Spinal forward flexion (main motion) =
a. +Ty
b. -Rx
c. +Rz
d. +Rx
Answer: d. +Rx
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Biomechanics
- A 59-year- old woman has been told by her orthopedist that the preferred treatment for her debilitating pain in both knees is knee replacement surgery. She agrees to have the surgery in one month when she will have time for rehabilitation. In the interim, the physician prescribes a medication for pain relief and to reduce inflammation. The woman is otherwise healthy, takes no medication, and has no known drug allergies. The physician decides on a nonsteroidal anti- inflammatory drug that has a high affinity for cyclooxygenase-2 (COX-2) and no affinity for COX-1. Compared to other NSAIDs, this drug is less likely to cause:
- A 69-year-old male presents to your office complaining of pain in his neck that extends bilaterally over his shoulders. He also complains of an aching sensation in both of his arms and loss of fine motor control of his hands. This has been progressing over the past six months. He worked in construction and had multiple small neck injuries during college wrestling and football. His overall health is quite good. On X-rays studies of his cervical spine you would expect to find?
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- A 54-year-old male construction worker has had low back pain for about two months. He has had previous episodes of low back pain. Now, the pain is more intense than it was on prior episodes and seems to be getting worse rather than improving over time. He does remember lifting very heavy steel beams and the pain is now unbearable. He complains of numbness in both legs and across his buttocks. He is embarrassed to report that he was incontinent of urine and stool this morning. You should plan on:
- A 25-year-old female medical student comes to your office asking for an MRI of her neck to confirm her suspicion that she has a herniated cervical disc. On exam, her triceps reflex is absent, and she has weakness of elbow extension and numbness on her long finger. You both expect the MRI to reveal a disc herniation at:
- A 57-year-old physician presents to his doctor complaining of neck pain that radiates down the lateral aspect of his right arm. He also complains of numbness in his right thumb with weakness on resisted thumb extension. You suspect a herniated disc compression which nerve root?
- A 54-year-old male construction worker has had low back pain for about two months. He has had previous episodes of low back pain. Now, the pain is more intense than it was on prior episodes and seems to be getting worse rather than improving over time. He does remember lifting very heavy steel beams and the pain is now unbearable. He complains of numbness in both legs and across his buttocks. He is embarrassed to report that he was incontinent of urine and stool this morning. You should plan on:
- A 35-year-old male presents to your office with complaints of back pain and some weakness in his left leg. It has been present for a few weeks and the back and leg pains have been increasing in intensity. You are concerned about a herniated lumbar disc. His left ankle jerk reflex (achilles tendon reflex) is absent and you find numbness on the lateral aspect of the lower leg and sole of his left foot. This is most commonly caused by a:
- A 35-year-old male presents to your office with complaints of back pain and some weakness in his left leg. It has been present for a few weeks and the back and leg pains have been increasing in intensity. You are concerned about a herniated lumbar disc. His left ankle jerk reflex (achilles tendon reflex) is absent and you find numbness on the lateral aspect of the lower leg and sole of his left foot. These findings are typical of compression of:
- A 25-year-old medical student comes to your office asking for an MRI of her neck to confirm her suspicion that she has a cervical disc herniation. On exam, her triceps reflex is absent. She has weakness of elbow extension and numbness on her long finger. You expect the MRI to reveal a disc herniation at at which of the following levels?
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- A 64-year-old school superintendent with known rheumatoid arthritis presents to the office with a recurrent episode of significant hand and wrist pain after having been virtually pain-free for about eight months on DMARD therapy as closely monitored by her rheumatologist. She questions the doctor as to how it could be that she has these painful chronic-recurrent flare-ups alternating with pain-free periods, all the while it seems that the "arthritis is getting better" with the medications. What would be the best explanation, based on the article by D. Marcus: "Treatment of Nonmalignant Chronic Pain?"
- A 56-year-old female with a known history of seropositive rheumatoid arthritis maintained on etanercept injections presents complaining of right knee pain and swelling for two days. She has been in good health otherwise and denies fevers and chills. She reports stiffness in the right knee that lasts for longer than 1 hour. Her other joints are doing well. You perform an arthrocentesis and remove 30cc of clear fluid. You send the sample to the lab, and 24 hours later no organisms are seen. The patient follows up later that day. The best course of management for this patient is:
- A 64-year-old woman diagnosed with gout has been taking chronic treatment for over one year. The prescribed medication enhances the excretion of uric acid. Her physician cautions her to contact him before starting any prescription or nonprescription medication. The antigout medication and many other drugs can compete for tubular transport. Examples include aspirin and other nonsteroidal anti-inflammatory drugs, loop and thiazide diuretics, certain anti-infective medications, and certain diabetes drugs. The chronic antigout medication prescribed for this patient is most likely:
- A 57-year-old man with chronic gout is given a prescription for a uricosuric agent. He is cautioned to avoid aspirin, NSAIDs, and other drugs that are secreted into the proximal tubule. The mechanism of action of the anti-gout medication is most likely direct inhibition of:
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- A patient with a history of hyperuricemia and three gouty flares in the past six months is placed on hypouricemic therapy. He is also prescribed a concomitant oral drug for prophylaxis of gouty flare. The second drug interferes with microtubule and spindle formation but its anti-gout actions are not well defined. One of this drug's early signs/symptoms of toxicity is: