USMLE questions

Question 1

What is Aortoiliac occlusion (Leriche syndrome)? What is the classic triad?

Answer 1

This is arterial occlusion at the bifurcation of the aorta into the common iliac arteries: characterized by the triad of bilateral hip, thigh and buttock claudication, impotence and symmetric atrophy of the bilateral lower extremities due to chronic ischemia

Question 2

What are the classic findings in compartment syndrome? the 5 Ps? What are some examples on how one can get compartment syndrome?

Answer 2

Pain: increased by passive stretching of muscles
Paresthesis: burning/tingling
Pallor: due to swelling and compromised perfusion
Pulselessness: late finding.
Paresis/paralysis: late finding: nerve and muscle ischemia and necrosis.

Consider full circumference burns, or extremities reperfused after 4-6 hours of ischemia (get massive edema).

Question 3

What is Tic douloureux?

Answer 3

trigeminal neuralgia: short bursts of excruciating lancing pain lasting from seconds to minutes in the distribution of the 2nd and 3rd branches of the trigeminal nerve.

Question 4

Varicocele

Answer 4

tortuous dilation of the pampiniform plexus of veins surrounding the spermatic cord and testis in the scrotum.

Question 5

Patient regularly exercises, presents with 6 weeks of right foot pain worsening over 1 week. Physical exam reveals pain between third and fourth metatarsal toes, and a clicking sensation when they are squeezed (what is this sign)? What does she have?

Answer 5

Mulder’s sign congruent with Morton neuroma, commonly seen with runners. This is a mechanically induced degenerative neuropathy seen in runners. Treatment: conservative, with bilateral shoe inserts. Surgery for its who fail conservative treatment.

Question 6

Pulsus paradoxus

Answer 6

Decrease in systolic bp of more than 10 mmhg on inspiration

Question 7

Kussmaul sign

Answer 7

Increase in cvp during inspiration in a spontaneously breathing pt