see also: [[cauda equina syndrome]], [[Neuro - lower limb]], [[Weakness]] see: [Dunn - Low back pain](x-devonthink-item://D33FBCC0-28BC-40C1-B234-FC21BBD34BB3) #OSCE practice: [RMH 2021 station 6](x-devonthink-item://CC843F8C-5839-42A1-A522-22B9B28B6C9D) > [!pearl] > As a general principle, there is almost never a time where I see value in invoking the phrase "red flags." In exams, we need to be specific about what these red flags are. In a medical note or a handover, stating that you have excluded "red flags" without elucidating what these reg flags are is itself a bit of a red flag that you might not know what the red flags are. For some reason, back pain in particular as a presentation seems to be associated with the phrase "red flag" **"Red Flags"** - abdominal pain ([[Abdominal Aortic Aneurysm|AAA]]) - [[Syncope]] ([[Aortic dissection]], AAA, [[Pulmonary Embolism|PE]]) - urinary incontinence/retention (cord compression / [[cauda equina syndrome]]) - saddle anaesthesia - fecal incontinence - significant bilat lower extremity weakness or sensory deficit - unexplained fever (epidural abscess, psoas abscess, [[Osteomyelitis]], [[Endocarditis]] with septic emboli) - IVDU (essentially the above concerns and discitis) - immunosuppression (eg AIDS, diabetes, corticosteroids, cancer, etc) - lumbar spine surgery within past year - recent bacterial infection - night pain or sweats, weight loss (malignancy) - duration > 6 weeks - mid-thoracic pain - age > 55 years - recent significant trauma ; or mild trauma if age > 50 - osteoporosis (stress fracture) - prolonged corticosteroids **Can't miss DDx** - Compression (cada equina, conus medullaris, epidural haematoma) - [[Renal colic|renal stone]] - [[Abdominal Aortic Aneurysm]] - [[Aortic dissection]] - [[Thoracic and lumbar trauma radiology#Fractures|thoracic fracture]] (osteoporotic or trauma) - [[Bone metastasis]] (osteoblastic or osteolytic lesion) - infection/inflammatory - pyelonephritis - pernephric abscess - epidural abscess - osteomyelitis - discitis - transverse myelitis **Other DDx to consider** - Thoracic pain - pneumonia - pulmonary embolism - MI - peptic ulcer disease - pancreatitis - lumbar pain - ectopic pregnancy - PID - ovarian torsion - renal artery or vein thrombosis **Non life-threatening causes** - mechanical low back pain - sciatica/radiculopathy - ankylosing spondylitis - spinal stenosis **Non-traumatic spinal cord disorders** - external compression - disc disease (most common) - extra spinal tumours - epidural abscess - intraspinal - syringomyelia - intraspinal tumour - vascular - vasculitis eg SLE - aortic diseases eg dissection due to interference with spinal blood flow - infective - myelitis (acute or transverse) - polio - autoimmune - ALS - MS - idiopathic -- motor neuron disease - congenital - arnold chiari syndrome # OSCE - [ACEM 2022.1 station 07](x-devonthink-item://0FE26BC3-D97B-4B1E-BE3F-72F2F22CF272)