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Clinical Prediction Rules > Clinical Prediction Rules NMT > Flashcards

Clinical Prediction Rules NMT Flashcards

1
Q

Cauda Equina Syndrome

A
  1. Rapid symptoms within 24 hours 89% sensitivity
  2. History of back pain 94% sensitivity
  3. Urinary retention 90% sensitivity
  4. Loss of sphincter tone 80% sensitivity
  5. Sacral sensation loss 85% sensitivity
  6. Lower extremity weakness or gait loss 84% sensitivity
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2
Q

Anterior Shoulder Instability after trauma:

A
  1. Apprehension

  2. Relocation

  3. Anterior Drawer
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3
Q

Lumbar Radiculopathy

A
  1. Dermatomal pattern (OR = 4.1)
  2. Pain on cough, sneezing, straining (OR = 3.2)
  3. More pain Sitting (OR=1.9
  4. Subjective muscle weakness (OR = 2.2)
  5. Subjective Sensory loss (OR = 2.1)
  6. Paresis/Motor Loss (OR = 3.7)
  7. +SLR (OR = 3.9)
  8. Unilat Ankle reflex (OR = 3.9)
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4
Q

Spine Cancer

A
  1. Age > 50 (sensitivity 0.77, specificity 0.71)
  2. previous history of cancer (sensitivity 0.31, specificity 0.98)
  3. failure to improve in 1 mo. of therapy (sensitivity 0.31, specificity 0.90)
  4. no relief with bed rest (sensitivity >0.90, specificity 0.46)
  5. duration of pain > 1 mo (sensitivity 0.50, specificity 0.81)
  6. COMBO: age >50 + cancer hx or unexplained wt loss + failure of conservative tx (sensitivity 1.00, specificity 0.60)
  7. Insidious onset (no stats)
  8. constitutional symptoms (no stats)
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5
Q

Ankylosing Spondylitis

A
  1. age at onset <40 (sensitivity 1.00, specificity 0.07)
  2. pain not relieved by supine position (sensitivity 0.80, specificity 0.49)
  3. morning back stiffness 0.64 0.59
  4. pain duration >3 months 0.71 0.54
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6
Q

Diagnostic Cluster Ankylosing Spondylitis

Interpretation

A

4 of 5 questions above positive also: improved by exercise 0.23 0.82 +LR = 1.27

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7
Q

Canadian Cervical Spine Rules: (high risk factors)

A
  1. Age > 65
    
2. Dangerous Mechanism of Injury (i.e. fall > 1m or 5 stairs, axial load to head, high-speed motor vehicle accident, motorized recreational vehicle, bicycle collision)

  2. Paresthesias in extremities
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8
Q

Canadian Cervical Spine Rules: (low risk factors that allow safe assessment of range of motion)

A
  1. Simple rear-end motor accident

  2. Normal sitting posture in emergency department

  3. Ambulatory at any time since injury
    
4. Delayed onset of neck pain and absence of midline tenderness
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9
Q

Using Canadian C-spine rules + Is the patient able to actively rotate the neck > 45 degrees to the right and the left? Indicates–

A

If there is (1) High Risk Factors or (2) Low Risk Factors and the inability to actively rotate the neck > 45 degrees to the right and the left, radiographs are indicated.

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10
Q

Carpal Tunnel Syndrome:

A
  1. Shaking hands for symptom relief

  2. Wrist-ratio index greater than .67

  3. Symptom Severity Scale score greater than 1.9

  4. Reduced median sensory field of digit 1

  5. Age greater than 45 years
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11
Q

Cervical Myelopathy:

A
  1. Gait deviation

  2. Positive Hoffmann’s test

  3. Positive inverted supinator sign

  4. Positive Babinski test
    
5. Age > 45 years
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12
Q

Cervical Radiculopathy:

A
  1. Positive Upper Limb Tension Test A

  2. Involved cervical rotation < 60 degrees
    
3. Positive Distraction Test

  3. Positive Spurling’s A
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13
Q

Closed Cervical Spine Fractures:

A
  1. Age < 55 years old

  2. Single (Marital status)

  3. Condition involved trauma

  4. Acute condition

  5. Condition involved ER visit
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14
Q

Deep Vein Thrombosis (DVT):

