shawky2005
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1. The most common cause of avascular necrosis is :
A.Trauma
B.Alcoholism
C.steroid theapy
D.metastatic disease
E.pancreatic disease
2.A former center for the Oakland Raiders football team retired in his 30's after a career of more than a decade. He now finds that he has a lot of stiffness in his right knee in the morning which soon abates, but by the end of the day he is taking non-steroidal anti-inflammatory medications for pain. These findings are most typical for:
A Rheumatoid arthritis
B Ankylosing spondylitis
C Osteoarthritis
D Lyme disease
E Osteomyelitis
3.An 85-year-old male has had epidodes of pain and decreasing joint motion of wrists, elbows, shoulders, and ankles for weeks at a time. There is no joint deformity or swelling. A joint aspirate is most likely to show
A Monosodium urate crystals
B Cholesterol crystals
C Plasma cells and lymphocytes
D Calcium pyrophosphate crystals
E White blood cells
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| krishie
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Is it-1a,2a,3acan u please give the right ans
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krish
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| mani
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1a (BRS says its idiopathic most commonly!!)
2c
3c
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| Malaysian
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1.its between A and C.....C I suppose.
2.C
3.No idea D I suppose.
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| meghana jadhav
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1A.Trauma ...as per kaplan
2.C Osteoarthritis ..
3.D Calcium pyrophosphate crystals ...
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megha
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| krishie
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please correct me if i am wrong.In 2nd q,doesnt the age,earlymorning stiffness go more in favour of RA?Ido agree that since he is a footballer,his joint has undergone sufficient wear and tear.In the third q,age,joints affected,bouts of pain go in favour of gout.Shawky,what are the ans?
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krish
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| sarangi2020
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B
B
D
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| meghana jadhav
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hi kreishi....
i think though there is morning stiffness but it should improve with movement by the day passes but here a pt is again having pain so he is taking pain killers at the end of day...there fore i think it is not rh arthritis...
pt has stiffness in his right knee in the morning which soon abates, but by the end of the day he is taking non-steroidal anti-inflammatory medications for pain.
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megha
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| mjl1717
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1)a
2)c
4)d
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| krishie
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guess u are right Meghana!
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krish
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| shawky2005
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1.A ( Trauma is the most common cause of avascular necrosis ... sure from it ... and this question is very very important and commonly recuring in usmle exams .... i know BRS says the MCC is idiopathic but this is completely wrong ... and for more information about this topic i advise u to read this article especially the causes
http://www.emedicine.com/radio/topic70.htm
2.C ( osteoarthritis ... and the explanation of meghana jadhav is very good ... i really learnt more and more from him ... but i want to add a small information ... morning stiffness of osteoarthritis lasts for less than half an hour ... while the morning stiffness of the RA lasts for more than an hour ... so krishie morning stiffnes is present in both and not specific to only RA )
3.D (Calcium pyrophosphate crystals .... really this question is very confusing ... the clinical picture of both gout and pseudogout is very identical so why we choose this answer and not monosodium urate crystals .... after search i found two points .....
a. the age of the patient is a very important point ... pseudogout is more common in the elderly while the peak incidence of gout is 30-60 years !!!
b. the affected joints .... The most common sites of pseudogout arthritis are the knee, wrist, and shoulder .... while the most common site of gout is the 1st metatarsophalangeal joint of the big toe (not mentioned in the history)
other points for differentiation (not in this case )
*** carpal tunnel syndrome may be the initial presentation of pseudogout.
*** gout symptoms develop rapidly over a few hours, whereas the onset of symptoms in pseudogout is usually more insidious and may occur over several days.
If there is any comments or another explanation ... i will be happy to read it ..
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| Malaysian
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shawky just wanted to bring it to your notice from your quote above 'and the explanation of meghana jadhav is very good ... i really learnt more and more from him' ........meghana jadhav is a lady's name!! Thanks for bringing up a new point which is an error in BRS about the idiopathis avascular necrosis thing.
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| krishie
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Thanx,guys!
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krish
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| shawky2005
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thanks Malaysian ... and sorry for meghana jadhav
as i dont know much about the latin names as i am an arabic one ....
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| meghana jadhav
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hey shawky...thats not a prb ......
and malysian....i dont know...even cant guess from u r name...u r a girl or a guy...just seems u r from malysia....
just kidding.....
....any way ....malyasian.....u will get usmle cd...soon
u will get it from the ecfmg...while...u r orange permit u get from NMB...they must have posted it..if u didnt get within few days then u can ask them....
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megha
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| Malaysian
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Yes.....thanks meghana......I finally received it today.I was thinking they won't post it!Yes you're right about the fact that I'm from malaysia.Also my surname is very similar to your's......I think you would have guessed it by now!
I needed to know.....are you O&G PG??Your knowledge in this field is rather good.If you aren't which books(s) are you using to cover female pathology?
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