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Target Audience Goal Learning Objectives Credits www.medscape.org This article is a CME certified activity. To earn credit for this activity visit: http://www.medscape.org/viewarticle/749267 CME Information CME Released: 09/09/2011; Reviewed and Renewed: 09/30/2013; Valid for credit through 09/30/2014 Target Audience This activity is intended for clinicians in primary care, orthopaedic surgery, and pediatrics. Goal The goal of this activity is to reinforce and highlight common concepts, situations, and presentations that clinicians will encounter on a regular basis in order to provide supportive continuing education that illustrates real-world conditions and situations. Learning Objectives Upon completion of this activity, participants will be able to: 1. Describe the typical presentation and management of a commonly encountered medical condition in clinical practice Credits Available Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Accreditation Statements For Physicians Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Medscape, LLC staff have disclosed that they have no relevant financial relationships. Contact This Provider For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected] Instructions for Participation and Credit There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test. Follow these steps to earn CME/CE credit*: 1. Read the target audience, learning objectives, and author disclosures. 2. Study the educational content online or printed out. 3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming. You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker. *The credit that you receive is based on your user profile. Hardware/Software Requirements To access activities, users will need: A computer with an Internet connection. Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser. Adobe Flash Player and/or an HTML5 capable browser may be required for video or audio playback. Occasionally other additional software may be required such as PowerPoint or Adobe Acrobat Reader. Faculty and Disclosures As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Author(s) Zoran Rajković, MD Primarius, Chief of Emergency Department; Head of the Traumatology and Orthopedic Surgery Department, Zabok General Hospital, Zabok, Croatia Disclosure: Zoran Rajković, MD, has disclosed no relevant financial relationships. Dr. Rajković does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States. Dr. Rajković does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States. Dino Papeš, MD Staff Physician, Department of Surgery, Zabok General Hospital, Zabok, Croatia Disclosure: Dino Papeš, MD, has disclosed no relevant financial relationships. Dr. Papeš does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States. Dr. Papeš does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States. Editor(s) Andréa B. Lese, MD Co-Director of Clinical Review, Medscape Reference Case Presentations; Resident, Department of Orthopedic Surgery and Rehabilitation, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut Disclosure: Andréa B. Lese, MD, has disclosed no relevant financial relationships. Jonathan N. Grauer, MD Associate Professor, Yale University School of Medicine; Co-Director, Orthopedic Spine Service, Yale-New Haven Hospital, New Haven, Connecticut Disclosure: Jonathan N. Grauer, MD, has revealed financial relationships with: Stryker; Medtronic, Inc.; Regeneration Technologies; Smith & Nephew; DePuy Orthopaedics Justin A. Siegal, MD MRI Section Head, Radiology, Virginia Mason Medical Center, Seattle, Washington Disclosure: Justin A. Siegal, MD, has disclosed no relevant financial relationships. Bruce Buehler, MD Professor, Department of Pediatrics, Pathology and Microbiology; Executive Director, Hattie B. Munroe Center for Human Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha Disclosure: Bruce Buehler, MD, has disclosed no relevant financial relationships. Craig A. Goolsby, MD Staff Physician, Department of Emergency Medicine, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas Disclosure: Craig A. Goolsby, MD, has disclosed no relevant financial relationships. Luis M. Soler, BA Editor, Medscape Reference, New York, NY Disclosure: Luis M. Soler, BA, has disclosed no relevant financial relationships. CME Reviewer(s) Nafeez Zawahir, MD CME Clinical Director, Medscape, LLC Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships. From Medscape CME Case Presentations A Teenage Athlete With a Painful Knee CME Zoran Rajković, MD; Dino Papeš, MD CME Released: 09/09/2011; Reviewed and Renewed: 09/30/2013; Valid for credit through 09/30/2014 Background Figure 1. Enlarge Figure 1. A 16-year-old boy is examined in the emergency department (ED) for acute-onset left knee pain and swelling. Two months ago, he suffered a patellar dislocation that was treated with rest, cryotherapy (ice), elevation, and immobilization. He recovered completely from this episode. The rest of his medical and surgical history is unremarkable. The family history is negative for knee problems or dislocations. He takes no medications on a regular basis and has no allergies. He is a high school student and a semiprofessional soccer player. This episode of knee pain started a week ago following a soccer match. The knee is moderately swollen and painful. At the onset of symptoms, the patient treated himself with cryotherapy, rest, and an elastic bandage, with mild improvement; however, the symptoms reappeared 3 days ago and have progressively worsened, prompting this visit to the ED. On examination, he appears to be in good condition. He is awake, alert, and in no acute distress. His vital signs show him to be afebrile, with a blood pressure of 125/75 mm Hg, a pulse of 75 beats/min, a respiratory rate of 15 breaths/min, and an oxygen saturation of 98% on room air. His skin is slightly pale but with normal skin turgor. Examination of his oral cavity shows dry mucus membranes. He has normal heart sounds. Auscultation reveals clear lungs without wheezes, rhonchi, or rales. The abdomen is soft and without tenderness, distention, masses, or hernias. Examination of the left hip is unremarkable, with normal range of motion noted. Examination of the left knee shows swelling with positive patellar ballottement indicating the presence of an effusion. The patient is holding his knee in mild flexion. On testing the range of motion, both terminal extension and flexion cannot be tested due to pain. Physical examination tests of the meniscus and ligaments are negative. The patient's workup includes a complete blood count (CBC), which is normal. In addition, x-rays of the knee are obtained (Figure 1), and an arthrocentesis is performed, yielding 30 mL of old blood. This is sent for cell count and culture,
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