Public Interest Law Initiative


By S. Gunock. Sterling College, Kansas.

Analysis of subjective knee complaints using visual 17 cheap arimidex 1 mg womens health today. Vastus medialis oblique/vastus lateralis analog scales discount 1 mg arimidex with amex pregnancy myths. Dysplasia of the quadriceps mechanism, with and without patellofemoral pain syndrome. Phys hypoplasia of the vastus medialis as related to the Ther 1995; 75(8): 672–683. Awareness of the retinaculum in evalu- patellofemoral syndrome. Biomechanics of the J Electromyogr Kinesiol 2004, 14(4): 495–504. Cowan, SM, KL Bennell, KM Crossley, PW Hodges, Hungerford, eds. Patellofemoral pain syndrome: A review and rehabilitation of nonarthritic anterior knee pain. Am Fam Physician 1999; Fulkerson, JP, and DS Hungerford, eds. Electromyographic analysis Surg [Am] 1990; 72: 1424–1429. Effects of static stretching on the maxi- medial and lateral quadriceps femoris muscle compo- mal length and resistance to passive stretch of short nents. The patello-femoral pain syndrome: subtalar joint position on patellar glide position in A clinical trial of the McConnell programme. Review of physiological effects of patellar taping on the onset of vastus medialis cryotherapy. Kowall, MG, G Kolk, GW Nuber, JE Cassisi, and SH Stern. Phys Ther 1998; 78(1): Patellar taping in the treatment of patellofemoral pain: 25–32. Chronic anterior knee pain in the adoles- 24(1): 61–66. Patello- five isometric exercises in the recruitment of the vastus femoral joint mechanics and pathology: I. Functional medialis oblique in persons with and without patello- anatomy of the patello-femoral joint. Larsen, B, E Andreasen, A Urfer, MR Mickelson, and 48. Patellar taping: A radiographic exami- extensor mechanism disorders. Clin Sports Med 1985; nation of the medial glide technique. Orthop Clin North Am 1979; 10: Surg [Am] 1968; 50: 1535–1548. Anterior In vivo and non-invasive three-dimensional patellar knee pain in children and adolescents: Diagnosis and tracking induced by individual heads of quadriceps. Increase of muscle strength from isometric tromyographic activity of the vastus medialis oblique quadriceps exercise at different angles. Loudon, JK, D Wiesner, HL Goist-Foley, C Asjes, and 52. Heintjes, E, MY Berger, SM Bierma-Zeinstra, RM KL Loudon. Intrarater reliability of functional per- Bernsen, JA Verhaar, and BW Koes. Exercise therapy formance tests for subjects with patellofemoral pain for patellofemoral pain syndrome. Conservative treatment effect of a patella brace on performance in knee exten- of patellofemoral subluxation. Am J Sports Med 1979; sion strength test in patients with patellar pain. An electromyographic the effectiveness of hip adduction in the optimization investigation of subluxation of the patella. J Bone Joint of the vastus medialis oblique contraction.

