I need a response to this assignment three references zero plagiarism SUBJECTIVE DATA :  CC: “Complains of dull pain in both of his knees” HPI: The 15-year-old Caucasian male complains of dull pain in bilateral knees. Complains of catching under unilateral or both knees. Onset gradual but increasing over time, especially in last two weeks. Dull knee pain and catching sensation behind the right knee cap. Rarely, notices the clicking in the left knee but continues to have less pain. Pain is worse with exercise and activity. Pain eases with rest, elevation and ice. Patient rates the right knee at 8/10 and left knee 6/10 PMI: Tonsillectomy at 5-year-old, Flu vaccination 2019 season, HPV immunization completed 2019, Tetanus 2019, hospitalizations CURRENT MEDICATIONS: None SH: RR is a middle school student at Austin Middle School. He plays football and basketball with the school. He is a nonsmoker and his household members are nonsmoking. He does not use alcohol and his father drinks 1-2 drinks/monthly and his mother does not drink. He lives in the house with both his parents. He makes good grades.  ROS GENERAL: no weight loss, no chills, no fever, no fatigue. CV: Negative for palpitations or flutters, negative for hypertension. No edema noted to bilateral upper extremities. No edema to lower extremities.  GI: No nausea/ vomiting no diarrhea, no stomach pain. PULMONARY: Denies cough, shortness of breath or labored breath. MUSCULOSKELETAL: Normal gait, ambulates without assistance or limb. NEUROLOGICAL: No headaches, dizziness, syncope, paralysis, ataxia, and denies numbness and tingling in the extremities. Denies seizures. Denies trauma. PSYCHIATRIC: No depression or anxiety OBJECTIVE DATA : VITALS: BP 120/68, P 86, RR 18, O2% 95%, 5’8”, 140#, BMI 21.3 GENERAL: Patient is a well-nourished 15-year-old Caucasian male. He is pleasant and cooperative. Complains of dull pain to knees. Right>left knee has catching sensation CV: Heart sounds auscultated S1 and S2, no S3, no murmurs, no gallops noted. GI: Flat abdomen, Bowel sounds normoactive in all 4 quadrants. No masses palpated. PULMONARY: Chest symmetrical, unlabored breathing, Clear lung sounds in all fields, Percussion tympanic in all fields. MUSCULOSKELETAL: Abnormal gait with limp favoring the right. Ambulates without assistance. No neck or back pain. Full ROM. Symmetrical bilateral upper extremities, no joint edema of pain. Full ROM. Full strength bilateral 5/5. Bilateral hip flexion 90 without pain, good strength 5/5. Right knee appears to have +1 edema to lateral aspect of knee and no bruising. Right knee is tender with palpation at the popliteal and tibiofemoral joint. Right knee is negative for the McMurray test. Negative Thessaly test to right knee. Right knee is positive at the Q angle 15 with clicking. Negative leg strength 4/5. Negative Thessaly’s test. Pain is passive and controlled range of motion. The left knee has no edema noted. Left knee has full ROM with .

1. I need a response to this assignment
three references
zero plagiarism
SUBJECTIVE DATA
:
CC: “Complains of dull pain in both of his knees”
HPI: The 15-year-old Caucasian male complains of dull pain in
bilateral knees. Complains of catching under unilateral or both
knees. Onset gradual but increasing over time, especially in last
two weeks. Dull knee pain and catching sensation behind the
right knee cap. Rarely, notices the clicking in the left knee but
continues to have less pain. Pain is worse with exercise and
activity. Pain eases with rest, elevation and ice. Patient rates the
right knee at 8/10 and left knee 6/10
PMI: Tonsillectomy at 5-year-old, Flu vaccination 2019 season,
HPV immunization completed 2019, Tetanus 2019,
hospitalizations
CURRENT MEDICATIONS: None
SH: RR is a middle school student at Austin Middle School. He
plays football and basketball with the school. He is a nonsmoker
and his household members are nonsmoking. He does not use
alcohol and his father drinks 1-2 drinks/monthly and his mother
does not drink. He lives in the house with both his parents. He

