1. Red Flags & Referral
A patient presents to PT with acute low back pain after lifting a heavy box. They have localized pain, no neurological deficits, and no red flags.
Treat (Conservative PT Management)
An ankle-brachial index (ABI) of less than 0.90 is most consistent with what condition?
Peripheral Artery Disease (PAD)
This condition is characterized by the classic phrase "the worst headache of my life."
Subarachnoid Hemorrhage (SAH)
This pediatric hip disorder most commonly affects boys ages 4–10 and often presents as knee pain with decreased hip internal rotation and abduction.
Legg-Calvé-Perthes Disease
A 60-year-old patient is referred to PT for shoulder pain. During the evaluation they mention increasing fatigue, night sweats, and an unexplained 15-pound weight loss over the past two months.
What should these symptoms make you concerned about?
Systemic pathology (especially malignancy)
A patient reports progressive low back pain, a history of breast cancer, and an unintentional 12-pound weight loss over the past month.
Urgent Referral
A patient presents with unilateral calf swelling and warmth after recent surgery. Which diagnostic imaging study is the gold standard initial test to evaluate your primary concern?
Venous Duplex Ultrasound
A patient reports low back pain that is relieved by sitting and leaning forward while pushing a shopping cart. What is the most likely diagnosis?
Lumbar Spinal Stenosis
What classic lower extremity position is most commonly seen in a patient with a displaced femoral neck fracture?
Shortened and externally rotated leg
A patient has been treated successfully for mechanical low back pain for four weeks. Today they report:
What changed, and what should you do?
The clinical presentation has changed from mechanical to non-mechanical/systemic.
➡️ Re-screen for red flags and refer to the medical provider.
During an evaluation, a patient reports new urinary retention, saddle anesthesia, and bilateral lower extremity weakness.
Emergent Referral
A patient reports fever, severe headache, photophobia, and neck stiffness. Which diagnostic test is considered the gold standard to confirm the suspected diagnosis?
Lumbar Puncture (CSF Analysis)
A patient presents with:
What is the most likely diagnosis?
Pericarditis
Which physical examination finding is MOST characteristic of acute compartment syndrome?
Pain with passive stretch
Match the condition with its classic pain referral pattern.
A. Myocardial infarction
B. Cholecystitis
C. Kidney pathology
D. Diaphragmatic irritation
A patient arrives for PT with calf pain, swelling, warmth, and pitting edema three weeks after a total knee replacement.
Urgent Referral
Match each laboratory or diagnostic test with its most associated condition:
A patient reports:
What is the most likely diagnosis?
Vertebral Osteomyelitis
Rank these conditions from most urgent to least urgent for medical referral:
A patient develops shoulder drooping and difficulty shrugging after a cervical lymph node biopsy.
Which cranial nerve was most likely injured? What is your treatment move?
Spinal Accessory Nerve (CN XI)
Acute--> Urgent referral
A 68-year-old patient presents for treatment of neck pain. During the history they report:
The patient specifically came to PT because they "slept wrong."
Emergent Referral
Diagnosis: Suspected Meningitis
A patient's Basic Metabolic Panel (BMP) reveals the following:
Which laboratory value is abnormal, and what symptom would you most expect to accompany it?
Hyponatremia (Na⁺ 128 mEq/L)
A 67-year-old patient presents with mid-thoracic pain that has progressively worsened over the past two months. They report:
What is the most likely diagnosis, and which finding is the strongest red flag?
Spinal Malignancy (Metastatic Disease)
Strongest Red Flag: History of cancer
Which of the following are recognized risk factors for osteonecrosis (avascular necrosis) of the femoral head?
A. Long-term corticosteroid use
B. Alcohol abuse
C. Sickle cell disease
D. Obesity
E. Hip trauma/dislocation
A, B, C, E
What are the four guiding principles of motivational interviewing?
Listen with empathy
Resist the righting reflex
Explore the patient's own motivations for change
Empower the patient