CHIR12007

Clinical Assessment and Diagnosis

Portfolio Exercises Week 1

Exercise 1:

Sign on to Weebly and Set up Portfolio page – Instructions as per CHIR13008; You will cre-
ate a new page for CHIR12007

Exercise 2:

Identify Red and Yellow Flags

A. Ms Howard, 77 yof, presents to your office with left low back pain and ‘sciatica’. Al-
though she has had mild low back pain for a while now, this more severe onset came
on 4 weeks ago when she rose from a seated position on her sofa. The pain is rated
6/10 and has become more constant, sometimes waking her in the early hours of the
morning. When questioned about her general health she explains she feels pretty
good generally. She has noticed that she has lost weight in the past few months
which she attributes to the stress she experienced a year ago after having surgery
for lung cancer. She was assured that the surgery was successful and has not had
any follow up for 6 months. 



RF: Red flags as per the pneumonic “TUNAFISH” involve: Trauma, Unexplained
weight loss, Neurological symptoms, Age >50, Fever, IV drug use, Steroid use or Hx
of cancer. Ms Howard is over the age of 50, she is experiencing sciatica which is a
neurological symptom and also is experiencing unexplained weight loss. Previously,
Ms Howard has undergone physical trauma with her surgery and also (involving that
same surgery) has a history of Cancer. 



YF: Yellow flags are the term used to identify psycho-social and occupational factors
that may increase the risk of chronicity in people presenting with a complaint (com-
monly back pain). Ms Howard is presenting with left lower back pain which is a yel-
low flag, however it doesn’t state that she has a poor attitude or belief system to this
back pain. Her weight loss, however, is what she thinks is attributed to the stress
from previous trauma of going through cancer a year ago. This would be considered
a psycho-social yellow flag. 


B. Mr Leigh, 29 yom, presents to your office with 1-week history of mid thoracic pain. He
has been feeling quite unwell with chills and a little bit of fever for the past few days
and thinks he may be coming down with the flu. He has a history of minor sports
trauma. He had a major motor vehicle accident 8 years ago and had a ‘plate put in
his neck to fuse 2 vertebrae’. He has not been able to work since the accident. He
self-declares he is addicted to heroin as a means of helping with his neck pain. You
are unable to proceed with examining his spine because the pain is too intense to
touch it. 



RF: Mr Leigh is experiencing neck and back pain which he is attributing to his MVA
 8 years ago and states that he has not been able to work since the accident due to
the pain and his addiction to Heroin. This is a yellow flag.

C. Ms Bell, 44 yof, presents to your office with a history of Migraines. She has previous-
ly seen a neurologist and had scans which are all clear. Past medical history is un-
remarkable. She has 2 children, both well. Her parents are well. Family history in-
cludes maternal grandmother with Diabetes Mellitus. Her paternal grandmother, who
mostly raised her, recently passed of complications due to lung cancer. She has had
past care with a chiropractor and physiotherapist, both with some success and she
would like you do the same treatment they did or she may end up with worse Mi-
graines. 





RF: Ms Bell is experiencing migraines which is considered a neurological symptom.
This is a red flag. 



YF: Ms Bell is experiencing migraines and holds the belief that her treatment must be
the same as her previous experiences with other manual therapists/practitioners (i.e.
Physio) or her Migraines may worsen. She has also undergone emotional trauma
with the recent loss of her grandmother who has raised her most of her life. These
are both considered psycho-social yellow flags.

Exercise 3:

Complete the table of red flag findings below (from lecture:

MUSCULOSKELETAL RED FLAGS

• Trauma
• Unexplained weight-loss
• Neurological symptoms
• Age >50
• Fever
• IV drug use
• Steroid use
• History of cancer

Exercise 4: Complete the table below


____________________:
______________________:
May refer through the sensory
may cause sharp pain acutely
portion of the motor nerves
and more of a dull, aching
(sclerotome) and is usually
sensation in the subacute or
described as a deep or boring
chronic period

pain


____________________: ________________________:
Electrical, numbing, tingling or Throbbing sensations are
shooting sensations
 attributable to vascular causes


Nociceptive or soft tissue pain: may cause sharp pain acutely and more of a dull
aching sensation in subacute or chronic periods.

Radicular pain: may refer through the sensory portion of the motor nerves and is
usually described as a deep or boring pain.

Neuropathic pain: electrical, numbing, tingling or shooting sensations.

Visceral or cardiovascular pain: throbbing sensations are attributable to vascular

causes. 

Exercise 5:

Complete the table below

VINDICATE
• Vascular 


• Inflammatory 


• Neoplastic


• Degenerative 


• Idiopathic


• Congenital 


• Autoimmune/allergy


• Trauma


• Endocrine