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Differential Dx > Lumbopelvic hip region > Flashcards

Lumbopelvic hip region Flashcards

1
Q

What are LBP red flags?

A
  • Age ≥ 50
  • History of cancer
  • Weight loss
  • Failure of PT
  • Fever, chills
  • Recent infection
  • Trauma
  • night pain
  • saddle anesthesia
  • LE neuro deficit
  • immunosuppression
  • bladder dysfunction
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2
Q

What are red flags for back related tumors?

A
  • > 50 y/o
  • PMH
  • weight loss
  • failure of conservative therapy
  • ambiguous presentation
  • constant pain
  • band-like distribution of pain to the abdomen
  • neuro LE signs
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3
Q

What infection is most common in the upper lower back

A

spinal osteomyelitis

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4
Q

When is spinal osteomyelitis most common?

A

30s

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5
Q

Pain from spinal osteomyelitis increases within __-___.

A

1-3 weeks

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6
Q

What is the most common type of infection of the vertebral body?

A

bacterial

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7
Q

What are red flags of spinal osteomyelitis?

A
  • recent infection
  • IV drug use/abuse
  • immunosuppression
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8
Q

What vertebral levels are commonly affected by spinal osteomyelitis?

A

1st and 2nd vertebral levels

–> spinous process TTP w/ global pain

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9
Q

(true/false) fever is common in both adults and children when they have spinal osteomyelitis

A

FALSE (common only in children)

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10
Q

What are red flags associated with back related infections?

A
  • deep constant pain that increases with WB and can radiate
  • fever, malaise, sweating
  • spinal rigidity
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11
Q

What are red flags for cauda equina syndrome?

A
  • 50 to 55 y/o
  • b/b changes
  • saddle paresthesia (L4-S2)
  • LE weakness (L4-S1)
  • sensory deficits of L4-S1
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12
Q

What are aggs and eases for saddle paresthesia?

A
  • Aggs: standing/walking
  • relief: flexion
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13
Q

What are red flags for spinal fx?

A
  • > 70 y/o
  • trauma
  • prolonged steroid use
  • loss of mobility/function
  • TTP over site of fx
  • increased pain with WB
  • edema in local area
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14
Q

What are red flags for abdominal aneurysm?

A
  • back, abdominal, or groin pain
  • PVD or CAD
  • > 50 y/o
  • smoker
  • HTN
  • DM
  • pulsatile mass
  • bruit w/ auscilation in the central epigastric area
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15
Q

(true/false) symptoms related to an abdominal aneurysm are associated with movement

A

FALSE

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16
Q

What are red flags for kidney disorders?

A
  • UNILATERAL flank pain or LBP
  • difficulty urinating
  • painful urination
  • hematuria
  • recent UTI
  • PMH of kidney stones
  • (+) precussion test over the kidney
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17
Q

What is pyelonephritis?

A

Infection of the kidney

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18
Q

What causes infection of the kidney (pyelonephritis)?

A

infection of ascending urinating tract

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19
Q

What is nephrolithesis?

A

kidney stones (excessive calcium, uric acid, or cysteine)

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20
Q

What are s/s of nephrolithesis?

A
  • back and abdominal pain
  • N/V
  • urinary frequency
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21
Q

What are risk factors for renal cancer carcinoma?

A
  • male
  • smoker
  • obese
  • HTN
  • genetics
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22
Q

What are the 2 components of the “Rule of Thumb” to rule in a painful SIJ?

A
  1. unilateral pain below L5
  2. Pain with sit –> stand transfer
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23
Q

(true/false) The SIJ moves.

A

True

Avg: 2-3 mm and < 4 degrees of ROT

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24
Q

What is the stork/gillet test used for?

A

Palpating SIJ movement

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25
Q

What palpation tests are used for detection of SIJ dysfunction?

A
  1. standing FLX test
  2. sitting PSIS palpation
  3. Supine-long sitting test
  4. prone knee FLX test

3 of 4 (+) tests are idea for Dx

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26
Q

(true/false) Individual SIJ palpation tests are reliable for SIJ dysfunction

A

FALSE

unreliable

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27
Q

What is a (+) Fortin’s sign?

