Injuries and Disorders - Anatomy

Inability to take more than 4 steps with the injured leg is one of the criteria of the is used order x-rays for suspected fractures around the knee complex, per the Ottawa knee rules. The other criteria are as follows: isolated tenderness at the patella or tenderness at the fibular head or patient age greater than 55 or inability to flex the knee past .

Although diagnostic imaging is needed to conclusively to rule in a fracture, the closed fist percussion sign has good diagnostic value in detecting vertebral compression fractures. Given that this tests involves hitting a patient in the back, clinicians may be hesitant to use this test. In such cases, the supine sign (increased pain with lying supine) can also be used to screen for vertebral compression fractures.

As their names suggest, the Ottawa knee and ankle rules, and the Amsterdam wrist rules are used to determine which patients should receive x-rays for suspected ankle, knee, and wrist fractures respectively. Well's criteria are used to screen for pulmonary embolisms (PEs) and deep vein thromboses (DVTs). It should be noted that there are distinct Well's criteria for PEs and DVTs.

The posterior cruciate ligament (PCL) is a large ligament located in the center of the knee behind the anterior cruciate ligament. The primary role of the PCL is to provide stability and prevent posterior deviation of the tibia relative to the femur. A posterior drawer test or tibial sag test can be used to assess PCL injury or damage.

In contrast, the anterior cruciate ligament (ACL) prevent anterior deviation of the tibia relative to the femur. Damage to the ACL can be assessed with an anterior drawer test.

(Superior Lateral Anterior Posterior) SLAP and Bankart tears are injuries to the glenoid labrum. Reverse-Hill Sachs and McLaughlin lesion are synonymous, however they are injuries to the anteromedial portion of the humeral head, and are caused by posterior dislocation of the humerus.

An open book fracture is an injury to the pelvis. In this injury, the pubic symphysis is disrupted, causing the pelvis to look like an open book.

Paget's disease is a bone disease characterized by rapid bone degradation, and rebound bone growth however, the bone is laid bone in a disorganized manner and is prone to further degeneration. Pott's disease is characterized by destruction of thoracic vertebra, secondary to tuberculosis infection. Osteogenesis imperfecta is a congenital disorder caused by abnormalities in type I collagen production, that makes the patient prone to fracture. de Quervain syndrome is also known as de Quervain tenosynovitis, and is characterized by irritation to the sheath covering the extensor pollicis brevis and abductor pollicis longus tendons.

A gunstock deformity (cubitus varus) refers to a deformity at the elbow joint, where the distal forearm is deviated medially (compared to typical anatomical alignment). Conversely, if a patient's distal forearm is deviated excessively laterally, she is said to demonstrate cubitus valgus. Cubitus varus is most commonly caused by supracondylar fractures of the humerus. Fortunately, this deformity is largely cosmetic in nature, and causes few functional limitations.

A Monteggia fracture refers to a fracture of the shaft of the ulna, and a concurrent dislocation of the head of the radius. Accordingly, this type of fracture-dislocation injury also affects the humeroradial joint (part of the elbow complex). This type of injury is often caused by falling on an outstretched arm, which could affect the glenohumeral and acromioclavicular joints as well.

A gamekeeper's fracture refers to an avulsion injury at the base of the proximal phalanx of the thumb, secondary to a rupture of the ulnar collateral ligament of the thumb. Mallet finger refers to a rupture of one of the extensor digitorum tendons, at the distal interphalangeal joints. A boxer's fracture is a fracture of one of the metacarpals. A Pott's fracture is a type of ankle fracture involving the medial and lateral malleoli.

A Hill-Sachs lesion occurs after the head of the humerus abuts that glenoid rim of the scapula, injuring the articular cartilage, when the humerus is dislocated anteriorly. If the humerus is dislocated posteriorly, it can result in a reverse Hill-Sachs lesion. SLAP and Bankhart lesions are injuries of the glenoid labrum and thus, are not viable answers to this question.

