FINAL 2 Flashcards
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
During physical exam which two tests below would you expect to be positive?
Empty can and painful arc
Hawkin-Kennedy
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
Based on the presentation, it’s more likely that the patient has which two
Shoulder impingement syndrome
Supraspinatus tendinitis/tendinosis
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
If you were to take x-ray studies of this patient’s cervical spine and shoulders, you would likely see
Evidence of humeral head elevation
A 25 yo male patient presents with worsening L insidious shoulder pain of 2 weeks duration. There is occasional referred pain without paresthesia into the upper arm on the involved side. He points to the antero-lateral shoulder region. He works as a landscape gardener and reports pain while operating a hedge trimmer and leaf blower. Pain interrupts sleep and he relays that brushing teeth, combing hair and putting on a jacket aggravate the pain. He struggles to raise his arm from his side without pain and weakness. Forward flexion, extension, internal/external rotation and adduction ranges are within normal limits on the involved side. He likes to swim for recreation but is unable to now. General health is otherwise good.
To manage this patient the best course of action would be to
Prescribe exercises to rehab the rotator cuff and scapular stabilizers
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
Based on the presentation, your clinical impression is leaning towards
Panner’s disease
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
To further assess this patient radiographically your best study would be to
Shoot a radial-head capitellum view
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
Management of this presentation would include
Rest and splint the elbow for 3 weeks initially
A 12 yo right handed female presents to office with complaints of right sided lateral elbow pain and stiffness. She reports painful click and/or pop in the elbow on certain movements. She relates that she plays little league softball twice a week as well as being a very active and competitive gymnast. There are no other complaints or symptoms in the upper limb to report. Inspection does not reveal any gross deformity. Her general health is otherwise good.
The most likely sequelae of this type of presentation if left untrated is
Avascular necrosis and deformity of the capitellum
A 23 yo male pt presents with a dull ache in the wrist made worse by pronating the hand and ulnar deviating the wrist. They claim that they fell on an outstretched hand about 2 months ago. Forced dorsiflexion of the wrist aggravates the condition as does resisted pronation. They point to the area of the anatomical snuffbox.
The most likely clinical impression in this case is
Scaphoid fracture
A 23 yo male pt presents with a dull ache in the wrist made worse by pronating the hand and ulnar deviating the wrist. They claim that they fell on an outstretched hand about 2 months ago. Forced dorsiflexion of the wrist aggravates the condition as does resisted pronation. They point to the area of the anatomical snuffbox.
On follow up x-ray, you would look for evidence of
Proximal pole fracture
A 23 yo male pt presents with a dull ache in the wrist made worse by pronating the hand and ulnar deviating the wrist. They claim that they fell on an outstretched hand about 2 months ago. Forced dorsiflexion of the wrist aggravates the condition as does resisted pronation. They point to the area of the anatomical snuffbox.
A possible potential sequelae is
Preiser’s disease
A 45 yo female patient presents with well localized left lateral hip pain and a mild limp. She claims symptoms have worsened since she has been jogging in preparation for a half marathon. She claims that pain occasionally radiates to the low back, lateral thigh and knee. She is having trouble sleeping on that side. Internal rotation is restricted.
The most likely clinical impression is
Subtrochanteric bursitis
A 45 yo female patient presents with well localized left lateral hip pain and a mild limp. She claims symptoms have worsened since she has been jogging in preparation for a half marathon. She claims that pain occasionally radiates to the low back, lateral thigh and knee. She is having trouble sleeping on that side. Internal rotation is restricted.
Which physical assessments/diagnostic tests would be beneficial in confirming your suspected clinical impression
Ober test
A 45 yo female patient presents with well localized left lateral hip pain and a mild limp. She claims symptoms have worsened since she has been jogging in preparation for a half marathon. She claims that pain occasionally radiates to the low back, lateral thigh and knee. She is having trouble sleeping on that side. Internal rotation is restricted.
To manage this patient you would exclude
Refer to a neurological specialist for a consultation immediately
Rigorous side posture adjustments to the lumbopelvic region
A 27 yo man presents with sudden onset of right knee pain that began 2 weeks ago when he felt his knee twist while descending stairs. He reported a sense of painful giving way and since then has experienced feelings of sharp pain and catching on the antero-medial joint line. The pain is increased with activities involving bending of the knee with decreased active flexion noted. Swelling increases at the joint line by the end of the day and he has difficulty bending his knee to 90. He also states that the knee is stiff upon arising in the morning.
