ANOREXIA CLINICAL REASONING CASE STUDY/Mandy
White, 16 years old-scored A+-
55 year old male with pain and stiffness in his lower thoracic spine, no history of
trauma. Adjustments provide relief but here is very little progress. The patient has a
history of diabetes - ANSWER: Diffuse idiopathic skeletal hyperstenosis (DISH)
62 year old female presents with complaints of a burning pain in her middle back.
There was no recent trauma. When she has pain in her back she also notices pain in
her stomach . The patient has been taking aspirin 325 mg daily - ANSWER: Peptic
Ulcer Disease (PUD)
47 year old female presents to the office with complaints of low back pin as well as
pain in the SI joint. NO history of trauma. She has a history of psoriasis and she does
have pain in her right knee as well. - ANSWER: Psoriatic arthritis
72 year old Caucasian male presents with sudden pain in the lower thoracic spine.
The pain began very suddenly and was accompanied by nausea. The patient was
hypertension no quit smoking about a month ago, but did smoke for 40 years -
ANSWER: Abdominal aortic aneurysm
A 32 year old female presets with complaints of pain in the lumbar spine and the
hip/groin region. There is no history of trauma, no family history of cancer. -
ANSWER: Endometriosis
A 74 year old female presents for pain in the thoracic spine that has gotten worse
over time. The patient has no history of injury. The patient was a smoker for 50 years
and she has a persistent cough which she attributes to her previous smoking -
ANSWER: Spinal metastasis from lung cancer
A 16 year old male presents with complaint of stiffness in the thoracic spine as well
as SI and hip pain. There is no history of trauma. Upon examination you notice he
does have a wider gait and slight hyperkyphosis - ANSWER: Ankylosing Spondylitis
A 19 year old male presents with complaints of pain in the right lower back. There is
no history of trauma but he has most of his pain with prolonged standing, climbing
the stairs, and with sitting. The patient likes to run for exercise, but since his pain
began he is unable to do so. Upon inspection he shows you it is in the right SI area -
ANSWER: Sacroiliitis
An 84 year old female presents for pain in the thoracolumbar area. There is no
history of injury. The patient has chronically used prednisone for psoriatic arthritis -
ANSWER: Osteoporotic Compression Fracture
, A 60 year old male presents for pain in the thoracic spine. There are complaints from
fever chills and night pain. The patient does have diabetes and history of surgery
total hip replacement six months ago. - ANSWER: Osteomyelitis
A 65 year old African American male presents with complaints of back pain that has
been progressively getting worse. There is no known injury, an he woke up with pain
one morning. The patient has a family history of cancer but he has no history
himself. - ANSWER: Multiple myeloma
A 14 year old male presents with complaints f pain and stiffness that begins in the
thoracic spine but he also has it down into the lumbar as well. He notices that he his
not able to fully stretch out the thoracic spine, although it is very stiff, and he has
had to change much of his able to due to pain and stiffness, as twisting causes severe
pain. - ANSWER: Scheuermanns disease
A 2 year old female presents with her mother and the mother states that her
daughter complains of having pain in her neck and she feels as if her daughters neck
is "short" and her daughter appears to have pain with movement - ANSWER: Kippel
Feil Syndrome
A 12 year old female presents with her father for an evaluation of pain in the
thoracic spine. Most of her pain is on the right side. She feels as if her legs are not
the same length and causes her to walk "funny" - ANSWER: Scoliosis
An 86 year old female presents with complaints of a burning pain her middle back
and rib areas. She states she is not able to touch the area without severe pain. She
does have flu like symptoms - ANSWER: Shingles
A 42 year old female presents complaining of in her neck. About 2 weeks ago she
was involved in a motor vehicle accident where she was rear ended. There has been
pain in her neck since the accident. Upon clinical examination, you find that she find
pain relief with cervical distraction and a positive Valsalva - ANSWER: Cervical disc
lesion
A 32 year old male presents with complaints of pain in his lower lumbar spine. The
patient recalls an incident where he bent down to pick up his son and put him in his
car seat, an he felt a sharp pain following. This initially was fine, but has gotten worse
over the past three weeks. The patient works as an electrician.Upon examination
you see that he has negative Valsalva and a negative Kemps test with standing . Most
of his pain is had when sitting for long periods of time - ANSWER: Lumbar disc bulge
A 45 year old female presents to the office today complaining of low back pain.
