer pain to the left shoulder. Primarily due to _ and _.
SPLEEN RUPTURE will refer pain to the left shoulder.
Primarily due to MONONUCLEOSIS AND LEUKEMIA
_ enlargement is a category _ red flag.
SPLEEN enlargement is a category I RED FLAG.
Which seat belt sign is being described: pain over spleen and lungs.
PASSENGER SIDE
Which seat belt sign can cause damage to the liver, gall bladder, and lungs (pneumothorax)?
Driver’s side
Ectopic pregnancy can refer pain to the _ _ and _ _
LEFT SHOULDER and LOWER BACK
_ _ can cause left shoulder or neck pain.
LYMPH NODES
Lung, gall bladder, bile duct will refer pain to the _ _
RIGHT SHOULDER
_ and _ can cause referred pain to the neck.
LUNGS AND LIVER can cause referred. . .
If lymph nodes are _ than _ _ or _/ _
GREATER THAN CM or FIRM/ HARD
Bile duct cancer might have _ _ _ pain
RIGHT UPPER QUADRANT
_ _, _ _and _ are common symptoms of meningitis. Similar signs to _ _.
NECK PAIN, MIGRAINE HEADACHES and FEVER are common symptoms of meningitis
Similar signs to MULTIPLE SCLEROSIS
Herniated nucleus pulposus red flags include _ _, major _ _ (less than /), and _ _. Only if _ _ is _ or _
Red flags include SIGNIFICANT HNP, major MUSCLE WEAKNESS (less than 3/5), and FOOT DROP
Only if NEUROLOGICAL DEFICIT is SIGNIFICANT or NEUROLOGICAL
Phrenic nerve, or any _ _ can refer pain to the _ and to the _.
Phrenic nerve or any INTERNAL BLEEDING can refer pain to the SHOULDER and to the NECK
Cardiac dysfunction (Pericarditis or MI), Pulmonary dysfunction (Carcinoma, abscess, pneumonia), hiatal hernia, or mediastinal tumor, aorta or esophageal problems can all refer pain to?
Can all refer pain to the SHOULDER
Malignant tumors, bone me tastes, Paget’s disease, shingles, brachial neuritis, and cervical disc syndrome can all refer pain to the?
Can refer pain to the SHOULDER
What type of Claudication is indicated by: limited standing or walking tolerance, unilateral\ bilateral. Aggravated by _ and _, and eased by _ _ and _.
Neurogenic claudication
Aggravated by STANDING AND WALKING and eased by LUMBAR FLEXION and SITTING
What is being described: leg pain limits walking, unilateral/ bilateral. Aggravated by walking and exertion and eased by standing or resting.
VASCULAR CLAUDICATION
Neurogenic claudication aggravating factors (2) and easing factors?(2)
SouthWest LouSiana
- STANDING AND WALKING
- LUMBAR FLEXION AND SITTING
Vascular claudication: aggravating factors (2)? Easing factors? (2)
WES R
Aggravating- walking and exertion (vascular insufficiency)
Easing- standing and resting
What are the warning signs of an aortic aneurysm? (5)
ERINS
- excessive sweating
- rapid pulse
- intense back/ abdominal pain
- nausea/ vomitting
- shock
Hypertension, smoking and hardening of the arteries (Artherosclerosis) are _ abdominal aorta _ _.
Are CONTROLLABLE abdominal aorta RISK FACTORS
Age, gender (more common in men), and family history are _ abdominal aneurysm _ _.
Are UNCONTROLLABLE abdominal aneurysm RISK FACTORS
_ _ symptoms are not variable with walking distance. _ are.
Neurogenic claudication symptoms are not variable
Vascular claudication symptoms ARE variable
. . . With walking distance
_ _ will be reduced with vascular claudication versus neurogenic claudication.
PERIPHERAL PULSES will be reduced with vascular . . .
The ascending aorta will cause pain across _ _ and _ the _.
Across THE CHEST and DOWN the ARMS
Abdominal pulsating mass*, Artherosclerotic vascular disease, pain at rest/ nocturnal pain, and age greater than 60 are all?
Acute abdominal aneurysm RED FLAGS
Avoid vasalva, avoid lifting over 25 pounds, and avoid end range trunk flexion are all _ _ _/ _ for abdominal aneurysm
Are all POST OP PRECAUTIONS/ CONTRAINDICATIONS
Male gender, family history, younger than 60, post menopausal woman, HTN, High LDL/ low HDL, diabetic, obese, smoker, sedentary and psychological issues (stress, hostility, anger) are all?
Are all risk factors for CORONARY ARTERY DISEASE
