PA 529 Clinical Presentations Solved
100% Correct
65-year-old woman with left knee pain. The pain has been present in both knees for
approximately 5 years and has been steadily getting worse. She describes stiffness,
sticking, and grinding of the right knee. Over the last 2 weeks, she has been taking
ibuprofen almost every day, requiring an increasing frequency of doses for adequate
pain control. On physical exam, there is swelling of the right knee and tenderness to
palpation. There is a palpable crepitus. - ANSWER-osteoarthritis
68 year old male presents with unilateral swelling and a stiff pain in his right knee. He
says he thought his arthritis was acting up, but has noticed more pain and swelling to
the area than normal and is concerned about possible infection to his knee. He is not
experiencing any fever, warmth, or erythema to the area, but has more difficulty bending
and extending his leg. What is the most likely diagnosis? - ANSWER-effusion
a 13-year-old girl who is being seen in your office for a routine well-child exam. She
denies back pain and states she began her menses 3 months ago. On Adams forward
bending asymmetry in scapular height is noted. She has 5 of 5 motor strength in all
muscle groups in her lower extremities and symmetric patellar and Achilles reflexes.
You obtain standing PA and lateral radiographs. - ANSWER-scoliosis
a 14-year-old with complaints of morning stiffness and fatigue for the past 3 months.
She complains of worsening stiffness after periods of inactivity and finds it difficult to
participate in sports, especially PE. Her mom is particularly concerned because her
daughter has been missing school and this has begun to affect her academic
performance. They are requesting a medical note to be dismissed from physical
education. - ANSWER-juvenile RA
A 15 year old soccer player complaining of left hip pain. She states that the pain is
mostly in her groin and she feels it "pop and click" while she is at soccer practice.
Physical exam elicits a positive Mccarthy sign. X ray is negative for any fractures or
bony abnormalities. An MRI is ordered. What is the most likely diagnosis? - ANSWER-
acetabular labral tear
a 16-year-old female with postural deformity and pain in the middle back. She is
premenarchal and reports pain across the shoulder blades that extended from the upper
thoracic spine down to the lower lumbar spine. The patient rates her pain as 6/10 on a
VAS and states that the pain and stiffness in her back are impacting their daily activities.
The patient is otherwise healthy. The physical examination reveals a significant
increase in the patient's thoracic kyphosis and lumbar lordosis, with marked angulation
of the thoracolumbar spine during forward bending. There are no other significant
clinical findings. - ANSWER-kyphosis
, A 17 year old male football player presents to the clinic with pain and a large bruise
located over the right hip. He states that he got tackled at football practice 2 days ago
and has noticed pain ever since. On exam you notice extreme tenderness over the area
and increased pain with adduction of the leg. - ANSWER-hip pointer pain
A 20 year old baseball player presents to your office with a dull, throbbing ache in his
shoulder. He has trouble sleeping on his right side. He also mentions that he is the top
pitcher for his team and he has noticed while pitching he feels a "catch" and his coach
complains that he isn't throwing fast enough anymore. He worries that his baseball
career might be ending and wants your help. What is your most likely diagnosis? -
ANSWER-SLAP tear
a 20-year-old male with complaints of left lateral ankle painfollowing an injury that
occurred when he was landing from a jump while playing basketball. On examination,
there is tenderness over the anterior talofibular ligament. He has an antalgic gait and
requires rest after walking 15 steps. The calcaneofibular and posterior talofibular
ligaments are nontender to palpation. Anterior drawer testing is positive for pain and
loss of endpoint. Inversion subtalar tilt testdoes not cause any pain and there is a firm
endpoint. - ANSWER-inversion sprain
a 22-year-old college basketball player with chronic anterior pain of her right knee. The
patient has had over 6 months of physical therapy without improvement. It initially only
bothered her during training, but she is now no longer able to compete and has pain
with daily activities. Physical exam reveals swelling of the anterior knee and tenderness
to palpation at the distal pole of the patella in full extension and no tenderness to
palpation at distal pole of the patella in full flexion - ANSWER-patellar tendonitis
a 22-year-old recreational soccer player who sustained a right knee injury 6 months
ago. He has been treated with rest and rehabilitation but is unable to play at his
previous level due to his knee "giving way." Physical exam reveals 10° varus alignment
when standing and a varus thrust with walking. Strength is full compared to the other
side. Ligamentous exam reveals a stable ACL and MCL but opens to a varus stress and
a 3+ posterior drawer and positive dial test at both 30° and 90° degrees of flexion. -
ANSWER-PCL
a 23-year-old male with redness of the eye as well as discharge. He reports that he
experiences pain with urination and stiffness and pain of the knee and ankle. With
further questioning, he reports a history of gonorrhea infection that was diagnosed and
treated approximately 5 weeks ago. He is otherwise healthy. On physical exam, there is
conjunctivitis, asymmetric oligoarthritis, and discharge from the urethral meatus. -
ANSWER-reactive arthritis
a 23-year-old woman arrives at the emergency room after a biking accident. She reports
acute pain after falling on her shoulder. On physical exam, there is swelling, erythema,
and tenderness on the anterior aspect of her right shoulder. No tenting of the skin is
100% Correct
65-year-old woman with left knee pain. The pain has been present in both knees for
approximately 5 years and has been steadily getting worse. She describes stiffness,
sticking, and grinding of the right knee. Over the last 2 weeks, she has been taking
ibuprofen almost every day, requiring an increasing frequency of doses for adequate
pain control. On physical exam, there is swelling of the right knee and tenderness to
palpation. There is a palpable crepitus. - ANSWER-osteoarthritis
68 year old male presents with unilateral swelling and a stiff pain in his right knee. He
says he thought his arthritis was acting up, but has noticed more pain and swelling to
the area than normal and is concerned about possible infection to his knee. He is not
experiencing any fever, warmth, or erythema to the area, but has more difficulty bending
and extending his leg. What is the most likely diagnosis? - ANSWER-effusion
a 13-year-old girl who is being seen in your office for a routine well-child exam. She
denies back pain and states she began her menses 3 months ago. On Adams forward
bending asymmetry in scapular height is noted. She has 5 of 5 motor strength in all
muscle groups in her lower extremities and symmetric patellar and Achilles reflexes.