About three days ago at work she went to pick up a box of paper and upon lifting she
felt a sharp pain in her lower back. There is more pain with sitting than standing, and
she does not have any pain that runs dow either of her legs. On examination she has
a positive kemps test. - ANSWER: Lumbar disc bulge
White, 16 years old-scored A+-
55 year old male with pain and stiffness in his lower thoracic spine, no history of
trauma. Adjustments provide relief but here is very little progress. The patient has a
history of diabetes - ANSWER: Diffuse idiopathic skeletal hyperstenosis (DISH)
62 year old female presents with complaints of a burning pain in her middle back.
There was no recent trauma. When she has pain in her back she also notices pain in
her stomach . The patient has been taking aspirin 325 mg daily - ANSWER: Peptic
Ulcer Disease (PUD)
47 year old female presents to the office with complaints of low back pin as well as
pain in the SI joint. NO history of trauma. She has a history of psoriasis and she does
have pain in her right knee as well. - ANSWER: Psoriatic arthritis
72 year old Caucasian male presents with sudden pain in the lower thoracic spine.
The pain began very suddenly and was accompanied by nausea. The patient was
hypertension no quit smoking about a month ago, but did smoke for 40 years -
ANSWER: Abdominal aortic aneurysm
A 32 year old female presets with complaints of pain in the lumbar spine and the
hip/groin region. There is no history of trauma, no family history of cancer. -
ANSWER: Endometriosis
A 74 year old female presents for pain in the thoracic spine that has gotten worse
over time. The patient has no history of injury. The patient was a smoker for 50 years
and she has a persistent cough which she attributes to her previous smoking -
ANSWER: Spinal metastasis from lung cancer
A 16 year old male presents with complaint of stiffness in the thoracic spine as well
as SI and hip pain. There is no history of trauma. Upon examination you notice he
does have a wider gait and slight hyperkyphosis - ANSWER: Ankylosing Spondylitis
A 19 year old male presents with complaints of pain in the right lower back. There is
no history of trauma but he has most of his pain with prolonged standing, climbing
the stairs, and with sitting. The patient likes to run for exercise, but since his pain
began he is unable to do so. Upon inspection he shows you it is in the right SI area -
ANSWER: Sacroiliitis
An 84 year old female presents for pain in the thoracolumbar area. There is no
history of injury. The patient has chronically used prednisone for psoriatic arthritis -
ANSWER: Osteoporotic Compression Fracture
, A 60 year old male presents for pain in the thoracic spine. There are complaints from
fever chills and night pain. The patient does have diabetes and history of surgery
total hip replacement six months ago. - ANSWER: Osteomyelitis
A 65 year old African American male presents with complaints of back pain that has
been progressively getting worse. There is no known injury, an he woke up with pain
one morning. The patient has a family history of cancer but he has no history
himself. - ANSWER: Multiple myeloma
A 14 year old male presents with complaints f pain and stiffness that begins in the
thoracic spine but he also has it down into the lumbar as well. He notices that he his
not able to fully stretch out the thoracic spine, although it is very stiff, and he has
had to change much of his able to due to pain and stiffness, as twisting causes severe
pain. - ANSWER: Scheuermanns disease
A 2 year old female presents with her mother and the mother states that her
daughter complains of having pain in her neck and she feels as if her daughters neck
is "short" and her daughter appears to have pain with movement - ANSWER: Kippel
Feil Syndrome
A 12 year old female presents with her father for an evaluation of pain in the
thoracic spine. Most of her pain is on the right side. She feels as if her legs are not
the same length and causes her to walk "funny" - ANSWER: Scoliosis
An 86 year old female presents with complaints of a burning pain her middle back
and rib areas. She states she is not able to touch the area without severe pain. She
does have flu like symptoms - ANSWER: Shingles
A 42 year old female presents complaining of in her neck. About 2 weeks ago she
was involved in a motor vehicle accident where she was rear ended. There has been
pain in her neck since the accident. Upon clinical examination, you find that she find
pain relief with cervical distraction and a positive Valsalva - ANSWER: Cervical disc
lesion
A 32 year old male presents with complaints of pain in his lower lumbar spine. The
patient recalls an incident where he bent down to pick up his son and put him in his
car seat, an he felt a sharp pain following. This initially was fine, but has gotten worse
over the past three weeks. The patient works as an electrician.Upon examination
you see that he has negative Valsalva and a negative Kemps test with standing . Most
of his pain is had when sitting for long periods of time - ANSWER: Lumbar disc bulge
A 45 year old female presents to the office today complaining of low back pain.
About three days ago at work she went to pick up a box of paper and upon lifting she
felt a sharp pain in her lower back. There is more pain with sitting than standing, and
she does not have any pain that runs dow either of her legs. On examination she has
a positive kemps test. - ANSWER: Lumbar disc bulge
