Musculoskeletal Usmle 2

Front 1

USMLE 2_Musculoskeletal_
What are the most common locations fro compartment syndrome?

Back 1

Anterior lower leg and anterior distal forearm 2' to trauma

Front 2

USMLE 2_Musculoskeletal_
Pt presents with pain out of proportion to physical findings. Pain with PASSIVE motion of toes and fingers. Dnx? Treatment?

Back 2

Compartment Syndrome. 6 P's:
Pain
Pulselessnes
Parasthesias
Poikilothermia
Paralysis
Pallor
Tnx-immediate fsciotomy to Down Pressure and Up Perfusion

Front 3

USMLE 2_Musculoskeletal_
PREGRNANT or MIDDLE-AGED woman who overuses her wrist flexors with aching thenar area of the hand. Dnx?

Back 3

Carpal syndrome.

Front 4

USMLE 2_Musculoskeletal_
What other conditions make pt be at risk for having a compartment syndrome? When are symptoms worse?

Back 4

DM
THYROID dysfunction
Symptoms are worse at night.

Front 5

USMLE 2_Musculoskeletal_
Signs or maneuvers to dnx carpal tunnel syndrome

Back 5

TINNEL sign (tapping) and PHALEN's maneuver (flex wrists for 60 seconds to reproduce the signs).

Front 6

USMLE 2_Musculoskeletal_
Tnx of carpal tunnel?

Back 6

Splint for the wrist- place it in a neutral position.
NSAID's
Corticosteroids
Sx only if sensory loss and thenar weakness are present.

Front 7

USMLE 2_Musculoskeletal_
Most common types of bursitis.

Back 7

Superficial bursae:
1.Olecranon
2.Prepatellar
3.Infrapatellar

Front 8

USMLE 2_Musculoskeletal_
Mechanism of bursitis. Treatment of bursitis.

Back 8

Overuse (repetitive use). Trauma. Systemic inflammatory dz. Infection.
Treat conservatively: NSSAID's for inflammation, elevation. Corticoids ONLY if no infection. Antibiotics is infection is present->septic?->7-10days of abix.

Front 9

USMLE 2_Musculoskeletal_
Most common locations of tendonitis- an inflammatory condition of overuse? Other risk factors?

Back 9

Achilles tendon.
ITB-Iliotibial band.
Patellar tendon.
SE of Rx-tosufloxacin (TFLX), gatifloxacin (GFLX), levofloxacin (LVFX), ciprofloxacin (CPFX), prulifloxacin (PUFX)

Front 10

USMLE 2_Musculoskeletal_
Tnx of tendonitis.

Back 10

NSAID's, ice for the FIRST 24-48 hours. Splinting.
Lidocaine and Corticosteroids if the rest fails.
NEVER inject the Achilles tendon

Front 11

Case 36_HyperPARAthyroidism_
What kind of lab values are found?

Back 11

HYPERcalcemia -s a hallmark. Also PTH stands for Phosphorus Trashing Hormone. Cl is nL to high. Classic ratio of Chloride to Phosphorus is 33:1

Front 12

Case 36_HyperPARAthyroidism_
What is the most common metabolic complication of the condition?

Back 12

KIDNEY stones

Front 13

Case 36_HyperPARAthyroidism_
What type of phsyc complications can hyperPARAthyroidism can cause?

Back 13

Depression
Psychosis
Coma

Front 14

Case 36_HyperPARAthyroidism_
What are the two most common causes of hypercalcemia?

Back 14

hyperPARAthyroidism and malignancy

Front 15

Case 27_Liver Tumor_
What is the gold standard test for Hepatocellular Carcinoma (HCC)?

Back 15

Laparascopic ultrasound. Also used for Adenoma and Adenocarcenoma when combined with biopsy.

Front 16

Case 27_Liver Tumor_
What is a high sensitivity and specificity test for HemANGIOMA (no specific s&s other than fullness after eating small amounts, gnawing pain in the RUQ)?

