Patient Encounter
A 58-year-old woman is scheduled for cataract surgery. History: well-controlled HTN and type 2 DM; no cardiac or pulmonary symptoms. She climbs 2 flights of stairs without stopping. Exam and vitals are normal.
Which preoperative test is indicated?
A. No additional testing
B. Resting ECG
C. Basic metabolic panel and A1c
D. Chest radiograph
E. Pharmacologic stress test
A. No additional testing
B. Resting ECG --> Cardiodisease, ischemia, stroke
C. Basic metabolic panel and A1c --> Uncontrolled Diabetes
D. Chest radiograph --> pneumonia, chest problems
E. Pharmacologic stress test --> Only for intermediate/high risk surgeries <4 MET
An 87-year-old woman has a laceration just inferior to the lateral malleolus. To assess the integrity of the superficial fibular (peroneal) nerve, where is the single best place to test light touch?
A) Plantar surface of the great toe
B) Web space between the first and second toes
C) Dorsum of the foot over the 3rd metatarsal shaft
D) Medial malleolus
E) Posterolateral heel
A) Plantar surface of the great toe --> Tibial Nerve
B) Web space between the first and second toes --> Deep Fibular Nerve
C) Dorsum of the foot over the 3rd metatarsal shaft
D) Medial malleolus --> Saphenous Nerve
E) Posterolateral heel --> Sural Nerve
Q: In open-chain motion, the primary movement of the subtalar joint is ____, and the primary movement of the talocrural (ankle) joint is ____.
A) inversion/eversion; dorsiflexion/plantarflexion
B) dorsiflexion/plantarflexion; inversion/eversion
C) abduction/adduction; circumduction
D) inversion/eversion; abduction/adduction
E) pronation/supination; dorsiflexion/plantarflexion
A) inversion/eversion; dorsiflexion/plantarflexion
B) dorsiflexion/plantarflexion; inversion/eversion
C) abduction/adduction; circumduction
D) inversion/eversion; abduction/adduction
E) pronation/supination; dorsiflexion/plantarflexion
While supine you find: ASIS inferior, PSIS superior, pubes level, medial malleolus inferior on the right. Standing flexion test is positive right. What’s the diagnosis?
A. Right posterior innominate
B. Right anterior innominate
C. Right superior innominate shear (upslip)
D. Right inflare
E. Right inferior pubic shear
A. Right posterior innominate
B. Right anterior innominate
C. Right superior innominate shear (upslip)
D. Right inflare
E. Right inferior pubic shear
You want the strongest evidence to guide a smoking-cessation intervention’s causal effect. Choose the best design:
A) Cross-sectional study
B) Ecologic study
C) Case-control study
D) Randomized controlled trial
E) Case series
A) Cross-sectional study
B) Ecologic study
C) Case-control study
D) Randomized controlled trial
E) Case series
A 64-year-old man is scheduled for elective outpatient inguinal hernia repair. He takes: lisinopril, amlodipine, metoprolol, atorvastatin, and metformin. BP and renal function are normal; no heart failure.
Which medication should be withheld on the morning of surgery (Anytime before is fine)?
A. Amlodipine --> Ca2+ inhibitor
B. Atorvastatin
C. Lisinopril --> ACE inhibitor
D. GLP-1 agonists
E. Metoprolol --> Beta Blocker
A. Amlodipine --> Can continue
B. Atorvastatin --> Can continue
C. Lisinopril --> Morning of Surgery
D. GLP-1 agonists --> Hold 1 week prior
E. Metoprolol --> Can continue
Where do you palpate the dorsalis pedis artery?
A) Immediately posterior to the medial malleolus
B) Lateral to the extensor hallucis longus tendon on the dorsum
C) Between the lateral malleolus and Achilles tendon
D) Inferior to the sustentaculum tali
E) In the tarsal tunnel deep to flexor retinaculum
A) Immediately posterior to the medial malleolus --> Posterior Tibial tunnel
B) Lateral to the extensor hallucis longus tendon on the dorsum
C) Between the lateral malleolus and Achilles tendon
D) Inferior to the sustentaculum tali
E) In the tarsal tunnel deep to flexor retinaculum
A patient has numbness of the medial three and a half toes and weakness in toe flexion of digits 2–3. Where is the lesion most consistent?
