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
A 50 year old patient with previous skin cancer, hits his head on a shelf.
What are three possible Diagnosis?
What three things are Signs/Symptoms?
What three things can be a Complications?
Diagnosis:
Canal Stenosis
Upper Motor Neuron Lesion (UMNL)
Central Disc Protrusion
Sign/Symptoms:
Clonus
Hyperreflxia of lower extremities
Bowel and Bladder disturbances
Complications:
Weakness of lower extremities
Paraplegia
Complete loss of Bowel and Bladder
A 62 year old male with low back pain. Nothing makes the pain better. Pain gets worse with walking. Pain is rated at a 9 out of 10.
What are three possible Positive Findings?
What three things are Sequelae?
What three things can be seen on X-ray?
Positive Finding:
Normocytic Normochromic Anemia
Increase in Serum Calcium
Increase in Proteins
Sequelae:
Severe Prolong Back Pain
Recurrent Infection
Renal Failure
X-ray:
Vertebral Plana
Pathological Fracture
Generalized Osteoporosis
A 36 year old male with a headache that has gotten worse over the last month. Pain is described as a dull ache and has an anterior head carriage.
What are three possible X-ray findings?
What three things Exam Findings?
What two things can be a Treatment?
X-ray:
Occipilization
Hypoplastic Disc
Congenital Anomaly
Exam Findings:
Abnormal Flexion/Extension Films
Hypertonic Pectoralis Major
Hypotonic Serratus Anterior
Treatment:
Myofacsial Release Technique
Ergonomic Retaining
A 43 year old male who is obese and diagnosed with Diabetes. Anterior drawer, Lachman’s and McMurry’s test are Negative.
What are three possible Differential Diagnosis?
What three things are X-ray findings?
What three things can be an Appropriate Diagnostic test?
Differential Diagnosis:
Calcium Pyrophosphate Deposition Disease (CPPD)
Pseudogout
Condrocalcinosis
X-Ray:
Calcification of the joint
Sharp Tibial Plateau
Subcondral Cyst
Diagnostic Test:
Joint Aspiration
MRI
Biopsy of the Articular Cartilage
A 30 year old male presents with left knee pain, was laying carpet two days ago when her heard a “pop”. No orthopedic exams were performed due to swelling.
What are three possible Positive Findings?
What three things are Treatment?
What three things can be a Next Step after initial care?
Positive Findings:
Bounce Home
McMurry’s
Apley’s Compression
Treatment:
One arm Crutch to reduce the weight
Cryotherapy
Refer to an Orthopedist
Next Step:
Knee extension brace
Water Resistance exercises
Progression back to full weight bearing activities
In the condition of Carpal Tunnel what are:
Two Differential Diagnosis
Three Causes
Three Treatments
Differential Diagnosis:
Median Nerve Compression
Anterior Interosious Nerve Syndrome (Pronator Teres)
Causes:
Tendinous Nerve Compression
Tendinous Sheath Inflammation
Tendinous Sheath Scaring
Treatment:
Fix for Wrist splint
Stretch wrist extensors
Adjust lunate A-P
A 26 year old football player was hit from behind and complains of neck pain.
What are three possible Common Findings on X-ray?
What three things are Differential Diagnosis?
What three other test can be ordered?
Common Findings on X-ray:
Congenital Block
Occiipalization
Atlas Hypertrophy
Differential Diagnosis:
Whiplash
Odontoid Fracture
Os Odentodium
Other test:
Flexion/Extension Films
MRI
Neurological Evaluation
A 19 year old female has low back pain and stiffness in the morning.
What are three Lab test?
What three things are Additional Findings?
What three things can be a done for Case Management?
Labs:
ANA
Serum Glucose
Anti-DNA
Additional Findings:
Malar Rash
Oral Ulcers
Discoid Lesion
Management:
Chiropractic Care
Avoid the Sun
Activities to Tolerance
A male patient was playing basketball two weeks ago and has eccemosis, pain and swelling in his ankle from an inversion sprain.
What are three Initial Treatments?
What three things are Long Term Treatments?
What three things can be a Complication?
Initial Treatment:
Refer to an Orthopedist
Ice
Place on Crutches
Long Term Treatment:
Wobble Board
Eversion Exercises
Orthopedics
Complications:
Non Union Fracture
Peronus Brevis Weakness
Excessive Bone Deformity
A 24 year old female with extreme neck pain. Right head tilt, looking over the left shoulder produces headache and SCM tightness.
What are three possible Diagnosis?
What three things are Causes?
What three things can be a Treatment?
