A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds.What should you do?
a) Make an immediate referral for an orthopedic evaluation without further assessment.
b) Tell her that it takes time for these bruises to improve, so she should be patient.
c) Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint.
d) Send her to the emergency room for reduction of this obvious wrist fracture.
A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
a) Check his blood sugar.
b) Have him drink 4 ounces of juice.
c) Call 911.
d) Ask him about his usual eating habits.
The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
a) High sensitivity thyroid-stimulating hormone (TSH) and free T4
b) Free T4 and serum calcium
c) Free T3 and T4
d) TSH and thyroxin antibodies
A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes.Which of the following tests should be ordered next?
a) Serum calcium
d) Urine specific gravity
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis?
a) History of hypertension
b) Her affected shoulder is also her dominant arm.
c) Her history of diabetes mellitus
d) Her work as a secretary predisposes her to repetitive motions.
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