A) Common fibular nerve at fibular neck
B) Deep fibular nerve in tarsal tunnel
C) Medial plantar nerve distal to tarsal tunnel
D) Lateral plantar nerve in the sole
E) Sural nerve near lateral malleolus
A) Common fibular nerve at fibular neck --> would affect dorsiflexion and eversion, not plantar flexion
B) Deep fibular nerve in tarsal tunnel
C) Medial plantar nerve distal to tarsal tunnel
D) Lateral plantar nerve in the sole --> Lateral 1 1/2 toes
E) Sural nerve near lateral malleolus
ASIS, PSIS, pubic tubercle, and medial malleolus are all superior on the left; SF test positive left.
A. Left posterior innominate
B. Left superior innominate shear
C. Left inferior innominate shear
D. Left superior pubic shear
E. Right inferior innominate shear
A. Left posterior innominate
B. Left superior innominate shear
C. Left inferior innominate shear
D. Left superior pubic shear
E. Right inferior innominate shear
Who should receive one-time AAA ultrasound screening?
A) Women 65–75 who have ever smoked
B) Men 65–75 who have never smoked
C) Men 65–75 who have ever smoked
D) Men ≥60 with diabetes only
A) Women 65–75 who have ever smoked
B) Men 65–75 who have never smoked
C) Men 65–75 who have ever smoked
D) Men ≥60 with diabetes only
During skin incision, a patient under general anesthesia develops tachycardia and hypertension despite no movement or recall later. Which anesthetic goal was most likely inadequately achieved, prompting you to deepen or rebalance the anesthetic?
A. Amnesia
B. Analgesia
C. Unconsciousness (hypnosis)
D. Skeletal muscle relaxation/immobility
E. Attenuation of autonomic reflexes
A. Amnesia
B. Analgesia
C. Unconsciousness (hypnosis)
D. Skeletal muscle relaxation/immobility
E. Attenuation of autonomic reflexes
A 23-year-old snowboarder sustains a laceration at the neck of the fibula. On exam, the foot slaps the ground during gait, and the patient cannot heel-walk. Which pattern of motor deficit is most consistent with a common fibular (peroneal) nerve injury at this level?
A) Marked loss of plantarflexion and inversion with preserved eversion
B) Marked loss of dorsiflexion and eversion with preserved plantarflexion and toe flexion
C) Isolated loss of great-toe extension with otherwise normal ankle dorsiflexion
D) Loss of abduction of the great toe with normal ankle movements
E) Weak plantarflexion and absent Achilles reflex with preserved dorsiflexion
A) Marked loss of plantarflexion and inversion with preserved eversion --> Tibial Nerve lesion
B) Marked loss of dorsiflexion and eversion with preserved plantarflexion and toe flexion
C) Isolated loss of great-toe extension with otherwise normal ankle dorsiflexion --> Deep fibular ONLY lesion
D) Loss of abduction of the great toe with normal ankle movements
E) Weak plantarflexion and absent Achilles reflex with preserved dorsiflexion
The most common avulsion fracture of the 5th metatarsal occurs when the proximal tuberosity is pulled away, typically due to traction from which muscle?
This should not be confused with the os peroneum, an accessory bone found within the tendon of which muscle?
A) Fibularis brevis; Fibularis longus
B) Fibularis longus; Fibularis brevis
C) Tibialis posterior; Fibularis brevis
D) Extensor digitorum longus; Fibularis tertius
E) Fibularis longus; Fibularis Tertius
A) Fibularis brevis; Fibularis longus
B) Fibularis longus; Fibularis brevis
C) Tibialis posterior; Fibularis brevis
D) Extensor digitorum longus; Fibularis tertius
E) Fibularis longus; Fibularis Tertius
The primary muscles in the Pelvic Diaphragm are what
A. Deep Transverse Perineal and Sphincter urethra muscles
B. Levator ani muscles and their fasciae
C. Pubococcygeus, puborectalis
D. Pyramidalis muscle and sphincter urethra muscles and their fasciae
E. Orange juice
A. Deep Transverse Perineal and Sphincter urethra muscles --> This is the urogenital diaphragm
B. Levator ani muscles and their fasciae
C. Pubococcygeus, puborectalis
D. Pyramidalis muscle and sphincter urethra muscles and their fasciae
E. Orange juice
A new automated BP cuff reads ~150/95 mmHg each time, while manual readings are 120/75 mmHg. Repeated automated trials stay ~150/95. This device has:
A) High validity, high reliability
B) High validity, low reliability
C) Low validity, high reliability
D) Low validity, low reliability
A) High validity, high reliability
B) High validity, low reliability
C) Low validity, high reliability
D) Low validity, low reliability
wo hypothetical inhaled agents are used at 1.0 MAC for maintenance:
Agent X: MAC 6.0%; blood–gas partition coefficient (λ) 0.6
Agent Y: MAC 1.2%; blood–gas partition coefficient (λ) 2.0
Assume similar fresh gas flows, ventilation, and patient factors. Which statement best describes the correct relationshipsamong potency, induction speed, and emergence speed?
