Master the board step 3

Master the Boards: USMLE Step 3
Treat with gabapentin or pregabalin. Tricyclic antidepressants are less effective
and have more adverse effects.
Carpal Tunnel Syndrome
Look for pain and weakness of the first 3 digits of the hand. Symptoms may
worsen with repetitive use.
Initial management is a splint. In CSS, inject steroids when you move the clock
forward if symptoms persist or worsen.
Radial Nerve Palsy
Also known as “Saturday night palsy,” this results from falling asleep or passing
out with pressure on the arms underneath the body or outstretched, perhaps
draped over the back of a chair. Radial nerve palsy results in a wrist drop.
Peroneal Nerve Palsy
This results from high boots pressing at the back of the knee. It results in foot
drop and the inability to evert the foot. May see “high boots” in the case.
There is no therapy. Peroneal nerve palsy resolves on its own.
7th Cranial Nerve (Bell’s Palsy)
Bell’s palsy results in hemifacial paralysis of both the upper and lower halves
of the face. There is also loss of taste on the anterior two thirds of the tongue,
hyperacusis, and the inability to close the eye at night. Hyperacusis results in
the inability to control the stapedius muscle of the middle ear, which acts as
a kind of “shock absorber” for sounds. Bell’s palsy is believed to result from a
viral infection.
Treat with steroids. It is not clear that acyclovir helps.
Reflex Sympathetic Dystrophy
Also called chronic regional pain syndrome, reflex sympathetic dystrophy
happens in a patient with previous injury to the extremity. Light touch, such
as from a sheet touching the foot, results in extreme pain that is “burning” in
quality.
Treat with NSAIDs, gabapentin, and occasionally nerve block. Surgical sympathectomy
may be necessary.
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