Vinettes (Irene Gold) Part III Flashcards
This is most vinettes. Some of the cards are just different things I had written down during the review. I include as much of a patient history as I had. I hope you find them helpful. Best of luck with your studies. :-D
A 71 year old patient present to the office with Low Back Pain after gardening, pain has came on 18 hours ago.
What are three possible Diagnosis?
What are three Treatments/Follow ups?
What three things can be a Progression of the complaint?
Diagnosis:
Osteoporotic Fracture
Pathological Fracture
Facet Arthritis
Treatments/Follow ups:
Cryotherapy
Modify Activities of Daily Living (ADL’s)
Refer to an Orthopedist; because of fractures
Progression:
Postural changes
Alter body bio-mechanics
Unrelenting back pain
A 41 year old female, pain with abduction, can’t reach over head. Positive findings on Apley’s Scratch and Impingement orthopedic exams.
What are three possible Diagnosis?
What three things are Observed?
What three things can be a Recommended/Rehab?
Diagnosis:
Shoulder Impingement
Supraspinatus Calcification
Hydroxyapatite Deposition Disease (HADD)
Observed:
- Positive Empty Can Test
- Positive Neer’s Test (Patient in a relaxed standing position. The arm to be tested should be moved passively by the examiner. The patients arm of the shoulder to be tested is positioned such that the arm is relaxed at the side of the body and the elbow is fully extended.From the starting position the examiner internally rotates the patients arm and forcefully moves the arm through the full range of forward flexion or until reports of pain.)
- Positive Codman’s Sign
Recommended/Rehab:
Transverse Friction Massage
Codman’s Exercises
Strengthening external should muscles
What three conditions can present with an Ivory White Vertebrae (IWV) on x-ray?
Mets (Blastic)
Paget’s
Hodgkin’s
Degenerative Spondylitis is seen with what problem?
Facet Arthritis
What three bones may be involved in a patient with an Ivory White Vertebrae (IWV)?
Pelvis
Skull
Femur
What are three possible sequelae of a patient with an Ivory White Vertebrae (IWV)?
Pathological collapse or a vertebrae
Malignant degeneration
Spinal canal stenosis
What are three findings if a patient is deficient in B12?
Stomach issues
Glove and stocking Paresthesia
Normocyctic Normochromic anemia
What is the conditions most often seen with facet issue?
Degenerative Joint Disease (DJD) with Canal stenosis
68 year old male with low back pain for six months. Pain is a dull ache and is better in the flexed position. There is an increase in pain with extension and rotation. Walking upstairs makes the pain decrease.
What are three possible Diagnosis?
What are three Symptoms?
What three things can be a Treatment?
Diagnosis:
Ligamentum Flava Hypertrophy
Central Disc Protrusion
Canal Stenosis
Symptoms:
- Decrease in the Deep Tendon Reflexes (DTR) or the lower extremity
- Disability
- Muscle weakness
Treatment:
NCV/EMG testing
Centralized Movements
Trial period of adjusting
What condition can present similar to DISH?
Diabetes Mellitus
What two things will be found in both DISH and Diabetes Mellitus?
Positive HLA B27 test
Ketones in the urine
A 19 year old patient present with difficulty walking.
What are three possible Differential Diagnosis?
What three things are Initial Treatment?
What three things can be a Associated Problems?
Differential Diagnosis:
Benign Paroxysmal Positional Vertigo
Vestibular Neuritisis
Free floating otoliths
Initial Treatments:
Epley’s Maneuver
Canalith’s Repositioning
Rule out intercranial pathology
Associated Problems:
Nausea
Loss of balance
Hearing Loss
Patient had Benign Paroxysmal Positional Vertigo
A 54 year old with low back pain and pain with extension. Kemp’s test is positive.
What are three possible Differential Diagnosis?
What three things are Positive Findings?
What three things can be a Management?
