Part 3 Boards Case Scenarios- Don't
Shuffle & Pick 3 Unless Notified Otherwise
Occipitalization
Rudimentary disc
Congenital block
AHC is key in the history - ANS-A 36 y/o male presents with neck pain and HA what
have been progressively worsening over the last 2 months. Pain is rated at 3/10.
Working on the computer and writing makes the pain worse and ice makes it better.
There is decreased ROM in flexion and extension. There are HT neck flexors,
suboccipital muscles and AHC.
What are the X-ray findings? (Pick 3)
-occipitalization
-butterfly vertebra
-rudimentary disc
-limbus bone
-retropharyngeal abscess
-congential block
-endplate destruction
-wide ZOT
-HT pec minor
- Tension HA
-Wasp waist deformity
*Not G because - because the pt is born with this, body will adapt - ANS-What
additional findings do you expect to see
-Sprengels deformity
- klippel feil syndrome
- hyperactive DTR's
-HT pec minor
- Tension HA
-Wasp waist deformity
- Neurologic deficits
- Visual disturbances
,ergonomic retraining
postural exercises
myofasical release
adjust cervical spine - ANS-What is the best initial treatment (4)
- surgery
- ergonomic retraining
- refer to oncologist
-postural exercises
- constant cervical traction
- myofasical release
- adjust cervical spine
-refer to ER
Olliers
benign bone tumor
multiple enchondromas
Pt dx: Ollier's dz - ANS-24 y/o male mechanic presents to your office with painful
swollen fingers. The pain went away and then came back. There is a decrease in Grip
strength and decrease in overall ROM due to swelling. What are possible DDX?
A. Olliers
B. Fibrous dysplasia
C. Hereditary multiple exostosis
D. benign bone tumor
E. multiple enchondromas
F. osteochondroma
G. scleroderma
H. gardner's syndrome
B. geographic appearance
E. cortical thinning
G. expansile lesions - ANS-What are radiographic signs seen
A. sessile appearance
B. geographic appearance
C. blister bone appearance
D. periostitis
E. cortical thinning
F. subchondral cyst
G. expansile lesions
H. CREST
,A. Pathological fracture
B. malignant degeneration
C. permanent deformity
Malignant means unstoppable growth, not CA - ANS-Potential Sequelae
A. Pathological fracture
B. malignant degeneration
C. permanent deformity
D. reversal of lesion
E. hypertrophy of skin
F. metastasis
G. skull enlargement
H. spinal deformity
A. Ketones in the urine
B. Glucosuria
E. Polyuria
Pt dx: Diabetes mellitus
Also could have muscle weakness due to "frequent trips" - ANS-45 year old female
presents with tingling in both of her feet. She cannot feel her
feet and frequently trips. She is 210lbs and 5'6". Her ROM and DTRs of the lower
extremity are all WNL. + Murphy's Punch on the Left. All orthos were negative.
She does have high cholesterol.
What are some associated findings
A. Ketones in the urine
B. Glucosuria
C. Hematuria
D. AV nicking
E. Polyuria
F. Urobilinogen in urine
G. muscle weakness
H. pale optic disc
A. Decreased wound healing
C. Increased vaginal secretions
G. neovascularization
C-yeast infections found with increased sugar in
, blood
neovascularization: this term is ALWAYS solely associated with DM - ANS-Other clinical
findings
A. Decreased wound healing
B. Kidney stones
C. Increased vaginal secretions
D. Vitamin B12 deficiency
E. Gastric distress
F. diarrhea
G. neovascularization
H. macrocytic anemia
A. low glycemic index diet
D. Co-treat with endocrinologist
G. Swimming instead of walking
Swimming instead of walking: due to the frequent trips - ANS-How would you treat this
patient
A. low glycemic index diet
B. Capacity of walking to cycling comparison
C. Increase physical activity
D. Co-treat with endocrinologist
E. NCV/EMG
F. Decrease exercise
G. Swimming instead of walking
H. Hot packs to relieve pain
C. Fibrous dysplasia
E. Benign bone tumor
G. Supraspinatus tendinitis
G because +Empty Can - ANS-17 year old female swimmer presents to your office with
a gradual onset of
shoulder pain. Pain is a 3-5/10 and experienced in 70-100 degrees of abduction.
She reports no injury or trauma. Upon physical exam you note an abnormal macule
on her back that has been there since birth. - Speeds test, + Yergason's, + Empty
can test.
