USMLE Step 2 CK Review- 23

Q- A 40-year-old woman complains of swelling in her neck. Examination reveals a small, non-tender nodule in her thyroid. Which of the following is the best next step of action?

A- Excisional biopsy

B- Fine needle aspiration

C- T4 and TSH levels

D- Ultrasound of the thyroid

C- T4 and TSH levels- It is the best next step to exclude malignancy. Malignant nodules are not functional.

Q- A patient presents with wrist pain at night. It affects his palm, thumb, index and radial half of his ring finger. Flexion of the wrist reproduces the pain. Which of the following signs is positive in this patient?

A- Chandler sign

B- Phalen sign

C- Tinel sign

D- Wonder sign

B- Phalen sign- It is positive in this patient. Tinel sign is reproduction of pain by tapping or percussion on the medial nerve.

Q- An old patient with a history of Rheumatoid arthritis is scheduled for a major operation. Which of the following is the most important test prior to surgery?

A- Anti-cyclic citrullinated peptide

B- Cervical spine x-ray

C- Erythrocyte sedimentation rate (SER)

D- Rheumatoid factor

B- Cervical spine x-ray- Prior to surgery and intubation, radiology is important to determine any fracture of cervical vertebra which is a complication of RA.

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