2. makes good grades.
ROS
GENERAL: no weight loss, no chills, no fever, no fatigue.
CV: Negative for palpitations or flutters, negative for
hypertension. No edema noted to bilateral upper extremities. No
edema to lower extremities.
GI: No nausea/ vomiting no diarrhea, no stomach pain.
PULMONARY: Denies cough, shortness of breath or labored
breath.
MUSCULOSKELETAL: Normal gait, ambulates without
assistance or limb.
NEUROLOGICAL: No headaches, dizziness, syncope, paralysis,
ataxia, and denies numbness and tingling in the extremities.
Denies seizures. Denies trauma.
PSYCHIATRIC: No depression or anxiety
OBJECTIVE DATA
:
VITALS: BP 120/68, P 86, RR 18, O2% 95%, 5’8”, 140#, BMI
21.3
GENERAL: Patient is a well-nourished 15-year-old Caucasian
male. He is pleasant and cooperative. Complains of dull pain to
knees. Right>left knee has catching sensation
CV: Heart sounds auscultated S1 and S2, no S3, no murmurs, no
gallops noted.

3. GI: Flat abdomen, Bowel sounds normoactive in all 4 quadrants.
No masses palpated.
PULMONARY: Chest symmetrical, unlabored breathing, Clear
lung sounds in all fields, Percussion tympanic in all fields.
MUSCULOSKELETAL: Abnormal gait with limp favoring the
right. Ambulates without assistance. No neck or back pain. Full
ROM. Symmetrical bilateral upper extremities, no joint edema
of pain. Full ROM. Full strength bilateral 5/5. Bilateral hip
flexion 90 without pain, good strength 5/5. Right knee appears
to have +1 edema to lateral aspect of knee and no bruising.
Right knee is tender with palpation at the popliteal and
tibiofemoral joint. Right knee is negative for the McMurray
test. Negative Thessaly test to right knee. Right knee is positive
at the Q angle 15 with clicking. Negative leg strength 4/5.
Negative Thessaly’s test. Pain is passive and controlled range of
motion. The left knee has no edema noted. Left knee has full
ROM with pain, negative McMurray’s test, negative Thessaly
test. Left knee Q angle at 15 degrees with clicking in knee. The
left knee strength is 5/5. Bilateral ankle is symmetrical. Right
ankle ROM intact, flexion 20 degrees and extension 45 degrees,
strength 5/5. Left ankle ROM intact, flexion 20 degrees and
extension 45 degrees, strength 5/5.
NEURO: Bilateral brachioradialis reflexes 2+ expected,
bilateral triceps reflex 2+ expected, bilateral patellar reflexes
2+ expected, bilateral Achilles reflex 2+ expected. No clonus
noted bilaterally.
DIAGNOSTIC RESULTS: 4-view x-ray of the bilateral knee,
MRI of the bilateral knee without contrast as indicated below.
ASSESSMENT
:

