Author Question: A 23-year-old female presents with ankle pain due to a fall while walking on ice 1 hour ago. You ... (Read 37 times)

beccaep · **on:** Jun 25, 2018

A 23-year-old female presents with ankle pain due to a fall while walking on ice 1 hour ago. You watch her limp as she walks into the emergency room. On physical examination, the ankle is erythematous, swollen, and tender to touch.

The patient cannot stand on the affected ankle. Range of motion is severely limited on inversion of the ankle. On palpation, there is no pain with pressure on the medial or lateral malleolus. Should this patient be sent for ankle x-rays according to the Ottawa ankle rules?
A. No, the ankle shows no tenderness over the medial or lateral malleolus
B. Yes, the patient is unable to bear weight on the ankle
C. Yes, ankle range of motion is limited
D. No, range of motion of the ankle is not limited in all planes

Question 2

A 33-year-old male marathon runner presents with knee pain. Which of the following tests is positive if the meniscus of the knee is torn?

A. McMurray's test
B. Straight leg raising sign
C. Anterior drawer sign
D. Lachman test

qytan · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
The following Ottawa rules recommend x-ray of the ankle if either one of the following conditions exist:

Inability to bear weight for four steps (both immediately and in emergency department)
Bone tenderness at posterior edge or tip of either malleolus

Answer to Question 2

ANS: A
Tears or disruptions of the meniscus sheath of cartilage are associated with OA in older persons and with athletic activities in younger persons. There is typically a sudden onset of pain and swelling over the lateral or medial joint line as well as locking and painful popping. Onset often follows a twisting injury. Point tenderness is present over the joint line, with mild effusion. A positive McMurray's test is often present.