HY FM from Melhman Medical Exam
Questions And Answers Practice
Questions with Solutions Newest |
Already Graded A+
- Patient has pain in the shoulder when raising the arm to paint a fence; Dx? - Answer-
sub acromial bursitis (caused by repetitive overhead motion)
- Patient has pain in the shoulder when raising the arm above the head; subacromial
bursitis isn't listed; Dx? - Answer- answer = rotator cuff injury
- Patient has pain in the shoulder lying on his or her side in bed; Dx? - Answer- rotator
cuff injury - Positive Gerber lift-off test � subscapularis injury � place dorsum of hand
against lower back so palm faces posteriorly; examiner applies pressure into palm +
asks patient to move hand � if pain, subscapularis injury
- Positive "empty can" or "full can" test; Dx? - Answer- supraspinatus injury � shoulder
is abducted to 90 degrees; then downward pressure is applied; elicits pain when patient
attempts to resist - Resistance to lateral rotation of shoulder elicits pain; Dx? �
Infraspinatus or teres minor injury - "Pitcher injury"? � Infraspinatus injury; but if a
pitcher has positive full or empty can test, use your head � still supraspinatus injury
- Patient has elbow pain after leaning on elbow for long periods; Dx? - Answer-
olecranon bursitis
- Patient has pain in lateral forearm with extension of elbow against resistance; Dx +
Tx? � - Answer- answer = lateral epicondylitis (tennis elbow); Tx = forearm strap
- Patient has pain in medial forearm with flexion of elbow against resistance; Dx + Tx? -
Answer- answer = medial epicondylitis (golfer elbow); Tx = forearm strap
- Wrist fracture + posterior displacement of radius; Dx? - Answer- Colles fracture
("dinner fork deformity") - Wrist fracture + anterior displacement of radius; Dx? � Smith
fracture
- Pain on lateral wrist in breastfeeding woman - Answer- deQuervain tenosynovitis �
answer = immediate steroid injection into the wrist. Dx with Finkelstein test (place thumb
in palm of hand; then wrap four digits over thumb; then ulnar deviate; pain at lateral
wrist with ulnar deviation is + test)
- Lump on the dorsum of hand alongside a tendon; painless; slightly mobile; Dx? -
Answer- ganglion cyst; Tx = needle drainage
,- Proximal ulnar fracture + anterior displacement of radial head; Dx? - Answer-
Monteggia fracture
- Radial shaft fracture + displacement of distal radioulnar joint; Dx? - Answer- Galeazzi
fracture
- Fracture of forearm in child with "bending" of the bone? - Answer- greenstick fracture
bc bone is soft so part of bone remains intact
- Fracture in child abuse - Answer- spiral fracture (from rotational force/twisting of limb);
also posterior rib fractures
- Patient has hip pain lying on his or her side in bed?; Dx? - Answer- trochanteric
bursitis
- Patient has lateral hip pain when palpated, when abducting against resistance, or
when standing on that foot; Dx? - Answer- greater trochanteric syndrome (gluteus
medius or minimus tendonopathy) - Patient has "locking" or "catching" of the knee; Dx?
� meniscal tear
- Patient has pain in the medial knee; Dx? - Answer- anserine bursitis
- Patient has pain in the lateral knee; Dx? - Answer- iliotibial band syndrome
- 44F + pain worse in knee when going down/up stairs or when sitting for long periods of
time + crepitus + BMI 39; Dx? - Answer- answer = patellofemoral syndrome
(patellofemoral pain syndrome); next best step in Mx = "strengthening exercises for
quadriceps muscles" + RICE (rest, ice, compression, elevation).
- 25F + pain in anterior knee on the inferior kneecap + plays basketball + pain initially
worse while playing but past few weeks hurts when done playing as well; Dx? - Answer-
answer = patellar tendonitis (Jumper's knee); next best step in Mx = "strengthening
exercises for quadriceps muscles" + RICE.
- 15M + 5'11" + plays soccer + knee pain; Dx? - Answer- Osgood-Schlatter -
>inflammation of patellar ligament at the tibial tuberosity; occurs in fast-growing, active
teenagers; USMLE wants "repeated avulsion microfractures" as an answer
- Patient has knee pain after spending long periods of time on her knees painting; Dx? -
Answer- prepatellar bursitis
- 32M + pain in anterior knee + fever 100.5F + joint effusion not present; Dx? - Answer-
septic bursitis
,- Any patient with red, warm, tender knee; next best step in Mx + Dx? - Answer- joint
aspiration (arthrocentesis); septic arthritis till proven otherwise
- 6M + viral infection + now has hip pain +/- fever; Dx? - Answer- answer = toxic
synovitis (aka transient synovitis), not septic arthritis � inflammation of the synovial
lining of hip joint; Tx is supportive.
