UWORLD

Question 1

nasal congestion, epistaxis, headache, cranial nerve palsies, serous otitis media, spread to cervical lymph nodes and non tender neck mass…dx and association with what?

Answer 1

nasopharyngeal carcinoma associated with EBV reactivation

Question 2

superficial unilateral hip pain in adult exacerbated by external pressure to upper lateral thigh

Answer 2

trochanteric busitis

Question 3

common complication of scaphoid fracture

Answer 3

osteonecrosis/avascular necrosis because blood supply enters at distal pole and flows proximally

nonunion of fracture also

may not initially show up on xray so stabilize with thumb spica and

Question 4

repetitive arm movements causing subacute pain on abduction associated with impingement syndrome

Answer 4

rotator cuff tendonopathy

Question 5

anterior knee pain, tenderness, erythema, localized swelling common in occupations of repetitive kneeling…dx and common assocation

Answer 5

prepatellar bursitis

staph aureus

Question 6

acute knee pain with “catching” or reduced range of motion…dx and treatment

Answer 6

meniscal tear…dx with MRI and surgery advised in younger patients with persistent pain

Question 7

stress fracture due to repeptitive activity on 2,3,4 metatarsals vs 5th

Answer 7

middle ones rest and analgesics

5th = increased risk of nonunion and more aggressive treatment

Question 8

respiratory distress, neurologic signs (confusion/visual field defects), petechial rash usually after fracture, pancreatitis, or orthopedic surgery

Answer 8

fat embolism syndrome

Question 9

full thickness burn with circumferential eschar formation…what to watch out for

Answer 9

acute compartment syndrome

Question 10

soft irregular mass in the testis that increases in size with standing and valsalva,

Answer 10

varicocele (more common on left side due to compression of left renal vein by SMA leading to retrograde stasis and valve impcompetence and dilation into spermatic vein

Question 11

tests for medial collateral ligament tear and medial meniscus tear

Answer 11

MCL - laxity in valgus stress testing, manage with RICE for most cases…dx with MRI
medial meniscus - thallsy mcmurray test, internal rotation produces catching or pain

Question 12

danger of using succinylcholine

Answer 12

depolarizing neuromuscular blocker = severe hyperkalemia nd cardiac arrythmia

Question 13

adolescent presents with fever, pharyngeal pain, earache deviated uvula, muffled voice, jaw muscle spasm (trismus)

Answer 13

peritonsillar abcess…treat with I and D plus antibiotics to cover group A strep and respiratory anaerobes

Question 14

post thyroidectomy, patient develops muscle cramps, anxiety, poor sleep, prolonged QT, NORMAL RENAL FUNCTION

Answer 14

hypocalcemia and hyperphosphatemia due to post surgical hypoparathyroidism

Question 15

hypotension, vomiting, abdominal pain, fever post op triggered by surgery in patient with cushingoid features

Answer 15

acute adrenal insufficiency….treat with hydrocortisone or dexmeth with lots of fluids

Question 16

impaired strength and pain/temperature in upper extremities…usually due to whiplash injury

Answer 16

syringomelia….enlargement of central canal of spinal cord due to CSF retention

Question 17

upper and lower motor neuron deficits with no loss of sensory function…twitching muscle weakness, cramping

Answer 17

ALS

Question 18

anterior shoulder dislocations can damage what nerve

Answer 18

axillary nerve (cannot abduct shoulder, and numbness over lateral shoulder)

Question 19

humeral mid shaft fractions can damage what nerve

Answer 19

radial nerve (cannot extend wrist and digits)

Question 20

fractures of medial epicondyle of humurus or deep lacerations of anterior wrist can damage what nerve

Answer 20

ulnar nerve (claw hand or sensory loss in middle hand)

Question 21

biceps reflex mediated by what

Answer 21

c5 c6 musculocutaneous nerve

Question 22

flaccid paralysis of lower extremity, UMN signs of spasticity and hyperreflexia, bowel and bladder dysfunction, preserved vibraiton and proprioceptions, loss of pain and temperature,

Answer 22

anterior cord syndrome from infarction fo spinal cord and decreased blood flow through anterior spinal artery
can be complication of thoracic aortic aneurysm repair

Question 23

pain and weakness of abduction at shoulder….patient fails drop arm test (cannot lower arm smoothly)

Answer 23

rotator cuff tear (usu. supraspinatus), confirm dx with MRI

Question 24

extra axial well circumscribed dural based pass that is partially calficfied…dx and treatment

Answer 24

meningioma…SURGICAL RESECTION

Question 25

multiple ring enhacing lesions at grey white junction (intra axial)

Answer 25

brain mets…CT rest of body for possible source

Question 26

short bursts of excruciating pain along front of face

Answer 26

trigeminal neuralgia (tic douloreaux)

Question 27

triad of bilateral hip, thigh, and buttock claudication, impotence and symmetric atrophy of bilateral lower extremities

Answer 27

aortoiliac occlusion (leriche syndroem)

Question 28

pain out of proportion to injury, pain on passive stretch, rapidly increasing swelling and tension, paresthesias

Answer 28

compartment syndrome
differentiated from arterial embolus (6 Ps)
and DVT (usually asymptomatic and not very very painful)

Question 29

few hours after cardiac cath, sudden hemodynamic instability and ipsilateral flank/back pain…dx and mgmt

Answer 29

retroperitoneal hematoma (complication of cardiac cath) dx confirmed with non contrast CT scan abd pelvis or abdominal US

treat with bed rest, intensive monitoring, IV fluids or transfusion

Question 30

post sternotomy, (less than 14 days), fever, tachycardia, chest pain, leukocytosis, sternal wound drainage, widened mediastinum

Answer 30

acute mediastiniitis, possible complication of cardiac surgery secondary to intraoperative wound contamination…treat with surgical debridement and antibiotics