Mehl. lower limb Dx

Question 1

Trochanteric bursitis Tx?

Answer 1

NSAIDs

Question 1

Vignette will be lateral hip pain that is worsened with palpation + lying on one’s side in bed. Dx?

Answer 1

Trochanteric bursitis

Question 2

USMLE will give inflammation of knee joint that sounds like septic arthritis, but they will say there’s no joint effusion. Dx?

Answer 2

Septic BURSITIS.

Question 3

Septic BURSITIS Tx?

Answer 3

antibiotics

Question 4

Aka housemaid’s knee; presents as anterior knee pain in people who are frequently on their knees (painters, plumbers, etc.). Dx?

Answer 4

Prepatellar bursitis

Question 5

Prepatellar bursitis Tx?

Answer 5

NSAIDs

Question 6

Inflammation of patellar tendon.??

Answer 6

Patellar tendonitis (“Jumper’s knee”)

Question 7

The answer on USMLE if they describe anterior knee pain that initially occurs only after finishing sports (e.g., basketball game), then progresses to more chronic pain.??

Answer 7

Patellar tendonitis (“Jumper’s knee”)

Question 8

Patellar tendonitis (“Jumper’s knee”) Tx?

Answer 8

Tx on NBME = “quadricep strengthening exercises.”

Question 9

!! Patellofemoral instability presentation is annoyingly similar to patellar tendonitis, but do not confuse.
Patellofemoral instability is misalignment of the patella at the trochlear groove of the femur.
Q can mention crepitus.

Answer 9

.

Question 10

Shows up on 2CK form as teenage girl who has knee pain worse after jumping or running + has crepitus, Dx?

Answer 10

Patellofemoral instability (patellar tendonitis / “jumper’s knee” not listed as answer).

Question 11

Aka chondromalacia patellae =Dx?

Answer 11

Patellofemoral pain syndrome

name implies softening of cartilage in the knee.

Question 12

The answer on NBME if they say pain that worsens when sitting for long periods of time, or when going up or down stairs. Dx?

Answer 12

Patellofemoral pain syndrome

Question 13

Patellofemoral pain syndrome Tx?

Answer 13

Tx = quadriceps strengthening exercises.

Question 14

Classic in obesity or those who squat heavy weight (knees think you’re obese). Dx?

Answer 14

Patellofemoral pain syndrome

Question 15

(+) anterior drawer test or Lachman test -> excessive anterior displacement of tibia relative to femur. Dx?

Answer 15

Anterior cruciate ligament injury

Question 16

Classically injured when knee is hyper-extended, or with a rotational force on a fixed, planted knee.

Answer 16

Anterior cruciate ligament injury

Question 17

answer if (+) posterior drawer test -> excessive posterior displacement of tibia relative to femur.

Answer 17

Posterior cruciate ligament injury

Question 18

Classically injured when knee hits the dashboard in car accident.

Answer 18

Posterior cruciate ligament injury

Question 19

If varus test induces excessive lateral motion of the knee compared to the unaffected side.

Varus test = hand placed on medial knee and pushing outward + other hand placed on lateral ankle and pushing inward.

Answer 19

Lateral collateral ligament injury

Question 20

answer if valgus test induces excessive medial motion of the knee compared to the unaffected side.

Valgus test = hand placed on lateral knee and pushing inward + other hand placed on medial ankle and pulling outward.

Answer 20

Medial collateral ligament injury

Question 21

Lateral knee pain where patient experiences “locking” or “catching” of the knee in partial flexion. Dx?

Answer 21

Lateral meniscal tear

Question 22

Lateral meniscal tear Dx with what test?

Answer 22

Diagnosed with McMurray test -> INTERNAL rotation of leg with concurrent knee extension causes lateral knee pain / “catching.”

Question 23

Medial knee pain where patient experiences “locking” or “catching” of the knee in partial flexion. Dx?

Answer 23

Medial meniscal tear

Question 24

Medial meniscal tear Dx with what test?

Answer 24

Diagnosed with McMurray test -> EXTERNAL rotation of leg with concurrent knee extension causes medial knee pain / “catching.

Question 25

Refers to a trio injury of the ACL, medial collateral ligament, and either the medial or lateral meniscus. how is called?

Answer 25

“Unhappy triad” Students are sometimes fanatical about this triad as though it has yieldness. USMLE doesn’t give a fuck. I cannot recall a single NBME question that has ever assessed this. This Dx primarily resides within the domain of Qbank, not the NBME.

Question 26

“Unhappy triad” = 3?

Answer 26

ACL, medial collateral ligament, and either the medial or lateral meniscus.

Question 27

The answer on USMLE if patient has inferomedial knee pain. Dx?

Answer 27

Pes anserine bursitis

Question 28

The answer on USMLE if they say lateral knee pain, usually in a runner. Dx?

Answer 28

Iliotibial band syndrome

Question 29

Iliotibial band runs from the hip to the knee. Pain may occur anywhere along the hip, lateral thigh, and lateral knee, but is worst in the latter.

Answer 29

.

Question 30

Iliotibial band syndrome Tx?

Answer 30

Tx = conservative with physiotherapy; NSAIDs for pain.

Question 31

Buzzy vignette is knee pain in fast-growing teenage male who plays soccer. Don’t pigeon-hole things, but that’s classic vignette. Inflammation of the patellar ligament at the tibial tuberosity. Mechanism is repeated stress on the growth plate of the superior tibia. Dx?

Answer 31

Osgood-Schlatter disease

Question 32

The answer on USMLE if they give severe heel pain that is worst when first getting out of bed in the morning. Dx?

Answer 32

Plantar fasciitis

Question 33

Answer on USMLE if patient has pain + abnormal growth occurring between the 2nd and 3rd metatarsals, usually worsened with high-heel shoes. Dx?

Answer 33

Morton neuroma

Question 34

Morton neuroma = Benign growth/tumor of intertarsal nerve; cause is idiopathic.

Answer 34

.

Question 35

Morton neuroma first line Dx? --> next to confirm Dx?

Answer 35

First step in diagnosis is x-ray to rule out arthritis + fractures. Ultrasound is then done to confirm Dx, which will show thickening of interdigital/intertarsal nerve.

Question 36

Morton neuroma Tx? 2

Answer 36

Tx = orthotics (comfortable shoes) + steroid injection.

Question 37

As discussed already, aka Charcot joint, where patient injures joint due to lack of joint sensation from peripheral neuropathy. Usually seen in diabetes; can also be seen in neurosyphilis. Dx?

Answer 37

Neurogenic joint

Question 38

The answer on USMLE when they say diabetic patient has “disorganization of the tarsometatarsal joints” on foot x-ray.

Answer 38

Neurogenic joint