Kaplan USMLE Step 1 prep: 4 questions involving hand pain

Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination^® (USMLE^®) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled four cases from Kaplan Medical involving hand pain. Each question comes with an expert explanation of the answer. You can check out all posts in this series.

The AMA and Kaplan have teamed up to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. If you're looking for additional resources, Kaplan provides free access to tools for pre-clinical studies, including Kaplan’s Lecture Notes series, Integrated Vignettes, Shelf Prep and more.

Think you can answer these questions involving patients with hand pain? Find out now.

1. Predict the loss from injury

   1. A 41-year-old woman comes to the physician because of a recent history of joint pain in her hands and knees, in addition to some mild weight loss and fatigue. She has a two-week history of swelling behind her left knee. She says the swelling has been progressively growing, and she has pain and difficulty in flexing the knee. Her serum is positive for rheumatoid factor.
   2. Physical examination shows an erythematous, fluid-filled mass in the left lateral popliteal fossa overlying the tendon of the biceps femoris. During aspiration of the cyst, a structure immediately adjacent to the tendon is injured. Which of the losses is most likely to occur in this patient?

2. Patient with rheumatoid arthritis

   1. A 54-year-old man comes to the physician for a follow-up examination because of progressive rheumatoid arthritis unresponsive to high-dose nonsteroidal anti-inflammatory drugs. Treatment with prednisone and hydroxychloroquine was started six weeks earlier.
   2. The patient is concerned about steroid-induced osteoporosis, because his father, who has type 2 diabetes, recently fell and broke his hip. Laboratory studies and a dual energy x-ray absorptiometry test of the spine and hip are ordered to address the patient's concerns. Which additional test would be recommended for this patient?

3. A man’s left-hand complications

   1. A 24-year-old construction worker comes to the physician because of awkwardness in using his left hand. He reports that two months ago he fell and landed on the heel of his outstretched hand. Physical examination shows that the fourth and fifth fingers are extended at the metacarpophalangeal joints and flexed at the interphalangeal joints. Which of the additional findings is most likely to be seen on physical examination?

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4. Which serum markers will be found?

   1. A 62-year-old woman with a history of arthritis comes to the physician for follow-up examination. Physical examination of the hands shows decreased range of motion bilaterally and marked ulnar deviation of the fingers. An X-ray shows joint erosions. She tells the physician that she recently had seven dental caries filled, which was unusual, because she has had very few dental problems in the past. Physical examination shows asymmetrical bilateral parotid gland enlargement. 

For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.