EXAM 2 NGR 6350 QUESTIONS WITH COMPLETE
SOLUTIONS
Osgood-Schlatter disease
Incomplete separation or avulsion of the tibial tuberosity
risk factors: 9-14 yrs old, active kids (running, jumping sports)
c/c: slight limp, pain worse w activity (squatting),
tenderness/swelling to tibial tuberosity
p/e: lump/mass, knee joint exam WNL, full ROM hip, painless,
tenderness to palp of tibial tubercle
tx: anti-inflammatory meds, restrict activity, ice after activity
PT referral for stretching (quad and ham) and strengthening (hip
and core)
ortho referral if no improvement (usually resolves by 14-15 y/o)
Sever disease
calcaneal apophysitis
r/f: 7-9 yr old, active in sports (hardwood, like basketball)
c/c: heel pain and painful limp w toe walking, worse w activity
p/e: point tenderness to heel, esp posterior and sides, limited
ankle dorsiflexion r/t pain
tx: stretching of Achilles tendon, limited workout on hard
surface or with cleats, symptom mgmt
Ortho ref when tx ineffective or dx unclear
SCFE
most common cause of atraumatic hip pain in adolescents
Slipped Capital Femoral Epiphysis (SCFE)
,spontaneous displacement of the proximal femoral epiphysis in a
posterior and inferior direction
r/f: 10-14 yr old, obesity, P.I., males, after minor strain/injury
p/e: limited internal rotation of affected hip, mild hip pain
referred to knee/thigh, NWB to affected side
Xray lateral and A/P hip
tx: NWB, surgery ASAP (ortho emergency) r/t risk of avascular
necrosis
grade 1 ankle sprain
no instability
negative anterior drawer or talar tilt/inversion test
minimal loss of function
mild edema and tenderness
managed by NP
toxic synovitis
self-limited viral issue of hip
c/c acute onset of limp, pain w palpation
p/e: decrease ROM hip, antalgic gait (clunky), low grade fever,
NO erythema, edema, or systemic symptoms
U/S: small effusion
labs: CBC, ESR/CRP to r/o bac/infectious processes
tx: activity modification, anti-inflammatory meds, resolves in 3-
5 days
Toxic synovitis
most common cause of atraumatic hip pain and limp in
preschoolers
, wrist fx
hx: FOOSH, abuse (hx/injury mismatch)
p/e: point tenderness at fracture site
managed by NP if no involvement of joint or epiphyseal plate,
otherwise ortho ref
tx: immobilization, pain control, regular followup
dislocation/subluxation of radial head
most common upper extremity injury of kids under 6 y/o
vitamin B12
health benefit: cysteine, source for glutathione (antioxidant)
deficiency leads to macrocytic anemia, mental hanges
sources: fish, shellfish, meat, eggs, dairy
watch out for your vegans/vegetarians
vitamin E
tocopherol
health ben: increased antioxidative protection, nervous
membrane protection, satiety
deficiency leads to food insecurity (hemolytic anemia, neuro
deficits)
sources: plant-based oils, nuts, seeds, fruit, veg
vitamin C
health ben: increased absorption of iron, increased antioxidant
protection, increased wound healing
deficiency causes tired, weak, irritable, decreased appetite and
SOLUTIONS
Osgood-Schlatter disease
Incomplete separation or avulsion of the tibial tuberosity
risk factors: 9-14 yrs old, active kids (running, jumping sports)
c/c: slight limp, pain worse w activity (squatting),
tenderness/swelling to tibial tuberosity
p/e: lump/mass, knee joint exam WNL, full ROM hip, painless,
tenderness to palp of tibial tubercle
tx: anti-inflammatory meds, restrict activity, ice after activity
PT referral for stretching (quad and ham) and strengthening (hip
and core)
ortho referral if no improvement (usually resolves by 14-15 y/o)
Sever disease
calcaneal apophysitis
r/f: 7-9 yr old, active in sports (hardwood, like basketball)
c/c: heel pain and painful limp w toe walking, worse w activity
p/e: point tenderness to heel, esp posterior and sides, limited
ankle dorsiflexion r/t pain
tx: stretching of Achilles tendon, limited workout on hard
surface or with cleats, symptom mgmt
Ortho ref when tx ineffective or dx unclear
SCFE
most common cause of atraumatic hip pain in adolescents
Slipped Capital Femoral Epiphysis (SCFE)
,spontaneous displacement of the proximal femoral epiphysis in a
posterior and inferior direction
r/f: 10-14 yr old, obesity, P.I., males, after minor strain/injury
p/e: limited internal rotation of affected hip, mild hip pain
referred to knee/thigh, NWB to affected side
Xray lateral and A/P hip
tx: NWB, surgery ASAP (ortho emergency) r/t risk of avascular
necrosis
grade 1 ankle sprain
no instability
negative anterior drawer or talar tilt/inversion test
minimal loss of function
mild edema and tenderness
managed by NP
toxic synovitis
self-limited viral issue of hip
c/c acute onset of limp, pain w palpation
p/e: decrease ROM hip, antalgic gait (clunky), low grade fever,
NO erythema, edema, or systemic symptoms
U/S: small effusion
labs: CBC, ESR/CRP to r/o bac/infectious processes
tx: activity modification, anti-inflammatory meds, resolves in 3-
5 days
Toxic synovitis
most common cause of atraumatic hip pain and limp in
preschoolers
, wrist fx
hx: FOOSH, abuse (hx/injury mismatch)
p/e: point tenderness at fracture site
managed by NP if no involvement of joint or epiphyseal plate,
otherwise ortho ref
tx: immobilization, pain control, regular followup
dislocation/subluxation of radial head
most common upper extremity injury of kids under 6 y/o
vitamin B12
health benefit: cysteine, source for glutathione (antioxidant)
deficiency leads to macrocytic anemia, mental hanges
sources: fish, shellfish, meat, eggs, dairy
watch out for your vegans/vegetarians
vitamin E
tocopherol
health ben: increased antioxidative protection, nervous
membrane protection, satiety
deficiency leads to food insecurity (hemolytic anemia, neuro
deficits)
sources: plant-based oils, nuts, seeds, fruit, veg
vitamin C
health ben: increased absorption of iron, increased antioxidant
protection, increased wound healing
deficiency causes tired, weak, irritable, decreased appetite and
