Ottawa Rules/Spinal Immobilisation Quiz

2.

Please click on the image to indicate where you would palpate to check for pain at the base of the 5th metatarsal.

3.

Kuldip a 48 year old male fell off his bike on the way to work this morning, he is normally fit and healthy and does not take any regular medication. You carry out a knee assessment and find the following there is some moderate swelling around the knee. There is pain (score of 5) directly on the patella as well as above and below and at either side of the patella. There is no isolated pain at the head of the fibula, he is able to bend his knee to 90 degrees and when he takes 4 steps at the scene he is able to compete it but complains of an increase in pain (pain score7). Kuldip needs to go to the Emergency department for an X-ray.

True
False

Correct Answer

A. False

Explanation

Although Kuldip has pain directly on the patella, it is not isolated as there is also pain in the area of the knee surrounding the patella, therefore it is not significant and does not require an X-ray.

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4.

The Ottawa rules are always appropriate for use on children.

True
False

Correct Answer

A. False

Explanation

The should be used with caution if under the age of 18. You must judge if the child is able to understand the questions and respond appropriately.

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5.

Brooke a 24 year old female was playing football and injured her ankle as a result of a bad tackle. She has no pain in the malleolar zone she also has no pain in the lateral or medial malleolus. She does have pain in the mid-foot region, this is focused at the base of the fifth metatarsal but not the navicular. She is able to weight bear with difficulty and has no other injuries of note or distracting factors. Brooke will need to have an X-ray.

True
False

Correct Answer

A. True

Explanation

Even though Brooke is able to weight bear, she also has mid-foot pain and pain at the base of the 5th metatarsal therefore will require an X-ray.

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1

6.

Jay a second year a Paramedic Student is practicing carrying out the Ottawa Knee rule. They first check the patella for isolated pain, then check the fibula head for isolated pain. They then ask the patient to take 4 steps. Finally they ascertain that the patient is under 55 and does not have any distracting factors. Jay has carried out all steps of the test correctly.

True
False

Correct Answer

A. False

Explanation

Jay forgot to check if the patient could bend the knee to 90 degrees.

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1

7.

Crystal is 60 and was at a family party when she stumbled in the high heels she had on and hurt her ankle, initially she was in quite a lot of pain but it has eased now. She limped up to meet the ambulance when you pulled up outside as she didn't want to make a scene at the party. There is some minor swelling in the malleolar region but not directly at the edge or proximal tips of the lateral and medial Malleolus. There is also no pain at the Navicular or base of the fifth malleolus. Crystal will require an X-ray

True
False

Correct Answer

A. True

Explanation

Crystals age >55 means that she should still require an X-ray, we would also need to ask if Crystal had been drinking any alcohol at the party as this could be a distracting factor.

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1

8.

Jo, is 42 and was in the gym taking part in a high intensity interval training class when she jumped and landed badly. She noted a sudden pain in the area indicated in red. You assess the rest of the foot and ankle and find no other areas of pain or swelling. Jane is currently unable to walk for 4 steps and seems in severe pain. Does Jane require an X-ray

Yes
No

Correct Answer

A. Yes

Explanation

The Ottawa ankle rules only allows us to rule out X-rays for the ankle/mid-foot area. Not the toes or heel. Immediate severe pain and an inability to weight bear could indicate a fracture so it would be a good idea to get this injury X-rayed.

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9.

Which of the following indicates we can not use the Ottawa knee rules on a patient.

> 50 years of Age
The injury was sustained 8 days prior
Patient is able to bend the knee 90 degrees
The patient has diabetes.

Correct Answer

A. The injury was sustained 8 days prior

Explanation

We can't use the Ottawa ankle rule if an injury is greater that 7 days old.

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1

10.

Which of the following are reasons that the Ottawa ankle rules should not be used to clear a patient from an X-ray.

The patient is intoxicated
The patient also sustained a bump to the head during the incident.
The patient has a nerve deficit to the limb caused by a previous stroke
All of the above

Correct Answer

A. All of the above

Explanation

The Ottawa ankle rules should not be used to clear a patient from an X-ray if the patient is intoxicated because their judgment may be impaired, leading to a potential misinterpretation of symptoms. Additionally, if the patient sustained a bump to the head during the incident, there could be a possibility of a head injury that needs to be further evaluated. Lastly, if the patient has a nerve deficit to the limb caused by a previous stroke, it may mask or alter the typical symptoms associated with ankle injuries, making it difficult to accurately assess the need for an X-ray. Therefore, all of the above reasons justify not using the Ottawa ankle rules in these cases.

