What are the following tests for: Apply compression test, Posterior Drawer,
Anterior Drawer, McMurray, Lachman?
Test Structure tested
Compression (Apley) Meniscus
Meniscus
McMurray
Lachman ACL
Anterior Drawer ACL
Posterior Drawer PCL
Describe Ottawa Ankle and Knee Rules.
Ankle X-ray Indications:
Pain in the malleolar zone AND any of the following:
1. Bone tenderness at the posterior edge or tip of the lateral malleolus
2. Bone tenderness at the posterior edge or tip of the medial malleolus
3. Inability to bear weight both immediately and in the emergency department (4
steps)
Foot X-ray Indications:
Midfoot pain (tarsal/metatarsal area) AND any of the following:
1. Bone tenderness at the base of the 5th metatarsal
2. Bone tenderness at the navicular
3. Inability to bear weight immediately and in ED
Notes:
High sensitivity (~99%), safe to rule out fractures
Not for patients with multiple traumas or altered consciousness
Ottawa Knee Rules
Purpose:
Determine when to order knee X-rays after acute knee injury
Indications for Knee X-ray (age ≥18):
Knee pain plus any of the following:
, 1. Age ≥55 years
2. Isolated patella tenderness (no other bone tenderness)
3. Tenderness at head of fibula
4. Inability to flex knee to 90°
5. Inability to bear weight immediately and in ED (4 steps)
Notes:
High sensitivity for detecting clinically significant fractures
Reduces unnecessary imaging
Witch’s Milk (Neonatal Breast Enlargement)
Benign breast tissue enlargement in newborns due to maternal estrogen exposure
May feel like a small firm lump under the nipple/breastbone area ± milky discharge
Reassurance only → do NOT squeeze (risk of infection)
Kawasaki Disease
Fever ≥5 days + ≥4: bilateral non-purulent conjunctivitis, strawberry tongue, cracked
lips, rash, peeling hands/feet, cervical lymphadenopathy
Risk of coronary artery aneurysms
Tx: IVIG + high-dose aspirin; echocardiogram required
17-Year-Old Requesting Birth Control
Parental consent NOT required for contraception in most U.S. states
Provide confidential counseling + STI screening
Emphasize dual protection (condoms + hormonal method)
Acute Gout – Red Toe Pain & Swelling
Colchicine dosing: 1.2 mg PO initially → 0.6 mg 1 hour later
Best when started within 24 hours of flare
NSAIDs (Indomethacin) = first-line if no contraindications
Osgood-Schlatter Disease
Overuse injury → painful bump over tibial tuberosity
Common in adolescent athletes during growth spurts
Clinical diagnosis; X-ray may show fragmentation but not required
Teenager Limping, No Trauma
Anterior Drawer, McMurray, Lachman?
Test Structure tested
Compression (Apley) Meniscus
Meniscus
McMurray
Lachman ACL
Anterior Drawer ACL
Posterior Drawer PCL
Describe Ottawa Ankle and Knee Rules.
Ankle X-ray Indications:
Pain in the malleolar zone AND any of the following:
1. Bone tenderness at the posterior edge or tip of the lateral malleolus
2. Bone tenderness at the posterior edge or tip of the medial malleolus
3. Inability to bear weight both immediately and in the emergency department (4
steps)
Foot X-ray Indications:
Midfoot pain (tarsal/metatarsal area) AND any of the following:
1. Bone tenderness at the base of the 5th metatarsal
2. Bone tenderness at the navicular
3. Inability to bear weight immediately and in ED
Notes:
High sensitivity (~99%), safe to rule out fractures
Not for patients with multiple traumas or altered consciousness
Ottawa Knee Rules
Purpose:
Determine when to order knee X-rays after acute knee injury
Indications for Knee X-ray (age ≥18):
Knee pain plus any of the following:
, 1. Age ≥55 years
2. Isolated patella tenderness (no other bone tenderness)
3. Tenderness at head of fibula
4. Inability to flex knee to 90°
5. Inability to bear weight immediately and in ED (4 steps)
Notes:
High sensitivity for detecting clinically significant fractures
Reduces unnecessary imaging
Witch’s Milk (Neonatal Breast Enlargement)
Benign breast tissue enlargement in newborns due to maternal estrogen exposure
May feel like a small firm lump under the nipple/breastbone area ± milky discharge
Reassurance only → do NOT squeeze (risk of infection)
Kawasaki Disease
Fever ≥5 days + ≥4: bilateral non-purulent conjunctivitis, strawberry tongue, cracked
lips, rash, peeling hands/feet, cervical lymphadenopathy
Risk of coronary artery aneurysms
Tx: IVIG + high-dose aspirin; echocardiogram required
17-Year-Old Requesting Birth Control
Parental consent NOT required for contraception in most U.S. states
Provide confidential counseling + STI screening
Emphasize dual protection (condoms + hormonal method)
Acute Gout – Red Toe Pain & Swelling
Colchicine dosing: 1.2 mg PO initially → 0.6 mg 1 hour later
Best when started within 24 hours of flare
NSAIDs (Indomethacin) = first-line if no contraindications
Osgood-Schlatter Disease
Overuse injury → painful bump over tibial tuberosity
Common in adolescent athletes during growth spurts
Clinical diagnosis; X-ray may show fragmentation but not required
Teenager Limping, No Trauma
