NMS Q&A Family Medicine

158 NMS Q&A Family Medicineapplying two 4-in. or 10-cm elastic supportbandages) followed by MRI of the left ankle.(B) Order stat x-rays of the left ankle, supportivedressing, crutches, and referral to an orthopedicsurgeon.(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.6 A 35-year-old woman comes to you with the complaintof left heel pain, which had its onset overseveral days with no history of trauma. It is worstduring the woman’s first steps in the morning orafter she has been sitting for prolonged periodsor standing for significant periods of time. You askher to walk without shoes in the back hallway ofyour office suite. You note that she exhibits valgusdeformities at both ankles when walking slowly orstanding. The os calcis is tender to compression butexhibits no erythema. There is neither hypesthesiaof the overlying skin of the heel nor the medialtract from the heel to the proximal sole. Which ofthe following is the most likely cause of this patient’scomplaint?(A) Achilles tendonitis(B) Retroachilles bursitis(C) Tarsal tunnel syndrome(D) Plantar fasciitis(E) Osteomyelitis7 An 18-year-old high school football player complainsof left hip pain after being tackled. The pain increaseswith rotation and lateral bending of the trunk. Hedenies radiation of the pain into the lower extremities.He bears weight well and examination findsincreased pain neither with eversion of the left hipnor with active flexion at the waist. Which of the followingis the probable diagnosis?(A) Contusion of the iliac crest(B) Inflammation of the greater trochanter of thehip(C) Inflammation of the lesser trochanter of the hip(D) Fracture of the left hip(E) Contusion of the pubic ramus8 A 19-year-old male high school football player isbrought to you 2 hours after the sudden onset ofsevere right anterior thigh pain during an explosivesprint in an early-season practice game. From a sittingposition on the examining table, he is able toextend the knee painfully. He exhibits visible swellingof the thigh with ecchymosis but no depression orunnatural concavity of the thigh contour. Which ofthe following is the least appropriate in the initialmanagement of a grade II muscle strain of thequadriceps?(A) Stretching of the affected muscles to decreaseshortening(B) Resistance training to rebuild muscle strength(C) Ice and compression with an elastic wrap(D) Crutch walking until patient can ambulatewithout limping(E) Avoidance of strenuous physical activity9 An 18-year-old high school football player was tackledfrom the right side by a linebacker who hit lowwith his shoulder thrusting against the lateral aspectof the knee. This occurred just as your patient wasplanting his right foot to pivot for turning left. Theevent occurred 8 days earlier, and he has been tryingto walk on the leg despite pain and swelling. Which ofthe following would you expect to find on examination(assume swelling has decreased enough to allowadequate examination), in addition to a positiveanterior drawer test, if your patient tore his anteriorcruciate ligament 8 days earlier?(A) Prepatellar swelling(B) Abnormal degree of varus deformity with varuspressure on the leg below the knee(C) Tenderness of the patella(D) Tenderness over the anterior aspect of the knee(E) An abnormal valgus deformity with valguspressure applied below the knee10 Which of the following symptoms or signs would beamong those characteristic of that knee injury?(A) Positive posterior drawer sign(B) Immediate intense pain(C) A knee-locking sensation(D) Pain and tenderness in the patella(E) A palpable spongy sensation overlying thepatella11 A 17-year-old boy has grown from 66 in. (1.68 m) to71 in. (1.8 m) within the past 18 months. He nowcomplains of pain in the posteromedial aspect ofthe distal one third of his right tibia since initiationof track training in the past 7 days. On examinationhe exhibits pes planus and tenderness in the area ofdescribed pain. The 128-Hz tuning fork applied tohis medial malleolus gives a normal result. Which ofthe following is the most likely diagnosis of thiscondition?