342. A 45-year-old swimmer presents with a sore right shoulder for nearly 2 mo. He was taking non-steroidal anti-inflammatory agents throughout this period with minimal relief. Over the last several days, he has developed pain with elevation of his arm above the horizontal and has some loss of passive motion in external rotation and with abduction. The pain is relieved after you inject 2 ml of lidocaine into the sub-acromial space. Which of the following is the most likely diagnosis?
a. Fracture of the surgical neck of the humerus b. Bicipital tendinitis due to snapping c. Cervical radiculopathy due to a herniated disk d. Calcific tendinitis e. Frozen shoulder due to a rotator cuff injury
343. A 7-year-old boy presents with a 1-year history of pain of the left anterior thigh. He has no history of trauma. On physical examination, he has limited hip motion, especially with abduction and internal rotation. A slight limp is noticeable with ambulation. Pain is brought on by activity and improves with rest. Which of the following is the most likely diagnosis?
344. A 20-year-old college student develops left shoulder pain after jumping into a lake from a swinging rope. She presents holding her arm beside her body (adducted) and avoiding any shoulder movement. On examination, the rounded contour of the shoulder is lost and the head of the humerus is felt under the coracoid process. Which of the following is the most likely diagnosis?
a. Inferior glenohumeral dislocation b. Rupture of the long head of the biceps c. Posterior glenohumeral dislocation d. Anterior glenohumeral dislocation
345. A 47-year-old man fell on his outstretched right hand while rollerblading. Several days later, he develops right wrist pain that is constant and progressive. Pain is in the area of the anatomical snuffbox and is worse with wrist flexion, extension, and ulnar deviation. The anatomical snuffbox is tender to palpation but there is no swelling. Finkelstein test is negative. Which of the following is the most likely diagnosis?
346. A 31-year-old man develops left ankle pain after stepping off a curb. He treated the injury with ice overnight but the next day could not walk due to the pain. On examination of the ankle, you notice that it is swollen and ecchymotic. The anterior and lateral aspects of the ankle are tender to palpation. Inversion of the ankle is painful. Which of the following is the most likely diagnosis?
a. Ankle sprain b. Rupture of the Achilles tendon c. Metatarsal stress fracture d. Plantar fasciitis e. Tarsal tunnel syndrome
347. An 81-year-old woman has recurrent back pain in her lumbar area. The pain radiates to her buttocks but is worse on the right side than the left side. Both sitting and walking aggravate the pain. She denies bladder dysfunction. On physical examination, the patient has diminished sensation and decreased reflexes of the right lower limb. Straight-leg raising and cross-leg raising tests are positive for reproduction of right lower limb symptoms. The patient has no spinal deformities. Which of the following is the most likely diagnosis?
a. Sciatica b. Osteomyelitis c. Cauda equina syndrome d. Kyphosis e. Epidural abscess
348. A 12-year-old boy is brought to your office 2 days after a fracture of the humerus in its distal third. The patient complains that he is unable to extend the wrist. Which of the following structures was most likely damaged?
a. Median nerve b. Ulnar nerve c. Radial nerve d. Axillary nerve e. Artery supplying the brachial plexus
349. A 60-year-old man was involved in a motor vehicle accident and suffered multiple long bone fractures and a severe injury to the pelvis. Two days following admission to the hospital, he develops a fever, tachypnea, and tachycardia. The rest of his physical examination reveals chest, neck, and conjunctival petechiae. Respiratory exam reveals scattered crackles bilaterally but no wheezes. Pulse oximetry reveals a hemoglobin saturation of 80% on room air. Which of the following is the most likely diagnosis?
a. Pneumothorax b. Pneumonia c. Exacerbation of chronic obstructive pulmonary disease (COPD)
d. Anemia from traumatic blood loss e. Fat embolism syndrome
350. An 18-year-old gymnast heard a "popping" sound in her left knee while practicing for the Olympic Games. Her knee immediately became swollen and painful. On physical examination, it is obvious that the left knee has an effusion. The anterior drawer test and Lach-man test are positive. McMurray test is negative. Which of the following is the most likely diagnosis?