Differential Diagnosis:
Degenerative Spondylosis (Most commonly at L4)
Facet Syndrome
Lower Cross Syndrome
Positive Findings:
Decrease in disc height
Meniscoid entrapment
Weak core muscles
Management:
William’s Flexion Exercises
Knee to Chest exercises
SPECT test
A 24 year old with head/neck pain in the Sub-occipital region.
What are three possible Diagnosis?
What three things are Accompanying Conditions?
What three things can be a Treatment?
Diagnosis:
Agenisis of the Posterior Arch
Congenital anomaly
Hypertrophy of the anterior tubercle
Accompanying Conditions:
Neurological Defects
Atlantoaxial Instability
Anterior Rachischisis ( Rare Spina Bifida with no fusion of the neural arch)
Treatment:
Avoid upper cervical adjustments
Take flexion/extension films
Neurological evaluation
A 64 year old with a shuffled gate and no arm movements while walking.
What are three possible Positive Findings?
What three things are Sequelae?
What three things can be a Follow Up?
Positive Findings:
Resting Tremor
Rigidity
Bradykesia (Slow walking)
Sequelae:
Cognitive Impairment
Difficulty Swallowing
Constipation
Follow Up:
Encourage daily activity
Modify home, so falls will happen less often
Refer to a Neurologist
Patient has Parkinson’s
What are the treatments and clinical findings of Scheuermann’s Disease?
Treatment:
Stop physical activity
Kinesotaping
Adjust Supine, in an A-P direction
Clinical Findings:
Muscle stiffness/fatigue
Intermittent Pain
Hyperlordosis of the lumbar spine
What are three findings with Diabetes Mellitus?
Vessel calcification
Waxy exudates
NVC studies
What condition is often seen with exacerbations and remissions, episodic?
Multiple Sclerosis (MS)
In the condition of Multiple Sclerosis (MS) what are three:
Follow Up
Associated Signs
Sequelae
Follow Up:
Electrodiagnosis
MRI of the Brain
Protein in the Cerebral-spinal fluid (CSF)
Associated Sign:
Diplopia/Visual Disturbances (Double Vision)
Hyperreflexia
Faculations
Sequelae:
Urinary Incontinence
Optic Atrophy
Vertigo
For the condition of Bell’s Palsy what cranial nerve is first effected and what subsequent cranial nerve is effected?
Cranial Nerve VII (7) effects Cranial Nerve VIII (8)
What two symptoms may be seen in a patient with Bell’s Palsy?
Hyeracusis- increased sensitivity to sound
Decreased ability to speak
In the condition of Rheumatoid Arthritis what are:
X-ray findings (Three)
Lab Test (Two)
Synonyms (Two)
X-ray:
Juxarticular osterosis
Uniform Joint space
Marginal erosion
Labs:
Increase in C Reactive Protein
Increase in Erythrocyte Sedimentation Rate (ESR)
Synonyms:
Sero-positive
Uniform Arthritisis
A 56 year old female with neck pain, radiates to the left arm down to the thumb and index finger. Distraction and Compression test are positive.
What are three possible Positive Findings?
What three things are Diagnosis?
What three things can be a Management?
Positive Findings:
Positive Bacody’s
Decrease sensation on lateral arm
Hyporefexia of Brachioradialis
Diagnosis:
C5/C5 IVF encroachment
Peripheral Nerve entrapment
Median nerve entrapment
Management:
NCV study
Adjust
Cervical traction with slight flexion
A 82 year old patient with sudden onset of Low Back Pain. States that ice makes it better and rates the pain an 8 out of 10. Pain is described as “Sharp”.
What are three possible Radiographic Findings?
What three things are Initial Diagnosis?
What three things can be a Treatment?
Radiographic Findings:
Osteopenia
Degenerative Disc Disease (DDD)
Arteriosclerosis Plaquing
Initial Diagnosis:
CT
DEXA- Osteopenia
Abdominal Ultrasound
Treatment:
Adjust lumbar spine
Fit for lumbar support
Limit certain physical activities
A 21 year old football player presents with shoulder pain.