Which of the following statements regarding gram-positive bacteria and septic arthritis is false? Staphylococcal species are more common than streptococcal species as a cause of septic arthritis B buy 1mg arimidex with visa menopause the musical las vegas. Group B streptococcal infection may be particularly virulent in dia- betic patients and may involve the axial joints (i purchase arimidex 1 mg on line women's health issues impact factor. Gram stain is a reliable tool to differentiate between Staphylococcus and Streptococcus, because Staphylococcus appears as clusters in bio- logic smears D. Initial therapy for suspected staphylococcal or streptococcal septic arthritis should be vancomycin Key Concept/Objective: To understand the presentation and treatment of septic arthritis caused by gram-positive bacteria Gram-positive bacteria remain the most common cause of septic arthritis, accounting for 70% to 80% of cases. Staphylococcal arthritis was particularly frequent in a series of patients with endocarditis related to intravenous drug abuse. Gram stain cannot be relied on to differentiate between Staphylococcus and Streptococcus, because in biologic smears, Staphylococcus may not exhibit the clusters seen when grown in vitro. Suspected staphylococcal joint infection should be treated initially with vancomycin until methi- cillin resistance can be excluded. Non-group A, α-hemolytic streptococci are the second most common cause of septic arthritis, accounting for 10% to 21% of culture-positive cases. The number of reported group B (and to a lesser extent, groups C and G) strepto- coccal infections has been increasing. Group B streptococcal infection may be particu- larly virulent in diabetic patients and may involve axial joints (e. Other manifestations of group B streptococcal sepsis include myositis, fasci- itis, and endophthalmitis. For initial therapy, vancomycin is a reasonable choice. Definitive therapy should be made on the basis of culture results. Which of the following statements about septic (bacterial) arthritis is true? Local inoculation of organisms into the joint space is the most com- mon route of acquisition B. The finger joints are the most commonly involved site E. Most cases are polyarticular Key Concept/Objective: To understand the epidemiology and pathogenesis of bacterial arthritis 48 BOARD REVIEW Patients with underlying joint damage from any cause (e. In the majority of cases, bacte- ria are presumed to reach the joint space via the bloodstream rather than by direct inoc- ulation (as would occur with postarthroplasty infections or with infections associated with trauma). The knee and hip are the most commonly involved joints; bacterial arthritis of the small finger joints is uncommon. Only 10% to 15% of cases of septic arthritis are polyarticular. HIV infection has not been identified as a risk factor for sep- tic arthritis. A 23-year-old sexually active woman presents with left knee and wrist pain. She initially experienced polyarthralgias and low-grade fevers for several days, after which she developed progressive left knee pain. On examination, she is febrile and has a significant effusion and pain with passive range of motion of the left knee. A few scattered necrotic pustular lesions are present on the extremities. The rest of the examination (including pelvic examination) is negative. Appropriate cultures are obtained, and a diagnostic aspirate of the knee joint reveals a WBC count of 45,000/mm3 (predominantly polymorphonuclear leukocytes), but the Gram stain is negative. Cultures of the joint fluid eventually yield Neisseria gonorrhoeae. Which of the following statements about gonococcal arthritis is true?

Sixty-seven (33 physiotherapy discount arimidex 1mg without a prescription menstrual vs ovarian cycle; 34 alone and orthotics will be necessary to control placebo) subjects completed the trial buy arimidex 1mg low price menstruation sync. The addition of orthotics therapy group demonstrated significantly better to a physiotherapy program in a group of PFPS response to treatment and greater improve- patients with documented rearfoot varus has ments in pain and functional activities than the been studied. The physiotherapy treatment also during aggravating activities after 8 weeks when changed the onset timing of VMO relative to VL compared with patients issued with a placebo measured using surface electromyography dur- foot insole. At baseline in both groups, VMO came on to off-the-shelf orthotics were those with forefoot significantly later than VL. Following treatment, valgus of 2°, passive great toe extension of 78°, or there was no change in muscle onset timing of the navicular drop of 3 mm. However, in the physiotherapy provide a review of the role of foot orthoses as an group, the onset of VMO and VL occurred simul- intervention in this condition. It is imperative that the subjects in the McConnell-based program showed patient’s symptoms are significantly reduced. Management will ple size was only sufficient to detect a large effect need to include specific VMO training, gluteal between the groups. The large dropout rate (up to control work, stretching tight lateral structures, 48%) at 12 months may have affected the results at and appropriate advice regarding the foot, be it this time point, especially since a significantly orthotics, training, or taping. The authors concluded that any References of the treatments could provide long-term 1. The effect of quadriceps improvements in pain and function. Bennell, K, P Hodges, R Mellor, C Bexander, and therapy have a beneficial effect at three months T Souvlis. The nature of anterior knee pain following sufficient to permit discharge from physiother- injection of hypertonic saline into the infrapatellar fat pad. While they noted that taping did not patella taping on patella position and perceived pain. The effect of open and closed Harris, Ruddy, Sledge, eds. The relation- Sports Phys Ther 1996; 23(2): 104–110. J Am Pod Assoc 1979; 69(2): biofeedback-controlled exercise versus conservative 159–161. Vastus medialis oblique/vastus lateralis mus- Rehab 2001; 82: 1692–1695. The knee as a biologic transmission with an and without patellofemoral pain syndrome. Clin Orthop Rel Res 1996; 325: 1995; 75(8): 672–682. The McConnell regimen for anterior knee pain: A randomised controlled trial. Cowan, SM, KL Bennell, PW Hodges, KM Crossley, and drome. Effect of patellar tus medialis obliquus and vastus lateralis in subjects taping on knee kinetics of patients with patellofemoral with patellofemoral pain syndrome. J Orthop Sports Phys Ther 1999; 29(11): Rehabil 2001; 82: 183–189. Awareness of the retinaculum in evaluat- obliquus relative to vastus lateralis in subjects with ing patellofemoral pain. Am J Sports Med 1982; 10(3): patellofemoral pain syndrome. Cowan, SM, PW Hodges, KL Bennell, and KM Patellofemoral Joint, 2nd ed. Altered vastii recruitment when people with Wilkins, 1990. The effect of Arch Phys Med Rehabil 2002; 83: 989–995. Therapeutic patel- and vastus lateralis muscle activity in persons with lar taping changes the timing of vastii muscle activation patellofemoral pain.

