Case-based MCQ

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⏳ Case-based MCQ | #Case_407 | #answer 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 ✅ B Exertional compartment syndrome is a condition in which the patient experiences pain over the anterior lower leg caused by a pressure buildup within the muscles of the leg. Patients typically complain of pain after a period of activity or exercise, and it is quickly relieved by rest. As blood flow to the muscle increases with activity, the muscle swells and becomes constricted by the encompassing fascia. Pain results from the ensuing ischemia. There may also be associated numbness in the dorsum of the foot or weakness on dorsiflexion at the ankle. The diagnosis is made by measuring pressures within the leg at rest followed by a reading after some exercise. Treatment consists of a surgical fasciotomy, which involves release of the tight fascia. ⚠ Answer A is incorrect. Acute compartment syndrome differs from exercise-induced or chronic compartment syndrome in that the former occurs secondary to a traumatic injury such as a fracture of one of the long bones or a crush injury. The patient would present with severe pain and clinically tight compartments at the time of examination with associated paresthesias. Treatment involves immediate fasciotomy to prevent cell death. ⚠ Answer C is incorrect. Pain associated with knee osteoarthritis would not likely resolve within a half hour of cessation of exercise. Patients typically experience pain, soreness, and swelling with activity that does not necessarily resolve immediately after rest. Treatment includes ice, nonsteroidal anti-inflammatory drugs, and limited activity. In addition, the patient’s age and lack of x-ray findings make this diagnosis unlikely. ⚠ Answer D is incorrect. Patellofemoral knee pain most commonly arises from an imbalance or irregularity of patellar movement or tracking. Conditions that predispose to these abnormalities include an imbalance in quadriceps strength, patella alta, recurrent patellar subluxation, direct trauma to the patella, and meniscal injuries. Patients suffering from any of the patellofemoral knee pain syndromes usually complain of anterior knee pain, and do not present in the manner described in the stem. ⚠ Answer E is incorrect. Stress fractures are tiny cracks in bone that result from overuse. Fatigued muscles and increasing the amount or intensity of an activity too rapidly may cause these cracks. Most stress fractures occur in the weight-bearing bones of the lower leg and the foot. Treatment consists of ice, nonsteroidal anti-inflammatory drugs, and rest for 6–8 weeks which allows ample time for healing. Evidence of fracture may never appear on plain radiographs or may not appear for 2–10. weeks after symptom onset, although triple-phase nuclear bone scans are more sensitive in the detection of stress fractures early in the clinical course. A patient with a tibial stress fracture would not be pain-free within 30 minutes of cessation of activity, nor would the patient likely experience a temporary loss of sensation over the dorsum of the foot.

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⏳ Case-based MCQ | #Case_407 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 26-year-old jogger presents to her primary care physician complaining of left lower leg pain when she exercises. She states that when she is not jogging, she is pain free, but when she jogs over 3 miles, she begins to note pain and tightness in her left lower leg. She states that she often has concurrent numbness and tingling in the top of her foot during these episodes of pain. When she ceases strenuous activity, all symptoms slowly subside over the course of half an hour. Physical examination is unremarkable and demonstrates a neurovascularly intact left lower extremity with supple compartments, and no focal areas of tenderness. Plain films of the left knee, tibia, and fibula are similarly unremarkable.

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⏳ Case-based MCQ | #Case_407 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 26-year-old jogger presents to her primary care physician complaining of left lower leg pain when she exercises. She states that when she is not jogging, she is pain free, but when she jogs over 3 miles, she begins to note pain and tightness in her left lower leg. She states that she often has concurrent numbness and tingling in the top of her foot during these episodes of pain. When she ceases strenuous activity, all symptoms slowly subside over the course of half an hour. Physical examination is unremarkable and demonstrates a neurovascularly intact left lower extremity with supple compartments, and no focal areas of tenderness. Plain films of the left knee, tibia, and fibula are similarly unremarkable.

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⏳ Case-based MCQ | #Case_407 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 26-year-old jogger presents to her primary care physician complaining of left lower leg pain when she exercises. She states that when she is not jogging, she is pain free, but when she jogs over 3 miles, she begins to note pain and tightness in her left lower leg. She states that she often has concurrent numbness and tingling in the top of her foot during these episodes of pain. When she ceases strenuous activity, all symptoms slowly subside over the course of half an hour. Physical examination is unremarkable and demonstrates a neurovascularly intact left lower extremity with supple compartments, and no focal areas of tenderness. Plain films of the left knee, tibia, and fibula are similarly unremarkable.

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⏳ Case-based MCQ | #Case_407 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 26-year-old jogger presents to her primary care physician complaining of left lower leg pain when she exercises. She states that when she is not jogging, she is pain free, but when she jogs over 3 miles, she begins to note pain and tightness in her left lower leg. She states that she often has concurrent numbness and tingling in the top of her foot during these episodes of pain. When she ceases strenuous activity, all symptoms slowly subside over the course of half an hour. Physical examination is unremarkable and demonstrates a neurovascularly intact left lower extremity with supple compartments, and no focal areas of tenderness. Plain films of the left knee, tibia, and fibula are similarly unremarkable.