TIC, CPG

Question 1

Canadian C-spine rules

Answer 1

Any high risk factors

• -age greater than 65
• -dangerous mechanism (fall from 1 meter, MVA over 100km/hr(62mph), rollover, bike accident)
• -parestheias in extremities

If no high risk factors, then AROM checklist:

• -simple rear-end MVA
• -no mid line tenderness
• -ambulatory
• -non-immediate pain

If yes to above, then assess ROM, if less than 45*, radiographs indicated

Question 2

Cervical pain with mobility deficits classification

Answer 2

Age less than 50
duration less than 12 weeks
symptoms isolated to neck
decreased cervical ROM

Question 3

6 predictors of positive response to c/s manipulation

Answer 3

NDI less than  11.5
Bilateral symptoms
Non-sedentary work
Neck feels better with movement
Extension doesn't aggravate symptoms
Diagnosis was spondylolysis 

4 of6=89% positive outcome

Question 4

T/s manipuation for cervical pain (6 items)

Answer 4

Symptom duration less than 30 days
No symptoms distal to shoulder
Looking up doesn't aggravate symptoms
FABQ-PA less than 12
Decreased upper thoracic kyphosis
Cervical extension less than 30

3 items present=86% chance of success

Question 5

CPR for cervical traction usage (5 items)

Answer 5

Peripheralization with lower cervical mobiliy testing
Positive shoulder abduction sign
Older than 55
ULTTa
Relief with manual traction

4 or more present, increase from 44-94% success rate. +LR of 23.1

3 present +LR of 1.44

Question 6

CPR to rule in/out CAD (5 items)

Answer 6

• Age >65 (55 for men)
• Known CVD
• Pain worse with exercise
• not reproduceable with palpation
• Patient believes cardiac origin

2 predictor variables met, Sn of .98

3 predictor variables met, Sn .87, Sp .8, +LR 4.52

Question 7

Ankylosing spondylitis CPR (4items)

Answer 7

• stiffness of greater than 30 min
• improvement with exercise, not rest
• awakening due to pain in 2nd half of night only
• alternating buttock pain

2 met= Sn.7, Sp.81
3 met=Sn.33, Sp.94

Question 8

Wanier’s cervical radiculopathy CPR (4 items)

Answer 8

• positive spurlings
• Ultta
• distraction
• cervical rotation less than 60 to involved side

all 4: +LR 30.3
3: +LR6.1

Question 9

Potential predictors for shoulder pain improving with t/s manip? (4 items)

Answer 9

• pain free flexion of 127 or less
• GH IR of less than 53
• not on pain meds for shoulder
• negative neer

Question 10

Red flags for metastatic cancer (5 items)

Answer 10

CA history
night pain/pain at rest
unexplained weight loss
Age over 50 or under 17
failure to improve

Question 11

Red flags for disc or vertebral infection? (4 items)

Answer 11

imunosuppression
prolonged fever over 100.4
IV drug use
recent UTI, cellulitis, pneumonia

Question 12

Red flags for vertebral fx (6 items)

Answer 12

prolonged corticosteroid use
mild trauma over age of 50
over 70 years old
osteoporosis
major trauma
bruising over spine following trauma

Question 13

Red flags for AAA (4 items)

Answer 13

pulsating mass in abdomen
history of atherosclerosis
throbbing, pulsing back pain at rest or in sitting
older than 60

Question 14

CPR for lumbar manip

Answer 14

• no symptoms distal to knee
  -less than 16 days
  FABQ-work less than 19
  -hypomobile lumbar segment
  -at least 1 hip has 35+ degrees of IR

Question 15

SIJ CPR

Answer 15

Thigh thrust
compression
distraction
sacral thrust
Gaenslan

3/5= SN.91, Sp.87

Patients must not centralize to use CPR

Question 16

SIJ CPR 2

Answer 16

Distraction
Compression
FABER
thigh thrust
Gaenslan

if less than 3 are positive, between 72 and 99% chance of no SIJ pain

Question 17

Hip OA CPR

Answer 17

pain
IR less that 15
pain with IR PROM
morning stiffness of up to 1 hour
older than 50

Question 18

Stenosis CPR (5 items)

Answer 18

bilateral symptoms
leg pain worse than back pain
pain during standing/walking
pain relief with sitting
older than 48.

Sp: 3 test: .88

Question 19

Cauda equina characteristics (5)

Answer 19

saddle anesthesia
bladder dysfunction
sexual dysfunction
bowel dysfunction
neurological deficits of LE

Question 20

Ottowa knee (5 items)

Answer 20

Age greater than 55
Isolated patellar tenderness
Tenderness of fibular head
Inability to flex beyond 90
Inability to bear weight immediately and in ED

Question 21

Meniscal Pathology Composite score (5 items)

Answer 21

History of catching/locking
Pain with forced hyperextension
joint line tenderness
Positive McMurray
pain with maximal flexion

If all 5: 92.3% chance of meniscus tear

3/5: 75%

Question 22

Strongest tests for PFPS

Answer 22

pain with isometric quadriceps contraction
pain with squatting
pain with palpation

2/3= +LR 4.0

Question 23

Carpal tunnel CPR (5 items)

Answer 23

• Age over 45
• Shaking hands for relief
• Wrist ratio (a/p->m/l)= .67 or higher
• Decreased thumb sensation
• Carpal tunnel severity score of 1.9 or higher

if all 5, +LR of 18.3, Sp 99%

Question 24

CPR for ankle manip (4 items)

Answer 24

• symptoms worse in standing
• symptoms worse in evening
• navicular drop 5mm or greater
• distal tib/fib hypomobility

if 3/4 positive, 95% chance of success

However, large confidence interval.

Question 25

Ottawa ankle rules

Answer 25

• pain in malleolar zone
• can’t bear weight for 4 steps
• pain on distal tibia
• pain on distal fibula

Question 26

Ottawa ankle rules (foot xray)

Answer 26

• pain in midfoot
• tenderness to navicular
• tenderness to base of 5th met
• can’t bear weight for 4 steps

Question 27

Wells DVT (9 positive scores, 1 negative score)

Answer 27

• active cancer
• paralysis/paresis or recent LE immobilization
• recent 3 days bed rest or major sx in 12 weeks
• localized tenderness to deep vein system
• Entire LE swelling
• calf 3cm larger than contralateral
• pitting edema
• superficial collateral (non-varicose) veins
• previous DVT
• alternate diagnosis likely -2.

High probability if 3+, mod if 1-2