\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{bee.f (bee.f)}
\pdfinfo{
  /Title (5002-case-8.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 8 Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{017075}
\definecolor{LightBackground}{HTML}{EFF6F6}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 8 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38540/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 13th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.


\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- 57 y.o. female\{\{nl\}\}- Back pain; T/L junction\{\{nl\}\}- Onset 1 day ago whilst bending forward cleaning the bath\{\{nl\}\}- Sudden onset, excruciating pain} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{- Severe pain\{\{nl\}\}- Nauseous w/ pain\{\{nl\}\}- 10/10 onset\{\{nl\}\}- Now 5/10\{\{nl\}\}- Constant pain \& nausea} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{AF:}} Any movement, painful to lie on back, couldn't sleep duet pain at night\{\{nl\}\}{\bf{RF:}} Rest, ice, gentle walking, paracetamol \& ibuprofen\{\{nl\}\}{\bf{AA:}} Movement; especially sudden} \tn 
% Row Count 10 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Extras}}\{\{nl\}\}- Chiro treatment for previous "rotator cuff" pain, treatment helped w/ US \& home exercises, no manipulation\{\{nl\}\}- IBS (upset tummy \& nerves)\{\{nl\}\}- Dizziness, GP diagnosed w/ vertigo\{\{nl\}\}- Menopause 8 yrs ago (49)\{\{nl\}\}- Osteoporosis; diagnosed 5 yrs ago\{\{nl\}\}- Prescribed medication (doesn't recall name) \& calcium but doesn't take them (worried about side effects)\{\{nl\}\}- Mother: osteoporosis} \tn 
% Row Count 19 (+ 9)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Examination Findings cal}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{General observations}}\{\{nl\}\}- Mild swelling over T/L junction\{\{nl\}\}- Appears tired \& frail\{\{nl\}\}- All movements guarded} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Gait}}\{\{nl\}\}- Extremely guarded} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Unable to lie supine due to pain} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Tx \& Lx ROM}}\{\{nl\}\}- Unable to perform due to pain} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Closed fist percussion}}\{\{nl\}\}- {\bf{Purpose:}} symptomatic (sharp, sudden pain) compression fracture\{\{nl\}\}- {\bf{Findings:}} pain over T/L junction} \tn 
% Row Count 10 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Percussion}}\{\{nl\}\}- Pain over T11-12 \& L1} \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Vibration}}\{\{nl\}\}- No pain\{\{nl\}\}- Discomfort over the T/L area} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Palpations}}\{\{nl\}\}- Generalised pain \& tenderness over Tx spine\{\{nl\}\}- Very TTP over T10-L2} \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Working diagnosis}}\{\{nl\}\}- Compression fracture of the Tx spine\{\{nl\}\}- Why a 57 y.o. would get a fracture so easily w/ such minimal trauma?} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{1.}} Extremely osteoporotic: due to bone density loss, fracture complications, multiple fractures, underlying health conditions (chronic RA, hyperthyroidism, GI disorders, prolonged use of steroids), hormonal factors (decline of oestrogen aka menopause, low testosterone), lack of treatment, age\{\{nl\}\}{\bf{2.}} Pathological fracture (osteoporosis, cancer, bone infection, Paget's disease, osteogenesis imperfect, osteomalacia, genetic disorder, nutritional deficiencies) \& there's underlying, undiagnosed cause for bone weakness} \tn 
% Row Count 14 (+ 11)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{How does compression fracture affect her MSK management?}}\{\{nl\}\}- Avoid high-velocity or high-impact spinal manipulations\{\{nl\}\}- Soft tissue \& lifestyle focus\{\{nl\}\}- Combined management plan w/ secondary healthcare professional} \tn 
% Row Count 19 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{What is vertigo?}}\{\{nl\}\}- Dizziness characterised by a sensation of spinning, swaying, \& tilting when standing still\{\{nl\}\}- Possible issue w/ inner ear (balance), brain, sensory pathways} \tn 
% Row Count 23 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{What other examinations could have been done?}}\{\{nl\}\}- Assess for gait, balance \& mobility (for fall prevention purposes to minimise further injury to osteoporotic pt)\{\{nl\}\}- Sensory examination (pt cannot lie supine due to pain ∴ try lying down)\{\{nl\}\}- Referral for MRI} \tn 
