Upper/Lower Limb Practice Questions

Question 1

A 52-year-old man with stage IV melanoma comes to the physician with his wife for a routine follow-up examination. He was recently diagnosed with new bone and brain metastases despite receiving aggressive chemotherapy but has not disclosed this to his wife. He has given verbal consent to discuss his prognosis with his wife and asks the doctor to inform her of his condition because he does not wish to do so himself. She is tearful and has many questions about his condition. Which of the following would be the most appropriate statement by the physician to begin the interview with the patient's wife?

Accepted Answer

What is your understanding of your husband's current condition?

Answer

Have you discussed a living will or goals of care together?

Answer

We should talk about how we can manage his symptoms with additional chemotherapy.

Answer

Why do you think your husband has not discussed his medical condition with you?

Answer

Your husband has end-stage cancer, and his prognosis is poor.

Question 2

A 6-month-old male presents to the emergency department with his parents after his three-year-old brother hit him on the arm with a toy truck. His parents are concerned that the minor trauma caused an unusual amount of bruising. The patient has otherwise been developing well and meeting all his milestones. His parents report that he sleeps throughout the night and has just started to experiment with solid food. The patient’s older brother is in good health, but the patient’s mother reports that some members of her family have an unknown blood disorder. On physical exam, the patient is agitated and difficult to soothe. He has 2-3 inches of ecchymoses and swelling on the lateral aspect of the left forearm. The patient has a neurological exam within normal limits and pale skin with blue irises. An ophthalmologic evaluation is deferred.

Which of the following is the best initial step?

Accepted Answer

Complete blood count and coagulation panel

Answer

Genetic testing

Answer

Ensure the child's safety and alert the police

Answer

Peripheral blood smear

Answer

Hemoglobin electrophoresis

Question 3

A 31-year-old woman presents with difficulty walking and climbing stairs for the last 3 weeks. She has no history of trauma. The physical examination reveals a waddling gait with the trunk swaying from side-to-side towards the weight-bearing limb. When she stands on her right leg, the pelvis on the left side falls. When she stands on her left leg, the pelvis remains level. Which of the following nerves is most likely injured in this patient?

Accepted Answer

Right superior gluteal nerve

Answer

Right inferior gluteal nerve

Answer

Right obturator nerve

Answer

Right femoral nerve

Answer

Left femoral nerve

Question 4

A 51-year-old woman comes to the physician because of progressively worsening lower back pain. The pain radiates down the right leg to the lateral side of the foot. She has had no trauma, urinary incontinence, or fever. An MRI of the lumbar spine shows disc degeneration and herniation at the level of L5–S1. Which of the following is the most likely finding on physical examination?

Accepted Answer

Weak Achilles tendon reflex

Answer

Difficulty walking on heels

Answer

Exaggerated patellar tendon reflex

Answer

Diminished sensation of the anus and genitalia

Answer

Diminished sensation of the anterior lateral thigh

Question 5

A 41-year-old woman presents with back pain for the past 2 days. She says that the pain radiates down along the posterior right thigh and leg. She says the pain started suddenly after lifting a heavy box 2 days ago. Past medical history is irrelevant. Physical examination reveals a straight leg raise (SLR) test restricted to 30°, inability to walk on her toes, decreased sensation along the lateral border of her right foot, and diminished ankle jerk on the same side. Which of the following nerve roots is most likely compressed?

Accepted Answer

First sacral nerve root (S1)

Answer

Fourth lumbar nerve root (L4)

Answer

Second sacral nerve root (S2)

Answer

Third sacral nerve root (S3)

Answer

Fifth lumbar nerve root (L5)

Question 6

A 23-year-old man presents with a blunt force injury to the head from a baseball bat. He is currently unconscious, although his friends say he was awake and speaking with them en route to the hospital. He has no significant past medical history and takes no current medications. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 165/85 mm Hg, pulse 50/min, and respiratory rate 19/min. On physical examination, there is a blunt force injury to the left temporoparietal region approximately 10.1–12.7 cm (4–5 in) in diameter. There is anisocoria of the left pupil, which is unresponsive to light. The patient is intubated and fluid resuscitation is initiated. A noncontrast computed tomography (CT) scan of the head is acquired and shown in the exhibit (see image). Which of the following is the most appropriate medical treatment for this patient?

Accepted Answer

Mannitol

Answer

Placement of a ventriculoperitoneal (VP) shunt

Answer

Acetazolamide

Answer

Placing the head of the bed at 0 degrees

Answer

Maintain a PaCO2 of 24 mm Hg

Question 7

A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. The physician sets aside an appointed time-slot and arranges a meeting in a quiet office to inform him about the diagnosis and discuss his options. He has been encouraged to bring someone along to the appointment if he wanted. He comes to your office at the appointed time with his daughter. He appears relaxed, with a full range of affect. Which of the following is the most appropriate opening statement in this situation?

Accepted Answer

What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?

Answer

Your lab reports show that you have an acute myeloid leukemia

Answer

You must be curious and maybe even anxious about the results of your tests.

Answer

I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.

Answer

Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?

Question 8

A 45-year-old man is brought to the emergency department following a motor vehicle collision. He reports right hip pain and numbness along the right thigh. Physical examination shows decreased sensation to light touch over a small area of the proximal medial thigh. X-rays of the pelvis show a displaced pelvic ring fracture. Further evaluation of this patient is most likely to show which of the following findings?

Accepted Answer

Impaired adduction of the hip

Answer

Sensory deficit of the dorsal foot

Answer

Absent cremasteric reflex

Answer

Impaired hip extension

Answer

Impaired extension of the knee

Question 9

A 35-year-old man is brought to the trauma bay by ambulance after sustaining a gunshot wound to the right arm. The patient is in excruciating pain and states that he can't move or feel his hand. The patient states that he has no other medical conditions. On exam, the patient's temperature is 98.4°F (36.9°C), blood pressure is 140/86 mmHg, pulse is 112/min, and respirations are 14/min. The patient is alert and his Glasgow coma scale is 15. On exam, he has a single wound on his right forearm without continued bleeding. The patient has preserved motor and sensation in his right elbow; however, he is unable to extend his wrist or extend his fingers further. He is able to clench his hand, but this is limited by pain. On sensory exam, the patient has no sensation to the first dorsal web space but has preserved sensation on most of the volar surface. Which of the following structures is most likely injured?

Accepted Answer

Radial nerve

Answer

Recurrent motor branch of the median nerve

Answer

Main median nerve

Answer

Lower trunk

Answer

Ulnar nerve

Question 10

A 13-year-old girl is brought to the physician by her father because of a 1-month history of pain in her right knee. She is a competitive volleyball player and has missed several games recently due to pain. Examination shows swelling distal to the right knee joint on the anterior surface of the proximal tibia; there is no overlying warmth or deformity. Extension of the right knee against resistance is painful. Which of the following structures is attached to the affected anterior tibial area?

Accepted Answer

Patellar ligament

Answer

Iliotibial band

Answer

Pes anserinus tendon

Answer

Quadriceps tendon

Answer

Anterior cruciate ligament

Upper/Lower Limb

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Bones and joints of upper limb

Muscles and movements of upper limb

Nerves and blood supply of upper limb

Clinical correlations of upper limb

Bones and joints of lower limb

Muscles and movements of lower limb

Nerves and blood supply of lower limb

Clinical correlations of lower limb

Comparison of upper and lower limb structures

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