Diagnosis:
Spastic Torticolis
Wry Neck
Myofascial Pain Syndrome
Causes:
Cold Environment
Biochemical
Focal Muscle Dystonia
Treatment:
Trigger Point Therapy
Vasocoolent Spray and Stretch
Myofascial Release Technique
A 12 year old male presents with neck pain and has decrease neck extension.
What are three possible Diagnosis?
What three things are Treatment?
What three things can be a Finding if not resolved?
Diagnosis:
Benin Bone Tumor
Expansial Bone Lesion
Enlargement
Treatment:
Surgical Curettage
Surgical Excision
Surgical Stabilization
If not Resolved:
Spinal Cord Compression
Painful Scoliosis
Gait Disturbances
A 50 year old female chronic shoulder pain, pain overhead, decrease ROM. No trauma, pain is relieved by aspirin. Gradual onset over the last four months and the pain is getting worse.
What are three possible Diagnosis?
What three things are Treatment?
What three things can be a Follow Up?
Diagnosis:
Adhesive Capsulitis (Frozen Shoulder)
Impingement Syndrome (Supraspinatus Muscle)
Bursitis
Treatment:
Finger Tip Wall Walk
Codman’s Pendulum Exercises
Ultrasound
Follow Up:
Strengthen Shoulder Stabilizers
Active ROM exercises
All finding were= NORMAL
In the condition of Scheuermann’s Disease:
What are:
Two x-ray findings?
Two other names?
Three signs/symptoms?
X-ray Findings:
End plate Irregularity
Decreased Anterior Body height
Other Names:
Juvenile Hyperkyposis
Vertebral Epiphestisis
Sign/Symptoms:
Early Degenerative Joint Disease (DJD)
Postural Fatigue
Worsening Anemia
In the condition of Scleroderma what are:
Three X-ray findings?
Three associated findings?
Three complications?
X-ray findings:
Acro-Osteolytsis
Systemic Sclerosis
Calcium Cutis
Associated Findings:
Raynaud’s Phenomenon
Skin Hardening
Positive ANA test
Complications:
Dysphgia
Gastroesophageal problems
Pulmonary Fibrosis
If a Patient has a Prostate issue:
What three Labs will be positive?
What other three conditions may they possible have?
What are three follow ups?
Labs:
Prostate Specific Antigen (PSA)
Alkaline Phosphate
Acid Phosphate
Conditions: Mets (Blastic) Paget's Hodgkin's *All have Ivory White Vertebrae on X-Ray*
Follow Up:
Refer to an Oncologist
MRI of the Prostate
Radio-nucleotide Bone Scan
In the condition of Regional Complex Pain Syndrome:
What are two other names?
What three ways can it be treated?
What are three additional findings?
Other Names:
Reflex Sympathetic Dystrophy Syndrome
Sudeck’s Atrophy
Treatment:
Triple Radio-nucleotide
Themography
Doppler Ultrasound
Additional Findings:
Atropic Skin Changes
Thenar Hypertrophy
Hyperhydrosis (Excessive Sweating)
What is two other names for the most common benign bone tumor or the hand?
What three findings will be present on the X-ray?
What is one differential diagnosis?
Other names:
Ollier’s Disease
Multiple Enchondromas
X-ray findings:
Geographical
Expansile
Cortical thinning
Differential Diagnosis:
Pathological Fracture
A 27 year old male with asthma, with cortical steroid injections, has limited right lateral flexion.
What are three possible X-ray Findings?
What three things are Progressions?
What three things can be a Next Step?
X-Ray Findings:
Hemivertebrae
Structural Scoliosis
Primary defect of growth center
Progressions: Neurological Defects Progressive Scoliosis Cardiac Involvement Degenerative Joint Disease (DJD)
Next Step:
Adjust
Spinal Stretching Exercises
Extension Muscle Rehab
A 30 year old male pain for a week. Supraspinatus tendon two years ago. Shoulder abduction, greater than 90 degrees creates pain. Flexion is limited. Muscle test is a 4 out of 5. Speed’s test is positive. Negative Orthopedic exams include: Empty can, Yeargason’s and Wright’s.
What are three possible Differential Diagnosis?
What three things are Prevention?
What three things can be a Follow Up?
Differential Diagnosis:
Bicipital Tendonitis
SLAP Lesion
Subdeltoid Bursitis
Prevention:
Strengthen Rotor Cuff muscles
Isometric curls
Ergonomic re-education
Follow Up:
Limit overhead movements
Passive ROM
MRI
The disc above affect which nerve?
The one below
If there is pain on the Lateral Aspect of the Medical Femoral condyle what condition is present?
Osteochondritis Dessecans (OCD)
What is the name of the positive Orthopedic exam for Osteochondritis Dessecans?
