Week 1- Medical Screening and Low Back Pain Flashcards
(40 cards)
1
Q
Evaluation/Intervention Components
A
1) Medical screening
2) Classify condition
2
Q
Aspects of medical screening
A
- 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)
3
Q
What happens in component 2: classify condition
A
Classify through evaluation of clinical findings of MSK impairments and associated tissue pathology
4
Q
What is the most common site of metastases?
A
The skeleton
5
Q
What percentage of metastases are in the lumbosacral region?
A
40%
6
Q
What metastatic cancer commonly causes lumbar spinal pain?
A
In prostate
7
Q
Sensitivity and specificity
A
-
8
Q
-
A
-
9
Q
-
A
-
10
Q
-
A
-
11
Q
-
A
-
12
Q
-
A
-
13
Q
-
A
-
14
Q
-
A
-
15
Q
-
A
-
16
Q
-
A
-
17
Q
What symptoms may indicate a back-related spinal infection?
A
- LBP, flank, or pelvic pain
- Tenderness over spinal process w/ percussion
- Concurrent infection or drug use
- Fever
18
Q
What is cauda equina syndrome?
A
- Compression and swelling of the cauda equina
- Neurologic emergency
- Surgery most successful w/in 72 hours
19
Q
Symptoms of cauda equina syndrome?
A
- Urine retention
- Saddle anesthesia
- Sensory/motor deficits in the feed (L4, L5, S1 areas)
20
Q
Symptoms of spinal compression fracture
A
- Major trauma
- Pain and tenderness
- Age > 50
- Female
21
Q
Symptoms of an abdominal aortic aneurysm
A
- 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
22
Q
What is ankylosing spondylitis?
A
- An inflammatory arthropathy
- Systematic rheumatic disorder
23
Q
Risk factors for ankylosing spondylitis
A
- Males > Females
- Hx of inflammatory conditions (IBS, Crohn’s)
24
Q
Symptoms of ankylosing spondylitis
A
- Morning stiffness > 30 min
- Improve LBP w/ exercise but not rest
- Night pain during 2nd half of night
- Alternating buttock pain
25
ID the GI Referral Patterns
-
26
Characteristics of cluster 1 to signify abdominal pain of MSK origin
- 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
27
Characteristics of cluster 2 to signify abdominal pain of MSK origin
- Eating certain foods does not make pain worse
| - Weight has not changed since symptoms started
28
ID renal/urinary referral patterns
-
29
Questions for renal/urinary disorders
- Do you have any trouble with urination?
| - Ask about changes in urine color, initiation, incontinence, flow changes
30
Symptoms in reproductive system to be aware of in males
- Urethral discharge
- Sexual dysfunction
- Pain during intercourse/ejaculation
31
Symptoms in reproductive system to be aware of in females
- Vaginal discharge
- Pain w/ intercourse
- Menstruation
- Frequency
- Length of cycle
- Dysmenorrhea
- # of pregnancies and deliveries
- Menopause
32
Common risk factors for depression
- 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
33
Most important questions to ask patients about depression
- Past 2 weeks, felt down, depressed, or hopeless?
| - Past 2 weeks, little interest or pleasure in doing things?
34
What are red flags in a PT practice?
Signs and symptoms that raise suspicion of serious spinal pathology
35
Levels of concern
- No concerning features
- Few concerning features
- Some concerning features
- Many concerning features
36
Decision for no concerning features
- Begin a trial of therapy
| - Revise management if clinical features change unexpectedly
37
Decision for few concerning features
- Begin a trial of therapy with watchful waiting
- Revise management if clinical features change unexpectedly
- Monitor progress closely (vigilance)
38
Decision for some concerning features
- Urgent referral
- DO NOT begin a trial of PT
- Further investigation or referral is warranted
39
Decision for many concerning features
- Emergency referral
- DO NOT begin a trial of PT
- Emergency referral is warranted
40
Red flags to watch out for
- Cauda equina syndrome
- Spinal fracture
- Spinal malignancy
- Spinal infection