A

The patient identifies the area surrounding the PSIS is the area of pain

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28
Q

What tests are used to identify pain originating from the SIJ?

A
  1. SIJ compression test
  2. ASIS distraction test
  3. Thigh thrust (femoral shear)
  4. Sacral thrust (provocation)
  5. R/L Gaenslen’s Test (Torque test)

If 3+ are positive, there is high specificity and sensitivity

Can replace the compression test with FABER (Patrick’s) test

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29
Q

What are infectious/inflammatory Dx involving the Lumbopelvic region?

A
  1. Spondyloarthropathy:
    - ankylosing spondylitis
    - Reiter’s
    - Psoriatic syndrome
    - Inflammatory bowel disease
  2. Vertebral osteomyelitis
  3. endocarditis
  4. TB
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30
Q

What is Paget’s disease?

A

Unexplained acceleration of bone deposition and resorption

Second most common metabolic bone disease

Common in males > 70 y/o

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31
Q

Symptoms:
- slowly progressing enlargement and deformity of multiple bones
- redness and warmth

A

Paget’s disease

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32
Q

What are bowel disturbances seen in those with colon cancer?

A
  • rectal bleeding
  • red-streaked stools
  • change of stool diameter
33
Q

What are red flags for colon cancer?

A
  • TTP of abdomen
  • ascites
  • metastases
34
Q

Where is inguinal hernia pain?

A

groin and/or scrotum

35
Q

symptoms:
- s/s exacerbated by coughing, sneezing, or resisted sit-ups
- TTP of inguinal canal

A

Inguinal hernia

36
Q

Appendicitis can present as an ____ due to similar s/s

A

inguinal hernia

appendicitis presents with flank pain. nausea, and anorexia

37
Q

What are red flags for appendicitis?

A
  • abdominal rigidity
  • (+) Mcburney’s points
  • (+) psoas and obturator signs
38
Q

Who is at risk of developing an ovarian cyst?

A

Female at childbearing age

39
Q

symptoms:
- sudden severe abdominal or pelvic pain
- gradual cycling of pain with menstrual irregularities

A

ovarian cyst

40
Q

What is adnexal torsion?

A

Twisting of the ovary and sometimes the fallopian tube, interrupting the arterial supply and causing ischemia

“Ovarian Torsion”

41
Q

What is the primary cause of ovarian torsion?

A

benign tumor > malignant tumor

42
Q

What are s/s of ovarian torsion?

A
  • sudden severe pelvic pain
  • nausea
  • vomiting
43
Q

(true/false) ovarian torsion is more common than testicular torsion

A

FALSE

44
Q

What is varicosities?

A

Twisted, enlarged veins of the ovaries

“Ovarian varicocele”

45
Q

Endometriosis is a pathologic condition of (anterograde/retrograde) menstruation

A

retrograde

46
Q

What is endometriosis?

A

Tissue resembling the normal lining of the uterus grows outside of the uterus

Stays in the pelvic cavity

47
Q

Up to _ % of women with endometriosis are infertile

A

50%

48
Q
A
49
Q

What is rectocele?

A

rectal prolapse

50
Q

What is cystocele?

A

Bladder prolapse

51
Q

Describe first degree uterine prolapse?

A

Uterus is dropped 1/3 of the way into the vaginal canal

52
Q

What is pelvic congestion syndrome associated with?

A

Pelvic varicose veins

Lower abdomen and groin

53
Q

What population commonly experiences pelvic congestion syndrome?

A

Women 20-45 y/o

54
Q

What is the cause of pelvic congestion syndrome?

A

idiopathic development of varicose veins during pregnancy

continue to progress in size

55
Q

symptoms:
- constant dull pelvic pain
- pelvic pressure
- pelvic heaviness
- aggs: prolonged standing

worse: at the end of the day

A

Pelvic congestion syndrome

56
Q

What is coccygodynia?

