daily question
Scott Rand
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Scott E Rand, MD FAAFP CAQSM
Director, Primary Care Sports Medicine Fellowship
Co Director of Sports Medicine, Houston Methodist Orthopedics and Sports Medicine Willowbrook
Assistant Professor of Clinical Family Medicine Houston Methodist Academic Institute
Adjunct Assistant Professor of Family and Community Medicine, Texas A&M University
Assistant Professor of Family Medicine in Clinical Medicine Weill Cornell Medical College.
13802 Centerfield Dr Suite 300
Houston, TX 77070
Scott Rand
Are there any narcotic substances that are not considered banned substances?
Scott Rand
A 22 year old weight lifter on the US team is taking spironolactone for acne control. Is this a banned substance and how would you alter management if it is?
Scott Rand
Give 3 examples of conditions that would warrant a therapeutic use exemption for the prescription of testosterone supplementation for an athlete
Scott Rand
A 13 year old female with a history of Legg-Perthes disease as a child presents to your clinic with worsening chronic left hip and groin pain. She reports occasional catching or locking. On exam she has pain with passive range-of-motion and reduced internal rotation and abduction. On MRI of the hip, you find which of the following:
A. Osteochondritis Dissecans of the femoral head
B. Labral Tear
C. Normal hip
D. Arthritis
Scott Rand
A 12 year old girl with no previous hip problems suffers an injury immediately after landing in the sand pit following setting her personal record in the long jump.
She now has pain and tenderness deep within the hip over the proximal and medial femur.
There is pain with passive internal and external rotation of the involved hip and with active hip flexion. The examination of the other hip is normal.
The most accurate diagnosis is:
A. Avulsion of the apophysis over the ischial tuberosity
B. Avulsion of the apophysis over the anterior superior ischial spine
C. Avulsion of the apophysis over the anterior inferior ischial spine
D. Avulsion of the apophysis over the lesser trochanter
E. Avulsion of the apophysis over the greater trochanter
Scott Rand
A 6-year-old boy presents to your office with foot pain that is increasing in severity. His parents state he has recently been limping. There is no history of trauma and he is otherwise healthy. Radiographs are shown in the attached files. Which of the following is the most appropriate treatment for this child?
1. Observation
2. Open biopsy and curettage
3. Long leg non-walking cast
4. Amputation
5. Short leg walking cast
Scott Rand
Scott Rand
A 6-year-old boy presents to your office with foot pain that is increasing in severity. His parents state he has recently been limping. There is no history of trauma and he is otherwise healthy. Radiographs are shown in the attached files. Which of the following is the most appropriate treatment for this child?
1. Observation
2. Open biopsy and curettage
3. Long leg non-walking cast
4. Amputation
5. Short leg walking cast
The
history and radiographs are consistent with Kohler's disease, avascular
necrosis of the tarsal navicular.
It was thought
orginially that the changes in this disease might be the result of an abnormal
strain that acts on a weak navicular, but a definitive answer has not been
found. Among the theories to explain the nature of this lesion, a more
satisfactory one is a mechanical basis that is associated with a delayed
ossification. The navicular is the last tarsal bone to ossify in children. This
bone might be compressed between the already ossified talus and the cuneiforms
when the child becomes heavier. Compression involves the vessels in central
spongy bone, leading to ischemia, which then causes clinical symptoms.
Thereafter, the perichondral ring of vessels sends the blood supply, allowing
rapid revascularization and formation of new bone. The radial arrangement of
the vessels of this bone is of great importance in explaining why the prognosis
of this lesion is always excellent.
Kohler's disease tends
to affect boys more frequently than girls between ages 6-9. Treatment includes
immobilization for symptom relief and observation while the navicular
re-ossifies.
Scott Rand
12 This 12 year old football player presented to clinic with complaints of pain in the left thumb after having it bent backward trying to catch a ball.
Scott Rand
This 15 year old male presented to clinic with complaints of severe left elbow pain and limited ROM after a fall on an outstretched hand.
Scott Rand
. This 15 year old male presented with several months of recurrent pain and swelling in his right knee whenever he played soccer.
Scott Rand
. This 12 year old male presented to the clinic with complaints of pain over the ulnar aspect of the right hand after hitting a tree when angry.
Scott Rand
An afebrile patient with acute low back pain notices pain going down the posterior-lateral aspect of her right thigh and leg. It is noted on your exam that she has the following: (+) straight leg raise test, a slight sensory deficit over the lateral aspect of the right lateral foot, a diminshed ankle jerk and weakness with plantar flexion of the great toe. It is also noted that it is hard for her to walk on her toes. Which nerve root is most likely affected?
A. L3
B. L4
C. L5
D. S1
E. L2
Scott Rand
Which of the following structures is the primary static stabilizer for preventing lateral subluxation of the patella?
A. medial patellofemoral ligament
B. vastus medialis obliquus (VMO)
C. medial patellotibial ligament
D. superficial oblique retinaculum
Scott Rand
17 year old football player tackles an opposing player and sustains a flexion injury of his neck. He falls to the ground. The ambulance is summoned and he is boarded and taken to the hospital. He is found to have an injury to the anterior spinal cord of his neck. Which of the following clinical findings match this lesion?
A. Loss of motor function and position sense on the same side of the body as the lesion and loss of pain and sensation on the opposite side of the body as the lesion
B. Bilateral lower extremity paralysis that is greater than the upper extremity paralysis. Bilateral loss of pain and temperature sensation, vibratory and proprioception is intact
C. Weakness in both upper extremities that is more severe than the weakness in both lower extremities. Sacral function is spared
D. After the period of spinal shock has resolved, the patient has no motor or sensory activity below the level of the lesion
Scott Rand
The anterior tibialis is the main dorsiflexor of the ankle, it originates on the anterolateral tibia and interosseus membrane and inserts on:
A. Medial cuneiform and base of 1st metatarsal
B. All 3 cuneiform bones, and the base of the 2nd metatarsal
C. Navicular bone
D. Anterior talus