Fascial planes and compartments — MCQs

During a thoracotomy procedure, a surgeon needs to access the posterior mediastinum. Which of the following structures forms the anterior boundary of the posterior mediastinum?

A 14-year-old boy is brought to the emergency department because of acute left-sided chest pain and dyspnea following a motor vehicle accident. His pulse is 122/min and blood pressure is 85/45 mm Hg. Physical examination shows distended neck veins and tracheal displacement to the right side. The left chest is hyperresonant to percussion and there are decreased breath sounds. This patient would most benefit from needle insertion at which of the following anatomical sites?

A 35-year-old man is brought to the emergency department from a kitchen fire. The patient was cooking when boiling oil splashed on his exposed skin. His temperature is 99.7°F (37.6°C), blood pressure is 127/82 mmHg, pulse is 120/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has dry, nontender, and circumferential burns over his arms bilaterally, burns over the anterior portion of his chest and abdomen, and tender spot burns with blisters on his shins. A 1L bolus of normal saline is administered and the patient is given morphine and his pulse is subsequently 80/min. A Foley catheter is placed which drains 10 mL of urine. What is the best next step in management?

A patient presents to the emergency department with arm pain. The patient recently experienced an open fracture of his radius when he fell from a ladder while cleaning his house. Surgical reduction took place and the patient's forearm was put in a cast. Since then, the patient has experienced worsening pain in his arm. The patient has a past medical history of hypertension and asthma. His current medications include albuterol, fluticasone, loratadine, and lisinopril. His temperature is 99.5°F (37.5°C), blood pressure is 150/95 mmHg, pulse is 90/min, respirations are 19/min, and oxygen saturation is 99% on room air. The patient's cast is removed. On physical exam, the patient's left arm is tender to palpation. Passive motion of the patient's wrist and fingers elicits severe pain. The patient's left radial and ulnar pulse are both palpable and regular. The forearm is soft and does not demonstrate any bruising but is tender to palpation. Which of the following is the next best step in management?

A 35-year-old man is referred to a physical therapist due to limitation of movement in the wrist and fingers of his left hand. He cannot hold objects or perform daily activities with his left hand. He broke his left arm at the humerus one month ago. The break was simple and treatment involved a cast for one month. Then he lost his health insurance and could not return for follow up. Only after removing the cast did he notice the movement issues in his left hand and wrist. His past medical history is otherwise insignificant, and vital signs are within normal limits. On examination, the patient’s left hand is pale and flexed in a claw-like position. It is firm and tender to palpation. Right radial pulse is 2+ and left radial pulse is 1+. The patient is unable to actively extend his fingers and wrist, and passive extension is difficult and painful. Which of the following is a proper treatment for the presented patient?

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 5/10 in severity at its worst and is described as a "burning" pain. He has noticed that the pain is acutely worse when he walks downhill. He has started riding his stationary bike more often as it relieves his pain. His past medical history is notable for hypertension, diabetes mellitus, and a prior myocardial infarction. He also sustained a distal radius fracture the previous year after falling on his outstretched hand. He takes aspirin, atorvastatin, metformin, glyburide, enalapril, and metoprolol. He has a 30-pack-year smoking history and drinks 2-3 glasses of wine with dinner every night. His temperature is 99°F (37.2°C), blood pressure is 145/85 mmHg, pulse is 91/min, and respirations are 18/min. On exam, he is well-appearing and in no acute distress. A straight leg raise is negative. A valsalva maneuver does not worsen his pain. Which of the following is the most appropriate test to confirm this patient's diagnosis?

Linear growth of bone is disturbed when a fracture occurs in which part?

A 14-year-old boy is brought to the physician for the evaluation of back pain for the past six months. The pain is worse with exercise and when reclining. He attends high school and is on the swim team. He also states that he lifts weights on a regular basis. He has not had any trauma to the back or any previous problems with his joints. He has no history of serious illness. His father has a disc herniation. Palpation of the spinous processes at the lumbosacral area shows that two adjacent vertebrae are displaced and are at different levels. Muscle strength is normal. Sensation to pinprick and light touch is intact throughout. When the patient is asked to walk, a waddling gait is noted. Passive raising of either the right or left leg causes pain radiating down the ipsilateral leg. Which of the following is the most likely diagnosis?

A 53-year-old man with a history of alcoholic liver cirrhosis was admitted to the hospital with ascites and general wasting. He has a history of 3-5 ounces of alcohol consumption per day for 20 years and 20-pack-year smoking history. Past medical history is significant for alcoholic cirrhosis of the liver, diagnosed 5 years ago. On physical examination, the abdomen is firm and distended. There is mild tenderness to palpation in the right upper quadrant with no rebound or guarding. Shifting dullness and a positive fluid wave is present. Prominent radiating umbilical varices are noted. Laboratory values are significant for the following: Total bilirubin 4.0 mg/dL Aspartate aminotransferase (AST) 40 U/L Alanine aminotransferase (ALT) 18 U/L Gamma-glutamyltransferase 735 U/L Platelet count 11,000/mm3 WBC 4,300/mm3 Serology for viral hepatitis B and C are negative. A Doppler ultrasound of the abdomen shows significant enlargement of the epigastric superficial veins and hepatofugal flow within the portal vein. There is a large volume of ascites present. Paracentesis is performed in which 10 liters of straw-colored fluid is removed. Which of the following sites of the portocaval anastomosis is most likely to rupture and bleed first in this patient?