A 51-year-old man is evaluated at hospital. A normal patient’s left hand is shown on the left; the patient’s left hand is shown on the right.

Impairment of which of the following is most likely to be seen in this patient?

A) Abduction of fingers
B) Forearm supination
C) 2nd finger flexion
D) Thumb opposition
E)  Wrist extension

A 61-year-old African-American woman is evaluated in hospital for severe left hip pain. She has a longstanding history of SLE managed with ibuprofen, acetaminophen, and prednisone. Which of the following is the most likely explanation for this patient’s presentation?

A) Acute sickle crisis
B) Adipocyte hypertrophy
C) Legg-Calve-Perthes
D) Osteoporosis
E) Pseudofracture

A 71-year-old man is evaluated post-operatively following a portosystemic shunt for esophageal varices on a background of alcoholic cirrhosis. A surgical anastamosis of which of the following veins is most likely to have mitigated the patient’s symptomatology?

A) Inferior mesenteric and superior mesenteric
B) Inferior mesenteric and splenic
C) Superior mesenteric and portal
D) Superior mesenteric and splenic
E) Splenic and left renal

A 7-year-old boy is brought to emergency 30 minutes following excruciating left scrotal pain. Physical examination shows a high-riding, horizontally oriented left testis. Which of the following is most likely to be seen in this patient?

A) Blue dot sign
B) Genitofemoral nerve impingement
C) Patent processus vaginalis
D) Positive cremasteric reflex
E) Positive Prehn sign

A 34-year-old man is brought in by ambulance following a motorcycle accident in which he hit the breaks suddenly and then was launched from the bike.

Which of the following is most likely to be seen in this patient?

A) Cubital tunnel syndrome + reduced shoulder abduction
B) Loss of sensation over lateral forearm + reduced biceps function + reduced shoulder abduction
C) Medial forearm paresthesias + diminution of wrist flexion
D) Pronated wrist + diminished shoulder sensation
E) Reduced shoulder abduction + sensation over deltoid

A 67-year-old woman comes to the physician for a 3-month history gradually worsening pain in her left knee. She describes the pain as dull and aching, worse in the evenings after a day of activity, and improves somewhat with rest. She has difficulty climbing stairs and reports stiffness in the morning that usually resolves within 15 minutes. There are no recent traumas or illness. On examination, her knee show bony enlargement and crepitus with movement. There is no significant warmth, erythema, or effusion noted. The joint range of motion is mildly reduced, particularly with flexion. Her hands show bony nodules at the distal and proximal interphalangeal joints. Radiographs reveal joint space narrowing and osteophyte formation. Which of the following is most likely to have prevented this patient’s condition?

A) Blood pressure management
B) Elimination of intense exercises
C) No specific preventive measures
D) Smoking cessation
E) Weight loss

A 72-year-old man is brought to hospital by his wife after a 30-minute episode of confusion and disorientation that was associated with the right side of his face and right arm becoming weak. He has a history of hypertension managed with hydrochlorothiazide. Physical and neurologic examination shows a slightly sluggish patient with no overt abnormalities. Temperature is 98.2 F, HR 72, RR 16, BP 140/90. Which of the following anatomic locations is the most likely downstream site of the thromboembolus in this patient?

A) Anterior cerebral artery; anterior to central sulcus; lateral hemisphere
B) Anterior cerebral artery; anterior to central sulcus; medial hemisphere
C) Anterior cerebral artery; posterior to central sulcus; lateral hemisphere
D) Anterior cerebral artery; posterior to central sulcus; medial hemisphere
E) Middle cerebral artery; anterior to central sulcus; lateral hemisphere
F) Middle cerebral artery; anterior to central sulcus; medial hemisphere
G) Middle cerebral artery; posterior to central sulcus; lateral hemisphere
H) Middle cerebral artery; posterior to central sulcus; medial hemisphere
I) Posterior cerebral artery

A 30-year-old  woman comes to the physician for a 1-day history of sharp left-sided chest pain. She describes the pain as increasing slightly with deep inspiration. One week ago she had mild coryza without fever. Physical examination shows no marked pain with palpation. Reaching behind the back and over the head does not worsen the pain. Serum creatine kinase is mildly elevated. She has no past medical history. Which of the following is the most likely explanation for this patient’s findings?

A) Costochondritis
B) Fibromyalgia
C) Mitral valve prolapse syndrome
D) Pleurodynia
E) Viral pleurisy

A 22-year-old man is brought to emergency following an injury while playing football. The MRI on the left (green arrow) is normal. The MRI on the right (red arrow) is our patient.

Which of the following is most likely to be seen in this patient?

A) Increased anterior translation of the tibia relative to the femur
B) Increased posterior translation of the tibia relative to the femur
C) Positive valgus stress test
D) Positive varus stress test
E) Reduced elbow extension and a pronated arm

A 23-year-old man is brought to emergency following a fall from his motorbike in the woods. A radiograph of the left arm is shown.

A decrease in which of the following is most likely to be seen in this patient?

A) 5th finger flexion
B) Interosseous muscle movement
C) Thumb adduction
D) Thumb opposition
E) Wrist extension