Week 1- Medical Screening and Low Back Pain

Question 1

Evaluation/Intervention Components

Answer 1

1) Medical screening

2) Classify condition

Question 2

Aspects of medical screening

Answer 2

• Appropriate for PT evaluation and intervention

vs

• Appropriate for PT evaluation and intervention WITH consultation w/ another health care provider (YELLOW FLAGS)

vs

• Not appropriate for PT evaluation and intervention (RED FLAGS)

Question 3

What happens in component 2: classify condition

Answer 3

Classify through evaluation of clinical findings of MSK impairments and associated tissue pathology

Question 4

What is the most common site of metastases?

Answer 4

The skeleton

Question 5

What percentage of metastases are in the lumbosacral region?

Answer 5

40%

Question 6

What metastatic cancer commonly causes lumbar spinal pain?

Answer 6

In prostate

Question 7

Sensitivity and specificity

Answer 7

-

Question 8

-

Answer 8

-

Question 9

-

Answer 9

-

Question 10

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Answer 10

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Question 11

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Answer 11

-

Question 12

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Answer 12

-

Question 13

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Answer 13

-

Question 14

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Answer 14

-

Question 15

-

Answer 15

-

Question 16

-

Answer 16

-

Question 17

What symptoms may indicate a back-related spinal infection?

Answer 17

• LBP, flank, or pelvic pain
• Tenderness over spinal process w/ percussion
• Concurrent infection or drug use
• Fever

Question 18

What is cauda equina syndrome?

Answer 18

• Compression and swelling of the cauda equina
• Neurologic emergency
• Surgery most successful w/in 72 hours

Question 19

Symptoms of cauda equina syndrome?

Answer 19

• Urine retention
• Saddle anesthesia
• Sensory/motor deficits in the feed (L4, L5, S1 areas)

Question 20

Symptoms of spinal compression fracture

Answer 20

• Major trauma
• Pain and tenderness
• Age > 50
• Female

Question 21

Symptoms of an abdominal aortic aneurysm

Answer 21

• Midline lower thoracic/lumbar pain (may be asymptomatic at time of diagnosis)
• Palpable pulsating abdominal mass
• Pain descriptors: throbbing, pulsating
• Patient unable to fiind comfortable position
• Hx of cigarette smoking
• Positive family hx
• History of AAA, vascular atherosclerotic disorders

Question 22

What is ankylosing spondylitis?

Answer 22

• An inflammatory arthropathy

- Systematic rheumatic disorder

Question 23

Risk factors for ankylosing spondylitis

Answer 23

• Males > Females

- Hx of inflammatory conditions (IBS, Crohn’s)

Question 24

Symptoms of ankylosing spondylitis

Answer 24

• Morning stiffness > 30 min
• Improve LBP w/ exercise but not rest
• Night pain during 2nd half of night
• Alternating buttock pain

Question 25

ID the GI Referral Patterns

Answer 25

-

Question 26

Characteristics of cluster 1 to signify abdominal pain of MSK origin

Answer 26

• Coughing sneezing, or taking a deep breath makes pain worse
• Bending, sitting, lifting, twisting, turning over in bed makes pain worse
• No change in bowel habit since symptoms came

Question 27

Characteristics of cluster 2 to signify abdominal pain of MSK origin

Answer 27

• Eating certain foods does not make pain worse

- Weight has not changed since symptoms started

Question 28

ID renal/urinary referral patterns

Answer 28

-

Question 29

Questions for renal/urinary disorders

Answer 29

• Do you have any trouble with urination?

- Ask about changes in urine color, initiation, incontinence, flow changes

Question 30

Symptoms in reproductive system to be aware of in males

Answer 30

• Urethral discharge
• Sexual dysfunction
• Pain during intercourse/ejaculation

Question 31

Symptoms in reproductive system to be aware of in females

Answer 31

• Vaginal discharge
• Pain w/ intercourse
• Menstruation
• Frequency
• Length of cycle
• Dysmenorrhea
• # of pregnancies and deliveries
• Menopause

Question 32

Common risk factors for depression

Answer 32

• Current/past hx of major depression
• Family hx of depression
• Hx of MI, CA, CVA, substance abuse/dependency, obesity, CHF, dementia, or DM
• Significant loos/change in social status
• Pregnanty/post-partum
• Fatigue/sleep disturbance
• Weight change
• Women > Men
• Chronic pain/2+ chronic diseases

Question 33

Most important questions to ask patients about depression

Answer 33

• Past 2 weeks, felt down, depressed, or hopeless?

- Past 2 weeks, little interest or pleasure in doing things?

Question 34

What are red flags in a PT practice?

Answer 34

Signs and symptoms that raise suspicion of serious spinal pathology

Question 35

Levels of concern

Answer 35

• No concerning features
• Few concerning features
• Some concerning features
• Many concerning features

Question 36

Decision for no concerning features

Answer 36

• Begin a trial of therapy

- Revise management if clinical features change unexpectedly

Question 37

Decision for few concerning features

Answer 37

• Begin a trial of therapy with watchful waiting
• Revise management if clinical features change unexpectedly
• Monitor progress closely (vigilance)

Question 38

Decision for some concerning features

Answer 38

• Urgent referral
• DO NOT begin a trial of PT
• Further investigation or referral is warranted

Question 39

Decision for many concerning features

Answer 39

• Emergency referral
• DO NOT begin a trial of PT
• Emergency referral is warranted

Question 40

Red flags to watch out for

Answer 40

• Cauda equina syndrome
• Spinal fracture
• Spinal malignancy
• Spinal infection