Item: 1 of 5 !

II f' Mark <:l t::>

Q. ld : 9949 [ Previous Next

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A 58-year-old homeless man is being evaluated for w rist pain after an injury. He w as found lying on the
sidew alk by a local shopkeeper, w ho then called for an ambulance. He does not remember the details of the
injury. The patient reports no other focal pain but says that he hurts "all over." On examination in the
emergency department, he appears intoxicated and distractible. He has scattered contusions and abrasions
in various stages of healing. There is diffuse sw elling at the distal forearm w ith significant tenderness. The
patient is uncooperative w ith further examination of the upper extremity due to pain . X-ray is show n in the
image below .

W hir h nf thQ. f n lln \Minn i~ thQ. mnc::t lik-Q.I\1 mQ.r h ::mic::rYI nf ini1 1n 1?
 Item: 1 of 5 !II f' Mark <:l t::>
Q. ld : 9949 [ Previous Next

4 1mage oe1ow .
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W hich of the follow ing is the m ost likely mechanism of injury?

r A. Direct blow to the w rist

r B. Hyperflexion of the w rist during a fall
r C. Punching w ith a clenched fist
r D. Sudden twisting of the hand
r E. Tripping and falling forward
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Item: 2 of 5 !II f' Mark <:l t::>
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Q. ld: 6162 [ Previous Next

A 50-year-old obese man comes to the emergency department w ith a painful left great toe. He w as sleeping
peacefully at night, w hen he w oke up w ith sudden severe pain in his left great toe. He never had this kind of
problem in the past. He denies trauma to the affected part. He smokes 1 pack of cigarettes daily and drinks
alcohol regularly. Physical examination show s normal vital signs. His left great toe is inflamed and sw ollen.
The patient does not allow further examination due to intense pain . There is no skin rash .

Item 1 of 2

W hat is the next step in making the diagnosis?

r A. Serum uric acid levels

r B. Arthrocentesis
r C. X-ray of the great toe
r D. MRI
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Item: 3 of 5 !II f' Mark <:l t::>
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Q. ld: 6163 [ Previous Next

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Item 2 of 2

The diagnosis of acute gout is made. W hich of the follow ing is the treatment of choice at this time?

r A. Allopurinol
r B. Colchicine
r C. Indomethacin
r D. Probenecid
r E. Methotrexate
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Item: 4 of 5 !II f' Mark <:l t::>
:ITl Q. ld : 5470 [ Previous Next

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A 26-year-old Caucasian man is brought to the emergency department. He is an alcoholic, and has been
drinking vodka for the last 48 hours. He states that he is unable to w alk because of severe muscular pain,
especially in his thighs. He has smoked one pack of cigarettes a day for the past 12 years, and occasionally
uses marijuana or cocaine. He has no other medical problems. His family history is not significant. His
temperature is 37.8C (100F), blood pressure is 100/60 mmHg, pulse is 11 6/min, and respirations are 20/min.
Examination show s a young man with dry skin and mucous membranes. The lungs are clear. There is
generalized muscular tenderness, especially in the thighs and shoulders. Muscular strength is decreased
globally. There are no other neurologic deficits. The patient's laboratory tests show the following:

Serum chemistry
Serum Na 147 mEq/L
Serum K 5.2 mEq/L
Chloride 107 mEq/L
Bicarbonate 20 mEq/L
BUN 58 mg/dl
Serum creatinine 2.3 mg/dl
Calcium 8.2 mg/dl
Glucose 72 mg/dl
CK 60,000 U/L

Urinalysis results are pending. Which of the following is the most appropriate course of action?

r A. Start intravenous furosemide.

r B. Start intravenous fluids.
r C. Start sodium polystyrene sulfonate (Kayexalate).
r D. Start intravenous bicarbonate.
r E. Request a nephrology consultation.
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<:l t::>
:CJ Item: 5 of 5
Q. ld : 5336 [
!II f' Mark
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-4

A 22-year-old soccer player comes to the emergency department w ith knee pain . During her practice earlier
that day she tried to run around another player on the right w hen she felt a popping sensation in her right knee
follow ed by pain and rapid sw elling. The patient has no other injury or blow to the knee. She has had no
significant prior knee injuries. Her past medical history is unremarkable. On physical examination, the right
knee is significantly sw ollen and tender. Ambulation appears awkward and she hesitates to bear w eight on
the right leg. Aspiration of the knee yields grossly bloody joint fluid. W hich of the follow ing is the most likely
diagnosis?

r A. Anterior cruciate ligament injury

r B. Medial collateral ligament injury
r C. Meniscal injury
r D. Patellofemoral pain syndrome
r E. Popliteal cyst rupture