Clinical Prediction Rules - Diagnosis

Question 1

Anterior Shoulder Instability

Answer 1

Apprehension
Relocation
Anterior Drawer

Question 2

Ankylosing Spondylitis (Berlin Criteria)

Answer 2

Morning stiffness >30min
Improvement in back pain with exercise but not with rest
Awakening because of back pain during the second half of the night only
Alternating buttock pain

Question 3

Ankylosing Spondylitis (IBP Criteria)

Answer 3

Age at onset <40
Insidious onset
Improvement with exercise
No improvement with rest
Pain at night with improvement on getting up

Question 4

Canadian Cervical Spine Rules (Indicating radiographs)

Answer 4

High risk factor:
1. age >65
2. Dangerous MOI
3. Paresthesias in extremities
Low risk factor:
1. simple rear-end MVA
2. normal sitting posture in ER
3. Ambulatory at any time since injury
4. Delayed onset of neck pain and absence of midline tenderness

1 high or don’t meet low -> imaging
meet all low then check c/s rot
Unable to rotate >45 deg B -> imaging

Question 5

Carpal Tunnel Syndrome

Answer 5

shaking hands for symptom relief
wrist-ratio index >.67
symptom severity scale score > 1.9
Reduced median sensory field of digit 1
Age >45

Question 6

Cervical Myelopathy

Answer 6

Gait deviation
Positive hoffmanns test
positive inverted supinator sign
positive babinski test
Age >45

Question 7

Cervical Radiculopathy

Answer 7

Positive ULTT A
Involved cervical rot <60deg
Positive distraction test
Positive spurling’s A

Question 8

Closed Cervical Fractures

Answer 8

Age <55 yo
Single (marital status)
Condition involved trauma
Acute condition
Condition involved ER visit

Question 9

Deep Vein Thrombosis

Answer 9

1. Active cancer
2. Immobilization of LEs
3. bedridden x 3 days, major surgery in prior 12 wks
4. Local tenderness
5. entire leg swollen
6. calf swelling >3cm, measured 10cm below tib tub
7. Pitting edema
8. Collateral superficial veins
9. Prior DVT
10. Alternative diagnosis at least as likely as DVT -2
    One for each except last is -2
    >3 = high probability

Question 10

Hip OA

Answer 10

Squatting as aggravating factor
\+ Scour test for groin or lateral hip pain
Active hip flex causing lat hip pain
Passive IR <25 deg
Active hip ext = pain

Question 11

Lumbar Spinal Stenosis

Answer 11

Bilateral symptoms
Leg pain > back pain
Pain during walking/standing
Pain relief with sitting
>48 yo

Question 12

MCL Pathology

Answer 12

Trauma by external force to leg
rotational trauma
pain with valgus stress test at 30deg
laxity with valgus stress test at 30deg

Question 13

Meniscal Pathology

Answer 13

History of catching or locking reported
Joint line tenderness
Pain with force hyperextension (modified bounce home test)
Pain with max passive flexion
Pain or audible click with McMurray

Question 14

Ottawa Ankle Rules

Answer 14

Pain in malleolar or midfoot area and either:
1. inability to bear weight immediately after injury and in the ED (take 4 steps)
OR
2. Bone tenderness at post edge of tib or fib or tip of med./lat malleolus
3. Bone tenderness at navicular or proximal base of 5th met

Question 15

Ottawa Knee Rules

Answer 15

age >55
Fib head TTP
Isolated tenderness of patealla with palpation
Inability to flex knee to 90
Inability to WB immediately and upon ER eval

Higher specificity vs PKR

Question 16

Pittsburgh Knee Rules

Answer 16

Blunt trauma or a fall as MOI, PLUS:
1. age >50 or <12
or
2. Inability to walk 4 WB steps in ED

Sensitivity = to OKR

Question 17

Pulmonary Embolism

Answer 17

1. Age >65. +1
2. Prior DVT or PE. +3
3. Surgery/fx w/in 1 mo. +2
4. Active malignant condition. +2
5. Uni LE pain. +3
6. Haemoptysis. +2
7. HR 75-94bmp. +3
8. HR 95+ BMP. +5
9. Pain with deep palpation of LE and unilateral edema. +4
   High >10
   Med 4-10
   Low <4

Question 18

Rotator cuff Pathology

Answer 18

Painful Arc Sign
Drop-arm Sign
Infraspinatus MMT

Question 19

Sacroiliac Joint Pain

Answer 19

3 of the following:
SI distraction
SI compression
Thigh Thrust test
Gaenslen's test
Sacral Thrust (laslett)
FABER/Patricks sign (van der Wurff)

Question 20

subacromial Impingement

Answer 20

Positive Hawkins Kennedy Test
Painful Arc Sign
Infraspinatus MMT

Question 21

Vertebral compression Fracture

Answer 21

Age >52
No presence of leg pain
BMI <22
Does not exercise regularly
Female

Question 22

RTC full thickness tear

Answer 22

night pain
>65yo
ER weakness

Question 23

Cervicogenic HA

Answer 23

Reduced c/s extension ROM
Painful upper cervical joint dysfunction
Positive craniocervical flexion test (decreased cervical muscle function/control)

Question 24

SLAP cluster

Answer 24

Crank
Anterior apprehension
OBriens test
Speeds/yergesons/bicep load II

Sensitivity: 75%
Specificty: 90%