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1

11.

The remaining questions are intended to help you become familiar with the JRCAL Immobilisation algorithm Figure 4.10. Please read through the algorithm and then use the quiz to see how much you remember without looking at it. Which of the following is not true

A patient under the age of 18 can not be cleared from spinal immobilisation using the algorithm
A patient under the influence of alcohol can not be cleared from spinal immobilisation using the algorithm
A patient with severe osteoarthritis can not be cleared from spinal immobilisation
A confused patient can not be cleared from spinal immobilisation using the algorithm

Correct Answer

A. A patient under the age of 18 can not be cleared from spinal immobilisation using the algorithm

Explanation

A patient under the age of 16 can not be cleared using the algorithm.

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12.

The algorithm can not be used if there is a dangerous mechanism of injury such as fall from a height. According to the algorithm a fall from a heigh is classed as:

>500 cm or 5 steps
> 1 m or 5 steps
> 1 m or 10 steps
>5 meters or 10 steps.

Correct Answer

A. > 1 m or 5 steps

Explanation

The algorithm cannot be used if there is a dangerous mechanism of injury such as a fall from a height. According to the algorithm, a fall from a height is classified as > 1 m or 5 steps. This means that if someone falls from a height greater than 1 meter or approximately 5 steps, the algorithm cannot be applied and alternative measures should be taken.

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13.

Which of the following patients would not be low risk according the the algorithm?

Was in a minor rear-end motor vehicle collision
Has been ambulatory since the time of the injury.
Has delayed onset of neck pain
Was in a minor side-impact motor vehicle collision

Correct Answer

A. Was in a minor side-impact motor vehicle collision

Explanation

The algorithm categorizes patients as low risk based on certain criteria. In this case, the patient who was in a minor side-impact motor vehicle collision would not be considered low risk according to the algorithm. This suggests that the algorithm considers minor rear-end collisions and delayed onset of neck pain as factors that can still classify a patient as low risk.

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14.

You should check your patient for abnormal neurology according the the JRCAL algorithm these are : Loss of sensation, numbness, ________, burning pain.

Correct Answer
Pins and Needles, Pins & Needles, Pins + Needles, Tingling, Tingling

Explanation
The correct answer is "Tingling." According to the JRCAL algorithm, abnormal neurology symptoms that should be checked in a patient include loss of sensation, numbness, burning pain, and tingling. "Pins and Needles," "Pins & Needles," and "Pins + Needles" are all synonymous phrases that describe the sensation of tingling in the body. Therefore, tingling is the appropriate term to complete the given list of symptoms.

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15.

Even if a patient is uncooperative, confused or distressed it is still imperative that a patient with a suspected spinal injury should be immobilised.

True
False

Correct Answer

A. False

Explanation

Forcing a patient in this condition to be immobilised could cause more damage than it prevents. If there is a clearly severe spinal injury or the patient is unmanageable, consideration should be given as to wether additional support may be required to sedate the patient.

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2

Ottawa Rules/Spinal Immobilisation Quiz

Indicate by clicking on the image where you would palpate to check for pain at the head of fibula in the patients right leg.

Quiz Preview

Please click on the image to indicate where you would palpate to check for pain at the base of the 5th metatarsal.

The Ottawa rules are always appropriate for use on children.

Which of the following indicates we can not use the Ottawa knee rules on a patient.

Which of the following are reasons that the Ottawa ankle rules should not be used to clear a patient from an X-ray.

The remaining questions are intended to help you become familiar with the JRCAL Immobilisation algorithm Figure 4.10. Please read through the algorithm and then use the quiz to see how much you remember without looking at it. Which of the following is not true

The algorithm can not be used if there is a dangerous mechanism of injury such as fall from a height. According to the algorithm a fall from a heigh is classed as:

Which of the following patients would not be low risk according the the algorithm?

You should check your patient for abnormal neurology according the the JRCAL algorithm these are : Loss of sensation, numbness, ________, burning pain.

Even if a patient is uncooperative, confused or distressed it is still imperative that a patient with a suspected spinal injury should be immobilised.