A
  1. Active Cancer (treatment ongoing or within previous 6 months): + 1 Point

  2. Paralysis, paresis or recent plaster immobilization of the LE: + 1 Point
    
3. Recently bedridden for 3 days or more, or major surgery within the previous 12 weeks requiring anesthesia: + 1 Point

  3. Localized tenderness along the distribution of the deep venous system: + 1 Point
    
5. Entire leg swelling: + 1 Point

  4. Calf Swelling at least 3cm larger than asymptomatic leg (measured 10cm below tibial tub): + 1 Point

  5. Pitting Edema confined in symptomatic leg: + 1 Point
    
8. Collateral superficial veins (nonvaricose): + 1 Point

  6. Previous DVT: + 1 Point
    
10. Alternative diagnosis at least as likely as a DVT: – 2 Points
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15
Q

Deep Vein Thrombosis (DVT) cluster probability

A

> 3: High Probability
1-2: Moderate Probability
0: Low Probability

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16
Q

Hip Osteoarthritis:

A
  1. Squatting as aggravating factor
    
2. (+) Scour Test for groin or lateral hip pain

  2. Active hip flexion causing lateral hip pain

  3. Passive internal rotation < 25 degrees

  4. Active hip extension causing hip pain
17
Q

Lumbar Stenosis:

A
  1. Bilateral symptoms

  2. Leg pain > back pain

  3. Pain during walking/standing

  4. Pain relief upon sitting

  5. > 48 years old
18
Q

MCL Injury:

A
  1. Trauma by external force to leg

  2. Rotational trauma

  3. Pain with valgus stress test at 30° (PVLS30)
    
4. Laxity with valgus stress test at 30° (LVLS30)
19
Q

Meniscus Injury:

A
  1. History of catching or locking reported by the patient

  2. Joint line tenderness
    
3. Pain with forced hyperextension (modified bounce home test)

  3. Pain with maximal passive knee flexion

  4. Pain or audible click with McMurray manuver
20
Q

Ottawa Ankle Rules:

A

Pain in malleolar or midfoot area and Either:

1. Inability to bear weight immediately after injury AND in the ED (taking 4 steps)
OR
2. Bone tenderness at the posterior edge of tibia or fibula or tip of medial or lateral malleolus

3. Bone tenderness at the navicular or proximal base of 5th metatarsal

21
Q

Ottawa Knee Rules

A
  1. Age > 55
  2. Tenderness at the head of the fibula

  3. Isolated tenderness of the patella during palpation

  4. Inability to flex the knee to 90 degrees
  5. Inability to bear weight immediately and upon ER evaluation
22
Q

Pittsburg Knee Rules:

A

Blunt trauma or a fall as mechanism of injury PLUS either of the following:

1. Age older than 50 years or Younger than 12 years

2. Inability to walk 4 weight-bearing steps in the emergency department

23
Q

Pulmonary Embolism:

A

Age 65 years or over: 1 Point

Previous Deep Vein Thrombosis or Pulmonary Embolism: 3 Points

Surgery or fracture within 1 month: 2 Points

Active malignant condition: 2 Points

Unilateral lower limb pain: 3 Points
Haemoptysis: 2 Points

Heart rate 75 to 94 beats per minute: 3 Points

Heart rate 95 or more beats per minute: 5 Points

Pain on deep palpation of lower limb and unilateral oedema: 4 Points

24
Q

pulmonary embolism pre-test probability (in points)

A

Pre-Test Probability: 8% (0-3 Points), 28% (4-10 Points), 74% (>11 Points)

25
Q

Rotator Cuff Pathology:

A
  1. Painful Arc Sign

  2. Drop-arm Sign

  3. Infraspinatus Manual Muscle Test

–OR:—

  1. Age > 65 years old

  2. Weakness in external rotation

  3. Night pain
26
Q

SI Joint Pain:

A
  1. SI Distraction

  2. SI Compression

  3. Thigh Thrust

  4. Gaenslen’s (right)

  5. Gaenslen’s (left)
    
6. Sacral Thrust
27
Q

Vertebral Compression Fracture:

A
  1. Age > 52 years

  2. No presence of leg pain

  3. Body mass index < 22

  4. Does not exercise regularly
  5. Female gender
  • –OR:—
    1. Female sex

    2. Age > 70 years old

    3. Significant trauma (major in young patients, minor in elderly patients)

    4. Prolonged use of corticosteroids
28
Q

Subacromial Impingement:

A
  1. Positive Hawkins-Kennedy Test

  2. Painful Arc Sign

  3. Infraspinatus Manual Muscle Test

Clinical Prediction Rules (1 decks)

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