- 6M + suspected JRA + red, hot, painful knee - Answer- must do arthrocentesis to rule
out septic arthritis. If the vignette sounds like classic transient synovitis (affects hip, not
knee), you do not need to do an arthrocentesis.
- 5F + 2-day Hx of limp and left hip pain + a week ago had watery stools and a temp of
100F + pain with weight-bearing and movement + no swelling or erythema; Tx? -
Answer- answer = ibuprofen (toxic synovitis). - Biggest risk factor for septic arthritis �
abnormal joint architecture
- Pt groups most likely to get SA - Answer- prosthetic joints, RA/OA, recent intense
exercise/joint trauma; peds (JRA)
- Kid + recurrent joint pain + anemia - Answer- JRA (anemia of chronic disease)
- Pt group most likely to get SA - Answer- those with prosthetic joints (can't be more
abnormal than fake joint) - Pt with OA or RA has red, warm, tender knee � do
arthrocentesis (septic arthritis) - 17F had kickboxing tournament last weekend + knee is
red, warm, tender � arthrocentesis (SA) - Kid + recurrent knee redness, warmth, pain +
fever � Juvenile rheumatoid arthritis (JRA; Still disease) - Kid + recurrent joint pain +/-
high ESR +/- rash � JRA
- Kid with suspected JRA has sore knee - Answer- must do arthrocentesis to rule out
septic arthritis - Patient has "knock-knees" (i.e., knees touch); Dx? � genu valgum
- Child has bow legs; Dx? - Answer- genu varum � can be seen in rickets
- Patient has lateral thigh pain; Dx? - Answer- meralgia paresthetica � due to lateral
femoral cutaneous nerve entrapment
- 9F + both legs bowed + parents noticed bowing since she started to walk + recently
bowing worse in right leg + x-ray while standing shows collapse of the medial aspect of
the metaphysis of proximal tibia + rest of vignette describes healthy, thriving patient;
Dx? - Answer- answer = tibia vara (Blount disease); wrong answer is rickets; should be
noted that bowing is physiologic age < 2 years; tibia vara.
- 18F + anorexia + runs long distances + has foot pain; Dx? - Answer- metatarsal stress
fracture
, - 42M + diabetes + decreased range of motion of the shoulder in all directions; Dx? -
Answer- adhesive capsulitis, aka "frozen shoulder" � Tx = range-of-motion exercises /
physiotherapy
- 25M + wakes up with heel pain + gradually improves throughout the morning; Dx? -
Answer- plantar fasciitis - 29M + pain in ball of the foot; Dx? � metatarsalgia � overuse
injury / from jumping or sports
- 44F + frequently wears high-heel shoes + painful lump on the underside of her foot
between her third and fourth toes; Dx? - Answer- answer = Morton neuroma � benign
growth of nerve tissue between the 2nd
and 3rd, or 3rd and 4th, metatarsal heads; usually from chronic irritation from high-heel
shoes; Mulder sign is replication of Sx when the metatarsal heads are compressed
together. - Answer-
- 4-month-old + "clicking/clunking" on physical exam - Answer- (+) Ortolani and Barlow
maneuvers � primary hip dysplasia (congenital hip dysplasia) � once these are
positive, the next best step is ORTHO REFERRAL if it is listed � referral always sounds
wrong, but this is the correct answer if it's listed; if it's not listed, do ultrasound if under 6
months, or x-ray if over 6 months. Tx is with abduction harness (Pavlik harness; looks
frog-leg-like)
- 5-8-year-old boy with painful limp; no other risk factors; x-ray shows contracted capital
epiphysis; Dx? - Answer- Legg-Calve-Perthes (idiopathic avascular necrosis); the word
"contracted" wins over "capital epiphysis" � this is a Q on one of the NBME forms
where everyone selects slipped capital femoral epiphysis (SCFE), but it's Legg-Calve-
Perthes; Tx = hip replacement
- 5-8-year-old boy with painful limp + sickle cell disease; Dx? - Answer- avascular
necrosis (but not Legg-Calve Perthes, because LCP is idiopathic)
- 5-8-year-old boy + painful limp + x-ray is negative + bone scan confirms diagnosis;
answer? - Answer- USMLE wants you to know that x-ray can be negative initially in
avascular necrosis, but bone scan or MRI can also pick it up
- 2-year-old boy running + playing with 8-year-old sister + they were holding hands and
he fell + now he holds arm pronated by his side; Dx? - Answer- nursemaid's elbow �
radial head subluxation
- 11-13-year-old overweight boy with a painful limp; Dx? - Answer- SCFE; Tx = surgical
pinning - Tissue mass in palm of hand + bent fingers; Dx? � Dupuytren contracture �
seen in alcoholism, diabetes, Norwegian descent, and epilepsy. Tx is surgical
- Tx for nursemaid's elbow - Answer- hyperpronation OR gentle supination (both are
correct answers; only one will be listed)