% Row Count 29 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Osteoporosis:}}\{\{nl\}\}⏺ {\bf{{\emph{Sx \& Ssx:}}}}\{\{nl\}\}- Height loss\{\{nl\}\}- Back pain\{\{nl\}\}- Fractures\{\{nl\}\}- Stooped posture\{\{nl\}\}- Decreased grip strength\{\{nl\}\}⏺ {\bf{{\emph{Treatment:}}}}\{\{nl\}\}- Routine assessment (not required if \textgreater{}40 y.o.)\{\{nl\}\}- Avoid high-velocity or high-impact spinal manipulations\{\{nl\}\}- Soft tissue \& lifestyle focus\{\{nl\}\}- Refer to GP for osteoporosis education / investigations in younger pts\{\{nl\}\}⏺ {\bf{{\emph{Management}}}} (if risk assessment suggest significant fracture risk):\{\{nl\}\}- Refer for imaging investigations \& medication advice\{\{nl\}\}- Lifestyle advice: no smoking, alcohol consumption \textless{}2 units / day\{\{nl\}\}- Food/diet: calcium \& vitamin D intake\{\{nl\}\}- Fall prevention (strength \& balance training)\{\{nl\}\}⏺ {\bf{{\emph{Why this pt so bad?}}}}\{\{nl\}\}- Drop in oestrogen from menopause (causing bone loss, increasing risk of osteoporosis)\{\{nl\}\}- Pt not taken their medication\{\{nl\}\}- Underlying pathological cause?} \tn 
% Row Count 19 (+ 19)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Different types of fractures in the Tx spine:}}\{\{nl\}\}- Compression/anterior wedge (most common; due to osteoporosis; post-menopausal, \textgreater{}50 y.o.)\{\{nl\}\}- Burst (axial compression; can cause neurological deficits)\{\{nl\}\}- Flexion-distraction (due to extreme forward bending force {[}RTA{]}; can cause posterior ligament tear)\{\{nl\}\}- Pathological (caused by infections/tumours; full vertebral collapse)} \tn 
% Row Count 27 (+ 8)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Rotator cuff disorder}} (supra/infraspinatus, teres minor, subscapularis - SITS):\{\{nl\}\}- {\bf{Rotator cuff tendinitis:}} inflammation of the tendons of the rotator cuff muscles; typically caused by overuse/repetitive motions\{\{nl\}\}- {\bf{Rotator cuff tear:}} tear in one or more rotator cuff tendons, can be partial or complete\{\{nl\}\}- {\bf{Rotator cuff impingement:}} rotator cuff tendons \& bursa compression\{\{nl\}\}- {\bf{Rotator cuff bursitis:}} inflammation of the bursa around the rotator cuff tendons\{\{nl\}\}⏺ {\bf{{\emph{Presentation:}}}}\{\{nl\}\}- Pain in shoulder: especially lifting or reaching overhead\{\{nl\}\}- Weakness in the shoulder, making it difficult to lift or carry objects\{\{nl\}\}- Limited ROM shoulder\{\{nl\}\}- Clicking/popping when moving shoulder\{\{nl\}\}- Swelling/tenderness in shoulder\{\{nl\}\}** Adhesive capsulitis (frozen shoulder) might present w/ Sx \& Ssx suggestive of rotator cuff disorder, but in this condition passive ROM is limited as well**\{\{nl\}\}⏺ {\bf{{\emph{Diagnosis:}}}}\{\{nl\}\}- Medical Hx, physical exam: AF, RF, ROM, strength, tenderness? swelling? deformity?\{\{nl\}\}- Referral for imaging: MRI (gold standard), US, x-ray, CT\{\{nl\}\}⏺ {\bf{{\emph{Management:}}}}\{\{nl\}\}- If acute rotator cuff tear caused by trauma is suspected (trauma, pain, \& weakness), refer!\{\{nl\}\}- Rest (acute phase)\{\{nl\}\}- Referral for corticosteroid injection\{\{nl\}\}- Paracetamol (if not helping, NSAIDs)\{\{nl\}\}- Stretching \& strengthening of the rotator cuff \& scapular muscles\{\{nl\}\}- Manual therapy / mobilisation} \tn 
% Row Count 57 (+ 30)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Difference between IBS \& IBD}}\{\{nl\}\}⏺ {\bf{{\emph{Irritable bowel syndrome (IBS):}}}}\{\{nl\}\}- Functional GI disorder affecting colon\{\{nl\}\}- Not associated w/ inflammation or damage to intestinal lining\{\{nl\}\}- {\bf{Presentations:}} recurrent abdominal pain/discomfort, changes in bowel habits (diarrhoea, constipation)\{\{nl\}\}- {\bf{Diagnosis:}} through Sx \& exclusion of other conditions (no specific diagnostic tests)\{\{nl\}\}- {\bf{Management:}} dietary modifications (avoid caffeine, alcohol, spice, fatty foods), medications, stress management\{\{nl\}\}⏺ {\bf{{\emph{Inflammatory bowel disease (IBD):}}}}\{\{nl\}\}- Chronic inflammatory disorder affecting whole digestive tract (inc. Crohn's \& Ulcerative Colitis)\{\{nl\}\}- Inflammation \& damage to intestinal lining\{\{nl\}\}- {\bf{Presented:}} abdominal pain, diarrhoea, rectal bleeding\{\{nl\}\}- {\bf{Diagnosis:}} medical Hx, physical exam, blood tests, imaging tests (endoscopy or colonoscopy)\{\{nl\}\}- {\bf{Management:}} medication (corticosteroids, immunodulators), nutritional support, surgery, lifestyle changes (exercise, avoid smoking \& stress)} \tn 
% Row Count 21 (+ 21)
% Row 4
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Menopause \& treatment}}\{\{nl\}\}- Ovaries stop producing eggs, levels of hormones (oestrogen \&progesterone) decrease\{\{nl\}\}- Can contribute to osteoporosis development (oestrogen regulates bone turnover {[}oestrogen drops = bone turnover increases = less bone density/mass{]})\{\{nl\}\}- {\bf{Sx \& Ssx:}} hot flashes, night sweats, vaginal dryness, mood changes, sleep disturbances\{\{nl\}\}- {\bf{Treatment:}} hormone replacement therapy (HRT {[}slows down bone turnover{]}), non-hormonal medications (e.g. SSRIs {[}reduce hot flashes \& improve mood{]}), lifestyle (regular exercise, reducing stress, avoid triggers {[}caffeine or alcohol{]})} \tn 
% Row Count 34 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}