What are three possible Diagnosis?
What three things are Initial Treatment?
What three things can be a Consequences?
Diagnosis:
Acromioclavicular (A-C) Ligament Sprain
Acromioclavicular (A-C) Separation
Coroclavicular ligament Sprain
Initial Treatment:
Refer to a surgeon for repair
Sling
Cryotherapy
Consequences:
Early onset of Arthritisis
Rotor Cuff Tendonopathy
Impingement syndrome (Supraspinatus Muscle)
A 50 year old male rates pain a 6-7 out of 10. Positive orthopedics are Hibbs and Anvil.
What are three possible X-ray Findings?
What three things are Sequelae?
What three things can be a Diagnosis?
X-ray:
Osteolytic Lesion
Metaphyseal Lesion
Osteopenia
Sequelae:
Increased infection
Unexplained weight loss
Aneurism
Diagnosis:
Multiple Myeloma (MM)***
Primary Neoplasm
Hematropic lesion
A 17 year old female complains of a dull aching pain rating at a 4-6 out of 10 and had a positive Stork Test. What condition does she have?
Spondylolysis
Stork Test is very indicative of this condition
If a patient has Lower Cross Syndrome what are
Three Clinical Findings
Three primary Case Management
Three muscles to strengthen to prevent injury
Clinical Findings:
Increased Lumbar Lordosis
Tight/Hypertonic Quadriceps
Hypertonic Lumbar erectors
Primary Case Management:
Take Stress Films
Temporary Stop Activities
Anti-Lordotic Bracing
Muscle to Strengthen:
Hamstring
Gluteus Maximus
Transverse Abdominal
A 58 year old with insidious onset of thoracic pain.
What are three possible Diagnosis?
What three things are Progressions?
What three things can be Primary Treatment?
Diagnosis:
DISH
Anterior Longitudinal Ligament Calcification
Ankylosis
Progressions:
Decrease in breathing (Hoarseness and Dyphagia)
Fatigue of postural muscles
Develop Hyperinsulinemia (Diabetes Mellitus)
Primary Treatment:
Monitor Diabetes
Positive HLA B27
Thoracic Brace/ Strengthen back muscles
In the condition of Bell’s Palsy;
What are two ways it can be classified?
What two symptoms can be see with it?
What are three treatments?
Classification:
Upper Motor Neuron Lesion (UMNL)
Cranial Nerve VII (7) Pathology
Symptoms:
Decreased taste discrimination
Increase tear production while chewing
Treatments:
Eye Patch
Adjust
Co-manage
What is seen upwards of 90% of the time with Rheumatoid Arthritis?
Baker’s Cyst
What condition is Ray Sign seen in?
Reactive Arthritis
A 10 year old female with right knee pain and swelling. No trauma, overweight, and has asthma, increased temperature and pain is relieved by aspirin.
What are three age related conditions?
What are three x-ray findings?
What are three signs from the history to help determine to diagnosis?
Age related conditions:
Chondroblastoma
Aneurysmal Bone Cyst (ABC)
Simple Bone Cyst (SBC)
X-ray findings:
Expansive
Metaphyseal
Fluid Filled
Signs:
Knee swelling
Gender
No history of trauma
A 25 year old football player has pain brought on by lateral flexion and has week toe off.
What are three positive exam findings?
What are two sequelae?
What are three treatments?
What nerve root and disc level are effected?
Positive Exam Findings:
Decreased Achilles Reflex
Weak Foot Eversion
Weak foot plantar flexion
Sequelae:
Caudia Equina Syndrome
Decreased bowel and bladder function
Treatments:
Flexion Distraction Technique
McKenzie Extension Exercises
Side Bridge exercises
S1 Nerve Root
L5 Disc
