7-8 Knee (Kusienski)

Question 1

Breakdown of TQs

Answer 1

1-2 anatomy tq;
2-3 osteopathic tq;
rest sx and tests

Question 2

A patient with “knock knees” is known as:

a) scoliosis
b) genu varus
c) genu recurvatus
d) genu valgus

Answer 2

d) genu valgus

Question 3

A patient with “bowed knees” is known as:

a) scoliosis
b) genu varus
c) genu recurvatus
d) genu valgus

Answer 3

b) genu varus

Question 4

What are ways to measure the knee?

a) range of motion
b) girth
c) Q angle
d) all of the above

Answer 4

d) all of the above

Question 5

When assessing the knee of a 42 yo female, you find her Q angle is greater than 21 degrees. What does this tell you?

a) there is a great tendency for increased lateral pull on the patella, leading to grinding of the patella on the underlying bones of the knee
b) there is a great tendency for increased medial pull on the patella, leading to grinding of the patella on the underlying bones of the knee
c) there is a great tendency for decreased superior pull on the patella, leading to grinding of the patella on the underlying bones of the knee
c) there is a great tendency for decreased inferior pull on the patella, leading to grinding of the patella on the underlying bones of the knee

Answer 5

a) there is a great tendency for increased lateral pull on the patella, leading to grinding of the patella on the underlying bones of the knee

Question 6

If a 29 yo female comes in complaining of right knee pain, what can you guarantee if her left knee is normal then:

a) you need an X-ray to figure out what is going on
b) the physician can’t feel the left capsule of the knee.
c) the ACL is most likely injured
d) The MCL is not injured

Answer 6

b) the physician can’t feel the left capsule of the knee.

You can NEVER palpate a normal capsule of the knee!

Question 7

A patient comes in with a swollen knee. You suspect an effusion of the knee. What test(s) could confirm this idea?

a) Bulge Sign
b) Bounce Home Test
c) Lachman’s sign
d) Pivot test

Answer 7

a) Bulge Sign

b) Bounce Home Test

Question 8

A 70 yo grandma comes complaints of a large bulge in the front of her knee. Hx reveals she was a previous housemaid. What is the likely diagnosis?

a) Osgood Slaughter’s disease
b) Baker’s Cyst
c) Patellofemoral syndrome
d) Prepatellar bursitis

Answer 8

d) Prepatellar bursitis

Question 9

A 12 yo child comes in complaining of swelling in the posterior aspect of their knee. You suspect that because it it is the posterior popliteal fossa, it could be a:

a) Osgood Slaughter’s disease
b) Baker’s Cyst
c) Patellofemoral syndrome
d) Prepatellar bursitis

Answer 9

b) Baker’s Cyst

Question 10

A 12 yo child comes in complaining of swelling in the posterior aspect of their knee. You suspect that because it it is the posterior popliteal fossa, it could be a Baker’s Cyst, which is a …?

a) tear and enlargement of the semimembranous bursa
b) tear and enlargement of the prepatellar bursa
c) tear and enlargement of the infrapatellar bursa
d) tear and enlargement of the pes anserine bursa

Answer 10

a) tear and enlargement of the semimembranous bursa

Question 11

True or False: Before you try draining a Baker’s cyst, you should always auscultate the area.

Answer 11

True! You need to make sure you do not have an arterial aneurysm because you are in the popliteal fossa

Question 12

All of the following are extensors of the knee EXCEPT:

a) Rectus femoris
b) Vastus medialis
c) Biceps femoris
d) vastus lateralis
e) Vastus intermedialis

Answer 12

c) Biceps femoris [flexor of the knee]

Question 13

Which is an external rotator of the knee?

a) semitendinosis
b) semimembranosus
c) popliteus
d) biceps femoris

Answer 13

d) biceps femoris

Semitendinosis, semimembranosus, popliteus are internal rotators of the knee.

Question 14

A 23 yo m football player complains of pain in his knee. Which test(s) would you use to test his collateral ligaments?

a) Apley’s distraction
b) Lachman’s test
c) Drawer’s Test
d) Valgus varus test

Answer 14

a) Apley’s distraction

d) Valgus varus test

Question 15

A 23 yo m football player complains of pain in his knee. Which test(s) would you use to test the integrity of the ACL and PCL?

a) Apley’s distraction
b) Lachman’s test
c) Drawer’s Test
d) Valgus varus test

Answer 15

a) Apley’s distraction
b) Lachman’s test
c) Drawer’s Test

Question 16

The Giant’s quarterback, Kyle Gunther, gives a talk about when he was standing and waiting for someone to be free, a defender rammed into him and caused a valgus force apply to his knee with external tibial rotation. What was the resulting injury?

