Red/Yellow Flags Flashcards by Albert Pannone

Name 5 red flags according to Mennell

Smallpox,
Influenza,
Genitourinary symptoms,
Prostate cancer,
acute kidney problems,
MS,
Parkinson's Disease,
TB,
Paget's Disease,
Appendicitis,
Sepsis - Bowel, Teeth, Tonsillitis,
Hemorrhoid

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Name 5 red flags according to Cyriax

Backache with fever,
Neoplasm,
Root pain > 8 months of duration or with gross limitation of every movement, 
weak psoas major, 
afebrile, 
osteomyelitis, 
aortic occlusion, 
spinal claudication, 
STD Fasciitis, 
Multiple Root Palsy,
Forbidden Area (TL junction) pain

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Current Subjective findings that are red flags for patients are:

Gradual increase in pain with prolonged time versus disc pattern,
Expanding pain to multiple segments,
Elderly patient - presentation of rapid increase in pain or stiffness over 1-2 months,
Pain increases by cough,
Paresthesia all over body provoked by neck flexion,
Cord symptoms,
History of cancer

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Current Objective Articular Findings that are red flags are:

Painful restriction - full articular pattern over a short period of time,
Gross limitations of sidebending,
End Feel - Soggy, empty, or muscle spasm

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Current Objective Non-Articular Findings that are red flags are:

Unusual myotome involvement: excessive loss of power, 2-3 nerve root signs and symptoms, painless weakness, fatigable weakness, painful resisted weakness,
Distal before central symptoms
Anemia

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Guidelines for red flags acccording to Waddell in 2004

Age less than 20 or greater than 50,
History and/or signs of serious trauma,
History of Neoplasm, 
Fever,
Neurological Deficits

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The CSAG and AHCPR red flags are

Age of onset greater than 50 rather than greater than 55,
Pain that worsens in supine,
Severe Night Pain

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In the sign of the buttocks, hip flexion PROM is just as limited as _________ and _______ ranges of motion

SLR, trunk flexion

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In the sign of the buttock there is painful weakness of hip ________

extension

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The sign of the buttock follows a _____ -_________ pattern of the hip

non-capsular

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______ in the buttock is unusual and is considered part of the sign of the buttock

swelling

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Having an empty end feel in ______ is part of the sign of the buttock

flexion

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Possible conditions associated with the sign of the buttock include:

Rheumatic Bursitis,
Osteomyelitis of the upper femur,
Neoplasm of the upper femur,
Neoplasm of the ilium,
Fractured sacrum,
Ischiorectal Abscess,
Septic Sacroiliitis,
Septic Bursitis

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These tests are misconstrued as the sign of the buttock

Kernig/Brudzinski Signs

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Brudzinski’s sign involves passive ________ flexion and produces flexion of the ______ and ________

neck, hips and knees

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Brudzinski’s sign is only seen in _______ cases of meningitis

severe

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Kernig’s sign involves passive extension of the _______ while the ______ is flexed

knee, hip

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Brudzinski’s sign involves passive neck _______ and produces _______ of the hips and knees

flexion, flexion

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Kernig’s sign involves passive _______ of the knee while the hip is _________

extension, flexed

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An aortic aneurysm is a _______ in the blood vessel

bulge

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An AAA is induced by ______ ________ of the aortic wall that causes a dilation or ballooning of the blood vessel

progressive weakening

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AAA typically takes place in what location?

under the kidneys

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Although less common you can have a _______ Anerysm

thoracic

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AAA can be caused by ____ _____ ______ such as Marfan’s Syndrome

Inherited genetic illnesses

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Possible causes of AAA include

``` Emphysema, smoking, obesity, male gender, substantial blood pressure, genetic elements high cholesterol ```

Name 5 Signs and Symptoms of AAA

``` Hoarseness, Bowel Obstruction, Chest or back discomfort, discomfort in the jaw, neck, and upper back, increased HR when going to a standing position, excess weight loss, nausea, vomiting, clammy skin, coughing up blood, anxiousness, difficulty swallowing, coughing, difficulty breathing ```

Treatment of AAA is typically

Stenting

Most caudal roots arising from the lumbar spine are ________

separate

Management of cauda equina is often _______ and ______

difficult and prolonged

The cauda equina usually terminates at the ______ disc but may go as far from ______ to _____

L1/2 disc | T12 body to L3/4 disc

The caudal spinal cord is termed the

conus medullaris

The conus medullaris is continuous as a filament below the cauda equina known as the

filum terminale

The dura and arachnoid meninges surround the filum terminale to the level of the ______ body

The first and second lumbar nerve roots has an angle of approximately __ to ___ degrees

70-80

The third and fourth lumbar nerve roots have angulations of ___ degrees

The fifth lumbar nerve root has an angle of __ degrees

The first sacral nerve root has an angle of __ degrees

The cauda equina can be impinged by

disc protrusion centrally, tumor, trauma

Symptoms of cauda equina include:

``` Loss of bowel and bladder patency, LE weakness or loss of sensation, Saddle anesthesia, Low back pain, Loss of reflex signs (lower motor neurons) ```

Management of caude equina is a _________ _________

medical emergency

Cauda equina needs to be surgically managed in ______ hours to be successful

48 hours

Sensitive signs of Cauda Equina according to Dayo et al include

urinary retention, unilateral/bilateral sciatica, Sensory/Motor Deficits and reduced SLR, Saddle Anesthesia

Signs and symptoms of Cauda Equina according to Ng et al include

``` Perineal Numbness, Loss of Urinary Sensation, Urinary Incontinence, Absent Anal Tone, Fecal Soiling, Painful retention, And Fecal Incontinence ```

Any Pathology in the abdomen can present with _______ _______

back pain

Simple _____ or ______ pain can mimic the pain of angina

thoracic or TL junction

______ pain can be produced by multiple organs

thoracic pain

Headaches are often _____ but occasionally _____

benign, serious

Cancers most common in men and women

Stomach, lung men | Breast, cervix women

Recognition of red herrings is often dependent on _____, ______, and _______ rather than rules

awareness, vigilance, and suspicion

Do not over rely on red flag lists as they are clinical ______ but not absolute _____

indicators, rules

95% of the time its a ______ ______ _____ but 5% have ______ related pain and 1% have ______ ______ ______ related to back pain

simple back ache, nerve, serious spinal pathology

Yellow Flags Include:

``` Exaggerated Responses (Waddell), "wrong" amount of activity, High stress, anger, Increased static muscle tone, poor posture, Poor diet, Exercise Habits, Excessive medications, Litigation ```

Yellow flag disorders include:

RA, Osteoporosis, Malignancy, Dizziness

Rheumatoid arthritis may lead to

ligamentous weakness and osteoporosis

Current or long term use of anticoagulants or steroids can cause

bone absorption and ligamentous weakness

These bones are especially vulnerable with osteoporosis

ribs

These techniques must be used with care in osteoporosis

pressure techniques

Osteoporosis is seen more commonly in

Menopausal women, Laxative users, Post gastrectomy, Anticoagulant users

In patients with malignancy careful ______ is not contraindicated as long as the possibility of metastasis has been thoroughly investigated and ruled out

mobilization

You should be careful with dizziness if it is produced or aggravated by_____ _____ and this contraindicates the techniques involving _____

neck rotation, rotation

Osteoporosis must be ______ before it is noted radiographically

severe

When treating children, care needs to be taken with the _______, in areas of ______ ______

growth plates, incomplete ossification