Back 16

ANGIOgraphy

Front 17

Case 27_Liver Tumor_
Define and contrast Benign tumor vs Malignant

Back 17

Benign does not spread hematogenously or via lymphatics. Malignant-does. 1' liver tumor may be benign, while 2'-always malignant (result of the mets: from GI, breast)

Front 18

Case 27_Liver Tumor_
What is the most common benign liver tumor? How is it confirmed?

Back 18

HEMANGIOMA. Angiography. NEVER biopsy!

Front 19

Case 27_Liver Tumor_
When is liver transplantation has no role in treatment?

Back 19

When tumor is 2'. It metastasized from some other place. I.e. with a new liver it'll happen again. What's the point..

Front 20

Case 27_Liver Tumor_
What is the gold standard test for Hepatocellular Carcinoma (HCC)?

Back 20

Laparascopic ultrasound. Also used for Adenoma and Adenocarcenoma when combined with biopsy.

Front 21

Case 27_Liver Tumor_
What is a high sensitivity and specificity test for HemANGIOMA (no specific s&s other than fullness after eating small amounts, gnawing pain in the RUQ)?

Back 21

ANGIOgraphy

Front 22

Case 27_Liver Tumor_
Define and contrast Benign tumor vs Malignant

Back 22

Benign does not spread hematogenously or via lymphatics. Malignant-does. 1' liver tumor may be benign, while 2'-always malignant (result of the mets: from GI, breast)

Front 23

Case 27_Liver Tumor_
What is the most common BENIGN liver tumor? How is it confirmed?

Back 23

HEMANGIOMA. Angiography. NEVER biopsy!

Front 24

Case 27_Liver Tumor_
When is liver transplantation has no role in treatment?

Back 24

When tumor is 2'. It metastasized from some other place. I.e. with a new liver it'll happen again. What's the point..

Front 25

Case 27_Liver Tumor_
What type of liver tumor is associated with oral contraceptives? Has to be rescected b/c malignant potential or hemorrhage.

Back 25

Focal Nodular Hyperplasia. Evaluate with HEMANGIOGRAPHY.

Front 26

Case 27_Liver Tumor_
Which tumor should not be biopsied?

Back 26

Hemangioma. Risk of hemorrhage.

Front 27

Case 52_Lumbar Prolapsed Nucleus Pulposus_
What is the best imaging diagnostic test?

Back 27

MRI or meylography

Front 28

Case 52_Lumbar Prolapsed Nucleus Pulposus_
Mechanical backache vs Entrapment neuropathy. Mechanism or injury.

Back 28

Minor trauma producing ligamentous or muscular injury vs Prolapsed intervertebral disk that applies pressure on an adjacent nerve in lumbosacral plexus (or a sacral nerve bundle like in cauda eqina)

Front 29

Case 52_Lumbar Prolapsed Nucleus Pulposus_
What level of disk herniation is most common?

Back 29

L4-5 and L5-S1. Lying flat relieves pain.

Front 30

Case 52_Lumbar Prolapsed Nucleus Pulposus_
What is a characteristic symptom with cauda equina?

Back 30

Bladder and bowel control difficulties, numbness. URGENT medical/surgical care required to avoid permanent damage.

Front 31

Case_53_Neonatal Jaundice (Persistent)_
When jaundice is persistent past 7 days of life, pathology may be implicated. I.e. beyond 2 wks-> PATHOLOGIC. Presence of what type of bilirubin indicates possibility of biliary atreasia?

Back 31

If CONJUGATED hyperbilirubinemia is present, that means that liver is mature to conjugate and hemolysis is not likely to be the reason of jaundice. Biliary atresia becomes a part of differential dnz

Front 32

Case_53_Neonatal Jaundice (Persistent)_
When has surgical correction to be done for biliary atresia?

Back 32

The latest is 12 wks (84 days) of age. I.e. if pnt is older than that-> look for a liver transplant as the next step in treatment.

Front 33

Case_53_Neonatal Jaundice (Persistent)_
What is important in preoperative management of the pt?

Back 33

Check coagulation abnormalities and correct with vit K and Fresh Frozen Plasma if necessary.