Which ortho test would be beneficial
McMurray
A 27 yo man presents with sudden onset of right knee pain that began 2 weeks ago when he felt his knee twist while descending stairs. He reported a sense of painful giving way and since then has experienced feelings of sharp pain and catching on the antero-medial joint line. The pain is increased with activities involving bending of the knee with decreased active flexion noted. Swelling increases at the joint line by the end of the day and he has difficulty bending his knee to 90. He also states that the knee is stiff upon arising in the morning.
Which is most likely clinical impression
Meniscus injury
A 27 yo man presents with sudden onset of right knee pain that began 2 weeks ago when he felt his knee twist while descending stairs. He reported a sense of painful giving way and since then has experienced feelings of sharp pain and catching on the antero-medial joint line. The pain is increased with activities involving bending of the knee with decreased active flexion noted. Swelling increases at the joint line by the end of the day and he has difficulty bending his knee to 90. He also states that the knee is stiff upon arising in the morning.
Which managment avenues would you pursue with this patient
Obtain x-rays of the knee based on the ottawa knee rules
Recommend crutches and co-managee with an orthopedist
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
If foot and first toe dorsiflexion elicited plantar foot pain the clinical impression would most likely be
Plantar fascitis
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
If passively flexing the second through fifth metatarsals elicited pain the clinical impression would most likely be
Metatarsalgia
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
If application of a 128 Hz tuning fork elicited pain at the second metatarsal the clinical impression would most likely be
Stress fracture
A 45 yo runner complains of exquisite pain at the bottom of the foot. Upon palpation and observation you notice pes cavus and taut fibers at the plantar aspect. Calluses are evident at the second metatarsal head.
Managing this patient would exclue
Foot cast, crutches for 6 weeks, and calcium supplements
A 24 yo soccer player presents with left sided medial shin pain that worsens during soccer practice. He complains of a mild cramping sensation down the medial aspect of the lower leg that feels tight and is tender to the touch. He complains of an intermittent pins and needles sensation that will travel down into his arch followed by a mild burning and aching sensation into his big toe on the bottom of the foot. He relates taht sometimes he feels like he loses muscle control of his lower leg and it feels weak. He claims he’s had shin splints before and that this feels very different. There are no reports of LBP. The posterior border of the shin palpates as tense and the skin appears shiny.
The most likely clinical impression is
Deep posterior compartment syndrome
A 24 yo soccer player presents with left sided medial shin pain that worsens during soccer practice. He complains of a mild cramping sensation down the medial aspect of the lower leg that feels tight and is tender to the touch. He complains of an intermittent pins and needles sensation that will travel down into his arch followed by a mild burning and aching sensation into his big toe on the bottom of the foot. He relates taht sometimes he feels like he loses muscle control of his lower leg and it feels weak. He claims he’s had shin splints before and that this feels very different. There are no reports of LBP. The posterior border of the shin palpates as tense and the skin appears shiny.
A possible sequelae to this presentation is
Loss of tibialis posterior pulse
A 24 yo soccer player presents with left sided medial shin pain that worsens during soccer practice. He complains of a mild cramping sensation down the medial aspect of the lower leg that feels tight and is tender to the touch. He complains of an intermittent pins and needles sensation that will travel down into his arch followed by a mild burning and aching sensation into his big toe on the bottom of the foot. He relates taht sometimes he feels like he loses muscle control of his lower leg and it feels weak. He claims he’s had shin splints before and that this feels very different. There are no reports of LBP. The posterior border of the shin palpates as tense and the skin appears shiny.
