NMS Q&A Family Medicine

152 NMS Q&A Family Medicine6 A 35-year-old woman complains of tingling andnumbness of the little finger on the left hand. Onexamination, you corroborate hypesthesia of the 5thfinger and also all of the ring finger, and you also findleft-side weakness of flexion of fingers and wrist. Thepatient is able to spread the fingers adequately. Whichof the following diagnoses is likely to account forthese symptoms?(A) Ulnar nerve injury(B) Carpal tunnel syndrome(C) C6 nerve root compression(D) C7 nerve root compression(E) C8 nerve root compression7 You have a 38-year-old female patient who complainsof lower back pain with no radiation with its onset2 days ago after she did some heavy lifting. She is afebrile.There is some limitation to full flexion androtation. There is no spinal or paravertebral tenderness.Motor and sensory examinations of her legs arenormal. On the SLR test, you can raise each of herlegs (with her knees in extension) 80 degrees off thetable without any radicular pain. Her pain is madeworse when she bends forward at the waist or twistsat the waist. The patellar and Achilles deep tendonreflexes are 2 and symmetrical bilaterally. Whenshe arises from the examining table, she turns ontoone side, throws her legs over the table side, and arisesfrom her flank down position with the help of herarms. Which of the following therapies or evaluationswould you recommend?(A) Order a magnetic resonance imaging (MRI) ofher lumbar spine after plain x-rays of thelumbar spine(B) Complete the physical examination and thenorder strict bed rest at home for 1 week(C) Order a nerve conduction velocity (NCV) test,electromyogram (EMG), and alkalinephosphatase isoenzyme testing (hepatic vs. boneorigin)(D) Order physical therapy sessions consisting oftraction, massage, and diathermy 3 times perweek for 2 weeks(E) Prescribe nonsteroidal anti-inflammatory drugs(NSAIDs) for 5 to 7 days8 A patient comes to you with the exact same story asthe one in Question 5 except for two differences.Instead of 38 years old she is 55 years old, and the pain,instead of starting at a definite known time 2 daysbefore she consulted you, has been present for severalweeks. She is unable to tell you what day or even whatweek the pain began. What she says is that the painhad been bothering her mostly at night for a numberof weeks during which she had difficulty finding a positioncomfortable for sleeping. For the last 2 to 3 weeks,she notices the pain by daytime as well. Her pain is notinfluenced by position and she can bend forward at thewaist and twist at the waist without aggravating thepain. Her SLR test is negative, and the knee jerks andankle jerks are 2 and symmetrical bilaterally. Whichof the following therapies or evaluations would yourecommend first?(A) Complete the physical examination, order anMRI of her lumbar spine, and draw alkalinephosphatase isoenzymes(B) Complete the physical examination and thenorder strict bed rest at home for 1 week(C) Order NCV test and EMG(D) Order physical therapy sessions consisting oftraction, massage, and diathermy 3 times perweek for 2 weeks(E) Prescribe NSAIDs for 5 to 7 days9 A car driven by a 35-year-old woman was struck frombehind. She notes the onset of pain several hours laterand by morning has significant neck pain with movementin any direction. Which of the following mechanismsis most likely the cause of her symptoms?(A) Hyperextension of neck(B) Subluxation of the body of C3 on C4(C) Contusion to the neck(D) Extreme rotation of the cervical spine(E) Fracture of a cervical vertebra10 You suspect a 55-year-old man has cervical radiculopathy.On examination, you note that there isdiminished sensation over the right radial aspects ofthe thumb and index finger. The triceps reflex is normaland compares with the left triceps, but the bicepsreflex is diminished as are the strengths of right elbowflexion and supination, as compared with the leftside. The patient is right-handed. Which of the followinglisted cervical roots do you believe is mostaffected in this patient’s radiculopathy?(A) C4(B) C5(C) C6(D) C7(E) T111 Regarding the patient in Question 10, he reports 1 weeklater that his pain is no better after heat, massage,NSAIDs, and cervical traction. You consider seekingthe opinion of a neurosurgeon. Which of the followingstudies would be the most helpful to provide thespecialist with a useful database before he or she seesthe patient?