A. X is more potent than Y; X induces faster; X emerges slower
B. X is less potent than Y; X induces faster; X emerges faster
C. X is less potent than Y; X induces slower; X emerges faster
D. X is more potent than Y; X induces slower; X emerges faster
E. X and Y have equal potency at 1 MAC, so induction and emergence speeds are equal
A. X is more potent than Y; X induces faster; X emerges slower
B. X is less potent than Y; X induces faster; X emerges faster
C. X is less potent than Y; X induces slower; X emerges faster
D. X is more potent than Y; X induces slower; X emerges faster
E. X and Y have equal potency at 1 MAC, so induction and emergence speeds are equal
A 35-year-old runner has numbness and burning on the plantar forefoot after long runs. Tinel sign is positive posterior to the medial malleolus. Plantarflexion strength and the Achilles reflex are normal. Sensation over the heel is intact.
Which nerve branch is most likely spared?
A) Medial plantar nerve
B) Lateral plantar nerve
C) Medial calcaneal branch of the tibial nerve
D) Deep fibular (peroneal) nerve
E) Sural nerve
A) Medial plantar nerve
B) Lateral plantar nerve
C) Medial calcaneal branch of the tibial nerve
D) Deep fibular (peroneal) nerve
E) Sural nerve
A runner develops two distinct ankle injuries over time.
First, he overuses tibialis anterior, producing repetitive inversion stress.
Later, he lands awkwardly, producing a forceful eversion injury that drives the talus laterally.
Which combination best describes the expected injuries?
A) Lateral ligament complex tear; isolated medial (deltoid) ligament tear
B) Lateral ligament complex tear; bimalleolar fracture-dislocation
C) Medial (deltoid) ligament tear; lateral ligament complex tear
D) High-ankle (syndesmotic) sprain; isolated medial malleolar fracture
E) Spring ligament rupture; trimalleolar fracture
A) Lateral ligament complex tear; isolated medial (deltoid) ligament tear
B) Lateral ligament complex tear; bimalleolar fracture-dislocation
C) Medial (deltoid) ligament tear; lateral ligament complex tear
D) High-ankle (syndesmotic) sprain; isolated medial malleolar fracture
E) Spring ligament rupture; trimalleolar fracture
A collegiate hurdler develops anterior hip pinching mid-season. Exam shows a left anterior innominate rotation pattern. Which muscle imbalance most likely contributed to this pattern?
A. Hypertonic hamstrings on the left
B. Hypertonic piriformis on the left
C. Hypertonic rectus femoris/quadriceps on the left
D. Weak iliopsoas on the left
E. Weak adductors on the right
A. Hypertonic hamstrings on the left
B. Hypertonic piriformis on the left
C. Hypertonic rectus femoris/quadriceps on the left
D. Weak iliopsoas on the left
E. Weak adductors on the right
A urine drug screen for SUD was tested in 100 adults: prevalence 20%; sensitivity 80%; specificity 75%. What are TNand PPV?
A) TN 60; PPV 50%
B) TN 75; PPV 80%
C) TN 60; PPV 44%
D) TN 75; PPV 57%
C) TN 60; PPV 44%
Diseased=20 → TP=0.8×20=16; FN=4. Non-diseased=80 → TN=0.75×80=60; FP=20. PPV=TP/(TP+FP)=16/36=0.444…≈44%.