A

coccygeal pain

57
Q

What aggravates coccygeal pain?

A
  • direct pressure
  • movement
58
Q

What are treatment options for coccygeal pain?

A
  • injections
  • coccyx pillow
  • manipulation
59
Q

Definition: small tear in the lining of the anal canal caused by passing hard and/or large stools during bowel movements

A

Anal fissure

60
Q

symptoms:
- burning pain and bright red blood with bowel movements

A

anal fissure

61
Q

What are thrombosed hemorroids?

A

swelling of the veins in the anus or outside of the rectum

Restricted venous blood flow –> vessels split –> blood pools & clots subcutaneously

62
Q

Definition: A cyst that develops along the coccyx near the cleft of the buttocks containing hair/skin

A

pilonidal cysts

Men 15-24 y/o

63
Q

chracteristics:
- dimple
- opening in the skin
- pus
- redness and warmth

A

Pilonidal cyst

64
Q

definition: infectious bone disease of the pubic symphysis

A

osteomyelitis pubis

Causes: pelvic surgery, childbirth, abdominal pathology, unknown

65
Q

symptoms:
- painful hip ABD
- Fever
- TTP over pubis symphysis
- waddling gait
- elevated WBCs
- elevated sedimentation rate

A

osteomyelitis pubis

Treatments: antibiotics, NSAIDS, rest, surgery

66
Q

What is the prognosis for osteomyelitis pubis?

A

Progressive without treatment

widening of the symphysis and increased bone destruction

67
Q

What is femoral head osteonecrosis associated with?

A
  • long-term corticosteroid use
  • sickle cell disease
  • DM
  • trauma
  • contralateral hip AVN
68
Q

presentation:
- Slow, progressive groin, greater trochanter, deep buttock pain
- pain can refer to the medial knee
- stiff hip joint
- FADIR restrictions

A

femoral head osteonecrosis

69
Q

What is legg-calve perthes disease?

A

Idiopathic loss of blood supply from the lateral ascending cervical artery to the femoral head

Affects 5-8 y/o

70
Q

Characteristics:
- pain with WB
- antalgic gait
- Involved LE is shortened and held in ER
- Painful and limited hip IR and ABD

A

Legg-calve perthes disease

71
Q

What is a slipped capital femoral epiphysis?

A

Progressive displacement of femoral head superiorly through the open growth plate

Primarily in adolescent males with a Hx of growth spurt or trauma

72
Q

Characteristics:
- diffuse groin/thigh/knee pain that is exacerbated with WB
- antalgic gait
- limb held in ER
- limited IR
- Hx of recent growth spurt or trauma

A

SCFE

73
Q

Characteristics:
- child or older adult with vague hip ache who had a recent bacterial infection
- not willing to WB or move on the involved side
- fluid is seen around the femoral head and may be seen going into the bladder on MRI

A

Septic hip arthritis

74
Q

What can a FAI cause?

definition: Decreased joint clearance between the femur and acetabulum especially when hip flexion is combined with adduction, and internal rotation (FADIR)

A

labral tear = progressive degeneration leading to osteoarthritis

75
Q

symptoms:
- Locking, clicking or catching sensation in hip joint
- Pain in hip or groin
- Stiffness or limited hip jt ROM

Causes:
- trauma
- abnormal structure
- repetitive motions
- osteoarthritis

A

labral tear

76
Q

Who is commonly seen with femoral neck Fx?

A

females > 70 y/o

77
Q

Characteristics:
- hip, thigh, knee pain
- severe, acute, constant groin pain
- history of a fall from standing position
- involved LE: shortened, abducted, and ER

A

Femoral neck Fx

78
Q

Meralgia paresthetica is the entrapment of what nerve?

A

Lateral Femoral Cutaneous nerve

79
Q

What is the presentation of meralgia paresthetica?

A
  • burning pain in the lateral thigh
  • aggravated with sitting, squatting, and wearing wide belts

Differential Dx (13 decks)

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