NMS Q&A Family Medicine

Musculoskeletal Problems of the Lower Extremities 159(A) Tibial stress syndrome(B) Stress fracture of the tibia(C) Fracture of the fibula(D) Grade 3 anterior ankle sprain(E) Venous insufficiency of the long saphenoussystem12 A 30-year-old athlete noted an instantaneous pain inthe proximal posterior medial aspect of the right calfwhile long-distance running earlier that day. He isafebrile. He limps on his right leg. There is swellingand ecchymosis and tenderness in an area approximately5 cm in diameter in the proximal posteriormedial aspect of the calf as well as ecchymosis in thelower leg and heel. He cannot stand on his toes on theright because of pain precipitated in the calf. Whichof the following diagnoses is most likely?(A) Achilles tendonitis(B) Achilles tendon rupture(C) Shin splints(D) Tibial stress fracture(E) Gastrocnemius tear13 A 40-year-old former athlete had been playing footballduring the annual family reunion. He noted suddenpain in the left lower calf area and is brought toyou complaining of posterior distal leg pain. Withthe patient supine and with his knee flexed, yousqueeze the midportion of his calf and do not observeany plantar flexion of the foot. Which of the followingdiagnoses is most strongly suggested by thesefindings?(A) Shin splints(B) Ruptured Baker cyst(C) Deep venous thrombosis(D) Tibial stress fracture(E) Achilles tendon rupture14 An 18-year-old white female collegiate track competitorhas complained of pain in the left midportionof the tibia over the past 2 weeks during hertraining, increasingly severe and longer lasting afterrunning sessions. In evaluation of this condition,you utilize the test of the vibrating 128-Hz tuningfork, for sensation when the stem is placed upon theipsilateral medial malleolus. The patient complainsof pain in the area of complaint. Which of the followingis true regarding the condition from whichthis patient suffers?(A) Normal x-rays rule out stress fractures as apotential cause of a patient’s symptoms.(B) Some limited running or jumping is permittedafter 2 weeks of treatment.(C) This is the most common of stress fractures.(D) It is caused by a blow to the lower leg.(E) Swimming is forbidden for the first 4 weeks oftreatment.15 A 35-year-old male army infantry reservist returnsfrom 2 weeks of annual field training that consistedof daily marches increasing in distance from 5 miles(8 km) the first day to 40 miles (64 km) the last day.He complains of pain in the left foot that began 3 daysbefore the end of the tour and increased in severitywith the distance walked. The pain lasted longer eachevening. Which of the following parts of the bonyanatomy of the foot deserves special attention on theplain x-ray?(A) First metatarsal(B) Talus(C) Navicular(D) Calcaneus(E) Fifth metatarsal16 A running back on a high school football team fallsbackward while being tackled. He lands with onedefender on his chest and another on his right foot,which is thus subjected to forced plantar flexion. Asteam physician you examine the player in the lockerroom in the supine position and perform the “bouncetest,” pressing downward on the forefoot. The patientreacts with pain. If the player has a fracture, which ofthe following sites for it is most likely?(A) Navicular(B) Fibula avulsion(C) Talus(D) Calcaneus(E) First metatarsal17 For several years, your 65-year-old male patient hascomplained of deep pelvic area pain following strenuousphysical activity. Lately he finds that this paincomes on whenever he walks any distance beyond1 mile (1.6 km). If he stops and sits down for as littleas 1 minute, the pain subsides and he can resumewalking for another 10 minutes or so. The pain tendsto radiate into both posterior proximal thighs, notreaching below the knees. He denies bowel or bladdersymptoms of dysfunction. Occasionally he noticesweakness and tends to buckle in the left leg beforegetting relief from sitting and resting. Deep tendonreflexes, results of the straight-leg raising test, andpulses of the lower extremities are all within normallimits. Which of the following is the most logicaldiagnosis to explain this patient’s symptoms?(A) Lumbar spinal stenosis(B) Herniated nucleus pulposus at the L5 to S1 level(C) Osteoarthritis of the lumbar spine(D) Prostatitis(E) Lumbosacral strain