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NBME3 knee problem... - quansar
#1
For each patient with chronic knee pain, select the most appropriate next step in management.

O A) Anterior cruciate ligament reconstruction
O B) Arthroscopic partial meniscectomy
O C) Quadriceps strengthening exercises
O D) Sympathetic blockade
O E) Total knee replacement
O F) Upper tibial osteotomy


29. An 18-year-old woman comes to the physician because of knee pain that has been present for 5 years. The pain is made worse by prolonged sitting and by going up and down steps. She has 10 degrees of hyperextension of both elbows. She becomes apprehensive when laterally directed pressure is applied to the patella. X-ray films show no abnormalities.



30. A 70-year-old man comes to the physician because of knee pain that has been present for 10 years. He is unable to comfortably walk further than one block and has difficulty sleeping because of the pain. He has pain on both medial and lateral sides of the knee. Range of motion is from 15 to 100 degrees, there is a bowleg deformity when he stands



What's your dx and answer
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#2
C???
FFF
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#3
for q30, it is osteoarthritis, so first F then in couple years will need to go to E

For q29, agree it is patellofemoral knee pain ... so CCC
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#4
u rite EEE
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#5
i think 30 is E
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#6
first one is lax patella....with features of positive apprehension test...would benifit from VMO/quads exercise

second one has a FFD with tricompartmental OA with deformity..has been for 10 years...severe impairmaint of mobility...70 yrs old...
sooo..a is not indicated..b is not indicated.....c might benifit ...but its too late now with a FFD...d is not indicated...TKR is definitely going to help ....so ee is the answer....upper Tibial osteotomy will help in unicompartmental OA where u shift the load from damaged to undamaged comp.//....here all the comp involved...so ff is not indicated....so eeee
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