WBR0127

Author	PageAuthor::Mahmoud Sakr M.D.
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Surgery
Sub Category	SubCategory::Surgery
Prompt	Prompt::25 y/o male patient is referred to you from his primary care physicians office for a evaluation of a possible meniscal tear of the right knee. Which of the following tests should you perform first:
Answer A	AnswerA::Lachman’s test
Answer A Explanation	AnswerAExp::Lachman’s test is used to detect an injury to the anterior cruciate ligament. The drawer tests are used to test rupture of the cruciate ligaments in the knee.
Answer B	AnswerB::Anterior drawer test
Answer B Explanation	AnswerBExp::The drawer tests are used to test rupture of the cruciate ligaments in the knee.
Answer C	AnswerC::Posterior drawer test
Answer C Explanation	AnswerCExp::The drawer tests are used to test rupture of the cruciate ligaments in the knee.
Answer D	AnswerD::Valgus stress test
Answer D Explanation	[[AnswerDExp::The Valgus stress test is a test for ligament damage. It involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus. If the knee is seen to open up on the medial side, this is indicative of medial collateral ligament damage and may also indicate capsular or cruciate ligament laxity.]]
Answer E	AnswerE::Mc Murray’s test.
Answer E Explanation	[[AnswerEExp::The McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee. It is a rotation test for demonstrating torn cartilage of the knee. A tear in the meniscus may cause a pedunculated tag of the meniscus, which may become jammed between the joint surfaces. To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole with the other hand. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress in order to identify a valgus deformity. The other hand rotates the leg externally while extending the knee. If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus. Likewise the medial knee can be stabilized in a fully flexed position and the leg internally rotated as the leg is extended. A tag, caused by a tear will cause a palpable or even audible click on extension of the knee. A positive test indicates a tear of the lateral meniscus.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::The McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee. It is a rotation test for demonstrating torn cartilage of the knee. A tear in the meniscus may cause a pedunculated tag of the meniscus, which may become jammed between the joint surfaces. To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole with the other hand. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress in order to identify a valgus deformity. The other hand rotates the leg externally while extending the knee. If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus. Likewise the medial knee can be stabilized in a fully flexed position and the leg internally rotated as the leg is extended. A tag, caused by a tear will cause a palpable or even audible click on extension of the knee. A positive test indicates a tear of the lateral meniscus. Lachman’s test is used to detect an injury to the anterior cruciate ligament. The drawer tests are used to test rupture of the cruciate ligaments in the knee. The Valgus stress test is a test for ligament damage. It involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus. If the knee is seen to open up on the medial side, this is indicative of medial collateral ligament damage and may also indicate capsular or cruciate ligament laxity. Educational Objective: References: ]]
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