Differential Dx

Question 1

Ottawa Knee Rules

Answer 1

Age >/= 55 y.o.

Isolated tenderness at the patella (no other bony tenerness)

Tenderness at the fibular head

Unable to flex the knee to 90 deg

Unable to bear weight bot immediately and in the ED

Question 2

Ottawa Ankle Rules

Answer 2

Bone tenderness at the posterior edge/tip of the lateral malleolus OR posterior edge/tip of the medial malleolus OR inability to bear weight immediately or in the ED

Bone tenderness at the base of the fifth metatarsal OR the navicular OR inability to bear weight immediately or in the ED

Question 3

Canadian C-Spine Rules

Answer 3

YES to:

Age greater than 65 years?

Dangerous mechanism?

Paresethesias in extremities?

NO to:

Any low-risk factor that allows safe ROMassessment

Simple rear-end MVA?

Sitting position in the ED?

Ambulatory at any time?

Delated neck pain onset?

No midline cervical tenderness?

If NO: radiograph … If YES:

Able to rotate neck actively 45 deg?

If NO: radiograph … If YES: no radiograph

Question 4

S&S of Meningitis

Answer 4

• Fever, headache, & vomiting
• Complaints of stiff and painful neck, nuchal rigidity
• Pain in the lumbar area and posterior thigh
• Brudzinski’s sign (flexion of the neck facilitates flexion of the hips and knees)
• Kernig’s sign (pain with hip flexion combined with knee extension)
• Sensitivity to light

Question 5

S&S of Hydrocephalus

Answer 5

• Enlarged head or bluging fontanelles in infants
• Headache
• Changes in vision
• Large veins noted on scalp
• Behavioral changes
• Seizures
• Alternation in appetite, vomiting
• “Sun setting” sign or downward deviation of the eyes
• Incontinence

Question 6

Peripheral Nervous System Pathology Profile for Anterior Horn Cell

Answer 6

Sensory component intact

Motor weakness and atrophy

Fasciculations

Decreased DTRs

Question 7

Peripheral Nervous System Pathology Profile for Muscle

Answer 7

Sensory component intact

Motor weakness; fasciculations are rare

Normal or decreased DTRs

Question 8

Peripheral Nervous System Pathology Profile for Neuromuscular Junction

Answer 8

Sensory component intact

Motor fatigue is greater than actual weakness

Normal DTRs

Question 9

Peripheral Nervous System Pathology Profile for Peripheral Nerve

Answer 9

Sensory loss along the nerve route

Motor weakness and atrophy in a peripheral distribution; may have fasciculations

Question 10

Peripheral Nervous System Pathology Profile for Peripheral Polyneuropathy

Answer 10

Sensory impairments; “stocking glove” distribution

Motor weakness and atrophy; weaker distally than proximally; may have fasciculaitons

Decreased DTRs

Question 11

Peripheral Nervous System Pathology Profile for Spinal Roots and Nerves

Answer 11

Sensory component will have corresponding dermatomal deficits

Motor weakness in an innervated pattern; may have fasciculations

Decreased DTRs