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NBME 23 Answers

nbme23/Block 4/Question#2 (59.7 difficulty score)
A 60-year-old woman with type 2 diabetes ...
Subacromial bursitis๐Ÿ”,๐Ÿ“บ
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 +3 
submitted by doomarion(3),
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omaarbucilS sitsriub = arlonNuct xctaebiErona fo pain, apni edhaov,er inap enwtebe ddeitol nad AC jinto

No npgnteimmei = nto ootrrat fufc tdinsitnie

Lkie ayayHah sdai dhviaees" csilisutpa uceass sveere sireontitcr fo bhto ativce and esaspvi naegr of otmvemen of eht glheeluamonr nitjo in lal splnae "

pamelalimlf  Not sure how true but wiki says that there can be positive impingement sign in subacromial bursitis. Aside from the above, is there any other specific symptoms we can look out for to confirm it is subacromial bursitis? (: https://en.wikipedia.org/wiki/Subacromial_bursitis +1  



 +2 
submitted by d_holles(199),
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udmSt__o/smwr/o_nfopscolsowehseohl.wlees/nist_esu/fuodh_sa/ttsgetiwk:b.

yex  There is a Q on UWorld about rotator cuff tendinitis #380186 w/ a similar presentation... I kind of remembered about that, but honestly I do not know how I got it right. +  
yex  Correction: Q id is # 1732 +  



 +1 
submitted by docred123(7),
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Wyh si het aewnrs ot itsh qsoietun tno vsAihiede Cslti..apui.s

hayayah  Adhesive capsulitis causes severe restriction of both active and passive range of movement of the glenohumeral joint in all planes (especially external rotation). +24  
catch-22  Adhesive capsulitis is aka "frozen shouder" so you can expect exactly that. The entire shoulder will be hard to move in all directions. +4  
meningitis  Since it says there is NO impingement sign, it cant be rotator cuff tendinitis correct? What other signs eliminate this option? +1  



 +0 
submitted by hello(353),
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hWy rae troat"ro cfuf etr"a adn o"ottarr cffu ntii"snedt wr?nog si ti cb hobt fo tsehe dwuol swho emptgmeniin g?ins si trehe a ywa to DxD one mfro eht t?hreo

snripper  It can't be rotator cuff problems because abduction is normal up to 90 degrees. +2  



 +0 
submitted by clamshell27(0),

Can anyone explain why bicipital tendonitis is incorrect?

shieldmaiden  Tendonitis from this tendon will have point tenderness on the anterior side of the joint or closer to the coracoid process. Inflammation is usually caused by impingement (@bicipital groove), which it says here there isn't +1  



 +0 
submitted by huszagmc(1),

Bursitis tends to cause pain both during movement and at rest (e.g. simply laying on your shoulder is painful), while tendonitis only causes pain while you are actively using the muscle of the inflamed tendon. This expands on @doomarion's comment! Note for both, though, that you can have point tenderness since you are actively putting pressure where there is inflammation...