351. A 15-year old boy presents with complaints of pain in the left hip and left proximal femur. The pain has been present for approximately 3 wk and is increasing in severity. It is worse at night and is relieved by aspirin. There is no history of trauma or previous hip or leg problems. Which of the following is the most likely diagnosis?
a. Osteosarcoma b. Paget's disease c. Osteoid osteoma d. Chondrosarcoma e. Muscle strain
352. A 17-year-old football player with his foot planted is tackled from the side, causing a forced val-gus bending of the knee. On physical examination, there is tenderness over the medial femoral condyle. McMurray test is negative for any palpable clicks. Which of the following is the most likely diagnosis?
a. Tear of the lateral meniscus b. Rupture of the lateral collateral ligament c. Rupture of the medial collateral ligament d. Dislocation of the patella e. Subluxation of the patella
353. A 30-year-old woman with a history of diabetes mellitus presents with a 3-wk history of hand numbness that often awakens her from sleep. The symptoms resolve after she shakes her hands for a few minutes. On physical examination, there is no sensory or motor deficit of her hands but there is a positive Tinel sign. Which of the following is the most likely diagnosis?
a. Thoracic outlet syndrome b. Carpal tunnel syndrome c. Dupuytren's contracture d. Mallet finger e. Ganglion f. Trigger finger
354. A 41-year-old construction worker complains of the sudden onset of severe back pain after lifting some heavy equipment. He describes the pain as being in his right lower back and radiating down the posterior aspect of his right buttock to the knee area. He has no bladder or bowel dysfunction. The pain has improved with bed rest. On physical examination, the patient has tenderness in his lumbar area with palpation. The straight-leg maneuver with the right leg increases the back pain at 80°. The straight-leg maneuver with the left leg also causes thigh pain. Sensation, strength, and reflexes are normal. Which of the following is the most likely diagnosis?
a. Nerve root compression b. Paravertebral abscess c. Lumbosacral strain d. Osteoporosis compression fracture e. Paget's disease
355. A 73-year-old man presents complaining of right lateral hip pain that worsens when he lies on his right side or when he is standing. He has no other complaints. Physical examination is normal. He has a negative Faber test. Which of the following is the most likely diagnosis?
a. Ischial bursitis b. Osteoarthritis of the hip c. Avascular necrosis of the hip d. Trochanteric bursitis e. Fracture of the proximal femur
356. A 2-year-old child cannot raise his arm completely on the right side and has torticollis. He has no other congenital abnormalities. Which of the following is the most likely diagnosis?
a. Slipped capital femoral epiphysis b. Juvenile rheumatoid arthritis c. Sprengel deformity d. Arnold-Chiari malformation e. Cerebral palsy
357. A 67-year-old musician presents with a long history of low back pain. Pain is worsened with prolonged standing and with exercise. For the last several months, the patient has noticed that the back pain comes on with walking less than one block and radiates to the buttocks. The pain is relieved by sitting for several minutes. On physical examination, there are no neurologic deficits and bilateral straight-leg raising maneuvers are normal. Peripheral pulses are strong and bilaterally equal. Which of the following is the most likely diagnosis?
a. Lumbar spinal stenosis b. Peripheral vascular disease c. Lumbosacral sprain d. Disk herniation e. Diffuse idiopathic skeletal hyperos-tosis
358. A 42-year-old man presents with a crush injury to his left lower extremity. He complains of severe leg pain that seems out of proportion to his injury. He also complains of paresthesias of the injured extremity. Leg examination is significant for pallor and coldness. The dorsalis pedis and posterior tibialis pulses are not palpable. Which of the following is the most likely diagnosis?
a. Arterial insufficiency b. Pelvic fracture c. Aortic insufficiency d. Aortic dissection e. Compartment syndrome
359. A 20-year-old woman presents complaining of proximal forearm pain exacerbated by extension of the wrist against resistance with the elbow extended. She denies trauma but is an avid racquetball player. Which of the following is the most likely diagnosis?
a. Lateral epicondylar tendonitis b. Medial epicondylar tendonitis c. Olecranon bursitis d. Biceps tendinitis e. Long thoracic nerve early paralysis
360. A 41-year-old man was recently in a motor vehicle accident (MVA) where he was the driver. He states he was wearing his seat belt at the time of the accident. A day after the accident, he developed neck pain that has now continued for 10 days. He is noticing crunching on extension and lateral bending of the neck. On physical examination, the patient has no neurologic deficits. His neck has no areas of tenderness and there are no areas of spasm. He has normal lateral bend, extension, and flexion of the neck. Which of the following is the most likely diagnosis?
a. Ankylosing spondylitis b. Osteoarthritis c. Reiter syndrome d. Whiplash e. Wry neck
DIRECTIONS: Each set of matching items in this section consists of a list of lettered options followed by several numbered items. For each numbered item, select the appropriate lettered option(s). Each lettered option may be selected once, more than once, or not at all. Each item will state the number of options to select. ChooSœnesaiély-fftiS number.
Was this article helpful?
This report may be oh so welcome especially if theres no doctor in the house Take Charge of Your Arthritis Now in less than 5-Minutes the time it takes to make an appointment with your healthcare provider Could you use some help understanding arthritis Maybe a little gentle, bedside manner in your battle for joint pain relief would be great Well, even if you are not sure if arthritis is the issue with you or your friend or loved one.