You obtain standing PA and lateral radiographs. - ANSWER-scoliosis
a 14-year-old with complaints of morning stiffness and fatigue for the past 3 months.
She complains of worsening stiffness after periods of inactivity and finds it difficult to
participate in sports, especially PE. Her mom is particularly concerned because her
daughter has been missing school and this has begun to affect her academic
performance. They are requesting a medical note to be dismissed from physical
education. - ANSWER-juvenile RA
A 15 year old soccer player complaining of left hip pain. She states that the pain is
mostly in her groin and she feels it "pop and click" while she is at soccer practice.
Physical exam elicits a positive Mccarthy sign. X ray is negative for any fractures or
bony abnormalities. An MRI is ordered. What is the most likely diagnosis? - ANSWER-
acetabular labral tear
a 16-year-old female with postural deformity and pain in the middle back. She is
premenarchal and reports pain across the shoulder blades that extended from the upper
thoracic spine down to the lower lumbar spine. The patient rates her pain as 6/10 on a
VAS and states that the pain and stiffness in her back are impacting their daily activities.
The patient is otherwise healthy. The physical examination reveals a significant
increase in the patient's thoracic kyphosis and lumbar lordosis, with marked angulation
of the thoracolumbar spine during forward bending. There are no other significant
clinical findings. - ANSWER-kyphosis
, A 17 year old male football player presents to the clinic with pain and a large bruise
located over the right hip. He states that he got tackled at football practice 2 days ago
and has noticed pain ever since. On exam you notice extreme tenderness over the area
and increased pain with adduction of the leg. - ANSWER-hip pointer pain
A 20 year old baseball player presents to your office with a dull, throbbing ache in his
shoulder. He has trouble sleeping on his right side. He also mentions that he is the top
pitcher for his team and he has noticed while pitching he feels a "catch" and his coach
complains that he isn't throwing fast enough anymore. He worries that his baseball
career might be ending and wants your help. What is your most likely diagnosis? -
ANSWER-SLAP tear
a 20-year-old male with complaints of left lateral ankle painfollowing an injury that
occurred when he was landing from a jump while playing basketball. On examination,
there is tenderness over the anterior talofibular ligament. He has an antalgic gait and
requires rest after walking 15 steps. The calcaneofibular and posterior talofibular
ligaments are nontender to palpation. Anterior drawer testing is positive for pain and
loss of endpoint. Inversion subtalar tilt testdoes not cause any pain and there is a firm
endpoint. - ANSWER-inversion sprain
a 22-year-old college basketball player with chronic anterior pain of her right knee. The
patient has had over 6 months of physical therapy without improvement. It initially only
bothered her during training, but she is now no longer able to compete and has pain
with daily activities. Physical exam reveals swelling of the anterior knee and tenderness
to palpation at the distal pole of the patella in full extension and no tenderness to
palpation at distal pole of the patella in full flexion - ANSWER-patellar tendonitis
a 22-year-old recreational soccer player who sustained a right knee injury 6 months
ago. He has been treated with rest and rehabilitation but is unable to play at his
previous level due to his knee "giving way." Physical exam reveals 10° varus alignment
when standing and a varus thrust with walking. Strength is full compared to the other
side. Ligamentous exam reveals a stable ACL and MCL but opens to a varus stress and
a 3+ posterior drawer and positive dial test at both 30° and 90° degrees of flexion. -
ANSWER-PCL
a 23-year-old male with redness of the eye as well as discharge. He reports that he
experiences pain with urination and stiffness and pain of the knee and ankle. With
further questioning, he reports a history of gonorrhea infection that was diagnosed and
treated approximately 5 weeks ago. He is otherwise healthy. On physical exam, there is
conjunctivitis, asymmetric oligoarthritis, and discharge from the urethral meatus. -
ANSWER-reactive arthritis
a 23-year-old woman arrives at the emergency room after a biking accident. She reports
acute pain after falling on her shoulder. On physical exam, there is swelling, erythema,
and tenderness on the anterior aspect of her right shoulder. No tenting of the skin is