a) LCL sprain
b) MCL sprain
c) PCL sprain
d) ACL sprain

Answer 16

b) MCL sprain

Question 17

The Giant’s quarterback, Kyle Gunther, gives a talk about when he was standing and waiting for someone to be free, a defender tried to hit him on the anteriomedial side force apply to his knee. What was the resulting injury?

a) LCL sprain
b) MCL sprain
c) PCL sprain
d) ACL sprain

Answer 17

a) LCL sprain

Question 18

A 80 yo male is tested to have a positive valgus/varus stress test at zero degrees and 30 degrees. You suspect just a ligament stretch. What is the treatment you would recommend?

a) Compression
b) Immobilization
c) Surgery

Answer 18

a) compression

PRICE = protection, rest, ice, compression, elevation

Question 19

A 80 yo male is tested to have a positive valgus/varus stress test at zero degrees and 30 degrees. You suspect a laxity without endpoint. What is the treatment you would recommend?

a) Compression
b) Immobilization
c) Surgery
e) Heat pack

Answer 19

c) Surgery

Question 20

What is a sag sign indicative of?

a) LCL sprain
b) MCL tear
c) PCL tear
d) ACL sprain

Answer 20

c) PCL tear

Question 21

A 37 yo m patient of yours went for an X-Ray after complaining of knee pain. You notice on the films that he has a Segond fracture. Which of the following describes a test that would be positive?

a) flexion of the knee with a slight compression and rotation of the knee
b) flexion of the knee with an attempted anterior pull
c) flexion of the knee with a lateral force on the tibia
d) flexion of the knee with a medial force on the tibia

Answer 21

b) flexion of the knee with an attempted anterior pull [Lachman’s test]

A segond fracture is indicative of ACL tear most of the time (can also indicate MCL tear, but less likely)

Question 22

42 yo male runner comes into your office complaining of medial joint tenderness around the knee. What test(s) would be most appropriate?

a) Drawer’s Test
b) McMurray’s
c) Apley’s distraction
d) Valgus varus test
e) Apley’s contraction

Answer 22

b) McMurray’s

Note: It is supposed to be Apley’s conpression test too, not Apley’s contraction

Question 23

A 52 yo patient complains of pain in their knee cap. Upon physical exam, you notice that when you put your hand over the patella and ask them to contract their quadriceps, they have pain and you feel a lots of grinding. What is a potential diagnosis?

a) Osgood Slaughter’s disease
b) Baker’s Cyst
c) Patellofemoral Pain syndrome
d) Chrondomalacia
e) Prepatellar bursitis

Answer 23

d) Chrondomalacia

Question 24

A 44 yo female complains of pain behind his patella. It gets worse when she walks up the stairs, squats, and sits down for too long at the movies. You notice a positive apprehension sign. What is a potential diagnosis?

a) Osgood Slaughter’s disease
b) Baker’s Cyst
c) Patellofemoral Pain syndrome
d) Chrondomalacia
e) Patellar tendonitis

Answer 24

c) Patellofemoral Pain syndrome

Question 25

A 44 yo female complains of pain behind his patella. It gets worse when she walks up the stairs, squats, and sits down for too long at the movies. You notice a positive apprehension sign. Assuming it is patellofemoral pain syndrome, what should xrays show in the sunrise view?

a) patella displaced medial to femoral sulcus
b) patella displaced anterior to femoral sulcus
c) patella displaced lateral to femoral sulcus
d) patella displaced posterior to femoral sulcus

Answer 25

c) patella displaced lateral to femoral sulcus

Question 26

A 44 yo female complains of pain behind his patella. It gets worse when she walks up the stairs, squats, and sits down for too long at the movies. You notice a positive apprehension sign. Assuming it is patellofemoral pain syndrome, what is NOT a recommended treatment?

a) Vastus medialis (VMO) strengthening
b) patella stabilizing brace
c) Orthotics
d) NSAIDS
e) none of the above

Answer 26

e) none of the above

Question 27

A 38 yo basketball player complains of knee pain. Upon physical exam, you note inferior patellar pole tenderness, and hamstring and quad tightness. What is the likely diagnosis?

a) Osgood Slaughter’s disease
b) Baker’s Cyst
c) Patellofemoral Pain syndrome
d) Chrondomalacia
e) Patellar tendonitis

Answer 27

e) Patellar tendonitis

Question 28

A 38 yo basketball player complains of knee pain. Upon physical exam, you note inferior patellar pole tenderness and hamstring and quad tightness. Suspecting patellar tendonitis, which is NOT a potential treatment?

a) Rehabilitation
b) Brace
c) Orthotics
d) NSAIDS
e) none of the above

Answer 28

c) Orthotics