musculoskeletal

Question 1

Middle-aged any-race male diabetic or injecting drug user with acute onset, poorly circumscribed area of cutaneous erythema, tense edema and severe pain out of proportion to physical findings, along with fever and leukocytosis

Answer 1

Necrotzing fasciitis (“flesh-eating bacteria”)

Question 2

Middle-aged any-race male diabetic (or trauma patient) with acute onset, well circumscribed area of discolored skin, tense edema, bullae, crepitus and severe pain, along with fever and leukocytosis

Answer 2

Clostridial myonecrosis (gas gangrene)

Question 3

Any age, any sex, any race patient with trauma, hemorrhage or edema of intact anatomic compartment, pain out of proportion to physical findings, deep pain with manipulation, especially with reperfusion

Answer 3

Acute compartment syndrome

Question 4

Any age, any sex, any race patient with trauma, hemorrhage or thrombosis and the five P’s, pain, pulselessness, pallor, paresthesia and paralysis

Answer 4

Acute loss of blood supply

Question 5

Middle-aged white female with obesity, low back pain radiating into buttock and posterior leg, altered urinary sensation, loss of urge to void, poor urinary stream and decreased perineal sensation

Answer 5

Cauda equina syndrome

Question 6

Middle-aged any sex any race diabetic with back pain, fever and decreased sensation and strength below some spinal level of innervation

Answer 6

Spinal epidural abscess

Question 7

Middle-aged any race male with trauma, toxin (illicit drugs or alcohol) or extreme overexertion and acute onset of muscle pain and weakness, reddish-brown urine and very high creatine kinase

Answer 7

Rhabdomyolysis

Question 8

Middle-aged any sex any race patient with recurring low back pain, especially if radiates into buttock and down the back of the leg (sciatica), and straight leg raise causes pain of sciatica

Answer 8

Lumbar disc herniation

Question 9

Elderly white female with sudden onset hip pain and fall, unable to bear weight on the leg, which may be externally rotated, abducted and slightly shortened

Answer 9

Hip fracture

Question 10

Young any race female athlete who lands awkwardly on feet from a jump, feels a pop in the knee and then pain, may be able to bear weight, but has abnormal anterior mobility of tibia (anterior drawer sign or Lachman test)

Answer 10

ACL tear

Question 11

Any age any sex any race patient whose ankle is inverted walking or running, with pain, edema and subcutaneous hemorrhage laterally

Answer 11

Ankle sprain