NMS Q&A Family Medicine

156 NMS Q&A Family Medicine14. The answer is E. Lower back pain. Even in patientsolder than 50 years of age, it ranks second only to heartdisease as cause of disability. Although upper respiratorytract infection competes with all other causes of disabilityin incidence of illness, the number of days of absencecaused by back pain in the under-50 age group exceedsthat caused by upper respiratory tract infection and, certainly,HIV infection.15. The answer is C. The pain in the lateral hip area,radiation down the ipsilateral thigh, and tenderness overthe greater trochanter are typical. Aseptic necrosis of thefemoral head and fracture both would have been verypainful upon eversion of the hip. Colon diverticulitis mostoften occurs in the sigmoid colon and results in deep tendernessin the left lower quadrant of the abdomen. Hipfracture would prevent the patient from walking into theoffice; a herniated disc would have resulted in a positiveSLR test.16. The answer is D. Injection of a glucocorticoid mixedwith a local anesthetic agent into the area of tendernesswould be appropriate and effective in the great majorityof cases. Such injections are best directed to within a centimeterof, but not into, the most tender point. Pelvic tractionwas in the past employed in lumbar disc herniationbut never had a place in the management of this condition.MRI of the lumbar spine would, at some point, beappropriate in lumbar disc disease, not in trochantericbursitis. Neurosurgical opinion would not be sought introchanteric bursitis.ReferencesBoyd RJ . Evaluation of neck pain . In: Coroll AH , May LA ,Mu l l e y AG , e d s . Primary Care Medicine . Philadelphia : JBLippincott Co ; 1995 .Hellmann DB , Stone JH . Arthritis and musculoskeletal disorders. In: Tierney LM , McPhee SJ , Papadakis MA , eds. CurrentMedical Diagnosis and Treatment . 43rd ed . New York :McGraw-Hill/Appleton & Lange ; 2004 : 778 – 832 .Maropis CG . Musculoskeletal problems of the neck and back .In: Rudy DR , Kurowski K , eds. Family Medicine: House OfficerSeries . Baltimore : Williams & Wilkins ; 1997 : 371 – 382 .McPhee SJ , Papadakis MA . Current Medical Diagnosis andTreatment 2010 , 49th ed . New York/Chicago : McGraw-Hill(Lange); 2010 .