Front 34

Case_53_Neonatal Jaundice (Persistent)_
What is the name of the procedure to treat biliary atresia in newborns under 12 wks of age? What's the complication and its management?

Back 34

Kasai procedure or Kasai portoenterostomy. Complication- COLANGITIS (scarring, inflammation, blockage of bile ducts). Treat with abix and cortecosteroids to fight infection and suppress inflammation which can cause more damage/scarring/obstruction.

Front 35

Case 48_Obesity (Morbid)_
What are the criteria for Sx alteration of GI system?

Back 35

BMI >35kg/m2 with comorbidities or BMI >40kg/m2 w/out comorbidities.
Imperial calculation LbsX704/inchesXinches or Metric kg/m2

Front 36

Case 48_Obesity (Morbid)_
Most common complication post-Sx restrictive procedure?

Back 36

Leakage from the attachment of stomach to the intestine-> leukocytosis, fever, L shoulder pain on post-op day 3-5.

Front 37

Case 48_Obesity (Morbid)_
Common late sequelae from gastric restrictive procedures?

Back 37

Anemia
Vitamin deficiency
Osteoporosis

Front 38

Case 42_Testicular Cancer_
What is the most common presentation of testicular CA?

Back 38

Painless scrotal mass (non-tender heavy sensation in the scrotum)

Front 39

Case 42_Testicular Cancer_
What are the tumor markers?

Back 39

beta-hCG and Alfa fetal protein.

Front 40

Case 42_Testicular Cancer_
What is the major division of the CA?

Back 40

seminoma (90%) and nonseminomatous germ cell tumors

Front 41

Case 42_Testicular Cancer_
What is the Sx procedure to prevent the spread?

Back 41

CA progresses up the lymphatic drainage. RETROPERITONEAL lymphadenectomy around vena cava and aorta (they follow spermatic cord into retroperitoneum). Do Sx before radiation, b/c the nodes will "petrify" and become impossible to remove.

Front 42

Case 42_Testicular Cancer_
When do you do radical inguinal orchiectomy?

Back 42

When the lesion within the scrotum is confirmed as a solid mass

Front 43

Case 48_Obesity (Morbid)_
What are the criteria for Sx alteration of GI system?

Back 43

BMI >35kg/m2 with comorbidities or BMI >40kg/m2 w/out comorbidities.
Imperial calculation LbsX704/inchesXinches or Metric kg/m2

Front 44

Case 48_Obesity (Morbid)_
Most common complication post-Sx restrictive procedure?

Back 44

Leakage from the attachment of stomach to the intestine-> leukocytosis, fever, L shoulder pain on post-op day 3-5.

Front 45

Case 48_Obesity (Morbid)_
Common late sequelae from gastric restrictive procedures?

Back 45

Anemia
Vitamin deficiency
Osteoporosis

Front 46

Case_53_Neonatal Jaundice (Persistent)_
When jaundice is persistent past 7 days of life, pathology may be implicated. I.e. beyond 2 wks-> PATHOLOGIC. Presence of what type of bilirubin indicates possibility of biliary atreasia?

Back 46

If CONJUGATED hyperbilirubinemia is present, that means that liver is mature to conjugate and hemolysis is not likely to be the reason of jaundice. Biliary atresia becomes a part of differential dnz

Front 47

Case_53_Neonatal Jaundice (Persistent)_
When has surgical correction to be done for biliary atresia?

Back 47

The latest is 12 wks (84 days) of age. I.e. if pnt is older than that-> look for a liver transplant as the next step in treatment.

Front 48

Case_53_Neonatal Jaundice (Persistent)_
What is important in preoperative management of the pt?

Back 48

Check coagulation abnormalities and correct with vit K and Fresh Frozen Plasma if necessary.

Front 49

Case_53_Neonatal Jaundice (Persistent)_
What is the name of the procedure to treat biliary atresia in newborns under 12 wks of age? What's the complication and its management?

Back 49

Kasai procedure or Kasai portoenterostomy. Complication- COLANGITIS (scarring, inflammation, blockage of bile ducts). Treat with abix and cortecosteroids to fight infection and suppress inflammation which can cause more damage/scarring/obstruction.