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 create 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’. Although
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: Unexplained weight loss. Lung cancer surgery. No post-operative follow up for 6months.
Age 77years. Stress. Low back pain 6/10, onset 4 weeks ago.

YF: None.

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: Fever + chills, general feeling of unwellness past week prior to presentation. Previous
trauma 8 years prior to presentation which resulted in fusion of neck vertebrae (unknown).
Heroin substance use for neck pain (with addictive habit).

YF: Not able to work since motor vehicle accident 8 years ago. Mid Tx pain.

C. Ms Bell, 44 yof, presents to your office with a history of Migraines. She has previously seen a
neurologist and had scans which are all clear. Past medical history is unremarkable. She has
 2 children, both well. Her parents are well. Family history includes 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 Migraines.

RF: None

YF: Recent loss of close family member due to illness that may have been prolonged; wants
the same treatment or she may ‘get worse’ – fear.

Exercise 3:

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

MUSCULOSKELETAL RED FLAGS

 Trauma

 Unexplained weight loss

 Neurologic symptoms

 AGE >50

 Fever

 Intravenous drug use

 Steroid use

 History of cancer
Exercise 4: Complete the table below

Bone and/or joint:

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

Neurogenic: Vascular:
Electrical, numbing, tingling or Throbbing sensations are
shooting sensations attributable to vascular causes
Exercise 5:

Complete the table below

VINDICATE

 Vascular

 Inflammatory

 Neoplastic

 Degenerative

 Idiopathic

 Congenital

 Autoimmune/Allergy

 Trauma

 Endocrine