Clinical Prediction Rules- Diagnosis

Question 1

Berlin Criteria for ankylosing Spondylitis

Answer 1

1. Morning stiffness > 30 min
2. improvement with exercise, not with rest
3. Awakening because of back pain, 2nd half of the night only
4. Alternating buttock pain

Question 2

IDP criteria for Ankylosing Spondylitis

Answer 2

1. Age of onset < 40 y.o
2. Insidious onset
3. Improve with exercise, not at rest
4. Pain at night, better with getting up

Question 3

Ottawa knee rules

Answer 3

for determining need for radiograph when suspecting fracture

1. Age > 55
2. tenderness at head of fibula
3. Isolated patella tenderness
4. Inability to flex the knee to 90
5. Inability to bear weight immediately, or in ED

Question 4

Pittsburg Knee rule

Answer 4

for determining need for radiograph when suspecting fracture
Blunt trauma/ fall as MOI + either
1. Age > 50 y or < 12
2. Inability to walk 4 steps in ED

Question 5

Ottawa Ankle Rules

Answer 5

Pain in malleoli area and either:

1. inability to bear weight immediately after injury/ ED
2. Bone tenderness at posterior edge of tibia- either malleolus
3. Bone tenderness at base of 5th MT

Question 6

Canadian Cervical spine rules- determine need for radiographs- for acute head/ neck imaging due to risk of fracture

Answer 6

1. age > 65
2. Dangerous mechanism of injury- > 5 feet, axial load to head, MVA, motorized recreational vehicle, bicycle collision
3. Paresthesia in extremities

Low risk- allow for assessment of ROM

1. Low impact, rear end MVA
2. Normal sitting posture in ED
3. Ambulatory at anytime since injury
4. Delayed onset of neck pain
5. Absence of midline tenderness

1 high risk/ 2 low risk
Ability to rotate neck 45 deg bilateral

Question 7

Wells Criteria- whats it for? How is it scored?

Answer 7

R/o DVT- scored 1 pt each (hi, mod, low)

1. Active cancer- receiving treatment within 6 months
2. Paralysis, paresis, recent plaster immobilization of lower extremity
3. Recently bedridden 3+ days
4. major surgery within 12 weeks, requiring anesthesia
5. Localized tenderness along deep venous system
6. Entire leg swelling
7. Calf swelling at least 3 cm larger (10 cm below tibial tuberosity)
8. Pitting edema
9. Collateral superficial veins
10. previous documented DVT
11. Alternative diagnosis as likely as DVT (-2 points)

3+ high
1-2- mod
0- low

Question 8

Pulmonary embolism

Answer 8

1. 65+ y/o (1 point)
2. Previous DVT/ PE (3 points)
3. Surgery/ fracture within a month (2 points)
4. Active malignant condition (2 points)
5. Unilateral lower limb pain (3 points)
6. HR- 75- 94 bpm (3 points), 95 > (5 points)
7. Pain on deep palpation of lower limb and unilateral edema (4 points)
8. Hemoptysis (2 points)

Question 9

SIJ pain cluster testing- Laslet/ Vanderworth

Answer 9

1. SI distraction
2. SI compression
3. Thigh trust
4. Gaenslen
5. Sacral thrust- Laslet OR FABER/ Patrick test- Vanderworth

> 3+ more sensitive and specific

Question 10

Hip OA- Altmans criteria

Answer 10

1. Hip pain, And
   2a. Hip IR < 15 And
   2b. EST < 45 mm/hr OR hip flexion < 115
   3a. Hip IR < 15 And
   3b. Pain on hip IR And
   3c. Morning stiffness of the hip < 60 min
   3d. Age > 50 years