Written Midterm

Clinical Cases

100

A patient comes into the clinic with low back pain. Explain your approach to a history, what questions would you ask? Is there something you could educate them on before they leave the clinic?

Normal hx questions (OLDCARTS, PPM FLOATS), systematic review, emphasis on red flags (ruling out CES).

Educate the patient on CES symptoms and to seek immediate medical attention if those symptoms arise. 

200

When performing a history for MS, what are the most common symptoms on initial presentation? What would you focus on in the physical?

1. Limb numbness/tingling, limb weakness (subacute onset), cerebellar symptoms.

2. Neuro exam, cranial nerve exam, cerebellar exam.

Imaging and labs

100

What are the Ottawa Ankle Rules?

1.    Bone tenderness at the posterior aspects of the medial malleolus

2.    Bone tenderness at the lateral malleolus

3.    Bone tenderness at the base of the fifth metatarsal

4.    Bone tenderness at the navicular

5.    The patient could not bear weight (4 steps) on the joint immediately following the injury.

300

What are the Canadian C-Spine Rules?

High-risk factors (recommend imaging)

• Age ≥ 65 years 
• Dangerous mechanism of injury: Examples include a fall from over 3 feet (or 5 stairs), axial load to the head, high-speed motor vehicle collision (e.g., > 100 km/hr, rollover, or ejection), motorized recreational vehicle accident, or a bicycle collision. 
• Paresthesias in the extremities

Low-risk factors (can proceed to neck rotation assessment) 

• Simple rear-end motor vehicle collision, Sitting position in the emergency department, Ambulatory at any time, Delayed onset of neck pain, and Absence of midline cervical-spine tenderness. 

Neck rotation assessment

• If any high-risk factors are present, imaging is recommended. 
• If no high-risk factors are present, check if any low-risk factors are present. 
• If low-risk factors are present, the patient can turn their neck 45 degrees in both directions. 
  • Imaging is not required: if the patient can actively rotate their neck 45 degrees to the left and 45 degrees to the right. 
  • Imaging is required: if the patient cannot actively rotate their neck 45 degrees to the left or right. 

EBP

100

What are the first line treatment interventions for patients with osteoarthritis? (4)

1. Education

2. Self-Management

3. Exercise

4. Weight Management

Patient Management

100

Given these conditions, which symptoms are classically seen in patients? 

1. RA

2. Sjorgrens

3. SLE

4. PsA

5. Reithers

1. RA - swan neck deformity, ulnar deviation, bouchard nodes

2. Sjorgrens - dry eyes and mouth

3. SLE - malar rash

4. PsA - nail pitting, silvery scales, rash on extensor surfaces

5. Reithers - urethritis, conjunctivitis, arthritis

Special Topics

100

Explain impairment vs disability. 

Impairment = a loss or abnormality of a psychological, physiological or anatomical structure or function. 

Disability = physical or mental condition that limits a persons movements, senses or activities.

200

What are the 6 P’s for compartment syndrome?

Pain, Pallor, Paresthesia, Paralysis, Poikilothermia (coldness), and Pulselessness

300

Name the 7 risk factors of serious pathology (red flags) for neck pain. 

Fracture/dislocation (osteoporotic fracture included, technically would be 8), cancer, vertebral infection, myelopathy, carotid/vertebral artery dissection, brain hemorrhage/mass lesion, inflammatory arthritides.