Questions And Answers Practice
Questions with Solutions Newest |
Already Graded A+
- Patient has pain in the shoulder when raising the arm to paint a fence; Dx? - Answer-
sub acromial bursitis (caused by repetitive overhead motion)
- Patient has pain in the shoulder when raising the arm above the head; subacromial
bursitis isn't listed; Dx? - Answer- answer = rotator cuff injury
- Patient has pain in the shoulder lying on his or her side in bed; Dx? - Answer- rotator
cuff injury - Positive Gerber lift-off test � subscapularis injury � place dorsum of hand
against lower back so palm faces posteriorly; examiner applies pressure into palm +
asks patient to move hand � if pain, subscapularis injury
- Positive "empty can" or "full can" test; Dx? - Answer- supraspinatus injury � shoulder
is abducted to 90 degrees; then downward pressure is applied; elicits pain when patient
attempts to resist - Resistance to lateral rotation of shoulder elicits pain; Dx? �
Infraspinatus or teres minor injury - "Pitcher injury"? � Infraspinatus injury; but if a
pitcher has positive full or empty can test, use your head � still supraspinatus injury
- Patient has elbow pain after leaning on elbow for long periods; Dx? - Answer-
olecranon bursitis
- Patient has pain in lateral forearm with extension of elbow against resistance; Dx +
Tx? � - Answer- answer = lateral epicondylitis (tennis elbow); Tx = forearm strap
- Patient has pain in medial forearm with flexion of elbow against resistance; Dx + Tx? -
Answer- answer = medial epicondylitis (golfer elbow); Tx = forearm strap
- Wrist fracture + posterior displacement of radius; Dx? - Answer- Colles fracture
("dinner fork deformity") - Wrist fracture + anterior displacement of radius; Dx? � Smith
fracture
- Pain on lateral wrist in breastfeeding woman - Answer- deQuervain tenosynovitis �
answer = immediate steroid injection into the wrist. Dx with Finkelstein test (place thumb
in palm of hand; then wrap four digits over thumb; then ulnar deviate; pain at lateral
wrist with ulnar deviation is + test)
- Lump on the dorsum of hand alongside a tendon; painless; slightly mobile; Dx? -
Answer- ganglion cyst; Tx = needle drainage
,- Proximal ulnar fracture + anterior displacement of radial head; Dx? - Answer-
Monteggia fracture
- Radial shaft fracture + displacement of distal radioulnar joint; Dx? - Answer- Galeazzi
fracture
- Fracture of forearm in child with "bending" of the bone? - Answer- greenstick fracture
bc bone is soft so part of bone remains intact
- Fracture in child abuse - Answer- spiral fracture (from rotational force/twisting of limb);
also posterior rib fractures
- Patient has hip pain lying on his or her side in bed?; Dx? - Answer- trochanteric
bursitis
- Patient has lateral hip pain when palpated, when abducting against resistance, or
when standing on that foot; Dx? - Answer- greater trochanteric syndrome (gluteus
medius or minimus tendonopathy) - Patient has "locking" or "catching" of the knee; Dx?
� meniscal tear
- Patient has pain in the medial knee; Dx? - Answer- anserine bursitis
- Patient has pain in the lateral knee; Dx? - Answer- iliotibial band syndrome
- 44F + pain worse in knee when going down/up stairs or when sitting for long periods of
time + crepitus + BMI 39; Dx? - Answer- answer = patellofemoral syndrome
(patellofemoral pain syndrome); next best step in Mx = "strengthening exercises for
quadriceps muscles" + RICE (rest, ice, compression, elevation).
- 25F + pain in anterior knee on the inferior kneecap + plays basketball + pain initially
worse while playing but past few weeks hurts when done playing as well; Dx? - Answer-
answer = patellar tendonitis (Jumper's knee); next best step in Mx = "strengthening
exercises for quadriceps muscles" + RICE.
- 15M + 5'11" + plays soccer + knee pain; Dx? - Answer- Osgood-Schlatter -
>inflammation of patellar ligament at the tibial tuberosity; occurs in fast-growing, active
teenagers; USMLE wants "repeated avulsion microfractures" as an answer
- Patient has knee pain after spending long periods of time on her knees painting; Dx? -
Answer- prepatellar bursitis
- 32M + pain in anterior knee + fever 100.5F + joint effusion not present; Dx? - Answer-
septic bursitis
,- Any patient with red, warm, tender knee; next best step in Mx + Dx? - Answer- joint
aspiration (arthrocentesis); septic arthritis till proven otherwise
- 6M + viral infection + now has hip pain +/- fever; Dx? - Answer- answer = toxic
synovitis (aka transient synovitis), not septic arthritis � inflammation of the synovial
lining of hip joint; Tx is supportive.
