My shoulder hurts !!!! next step... - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-26-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Question My shoulder hurts !!!! next step...

A 59-year-old woman is evaluated for a 3-week history of pain in the right upper scapula and
trapezius areas. There are no paresthesias.
On physical examination, the shoulder has full range of motion without eliciting worse pain or
altering the character of the pain. There is no sign of rotator cuff pain or weakness with
testing against resistance. There are no signs of impingement. The shoulder apprehension
test is negative. Strength, deep tendon reflexes, and sensation are normal bilaterally.
What is the most appropriate next step in this patient's management?
(A) Chest radiograph
(B) Intra-articular corticosteroid injection
(C) Physical therapy
(D) Radiograph of the shoulder
(E) Skeletal muscle relaxant
Reply With Quote Quick reply to this message
The above post was thanked by:
dryogi (05-26-2012)



  #2  
Old 05-26-2012
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 237 Times in 128 Posts
Reputation: 247
Send a message via MSN to shyangel18
Default

E, Skeletal muscle relaxant?
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #3  
Old 05-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

hmm.. im confused between D and E.
on the actual exam i think id go with E
Reply With Quote Quick reply to this message
 
  #4  
Old 05-26-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS+3
Posts: 14
Threads: 5
Thanked 2 Times in 2 Posts
Reputation: 12
Default

(C) Physical therapy
Reply With Quote Quick reply to this message
  #5  
Old 05-26-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

there's no clue to anythings in the hx
since the exam is completely normal, i wont go with shoulder xray
Rx option given seems just to distract
i will go with CXR , to rule out lung cancer invading the cervical roots, but the hx didn;t mention any risk factors (e.g. smoking) or associated horner ?
Reply With Quote Quick reply to this message
  #6  
Old 05-26-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 23
Threads: 1
Thanked 13 Times in 9 Posts
Reputation: 23
Default

Since its asking most approriate, i think "E"
Reply With Quote Quick reply to this message
  #7  
Old 05-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Since any shoulder/nerve problem has been ruled out and there is no clue to a chest pathology and the only clue points to a muscle pathology, I'll go with E

All about shoulder & Tests
Reply With Quote Quick reply to this message
  #8  
Old 05-26-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

ans is chest xray

this is referred pain because her physical exam is normal, there are no associated numbness or weakness. Chest xray will rule out the cause of this pain...

here is the qbank expln
The most appropriate next step in this patient's management is a chest radiograph to
evaluate for a cause of referred pain to the shoulder. Referred shoulder pain, in contrast to
intrinsic shoulder problems, is always associated with a normal shoulder examination
that
does not alter the severity or the character of the pain.
Reply With Quote Quick reply to this message
The above post was thanked by:
dryogi (05-26-2012), Novobiocin (05-26-2012), um aala (05-26-2012)
  #9  
Old 05-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Quote:
Originally Posted by tyagee View Post
ans is chest xray

this is referred pain because her physical exam is normal, there are no associated numbness or weakness. Chest xray will rule out the cause of this pain...

here is the qbank expln
The most appropriate next step in this patient's management is a chest radiograph to
evaluate for a cause of referred pain to the shoulder. Referred shoulder pain, in contrast to
intrinsic shoulder problems, is always associated with a normal shoulder examination
that
does not alter the severity or the character of the pain.
Very good question. I am gonna subscribe to Kaplan Q Bank now.
Reply With Quote Quick reply to this message
  #10  
Old 05-26-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

The golden rule is if a pt >40 smoker comes with shoulder pain, this should be alarm sign , do cxr to rule out superior sulcus tumor
Reply With Quote Quick reply to this message
The above post was thanked by:
mbbs2010 (05-27-2012)
  #11  
Old 05-27-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by Novobiocin View Post
Very good question. I am gonna subscribe to Kaplan Q Bank now.
its not kaplan qbank
Reply With Quote Quick reply to this message
  #12  
Old 05-27-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

Quote:
Originally Posted by tyagee View Post
ans is chest xray

this is referred pain because her physical exam is normal, there are no associated numbness or weakness. Chest xray will rule out the cause of this pain...

here is the qbank expln
The most appropriate next step in this patient's management is a chest radiograph to
evaluate for a cause of referred pain to the shoulder. Referred shoulder pain, in contrast to
intrinsic shoulder problems, is always associated with a normal shoulder examination
that
does not alter the severity or the character of the pain.
can you provide the explanation for how one would rule out E? or just a muscle spasm/pain
Reply With Quote Quick reply to this message
  #13  
Old 05-27-2012
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 237 Times in 128 Posts
Reputation: 247
Send a message via MSN to shyangel18
Default

okay seriosuly i think its a v silly question!! heres why

first if its refred pain like the explanation said, then its a cardiac cause! refered pain frm diaphragm is reffered to the right shoulder, so inf wall MI can causes pain in right shoulder, in that case, one there shud be SOB in h/o and if its not given, the Best Next Step is not XRAY!! its an ECG!!! so the logic they presented is stupid

second, i recently did a v similar question in Kaplanqbank where they had a pt with no obvious S/S on Clinical exam except pain in the shoulder, and the best next step was to give a freakn painkiller!! and not get into CXR or even shoulder xrays or any of those!!

