The Road to 250

11 July 2017
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A 10-year-old boy is brought to the pediatrician by his mother because he has
been complaining of difficulty using his right hand. The mother states that her
son has had a fever for several days but that she grew more concerned when
he was unable to extend his wrist at the breakfast table today. On examination,
the boy is found to have a right wrist drop and some difficulty with shoulder
abduction. A thorough work-up reveals a soft tissue mass in the right shoulder.
Ultrasonography is suggestive of an abscess.

Which of the following structures is most likely being compressed by the

abscess?

A. Medial cord
B. Anterior division of the middle trunk
C. Radial nerve
D. Posterior cord
E. Ventral rami of C3C5
A 10-year-old boy is brought to the pediatrician by his mother because he has
been complaining of difficulty using his right hand. The mother states that her
son has had a fever for several days but that she grew more concerned when
he was unable to extend his wrist at the breakfast table today. On examination,
the boy is found to have a right wrist drop and some difficulty with shoulder
abduction. A thorough work-up reveals a soft tissue mass in the right shoulder.
Ultrasonography is suggestive of an abscess.

Which of the following structures is most likely being compressed by the

abscess?

A. Medial cord
B. Anterior division of the middle trunk
C. Radial nerve
D. Posterior cord
E. Ventral rami of C3C5
An otherwise healthy infant boy born via vaginal delivery has an
abnormal appearance of his right limb. His arm hangs by his side,
adducted, extended, and medially rotated. His forearm is pronated, and
his hand is flexed at the wrist.

Which of the following muscles is still functioning in this patient?

A. Deltoid
B. Triceps
C. Biceps
D. Infraspinatus
E. Supraspinatus
An otherwise healthy infant boy born via vaginal delivery has an
abnormal appearance of his right limb. His arm hangs by his side,
adducted, extended, and medially rotated. His forearm is pronated, and
his hand is flexed at the wrist.

Which of the following muscles is still functioning in this patient?

A. Deltoid-axillary nerve (C5,6) from the posterior cord of the brachial
plexus
B. Triceps-radial nerve
C. Biceps-musculocutaneous nerve (C5,6)
D. Infraspinatus-suprascapular nerve (C5,6) from the superior trunk of
the brachial plexus
E. Supraspinatus-suprascapular nerve (C5,6) from the superior trunk
of the brachial plexus
A construction worker accidentally drives a nail into his thigh with a nail gun. The nail is removed, but the area remains painful
and edematous, and a diagnosis of cellulitis is made. After a few days the skin over the affected area becomes spongy and
produces a crackling sound on palpation. A blood-tinged exudate is also observed.

To which of the following organisms was this man most likely exposed?

A. Obligate anaerobic rod that produces a phospholipase toxin

B. Obligate anaerobic rod that produces a neurotoxin.
C. Facultative anaerobic rod with a protein capsule
D. Anaerobic filamentous rod that forms yellow "sulfur granules
E. Dimorphic fungus that at body temperature appears as cigar-shaped, unequal budding yeast
A construction worker accidentally drives a nail into his thigh with a nail gun. The nail is removed, but the area remains painful
and edematous, and a diagnosis of cellulitis is made. After a few days the skin over the affected area becomes spongy and
produces a crackling sound on palpation. A blood-tinged exudate is also observed.

To which of the following organisms was this man most likely exposed?

A. Obligate anaerobic rod that produces a phospholipase toxin

B. Obligate anaerobic rod that produces a neurotoxin.
C. Facultative anaerobic rod with a protein capsule
D. Anaerobic filamentous rod that forms yellow "sulfur granules
E. Dimorphic fungus that at body temperature appears as cigar-shaped, unequal budding yeast
Several days after a bioterrorist attack with an unidentified pathogen, patients begin presenting to emergency departments
with painless skin sores on their face, neck, and arms, like the one shown in the image. Patients also have significant edema in
the areas around the ulcers. Biopsy of ulcers show necrosis.

Which of the following organisms releases a toxin with a similar mechanism of action as one of the toxins produced by the
pathogen in this attack?

A. Staphylococcus aureus
B. Enterohemorrhagic E. coli
C. Mycobacterium tuberculosis
D. Streptococcus pyogenes
E. Corynebacterium diphtheriae
F. Vibrio cholerae
Several days after a bioterrorist attack with an unidentified pathogen, patients begin presenting to emergency departments
with painless skin sores on their face, neck, and arms, like the one shown in the image. Patients also have significant edema in
the areas around the ulcers. Biopsy of ulcers show necrosis.

Which of the following organisms releases a toxin with a similar mechanism of action as one of the toxins produced by the
pathogen in this attack?

A. Staphylococcus aureus
B. Enterohemorrhagic E. coli
C. Mycobacterium tuberculosis
D. Streptococcus pyogenes
E. Corynebacterium diphtheriae
F. Vibrio cholerae