Red Flags

Question 1

PMH

Answer 1

• personal/family Hx of cancer
• recent infection (especially followed by neuro symtpoms)
• recurrent colds/flu
• Hx of recent trauma
• Hx of immunosuppression
• Hx of injection drug use

Question 2

Risk Factors

Answer 2

• substance abuse, tobacco, alcohol
• old/young age, gender specific
• high/low BMI
• radiation exposure
• race/ethnicity
• domestic violence

Question 3

Clinical Presentation 1

Answer 3

• insidious onset
• symptoms not improved by PT
• significant weight loss/gain without effort
• gradual, progressive, cyclical presentation of S/S
• unrelieved by rest or change in position

Question 4

Clinical Presentation 2

Answer 4

• if self-cope means no longer work
• symptoms out of proportion to injury
• symptoms persist beyond expected healing
• unable to alter symptoms during exam
• does not fit expected pattern

Question 5

Clinical Presentation 3

Answer 5

• no discernible pattern of symptoms
• a continually growing mass
• postmenopausal vaginal bleeding
• change in muscle tone
• bilateral symptoms

Question 6

Pain Patterns 1

Answer 6

• back or shoulder pain
• pain with and painless ROM
• pain not consistent with emotional or psychological overlay
• Night pain
• constant and intense pain

Question 7

Pain Patterns 2

Answer 7

• pain made worse by activity and relieved by rest
• throbbing knifelike, boring, deep ache pains
• poorly localized pain
• pain with S/S of viscera or systemic involvement
• change with MS symptoms with food intake

Question 8

Associated Signs and Symptoms

Answer 8

• recent signs of confusion with infection\
• presence of constitutional symptoms
• proximal weakness w/ DTR changes
• joint pain w/ skin rashes
• cluster of S/S
• unusual menstrual cycle/symptoms

Question 9

Immediate Referrals

Answer 9

• angina pain not relieved in 20 minutes
• angina w/ nausea, vomiting, sweating
• Bowel/bladder incontinence, saddle anesthesia
• inadequate ventilation or CO2 retention
• positive McBurney’s point or rebound tenderness
• sudden worsening of intermittent claudication
• throbbing chest, back, abdominal pain increases w/ exertion
• changes in size, shape, tenderness of lymph nodes

Question 10

Referrals for General Systemic

Answer 10

• unknown cause
• lack of significant NMS S/S
• lack of progress in PT
• changes in health status persist 7-10 days beyond
• jaundiced who isn’t diagnosed or in treatment

Question 11

Referrals for Women

Answer 11

• symptoms correlated with menses
• uterine bleeding after menopause
• vaginal bleed or elevated BP during pregnancy
• low back, hip, pelvic, groin, or SI symptoms w/o known etiologic basis

Question 12

Referrals related to Vitals

Answer 12

• persistent rise/fall of BP
• BP rise in women taking birth control
• pulse increase 20 bpm in 3 minutes
• difference in pulse pressure of more than 40 mmHg
• persistent low grade fever
• any unexplained fever

Question 13

Referrals for Cardiac Functioning

Answer 13

• more than 3 sublingual nitroglycerine to relieve angina
• severe chest pain
• angina pain radiates to jaw/left arm
• upper back feel abnormally cool, sweaty, moist
• palpitation in person with Hx of sudden death in family
• new arrhythmias following CVA
• unable to climb 1 flight of stairs
• worsening dyspnea w/ cardiac involvement
• syncope without warning

Question 14

Referrals for Cancer

Answer 14

• CAUTIONS mnemonic for early warning signs
• soft tissue lumps that persist or grow
• women presenting with unknown chest, breast, axillary, or shoulder pain
• man with pelvic, groin, SI, low pack pain with history of prostate cancer
• new onset acute back pain
• bone pain, especially WB persisting 1 week

Question 15

Referrals for Pulmonary

Answer 15

• shoulder pain aggravated by respiratory movements
• shoulder pain aggravated by supine positioning
• shoulder or chest pain subsides w/ lying on painful side
• weak or rapid pulse accompanied by fall in BP

Question 16

Referrals for Genitourinary

Answer 16

• abnormal urinary constituents (color, odor, amount, flow)
• blood in urine
• C-spine pain w/ urinary incontinence

Question 17

Referrals for GI

Answer 17

• back pain and abdominal pain at same level
• back pain of unknown cause w/ family Hx of cancer
• back/shoulder pain w/ person taking NSAIDs
• back/shoulder pain relieved by bowel movement

Question 18

Contraindications to PT

Answer 18

• uncontrolled chronic heart failure/pulmonary edema
• active myocarditis
• resting HR +120 bpm
• resting systolic BP +180
• resting diastolic BP +105
• moderate dizziness, near syncope
• marked dyspnea
• unusual fatigue
• unsteadiness
• irregular pulse w/ dizziness, nausea, shortness of breath
• post-op posterior calf pain
• unstable blood sugar levels