Wilson’s Test;
pain with internally rotating the tibia during extension of the knee between 90° and 30°, then relieving the pain with tibial external rotation
What condition has the following characteristics:
Painless
20 year old female
Expansile
Eccentric Location
Blood Filled
Found in the Metaphyseal and Diaphyseal areas of the bone
Aneurysmal Bone Cyst (ABC)
What is the most common benign bone tumor of the spine?
Hemagioma (Vascular Neogenisis)
What is the appearance of a Hemagioma on X-Ray?
Corduroy Cloth
What two additional findings are often seen in a patient with a Hemagioma?
Vertebral body expands into the cord
Calvirum (Skull) Involvement
What condition is found most in males, peaking at the age of 20. Found in the spine and in long bones and considered a very large Osteoid Osteoma?
Osteoblastoma
What three symptoms will a Osteoblastoma produce?
Decrease ROM
Muscle splinting
Scoliosis
What are three treatments for Osteoblastoma?
Surgical Curettage
Surgical Excision
Surgical Reconstruction
What two things will happen to the patient if nothing is done to an Osteoblastoma?
Painful scoliosis
Spinal canal stenosis with neurological effects
If there is pinpoint/one finger pain in the abdominal region what does the patient have?
Peptic Ulcer
If the patient is able to pinpoint the pain in the shoulder what condition do they have?
Bursitis
Urinary Bladder has referred pain where?
Supra pubic region
Where is the referral for small intestine issues?
Peri-umbilical region
If a patient has dermatomal pain where does it originate?
Nerve Root
What type of pain comes from a facet?
What is the lowest area facet pain will travel to?
Type: Scleratogonous
Travel: Never below the knee
Where is kidney pain felt?
In the flank region on the posterior aspect of the patient
Where is pain from a pancreatic issue located and what makes it better?
Located: T10-T12
Better: Leaning forward
What is the pain referral patten for the Gallbladder?
Inferior angle of the right scapula
In what population do you often see Gallbladder issues?
Females, over 40, with flatulence, multiple kids, that eat fast food fatty meals
What is the pain referral pattern for a patient with a heart problem?
Left shoulder, down the medial arm and forearm to the hand
If a patient has blurred vision and a throbbing migraine.
Two clinical findings?
Three treatments?
Two Aggravating factors?
Clinical Findings:
Photophobia
Nausea
Treatments:
Adjust
Dietary Log
Massage Therapist
Aggravating Factors:
Red wine
Hormonal Imbalance
A 50 year old smoker that has pain with walking.
Three Differential Diagnosis
Three Labs to be ordered
Three Treatments
Differential Diagnosis:
Deep Vein Thrombosis (DVT)
Vascular Claudication
Phlebitis
Labs:
D-Dimer
Complete Blood Count (CBC)
Doppler Ultrasound
Treatments:
Compressive Socks
Elevate Legs
Anticoagulant Therapy
What are four radiographic findings for Paget’s Disease?
Saber Sign
Shepard’s Crook
Cotton Wool Skull
Brim Sign
What condition is the most primary malignancy of bone and does not destroy the pedicle?
Multiple Myeloma
What is the radiographic finding on the skull for Multiple Myeloma?
What does it do to the color of the x-ray?
Skull will have multiple holes similar in size
X-ray will be darker
What are four Lab findings to confirm Multiple Myeloma?
M spike on Immnoelectrophorisis
Reverse in the A/G ratio
Bence Jones Proteinuria
Elevated ESR
What is the rule when there are two cranial nerves that have a reflex?
Lower numbered Cranial nerve= Sensory
Higher numbered cranial nerve= Motor
What type of Lesions are all Cranial Nerve Lesions?
Lower Motor Neuron Lesions (LMNL)
What is the treatment for all muscle spasms? (Four Things)
Trigger Point Therapy
Spray and Stretch
Cryotherapy
TENS unit
When performing Romberg’s Test:
Where is the problem?
Patient struggles with eyes open:___________
Patient struggles with eyes closed:__________
Patient has not problem with this test:________
Open: Cerebellum
Closed: Posterior Columns
No problem: Vestibular (C.N VIII (8))
A 35 year old female has bilateral head and neck pain. She is a bank teller.
What is three Etiology?
What are three Managements?
Three things to Adviser her to do?
Etiology:
Cervical Rib
Hypertonic Scalene Medicus
Neurological Compromise
Management:
Stretch Pectoralis Muscles
Neck retraction
Stretch Scalene muscles
Advice:
Refer for Neurological Consult
Order Nero-diagnostic studies
NCV studies