Osteophytes (bone spurs) are bony projections that form at joints. Osteophytes occur when there are changes to bone formation via aging, mechanical instability, degeneration, and disease, including arthritis (which is the most common cause of osteophyte formation). Osteophytes form naturally on the spine via degeneration of the vertebrae with aging. Osteophytes do not cause pain, but may impinge on nerves which will lead to pain, and/or numbness and tingling sensations. Chondrocytes are cartilage cells.

Enthesophytes are bony projections that form at ligament or tendon attachments.

Osteoporosis is a breakdown of bone, commonly due to a lack of calcium, which is typically lost faster in females due to a menstruation cycle, and chronic breakdown with age. Also, females have less bone density to begin with.

Osteo- (which is going to be a Latin based root word for bone) will help you eliminate the other answers, which are all inflammation of non-bony structures within the body.

Blood collecting in the left upper quadrant would suggest a splenic laceration.

The spleen is one of the most commonly injured organs with blunt abdominal trauma. It can and will bleed enough to make a patient hemodynamically unstable. Ultrasound performed in the trauma bay looks at four potential spaces of fluid collection: Morrison's pouch (right upper quadrant/liver), splenorenal recess (left upper quadrant/spleen), subxiphoid (heart), and the pouch of Douglas (suprapubic/pelvis). The liver is located in the right upper quadrant of the abdomen and the spleen in the left upper quadrant

This patient's ultrasound showed fluid collection in the perisplenic space as well as extensive bleeding, which would suggest a splenic laceration as the cause of the patient's condition.

The liver is in the right upper quadrant. The right and left iliac arteries are in the right and left lower quadrants, respectively. Bladder laceration would result in fluid collection in the pelvis.

Giardiasis is the disease caused by the Giardia parasite. The parasite is passed through feces and can live up to several weeks outside of a host. Common symptoms of giardiasis is diarrhea, gas, stomach cramps, and dehydration. It is treated via prescription medication. Gastritis is characterized by inflammation of the stomach. In giardiasis, the intestines are affected. Gout is a rheumatoid disease and is not caused by an infectious agent. Geranium is a type of flower.

Salmonella is an illness caused by a bacterium. Salmonella is often found in raw egg or poultry. It typically presents with gastrointestinal discomfort, diarrhea, and fever. It can be treated with antibiotics, but rarely becomes serious unless it is present in the old, the young, or the immunocompromised.

The correct answer is the lower esophageal sphincter. In "heartburn," a patient's lower esophageal sphincter, which separates the distal esophagus from the proximal stomach, transiently relaxes its tone, inappropriately allowing food/digestive contents that have been acidified for digestion in the stomach to travel backwards into the distal esophagus. In patients with normal lower esophageal sphincter tone, i.e. without GERD, digestive contents that have passed to the stomach remain in the stomach without traveling backwards and causing an acidic, burning sensation in the esophagus.

The other answers are incorrect for the following reasons:

The epiglottis prevents food from being swallowed into the airway by closing off the airway temporarily during swallowing. It does not separate the esophagus from the stomach.

The upper esophageal sphincter is located proximally in the esophagus and opens to allow food to enter the esophagus from the pharynx. It does not separate the esophagus from the stomach.

The ileocecal valve is located distally in the small intestine, separating the ileum from the cecum of the colon. It functions to prevent colo-ileal reflux, but not gastro-esophageal reflux.

The left mainstem bronchus does not play any role in digestion of food or acid reflux, as it is part of the more distal respiratory tract.

Thiamine is a vitamin required for the metabolism of carbohydrates and amino acids. Deficiency of this vitamin results in beriberi, a disease typically of the malnourished. Symptoms of this disease manifest in many different ways such as heart failure, neuropathy, and leg swelling.

Acute diverticulitis: left lower quadrant

Acute pancreatitis: epigastric, can radiate to back, poorly localized, leaning forward may help alleviate pain, laying supine aggravates. May have positive Grey Turner's sign and Cullen's sign.

Acute cholecystitis: Right Upper Quadrant, Positive Murphy Sign, may radiate into right shoulder and scapula

Peptic ulcer: epigastric, may radiate to back, wakens patient at night, possible relief with certain foods, gnawing/aching pain, heartburn