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1. A 55-year-old man comes to the office because of a 1-month history of right knee pain. He reports no recent trauma to his knee but says that he has recently increased his weekly running distance from 12 miles to 30 miles. On physical examination he has aching knee pain with squatting. The rest of the physical examination is normal. Which of the following factors in the patient's history , if present, would indicate the patellofemoral joint as the source of the pain?
A) Associated thigh pain
B) Buckling of the knee
C) Increased pain with stair climbing
D) Locking of the knee
E) Prominent knee swelling
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2. A 17-year-old African-American girl comes to the health center because she wants contraception. She has been sexually active for the past 2 years. She has never taken oral contraceptive therapy. She says that her boyfriends use condoms some of the time. Past medical history is unremarkable. She takes no medication and has no allergies. She does not drink alcoholic beverages. She smokes one-half pack of cigarettes per day. Her last menstrual period, which was normal, was 3 weeks ago. She has had no vaginal symptoms. The patient is 165 cm (5 ft 5 in) tall and weighs 62 kg (137 lb). Pulse is 62/min and blood pressure is 106/64 mm Hg. Physical examination, including pelvic examination, is normal. Which of the following is the most appropriate recommendation for contraception in this patient?
A) Combination oral contraceptive therapy
B) Diaphragm
C) Intrauterine device (IUD)
D) Levonorgestrel
E) Spermicidal jelly
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d.i dont think its ans is A cos she smokes...
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E) Prominent knee swelling
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For the first question, retropatellar knee pain, which most often is aggravated during knee flexion and quadriceps contraction-causing activities is the most common presentation. These activities include squats, ascending/descending stairs. Also, the "theatre sign" or "movie-goer's knee" are terms used when the knee is flexed while sitting for a long period of time. Hence, I'd go with C!
For the 2nd question, why can't she get OCP's? Her smoking is not heavy and she's not > 35, considering the contraindications pasted below. Also, remember that with levonorgestrel she would have to avoid smoking altogether because it increases the risk of developing a heart attack, stroke, or blood clot. So I'd go with A on this one!
Absolute contraindications to OCP's:
1. hx. of thromboembolic event or stroke
2. active liver dz.
3. hx. of estrogen dependent tumor
4. pregnancy
5. abnormal uterine bleeding
6. heavy smoker > 35 yo
7. hypertriglyceridemia
Relative contraindications to OCP's:
1. migraine headaches
2. poorly controlled HTN
3. anticonvulsant drug tx.
