NMS Q&A Family Medicine

chapter 25Musculoskeletal Problemsof the Lower ExtremitiesExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Each of the following is an accepted indication forplain x-rays of the knee following injury except forwhich case description?(A) Patient older than 55 years old(B) Tenderness of the fibula(C) Patient hears and feels a “pop” as he pivots witha heavy box(D) Tenderness of the patella(E) Patient unable to flex knee to 90 degrees2 A 28-year-old factory worker pivoted on the left legwhile transferring a 75-pound item from one benchto another and experienced immediate left knee painfollowed shortly by swelling. Upon examination thephysician finds a positive “sag test.” Which of the followingis the equivalent to that test?(A) McMurray test(B) Lachman test(C) Anterior drawer test(D) Posterior drawer test(E) Valgus stress test3 A 35-year-old woman complains of knee pain andmanifests tenderness over the medial retinaculum ofthe patella. Which of the following would most corroboratea diagnosis of patellofemoral pain syndrome?(A) Pain and tenderness over the patella proper(B) The “J sign” on examination(C) Swelling over the patella without palpableeffusion(D) Tenderness over the quadriceps tendon(E) Knee pain without local findings but withtenderness over the lateral epicondyle4 A 24-year-old male graduate student and committedamateur athlete comes to see you 1 day after sufferingan inversion injury (ankle turned violently inwardly)of the left ankle in pick-up basketball. He was able tobear weight painfully and applied ice last eveningwith a resultant reduction of moderate swelling. Onexamination the patient has a “goose egg” type ofswelling just inferior to the lateral malleolus, with anegative anterior drawer test; passive inversion of theankle allows 10 degrees as it does on the right (noninjured)side. There is no tenderness of the tip orposterior edge of the left lateral malleolus and notenderness of the posterior edge of the medial malleolus.Which of the following initial dispositions is themost logical?(A) Use supportive dressing (e.g., double layers ofsheet wadding or similar material beforeapplying two 4-in. or 10-cm elastic supportbandages) followed by a magnetic resonanceimage (MRI) of the left ankle.(B) Order stat x-rays of the left ankle and same-dayreferral to an orthopedic surgeon.(C) Order stat x-rays, as well as crutches forambulation for 3 weeks.(D) Use supportive dressing or an air cast, ordercrutches until weight bearing takes placewithout pain, and suggest continued iceapplication for 1 day more. Have the patientreturn for follow-up in 1 week.(E) Encourage immediate weight bearing by thepatient and have him return if not improved in3 days.5 The patient in the previous question did well onyour management but returns to you 1 year laterafter another inversion injury of the left ankle. Onthis occasion, he was unable to bear weight at thesite of the accident. Examination within the first2 hours showed a large fusiform swelling centeredanteriorly on the lateral malleolus. When you graspthe ankle and pull the foot forward, there is definiteforward motion compared with the response to thesame maneuver on the right. Which of the followingdispositions constitutes the wisest course?(A) Use supportive dressing (e.g., double layers ofsheet wadding or similar material before157