Acute back pain scenario
- Washes hands, introduces self
- Confirms patient identity
- Checks patient comfort before starting
- History of presenting complaint
- site of pain
- associated focal neurology
- history of trauma?
- Specific questions:
- bilateral sciatica/radicular type pain
- bladder/bowel symptoms
- erectile dysfunction
- bony tenderness
- fever
- Systems review
- Resp - cough (spinal mets?)
- B symptoms: weight loss, night sweats
- Past medical history including previous cancer, immunosuppression
- Drug history and allergies
- Social history
- including travel history/possible exposure to TB/IVDU
- Appropriate management plan including investigations
- Explains differentials
- Invites questions
- Address patient concerns
- Thanks patient
- Global mark examiner
- Global mark patient
specific red flags (CKS)
- Cauda equina
- Sudden-onset bilateral radicular leg pain or unilateral radicular pain progressing to bilateral pain
- severe or progressive neurological deficit such as major motor weakness of knee extension, ankle eversion, or foot dorsiflexion.
- Gait disturbance or difficulty walking.
- Recent-onset erectile dysfunction or sexual dysfunction.
- Perianal or perineal sensory loss (saddle anaesthesia or paraesthesia).
- Unexpected laxity of the anal sphincter.
- Recent-onset difficulty initiating micturition or impaired sensation of urinary flow; urinary retention and/or overflow urinary incontinence (late signs).
- Recent-onset loss of sensation of rectal fullness; faecal incontinence (late sign).
Cancer red flags