4. Patellar tendinopathy “jumper’s knee”-Overuse and overload to
the patellar tendon. Gradual onset of pain and then becoming
intolerable. Patient’s complain of dull aching pain with clicking
or popping of joint (Dains, Baumann, & Schneibel, 2019, p. 21).
A goniometer is used to measure the center of the patella to
anterior superior iliac spike, the center of patella to tibial
tubercle angle > 10 degrees in males and 15 degrees in females
indicate tendinopathy (Dains, Baumann, & Schneibel, 2019, p.
21).
Osgood-Schlatter disease is an overuse injury and traction
apophysis (Patel & Villalobos, 2017, p. 194). This disease is
seen mostly in adolescent males in the Tanner stage of 2 or 3.
Rapid growth and increased physical activity predispose the
development of the condition. Localized tenderness and pain
with resisted knee extension are an indicator of the disease. 4
view x-rays of the knee are used to diagnose. In an x-ray an
ossicle may show in the fragmentation of the tibial tubercle in
the patellar tendon.
Juvenile Osteochondritis Dissecans-Delamination and localized
necrosis of the subchondral bone with or without the
involvement of the overlying articular cartilage (Patel &
Villalobos, 2017, p. 194). Repetitive microtrauma and local
bone vascular insufficiency may be the cause. The lesion can be
open or closed and stable or unstable (Patel & Villalobos, 2017,
p. 194). Clinical signs develop in the late stages. A patient may
have pain after exercising and swelling. Testing for Wilson’s
sign with the knee flexed at 30 degrees and internally rotated
elicits pain. X-rays of both knees are indicated to compare
healthy knee with a damaged knee. A 2-view with a tunnel view
assists in identifying the lesion. MRI’s assist in determining
the instability of the knee, more notable in adult anatomy (Patel
& Villalobos, 2017, p. 194).

5. Medial Meniscus tear- Patients complain of pain when the
McMurray maneuver test and the Thessaly test is performed.
The McMurray maneuver is to lay the patient supine and
maximally flex knee and hip while externally and internally
rotating the tibia with one hand on the distal end of the tibia
and other hand palpating joint (Dains, Baumann, & Schneibel,
2019, p.19). The Thessaly test is the patient stands in front of
the examiner while holding their arms. The patient stands flat-
footed with one leg and flexes other legs up at 90 degrees. The
weight-bearing leg is flexed at 10 degrees and the patient
rotates on the weight-bearing leg. The test is positive if the pain
is recreated while the leg is maneuvering. MRI of the affected
knee will confirm this diagnosis.
Idiopathic anterior knee pain- The patella-femoral pain refers to
no specific vague anterior knee pain in adolescents. This
condition is the cause of 30% of adolescents' knee pain and
occurs more in females. The condition is caused by
malalignment and abnormal tracking of the patella. It affects
one or both knees in and the patient complains of the knee
locking, catching, or giving way. Examiner assesses abnormal
gait, hip asymmetry, increased lumbar lordosis. Pain is created
with patellar inhibition or the compression test. Also, the
examiner may place with skin marker one dot above the knee,
midline, and a few inches below the knee and flex while looking
for malalignment. This condition is treated conservatively with
strengthening, good mechanics, and muscle control (Patel &
Villalobos, 2017, pp. 191-192).
Assessment of the adolescent male with knee pain
includes asking if he can determine the exact source of the pain.
Questions of the severity, frequency, and length of pain are
important. What does the patient do to relieve the pain? Has the
patient tried to rest, ice, and anti-inflammatories? Is there a

6. specific injury? Additional testing on knees is the ballottement
test for fluid on the knee, anterior and posterior drawer test, and
varus and valgus stress test for unstable ligaments (Ball et al.,
2019). Measure and compare the size of the limbs assists in
diagnosing. Maneuvers, physical examination, and radiological
diagnostic studies assist practitioners in finalizing diagnosis,
however, the information the patient gives us is just as
important.
References
Ball, J.W., Dains, J.E., Flynn, I. A., Solomon, B.S., & Stewart,
R. W. (2019). Musculoskeletal system: Keypoints
. In Seidel’s guide to physical examination: An
interprofessional approach
(9th ed.). St. Louis, MO: Elsevier Mosby
Dains, J.E., Baumann, L. C. & Schneibel, P. (2019). Lower
Extremity Pain.
Advanced Health Assessment and Clinical Diagnosis in Primary
Care
(6th ed.). St.
Louis, MO: Elsevier Mosby
Patel, D., & Villalobos, A. (2017). Evaluation and management
of knee pain in young athletes: overuse injuries of the knee.
Translational Pediatrics
6 (3). (pp.
190-198). Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532199/pdf/tp-
06-03-190.pdf