may i ask which qbank u use tyagee?? dont get offended, this isnt abt u. but yes these qbanls come up with the silliest quesitons at times. exam questions wont be so illogical!
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #14  
Old 05-27-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Quote:
Originally Posted by shyangel18 View Post
okay seriosuly i think its a v silly question!! heres why

first if its refred pain like the explanation said, then its a cardiac cause! refered pain frm diaphragm is reffered to the right shoulder, so inf wall MI can causes pain in right shoulder, in that case, one there shud be SOB in h/o and if its not given, the Best Next Step is not XRAY!! its an ECG!!! so the logic they presented is stupid

second, i recently did a v similar question in Kaplanqbank where they had a pt with no obvious S/S on Clinical exam except pain in the shoulder, and the best next step was to give a freakn painkiller!! and not get into CXR or even shoulder xrays or any of those!!

may i ask which qbank u use tyagee?? dont get offended, this isnt abt u. but yes these qbanls come up with the silliest quesitons at times. exam questions wont be so illogical!
You are missing the point here--You have to pick the best answer among the given choices. Nobody will disagree with your explanation that there can be numerous causes of such a pain.
Reply With Quote Quick reply to this message
  #15  
Old 05-27-2012
shyangel18's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 388
Threads: 48
Thanked 237 Times in 128 Posts
Reputation: 247
Send a message via MSN to shyangel18
Default

well yes u r right
but hten these questions are misleading too!! so i felt its imp that i made it clear
so like if anyone of us comes across a questions similar to the one i had in kaplan qbank, as described above, we would be chosing the wrong anser!! instead of treating the patient, we'l prolly go for a CXR! wen its not required!!
in this case, the answer should have been E, muscle relaxant.
__________________
Ppl come here to study n ponder
I am here to Excell like Thunder!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message



  #16  
Old 05-27-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default useful points in pulmonary (from book Alarm Bells)

Quote:
1 Haemoptysis should be investigated in smokers over 40.
2 Do not ignore shoulder pain in smokers over 40.
3 Weight loss and night sweats may be due to tuberculosis.
4 Falling asleep while driving or at work may be due to obstructive sleep apnoea.
5 Not all wheezing is caused by asthma.
6 An asthmatic who wakes at night with cough and wheeze is at risk of a life-threatening attack.
7 Early morning headache in a patient with lung disease may be due to carbon dioxide retention.
8 A stuffy nose with chest symptoms could indicate
Wegener’s granulomatosis.
9 Do not forget to ask about the budgie!
10 An asthmatic with nasal polyps might be hypersensitive to
NSAIDs.
the point is, concept is telling u dont miss that fact, i agree with u the question is somehow stupid, cuz u need to figure the answer from giving unlogical explanation to other ans like i did
Reply With Quote Quick reply to this message
The above post was thanked by:
shyangel18 (05-27-2012)
  #17  
Old 05-27-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

Quote:
Originally Posted by bisho View Post
the point is, concept is telling u dont miss that fact, i agree with u the question is somehow stupid, cuz u need to figure the answer from giving unlogical explanation to other ans like i did
But this patient isn't a smOker..
Really vague question. NO significant history.
Reply With Quote Quick reply to this message
The above post was thanked by:
shyangel18 (05-27-2012)
  #18  
Old 05-27-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by shyangel18 View Post
may i ask which qbank u use tyagee?? dont get offended, this isnt abt u. but yes these qbanls come up with the silliest quesitons at times. exam questions wont be so illogical!
first and foremost, the source is very authentic .[no, its not nbme ]

why not muscle relaxants?
here is what qbank says

Quote:
Physical therapy would be a reasonable option if the shoulder pain were found to be
musculoskeletal in nature; however, given her full range of motion and no localizing signs on
examination
, physical therapy is unlikely to be helpful and further evaluation for the cause of
the shoulder pain is warranted. Likewise, without evidence of either a musculoskeletal or an
intra-articular etiology, neither a skeletal muscle relaxant nor intra-articular corticosteroid
injection would be appropriate.
Reply With Quote Quick reply to this message
  #19  
Old 05-27-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by tyagee View Post
A 59-year-old woman is evaluated for a 3-week history of pain in the right upper scapula and
trapezius areas. There are no paresthesias.
On physical examination, the shoulder has full range of motion without eliciting worse pain or
altering the character of the pain
. There is no sign of rotator cuff pain or weakness with
testing against resistance
. There are no signs of impingement. The shoulder apprehension
test is negative.
Strength, deep tendon reflexes, and sensation are normal bilaterally.
Referred shoulder pain, in contrast to intrinsic shoulder problems, is always associated with a
normal shoulder examination...

make sense?
Reply With Quote Quick reply to this message



Reply

Tags
Rheumatology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Severe shoulder and arm pain step1an USMLE Step 2 CK Forum 4 08-20-2011 04:50 PM
Alcoholic with shoulder wound Hope2Pass USMLE Step 1 Forum 9 08-13-2011 08:39 AM
Shoulder weakness and fever aghammoud85 USMLE Step 2 CK Forum 3 06-14-2011 01:19 PM
Question: shoulder problem fin-84 USMLE Step 1 Forum 6 11-03-2010 10:48 AM
Shoulder Abductors Sabio USMLE Step 1 Mnemonics 0 09-10-2009 07:02 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)