A 21-year-old man presents to the emergency department for evaluation of pain and fever cheap 1 mg arimidex visa pregnancy 0 thru 40 wks. One week ago arimidex 1 mg without prescription menopause joint and muscle pain, the patient was involved in a head-on motor vehicle accident; he was not wearing a seat belt. At that time, the patient underwent an emergent resection of his spleen. The patient states that for the past 2 days, he has been experiencing swelling and redness of his incision site, as well as fever. On physical examination, the patient’s temperature is 102° F (38. Diffuse swelling and induration is noted at his incision site, and diffuse erythema surrounds the incision. Laboratory values are remarkable for a white blood cell (WBC) count of 26,000/mm3 and a differential with 50% neutrophils and 22% band forms. Which of the following statements regarding neutrophilia is true? Neutrophilia is usually defined as a neutrophil count greater than 1,000/mm3 B. Thrombocytosis is commonly associated with splenectomy, but splenectomy has no association with neutrophilia C. Serious bacterial infections are usually associated with changes in the number of circulating neutrophils, as well as the presence of younger cells, but they are not associated with changes in neutrophil morphology D. With serious bacterial infections, characteristic morphologic changes of the neutrophils include increased numbers of band forms and increased numbers of cells with Dohle bodies and toxic granulations Key Concept/Objective: To know the definition and morphologic characteristics of neutrophilia Neutrophilia, or granulocytosis, is usually defined as a neutrophil count greater than 10,000/mm3. Neutrophilia most often occurs secondary to inflammation, stress, or corti- costeroid therapy. Serious bacterial infec- tions and chronic inflammation are usually associated with changes in both the number of circulating neutrophils and their morphology. Characteristic changes include increased numbers of young cells (bands), increased numbers of cells with residual endoplasmic retic- ulum (Dohle bodies), and increased numbers of cells with more prominent primary gran- ules (toxic granulation). These changes are probably caused by the endogenous production of granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor and are also seen with the administration of these growth factors. A 61-year-old woman visits your clinic for a follow-up visit. She has been coming to you for several weeks with complaints of diffuse rash, intermittent fevers, persistent cough, and dyspnea. Laboratory results were significant only for a WBC count of 15,000/mm3 with 40% eosinophils. You have completed an extensive workup for underlying allergy, connective tissue disease, malignancy, and parasitic infection, with negative results. A bone marrow biopsy revealed hypercellular marrow with eosinophils constitut- ing 50% of the marrow elements. Your working diagnosis is hypereosinophilic syndrome (HES). Which of the following statements regarding HES and eosinophilia is true? The criteria used to diagnose HES are an unexplained eosinophil count of greater than 1,500/mm3 for longer than 6 months and signs or symptoms of infiltration of eosinophils into tissues B. The term HES is often used for patients with chronic eosinophilia resulting from parasitic infection C. Eosinophilia is defined as an eosinophil count greater than 500/mm3 D. Long-term corticosteroid therapy is the only available therapy for HES Key Concept/Objective: To understand HES Evaluation of the patient with eosinophilia (i. The term HES is often used for patients with chronic eosinophilia of unknown cause. The cri- teria used to diagnose HES are an unexplained eosinophil count of greater than 1,500/mm3 for longer than 6 months and signs or symptoms of infiltration of eosinophils into tissues. If symptoms involving the lungs or the heart are present, prednisone at a dosage of 1 mg/kg/day should be given for 2 weeks, followed by 1 mg/kg every other day for 3 months or longer.

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