A 27-year-old woman undergoes laparoscopic ovarian cystectomy with a halogenated volatile anesthetic. Ten minutes after induction, her end-tidal CO₂ rises rapidly despite increased ventilation; she develops generalized muscle rigidity, tachycardia, and a rising temperature.
Which adverse effect best explains this presentation and indicate what drug would cause this?
A. Hepatoxicity, Halothane
B. Diffusional Hypoxia, Nitrous Oxide
C. Malignant Hyperthermia, Nitrous Oxide
D. Etomidate, Adrenal Surpression and Seizures
E. Malignant Hyperthermia, Halothane
A. Hepatoxicity, Halothane
B. Diffusional Hypoxia, Nitrous Oxide
C. Malignant Hyperthermia, Nitrous Oxide
D. Etomidate, Adrenal Surpression and Seizures
E. Malignant Hyperthermia, Halothane
“Angiography shows an occlusion of the anterior tibial artery a few centimeters proximal to the ankle mortise. Which vessel most effectively supplies blood to the distal anterior ankle/dorsalis pedis via the lateral malleolar anastomosis?”
A) Lateral tarsal artery from dorsalis pedis
B) Perforating branch of the fibular artery via the anterior lateral malleolar network
C) Medial plantar artery via the plantar arch to the arcuate artery
D) Posterior tibial recurrent artery
E) Superior lateral genicular artery
A) Lateral tarsal artery from dorsalis pedis
B) Perforating branch of the fibular artery via the anterior lateral malleolar network
C) Medial plantar artery via the plantar arch to the arcuate artery
D) Posterior tibial recurrent artery
E) Superior lateral genicular artery
A 44-year-old teacher reports heel pain that is most intense when taking the first few steps in the morning and after prolonged standing.
An ultrasound image (shown) demonstrates thickening of the plantar fascia to 6.7 mm with a hyperechoic, irregular contour at the calcaneal tuberosity.
Which of the following best describes the pathological process and functional consequence evident in this finding?
A) Inflammatory microtears at the origin of the plantar aponeurosis, weakening dynamic support of the medial longitudinal arch during toe-off
B) Chronic traction injury of the Achilles tendon, weakening plantarflexion and producing posterior heel pain
C) Degeneration of the spring (plantar calcaneonavicular) ligament, leading to collapse of the medial arch and flatfoot deformity
D) Entrapment of the medial calcaneal branch of the tibial nerve, producing burning pain along the plantar heel
E) Rupture of the long plantar ligament, destabilizing the cuboid and lateral longitudinal arch
A) Inflammatory microtears at the origin of the plantar aponeurosis, weakening dynamic support of the medial longitudinal arch during toe-off
B) Chronic traction injury of the Achilles tendon, weakening plantarflexion and producing posterior heel pain
C) Degeneration of the spring (plantar calcaneonavicular) ligament, leading to collapse of the medial arch and flatfoot deformity
D) Entrapment of the medial calcaneal branch of the tibial nerve, producing burning pain along the plantar heel --> Would cause burning and tingling, not thickening
E) Rupture of the long plantar ligament, destabilizing the cuboid and lateral longitudinal arch
A 31-year-old postpartum patient reports sharp lumbosacral pain that peaks as she transitions from sitting to standingand again when returning to sit. She denies radicular symptoms. Exam is otherwise benign. Which structure is mostimplicated in this “click-clack” presentation?
A. Iliolumbar ligament
B. Long dorsal sacroiliac ligament
C. Sacrospinous ligament
D. Sacrotuberous ligament
E. Ischiofemoral ligament
A. Iliolumbar ligament
B. Long dorsal sacroiliac ligament
C. Sacrospinous ligament
D. Sacrotuberous ligament
E. Ischiofemoral ligament
A research team evaluating an ultrasonographic screening tool for abdominal aortic aneurysm (AAA) decides to raise the aortic diameter cutoff for calling a “positive” screen by 15% compared with the previous threshold. Which of the following outcomes is most likely to result from this decision?
A) Increased positive predictive value and increased specificity
B) Increased positive predictive value and decreased specificity
C) Decreased positive predictive value and increased specificity
D) Increased negative predictive value and increased specificity
E) Increased sensitivity and increased positive predictive value
A) Increased positive predictive value and increased specificity.
TP - FP - PPV +
FN + TN + NPV -
Sens - Spec +