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1. Calf pain, oedema and venous
distension is most likely to be
a) Diabetic neuropathy.
d) Shin splints.
2. Burning pain with paraesthesia
and sensory loss is most likely to be
a) Diabetic neuropathy
d) Shin splints.
3. Stress fractures are:
a) More common in men.
b) Likely to cause associated erythema.
c) Usually caused by overuse or bone
d) Caused by ischaemia of deep
4. Corticosteroids may delay fracture
healing due to:
a) Inhibition of prostaglandin synthesis.
b) Anti‐inflammatory effects.
c) Immunosuppressant effects.
5. Of the below, which option would
NOT be appropriate advice to
provide to a doctor on anti-
inflammatory medicines and
a) Short term NSAID use is always
associated with delayed fracture
b) Prolonged use of corticosteroids can
lead to osteoporosis and increased
c) Administration of NSAIDs in animals
(not short‐term) has been shown to
cause delayed fracture healing.
d) COX‐2 ‐inhibitors should be avoided
in patients who have a high risk of
delayed fracture healing.
• Stress fractures are more common in
women and can cause pain, swelling
• NSAIDS and corticosteroids may reduce
fracture healing rates.
• Pharmacists should advise such
patients to avoid long term treatment
with over the counter NSAIDs for pain
relief, as these may delay fracture
• It is essential that patients with a
suspected stress fracture be referred to
a medical practitioner for review and
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Sports Exerc 2002;34(1):32–40.
3. Sports Medicine Australia. Shin pain. A guide to prevention
and management.2010; At: http://sma.org.au/wp-content/
4. Miller T, Layzer R. Muscle cramps. Muscle Nerve 2005;32:431–
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7. State Government of Victoria – Better health channel: Deep
vein thrombosis. 2011. At:www.betterhealth.vic.gov.au/bhcv2/
8. Tesfaye S, Selvarajah D. Advances in the epidemiology,
pathogenesis and management of diabetic peripheral
neuropathy. DiabetesMetab Res Rev 2012; 8(1):8–14 .
9. Mayo Clinic . Stress fractures.2010;At: www.mayoclinic.com/
10. Patel D, Roth M, Kapil N. Stress fractures: Diagnosis, treatment,
and prevention. Am Fam Physician 2011;83(1):39–46.
11. Gaston M, Simpson A. Inhibition of fracture healing. J Bone
Joint Surg 2007; 89-B(12):1553–60 .
12. Yates J, Shah S, Blackwell J. Do NSAIDs impede fracture
healing? J Fam Pract 2011;60(1):41–2 .
13. Geusens P, Emans P, de Jong JA, van den Bergh J. NSAIDs
and fracture healing. Current opinion in rheumatology
14. Ippokratis P, Georgouli T, Calori G, Giannoudis P. Do Non-
steroidal anti-inflammatory drugs affect bone healing? A
critical analysis. Scientific World Journal 2012;1–14 .
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