What are possible diagnoses
A. Biceps tendinitis
B. Bicep instability
Shuffle & Pick 3 Unless Notified Otherwise
Occipitalization
Rudimentary disc
Congenital block
AHC is key in the history - ANS-A 36 y/o male presents with neck pain and HA what
have been progressively worsening over the last 2 months. Pain is rated at 3/10.
Working on the computer and writing makes the pain worse and ice makes it better.
There is decreased ROM in flexion and extension. There are HT neck flexors,
suboccipital muscles and AHC.
What are the X-ray findings? (Pick 3)
-occipitalization
-butterfly vertebra
-rudimentary disc
-limbus bone
-retropharyngeal abscess
-congential block
-endplate destruction
-wide ZOT
-HT pec minor
- Tension HA
-Wasp waist deformity
*Not G because - because the pt is born with this, body will adapt - ANS-What
additional findings do you expect to see
-Sprengels deformity
- klippel feil syndrome
- hyperactive DTR's
-HT pec minor
- Tension HA
-Wasp waist deformity
- Neurologic deficits
- Visual disturbances
,ergonomic retraining
postural exercises
myofasical release
adjust cervical spine - ANS-What is the best initial treatment (4)
- surgery
- ergonomic retraining
- refer to oncologist
-postural exercises
- constant cervical traction
- myofasical release
- adjust cervical spine
-refer to ER
Olliers
benign bone tumor
multiple enchondromas
Pt dx: Ollier's dz - ANS-24 y/o male mechanic presents to your office with painful
swollen fingers. The pain went away and then came back. There is a decrease in Grip
strength and decrease in overall ROM due to swelling. What are possible DDX?
A. Olliers
B. Fibrous dysplasia
C. Hereditary multiple exostosis
D. benign bone tumor
E. multiple enchondromas
F. osteochondroma
G. scleroderma
H. gardner's syndrome
B. geographic appearance
E. cortical thinning
G. expansile lesions - ANS-What are radiographic signs seen
A. sessile appearance
B. geographic appearance
C. blister bone appearance
D. periostitis
E. cortical thinning
F. subchondral cyst
G. expansile lesions
H. CREST
,A. Pathological fracture
B. malignant degeneration
C. permanent deformity
Malignant means unstoppable growth, not CA - ANS-Potential Sequelae
A. Pathological fracture
B. malignant degeneration
C. permanent deformity
D. reversal of lesion
E. hypertrophy of skin
F. metastasis
G. skull enlargement
H. spinal deformity
A. Ketones in the urine
B. Glucosuria
E. Polyuria
Pt dx: Diabetes mellitus
Also could have muscle weakness due to "frequent trips" - ANS-45 year old female
presents with tingling in both of her feet. She cannot feel her
feet and frequently trips. She is 210lbs and 5'6". Her ROM and DTRs of the lower
extremity are all WNL. + Murphy's Punch on the Left. All orthos were negative.
She does have high cholesterol.
What are some associated findings
A. Ketones in the urine
B. Glucosuria
C. Hematuria
D. AV nicking
E. Polyuria
F. Urobilinogen in urine
G. muscle weakness
H. pale optic disc
A. Decreased wound healing
C. Increased vaginal secretions
G. neovascularization
C-yeast infections found with increased sugar in
, blood
neovascularization: this term is ALWAYS solely associated with DM - ANS-Other clinical
findings
A. Decreased wound healing
B. Kidney stones
C. Increased vaginal secretions
D. Vitamin B12 deficiency
E. Gastric distress
F. diarrhea
G. neovascularization
H. macrocytic anemia
A. low glycemic index diet
D. Co-treat with endocrinologist
G. Swimming instead of walking
Swimming instead of walking: due to the frequent trips - ANS-How would you treat this
patient
A. low glycemic index diet
B. Capacity of walking to cycling comparison
C. Increase physical activity
D. Co-treat with endocrinologist
E. NCV/EMG
F. Decrease exercise
G. Swimming instead of walking
H. Hot packs to relieve pain
C. Fibrous dysplasia
E. Benign bone tumor
G. Supraspinatus tendinitis
G because +Empty Can - ANS-17 year old female swimmer presents to your office with
a gradual onset of
shoulder pain. Pain is a 3-5/10 and experienced in 70-100 degrees of abduction.
She reports no injury or trauma. Upon physical exam you note an abnormal macule
on her back that has been there since birth. - Speeds test, + Yergason's, + Empty
can test.
What are possible diagnoses
A. Biceps tendinitis
B. Bicep instability
