Tests and scores

Question 1

What’s Lachman’s test?

Answer 1

Test of the integrity of anterior cruciate ligaments (knee) -> done at 30^o

*a variation of ‘ anterior drawer test’ -> done at 90^o

Question 2

What’s a McMurray test?

Answer 2

It’s to determine meniscal injuries

• knee is flexed at 90^o and lateral pressure applied to the joint + external rotation of lower leg
• pain or palpable crepitus = lateral meniscal injury

Question 3

What’s Simmond’s test?

Answer 3

to assess the integrity of the Achilles tendon -> to check for rupture of Achilles tendon

Question 4

What’s a patellar apprehension test?

Answer 4

• used to asses dislocatability of the patella
• pressure is applied to the patella -> if a patient feels anxious that knee cap is going to ‘pop out’ - positive test

Question 5

What’s the name of the score used to grade the spread and prognosis of prostate cancer?

Answer 5

Gleason score

*the higher the score the worse prognosis

Question 6

How to take/measure ankle-brachial-pressure index (ABPI)?

Answer 6

the greatest of systolic pressure in either posterior tibial a. or dorsalis pedis a.

divide by

brachial systolic pressure at the same side

Question 7

Is the 1.3 or higher result normal on ABPI?

Answer 7

No, that can be a result that is abnormally raised by calcification of the artery e.g. in diabetic person → need to refer for further investigaiton

Question 8

What would the following readings of ABPI mean:

• 0.5 - 1.0
• 0.3 - 0.5
• 0.2 and <

Answer 8

• 0.5 - 1.0 → intermittent claudication
• 0.3 - 0.5 → rest pain
• 0.2 and less → acutely ischaemic leg and gangrene

*1.0 is normal

Question 9

What’s Kantor/string sign?

Answer 9

• Presents stricture (area resulting from chronic inflammation and scarring) formation in e.g. Crohn’s
• It is visible on small bowel enemas

Question 10

Salter-Harris classification

Answer 10

mnemonic: SALTeR
* I Slipped → # across the physis with no other fragment
* II Above → # across the physis with metaphyseal fragment
* III Lower → # across the physis with epiphyseal fragment
* IV Through → # through the physis with epiphyseal + metaphyseal fragment
* V Rammed → rush injury to the physis

Question 11

What scale is used to assess the extent of burns? (in adults)

Answer 11

Wallace’s ‘rule of nines’

Question 13

Hip fractures

• name the score
• grades and description

Answer 13

The Garden system

• Type I: Stable fracture with impaction in valgus.
• Type II: Complete fracture but undisplaced.
• Type III: Displaced fracture, usually rotated and angulated, but still has bony contact.
• Type IV: Complete bony disruption.

Question 15

Serum ‘triple test’

• what is it for?
• what are its (3) components?
• when in gestation is it available?

Answer 15

For: Spina Bifida and Down’s syndrome

*triple test estimates the risk of Down Syndrome. if 1:250 (positive) then amniocentesis or Chorionic Villus Sampling is offered

Markers used:

• AFP (alpha-fetoprotein)
• bHCG
• oestriadol

Available: 14-20 weeks gestation

Question 16

Upper GI bleed and scores

• what to use before endoscopy
• what to use after endoscopy

Answer 16

• Blatchford →before endoscopy
• Rockfall →after endoscopy

Question 18

What’re Light’s criteria?

Answer 18

• help to distinguish between transudate vs exudate
• exudates have a protein level of >30 g/L
• transudates have a protein level of <30 g/L

if the protein level is between 25-35 g/L, Light’s criteria should be applied.

An exudate is likely if at least one of the following criteria are met:

pleural fluid protein divided by serum protein >0.5

pleural fluid LDH divided by serum LDH >0.6

pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Question 20

What is Framingham risk score used for?

Answer 20

To estminate 10-years risk of hear attack

Question 21

What’s Kocher’s criteria are used for and what the score mean?

Answer 21

Used to assess the possibility of septic arthritis in children (4 point criteria)

• Non-weight bearing - 1 point
• Fever >38.5ºC - 1 point
• WCC >12 * 109/L - 1 point
• ESR >40mm/hr

The probabilities are calculated thus:

• 0 points = very low risk
• 1 point = 3% probability of septic arthritis
• 2 points = 40% probability of septic arthritis
• 3 points = 93% probability of septic arthritis
• 4 points = 99% probability of septic arthritis

Question 23

What’s Modified-Glasgow Score is used for?

What are its components?

Answer 23

Use: to stratify patients by risk of severe pancreatitis.

A score of ≥3 suggests a significant increase in likelihood of severe pancreatitis. These patients may benefit from intensive care.

Components:

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

Question 24

The criteria used to diagnose rheumatic fever

• components
• how many diagnostic

Answer 24

Modified Dukett Jones criteria

Major:

• pancarditis
• polyarthritis
• Sydenham’s chorea
• erythema marginatum
• subcutaneous nodules

Minor:

• fever
• arthralgia
• high ESR or WCC
• heart block

Diagnostic: evidence of streptococcal infetion (anti-streptolysisn-O titrates) + 2 major criteria OR + 2 minor and 1 major