- 6M + suspected JRA + red, hot, painful knee - Answer- must do arthrocentesis to rule
out septic arthritis. If the vignette sounds like classic transient synovitis (affects hip, not
knee), you do not need to do an arthrocentesis.
- 5F + 2-day Hx of limp and left hip pain + a week ago had watery stools and a temp of
100F + pain with weight-bearing and movement + no swelling or erythema; Tx? -
Answer- answer = ibuprofen (toxic synovitis). - Biggest risk factor for septic arthritis �
abnormal joint architecture
- Pt groups most likely to get SA - Answer- prosthetic joints, RA/OA, recent intense
exercise/joint trauma; peds (JRA)
- Kid + recurrent joint pain + anemia - Answer- JRA (anemia of chronic disease)
- Pt group most likely to get SA - Answer- those with prosthetic joints (can't be more
abnormal than fake joint) - Pt with OA or RA has red, warm, tender knee � do
arthrocentesis (septic arthritis) - 17F had kickboxing tournament last weekend + knee is
red, warm, tender � arthrocentesis (SA) - Kid + recurrent knee redness, warmth, pain +
fever � Juvenile rheumatoid arthritis (JRA; Still disease) - Kid + recurrent joint pain +/-
high ESR +/- rash � JRA
- Kid with suspected JRA has sore knee - Answer- must do arthrocentesis to rule out
septic arthritis - Patient has "knock-knees" (i.e., knees touch); Dx? � genu valgum
- Child has bow legs; Dx? - Answer- genu varum � can be seen in rickets
- Patient has lateral thigh pain; Dx? - Answer- meralgia paresthetica � due to lateral
femoral cutaneous nerve entrapment
- 9F + both legs bowed + parents noticed bowing since she started to walk + recently
bowing worse in right leg + x-ray while standing shows collapse of the medial aspect of
the metaphysis of proximal tibia + rest of vignette describes healthy, thriving patient;
Dx? - Answer- answer = tibia vara (Blount disease); wrong answer is rickets; should be
noted that bowing is physiologic age < 2 years; tibia vara.
- 18F + anorexia + runs long distances + has foot pain; Dx? - Answer- metatarsal stress
fracture
, - 42M + diabetes + decreased range of motion of the shoulder in all directions; Dx? -
Answer- adhesive capsulitis, aka "frozen shoulder" � Tx = range-of-motion exercises /
physiotherapy
- 25M + wakes up with heel pain + gradually improves throughout the morning; Dx? -
Answer- plantar fasciitis - 29M + pain in ball of the foot; Dx? � metatarsalgia � overuse
injury / from jumping or sports
- 44F + frequently wears high-heel shoes + painful lump on the underside of her foot
between her third and fourth toes; Dx? - Answer- answer = Morton neuroma � benign
growth of nerve tissue between the 2nd
and 3rd, or 3rd and 4th, metatarsal heads; usually from chronic irritation from high-heel
shoes; Mulder sign is replication of Sx when the metatarsal heads are compressed
together. - Answer-
- 4-month-old + "clicking/clunking" on physical exam - Answer- (+) Ortolani and Barlow
maneuvers � primary hip dysplasia (congenital hip dysplasia) � once these are
positive, the next best step is ORTHO REFERRAL if it is listed � referral always sounds
wrong, but this is the correct answer if it's listed; if it's not listed, do ultrasound if under 6
months, or x-ray if over 6 months. Tx is with abduction harness (Pavlik harness; looks
frog-leg-like)
- 5-8-year-old boy with painful limp; no other risk factors; x-ray shows contracted capital
epiphysis; Dx? - Answer- Legg-Calve-Perthes (idiopathic avascular necrosis); the word
"contracted" wins over "capital epiphysis" � this is a Q on one of the NBME forms
where everyone selects slipped capital femoral epiphysis (SCFE), but it's Legg-Calve-
Perthes; Tx = hip replacement
- 5-8-year-old boy with painful limp + sickle cell disease; Dx? - Answer- avascular
necrosis (but not Legg-Calve Perthes, because LCP is idiopathic)
- 5-8-year-old boy + painful limp + x-ray is negative + bone scan confirms diagnosis;
answer? - Answer- USMLE wants you to know that x-ray can be negative initially in
avascular necrosis, but bone scan or MRI can also pick it up
- 2-year-old boy running + playing with 8-year-old sister + they were holding hands and
he fell + now he holds arm pronated by his side; Dx? - Answer- nursemaid's elbow �
radial head subluxation
- 11-13-year-old overweight boy with a painful limp; Dx? - Answer- SCFE; Tx = surgical
pinning - Tissue mass in palm of hand + bent fingers; Dx? � Dupuytren contracture �
seen in alcoholism, diabetes, Norwegian descent, and epilepsy. Tx is surgical
- Tx for nursemaid's elbow - Answer- hyperpronation OR gentle supination (both are
correct answers; only one will be listed)
