Human Anatomy and Physiology : Help with Evaluation Methods for Bones
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Example Questions
Example Question #1 : Help With Evaluation Methods For Bones
The fulcrum test and the patellar-pubic percussion test are tests for fractures of which bone?
Ischium
Ilium
Pubis
Patella
Femur
Femur
These are tests for femur fractures, specifically for fractures of the femoral neck. The fulcrum test involves having the patient sit with his/her affected leg hanging off the edge of a surface, then the examiner will place his/her forearm under the shaft of the femur. If the patient experiences pain in the femur upon applying downward force on the knee, the result is positive, and the patient has fractured the femur. The patellar-pubic percussion test involves the use of a stethoscope on the lateral aspect of the pubic symphysis of the leg being examined. The patella is tapped with the tip of a finger or a tuning fork. Normally, there will be a distinct, loud sound that is caused by each tapping; if the sound is dissipated or muffled, this indicates a femoral fracture.
Example Question #2 : Help With Evaluation Methods For Bones
A patient comes into the emergency room (ER), complaining of pain in his knee. You think the patient might have a fracture, and may need an x-ray, but you are uncertain. Which of the following findings would warrant an x-ray of the patient’s knee?
The patient is younger than 55
He is unable to take more than 4 steps with his injured leg
He has bruising around his patella
He is unable to flex his knee past
He has tenderness at his tibial tuberosity
He is unable to take more than 4 steps with his injured leg
Inability to take more than 4 steps with the injured leg is one of the criteria of the is used order x-rays for suspected fractures around the knee complex, per the Ottawa knee rules. The other criteria are as follows: isolated tenderness at the patella or tenderness at the fibular head or patient age greater than 55 or inability to flex the knee past 
Example Question #3 : Help With Evaluation Methods For Bones
The closed fist percussion sign would be useful for diagnosing which pathology?
Femoral neck fracture
Acetabular labrum tear
Vertebral compression fracture
Glenoid labrum tear
Vertebral compression fracture
Although diagnostic imaging is needed to conclusively to rule in a fracture, the closed fist percussion sign has good diagnostic value in detecting vertebral compression fractures. Given that this tests involves hitting a patient in the back, clinicians may be hesitant to use this test. In such cases, the supine sign (increased pain with lying supine) can also be used to screen for vertebral compression fractures.
Example Question #4 : Help With Evaluation Methods For Bones
Which of the following diagnostic criteria is not used to screen for fractures?
Ottawa ankle rules
Amsterdam wrist rules
Ottawa knee rules
Well's criteria
Well's criteria
As their names suggest, the Ottawa knee and ankle rules, and the Amsterdam wrist rules are used to determine which patients should receive x-rays for suspected ankle, knee, and wrist fractures respectively. Well's criteria are used to screen for pulmonary embolisms (PEs) and deep vein thromboses (DVTs). It should be noted that there are distinct Well's criteria for PEs and DVTs.
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