To manage this patient, you would avoid what two
Strapping the shin with a tnesor bandage
Rest, ice, elevation and compression
A 35 yo male presents with severe should pain that woke him up from sleep this morning. He denies injury or overuse type of behavior. ROM is very painful but it WNL. History reveals that he had a tetanus vaccination 3 weeks ago because it was recommended as a 10 year booster by his PCP. X-rays are negative for HADD or OA. What diagnostic consideration should be at the top of the list
Parsonage-turner syndrome
Often described as severe and limiting pain in a 5 yo following a sudden yank or pull on the arm, this condition is characterized as a
Transient damage or impingement of the annular ligament
Match teh fracture category with it’s sub category
Extrascapular/trochanteric
There are 2 types of femoroacetabular impingement syndrome presentations. Which one fo the following statements is correct
The pincer type is due to an aberrant acetabular shap
AVN of the femoral head can typically result as a sequel to a number of problems or conditions. Which of the ofllowing is the most common primary reason (up to 20% of cases) according to souza
Sub-capital fractures
The lateral capsular sign associated with tibial avulsion following severe ACL injury is termed
Segond fx
Which of the following is NOT considered one of the true P’s when considering the symptoms of compartment syndrome
Poikilosis
Pain, paresis, parasthesia, poikilothermia, pallor, pulselessness
Which of the follwoing would most likely indicate PINS (posterior interosseous nerve syndrome
Weakness of middle finger extension
An avulsion of the anterior-superior glenoid labrum (lip) at the attachment of the bicep tendon is termed a/an
SLAP lesion
An impaction injury/compression fracturs to the posterior superior aspect of the humeral head complicated by chronic instability or dislocations is termed a/an
Hill-Sachs lesion
Ankle and foot injuries are very common yet only about 15% of patients will present with an associated fracture. Because of this the ottawa foot and ankle rules were developed to eliminate unnecessary x-rays. Which of the following would NOT be considered a criterion according to the physicians who designed the rules
Tenderness at the head of the 2nd metatarsal in the mid foot
According to the ottawa knee rules, in which of the ofllowign cases would it NOT be considered necessary to x-ray the knee in a patient hwo fell off a bar stool and landed on teh front of his knee teh night before presenting to your office
Patient can flex knee to 90
According to Souza, which type of stress fx accounts for more than half of all stress fxs found in athlets
Tibial shaft
Patellar femoral tracking syndrome (PFTS) or patellofemoral arthralgia can be caused by
All
Quads msucle imbalance
Patella alta/baja
Genu valgus
Synovial plica syndrome
A lisfranc injury is described as
Fracture/dislocation of the tarsal-metatarsal joints
Patients who dislocate a shoulder might have a number of associated complications. From the list below, which of the ofllowing is the most likely complication to occur and therefore needs to be ruled in or out whenever a patient with one of these injuries presents
Hill-Sachs fx
A positive fat pad sign on and elbow x-ray is usually due to
Acute trauma/fracture
With regards to muscle testing of patients with upper cross syndrome, using mechanoreceptor theory of hilton’s law, which combination below fits best in terms of joint dysfunction or subluxation
Pec major clavicular/SC joitn
In a patient with carpal tunnel syndrome, which management avenues would you exclude
Splinting the wrist in 30-40 degrees of flexion and radial deviation at night
Most common acute hip joint pathology in children between 3-10
Transient synovitis of the hip (toxic hip)
To determine a grade 3 AC joint separation, a greater than 1.3 cm distance must be detected at which joinot listed below
Coracoclavicular
A patient presenting with positive mill and cozen tests would likely have a common elbow condition. Which of hte follwoing protocols would be exclude in managing this patient
Splint in 35-40 degrees wrist flexion
According to Souza, painless giving way in the knee is more likely to indicate
ACL instability
Normal cubitus angle ranges from ___
Normal femoral coxa angle ranges from ___
Normal Q angle ranges from ____
10-25
120-130
10-15
Which of the ofllwoing is one of the most common causes of plantar fascitis and often overlooked during management of this very annoying and tenacious condition
Tight and contracted triceps surae and achilles
Regarding hip joint girdle biomechanics, which statements hold true
None
Regarding TOS which combination fits best
Wrights - subcoracoid space compression
Pt adolescent male presents complaining of shoulder pain of several months duration. ROM is decreased and there is marked weakness on external rotation with a positive empty can test. X-ray shows proximal humeral physis widengin with sclerosis of the proximal humeral metaphysis. There is evidence of triangular metaphyseal avulsion. The radiographic classification would be
Salter-Harris 2
Regarding lower leg vascular compromise, which statement is correct
Vascular claudication causes ischemic changes to teh tissues resulting in cramping
The jobe relocation test is designed by
Substantiate the presence of GH instability
Kohler disease
Tarsal navicular
Sever disease
Calcaneal tubercle
Preiser’s disease
Proximal scaphoid pole
Sindig-larsen disease
Inferior patellar pole
Panner’s disease
Radial head capitellum
Iselin’s disease
5th met base
