Welcome back to RoshCast for Episode 52! For those of you taking the upcoming in-training exam, an early congratulations! All of your hard work will surely pay off soon. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team!

Begin to be now what you will be hereafter.–William James

Question 1

A 64-year-old woman presents to the emergency department with a right-sided headache. Past medical history includes hypertension, migraines, and polymyalgia rheumatica. Her symptoms started three days ago and have progressively worsened. She states that this headache is different from her previous migraines. It is frontal and she describes it as an ache without radiation of symptoms. She does describe worsening of symptoms with eating as well as when she brushes her hair. She admits to feeling more tired the last couple of days as well as having partial vision loss in the right eye. She denies any nausea or vomiting. Vital signs demonstrate a temperature of 38°C but otherwise are within normal limits. Physical examination is remarkable for tenderness to palpation over the right temple and visual acuities of 20/40 OS and 20/80 OD. What is the most appropriate next step in this patient’s management?

A. Intravenous methylprednisolone

B. Obtain erythrocyte sedimentation rate and C-reactive protein to confirm the diagnosis

C. Obtain temporal artery biopsy

D. Oral prednisone

Teaching Image

Question 2

A 42-year-old man presents to the emergency department with lower back pain that started acutely while lifting a couch. He complains of pain radiating to the right posterolateral calf. He denies any bowel or bladder incontinence. On examination, he has decreased plantar flexion at the right ankle and numbness of the right lateral foot. Disk herniation at which level is most likely responsible for his findings?

A. L2–L3

B. L3–L4

C. L4–L5

D. L5–S1

Teaching Image

Question 3

Which of the following is most likely to be seen in hepatorenal syndrome?

A. Arteriolar congestion

B. Histologically normal kidneys

C. Necrosis of the renal tubules

D. Segmental sclerosis of the renal glomeruli

Teaching Image

Question 4

A 27-year-old man presents to the ED with left-hand pain. He was at work as an auto mechanic when he accidentally injected his left index finger with a grease gun. On physical exam, the digit is swollen with a central pinhole wound. The remainder of the hand exam is unremarkable. Which of the following will best determine the amount of tissue damage a substance will cause?

A. Chemical properties of the substance

B. The pressure of the injection

C. The temperature of the substance injected

D. The volume of the substance injected