Ortho 2: Differential Diagnosis

red flag indicators for systemic disease (4)

unexplained weight loss, fever >100F for more than 2 weeks, night pain, fatigue affecting ADLs

If a patient presents with a vague or minor red flag, what is your plan of action?

Trial of therapy

If a patient presents with multiple red flags, what is your plan of action?

Watchful waiting

If a patient presents to the clinic with significant loss of strength, chest pain, bowl and bladder changes, what is your plan of action?

Urgent or emergency referral

“Signs” are described as

observable or measureable

“symptoms” are described as

perceived and described by patient

constitutional signs include (9)

fever, fatigue, unexplained weight loss, nausea, numbness, dizziness, night pain, SOB, saddle anesthesia

when are we worried about weight loss?

when it is unintentional and pt has had 10% loss in less than 4 weeks

numbness or tingling may suggest _____ dysfunction

neurological

what is night pain

pain that awakens that patient and keeps them awake, especially if they must get up and walk around

Cardaic Signs that may be indicative of issues

angina unrelieved by rest, referred jaw pain, dyspnea, diaphoresis

saddle anesthesia

difficulty controlling bowel and bladder function may indicate cauda equina syndrome

if a patient answers yes to a red flag question, how should you follow up?

is there an explanation for it? have they mentioned it to their physician? if the physician is aware of it, has it changed at all?

mneumonic for the early warning signs of cancer presence

CAUTION

what are the early warning signs of possible cancer presence

Change in bowel or bladder habits, A sore throat that does not heal in 6 weeks, Unusual bleeding or discharge, Thickening or lump in breast or elsewhere, Indigestion or difficulty in swallowing, Obvious changes in a wart or mole, Nagging cough or hoarseness

at what time are you worried about a patient presenting with red flags?

if there is no change after 4 weeks of conservative treatment

osteoporosis

condition that makes bones weak and fragile so they break easily

myeloma

blood cancer that forms in plasma cells

at what point as steroids a red flag for fractures?

>5mg for > 3 months

fracture red flag ages, women and men

women: > 65, Men: >75

red flags for malignancy

History of cancer!!, band like pain, weight loss, signs of hypercalcemia (fatigue, nausea, fever)

cauda equina red flags

unilateral → bilateral leg pain, motor weakness/clumsy, reduced saddle sensation, bladder issues, sexual dysfunction

Spinal Infection Red Flags

fever, chills, constant worsening pain, IV Drug Use, recent infection with fever

red flags for cord compression

gait deviation, positive hoffman, babinski, clonus, inverted supinator sign, hyperreflexia

what is the most common cause of cauda equina syndrome?

central disc herniation of L4-:5 or L5-S1 level

myeloma most commonly affects the _____ spine.

thoracic

most common place for metastatic bone disease?

thoracic spine

what is the triad of symptoms for spinal infection?

back pain, fever, neurological dysfunction