We need content writers for our online test prep question banks - for USMLE Step 2CK
- Specific content in the form of questions for USMLE Step 2ck . Questions should be in USMLE 2CK format with question followed by single best answer type. Each question should give explanation in detail including why a certain option is correct. Explanation portion should include incorrect choices addressing each option why that option is incorrect. Where applicable, please include images, graphs and slides within the explanation. Some of the questions should also include images in the question stem. References should be cited at the end of each question.
Payment : Starting price $5 per question but if quality is good, can pay more. Open to negotiation. We want to start with 1000 questions and then add more. We can create partial projects about 200 to 300 questions per each freelancer depending on your availability and turn-around times.
We need a physician who passed his USMLEs to complete this task
Below is the format we will need:
Category : Orthopedics
An 18-year-old woman is brought to the emergency department after jumping from a 30-foot bridge in a suicide attempt. She landed on her right leg and heard a snap, immediately feeling excruciating pain in her thigh. Bystanders immediately noticed a deformed right lower extremity. Her past medical history is unknown. On physical examination, the patient is screaming in pain and crying. Her blood pressure is 142/78 mm Hg and pulse 110 beats/minute. Initial evaluation reveals extreme tenderness to movement and palpation of the right thigh, and there is marked swelling over the region. The compartmental pressure of the right thigh is 15 mm Hg. The popliteal and pedal pulses on the right are barely palpable. Corresponding left-sided pulses are 2+. Radiograph film shows a comminuted fracture through the right femoral diaphysis with lateral angulation. There are no other obvious injuries and a FAST exam is negative. What is the most appropriate management of this patient?
Splinting and CT angiography of the right leg
Reduction of the fracture
Intravenous resuscitation with
Correct answer is A:
The patient does not have normal pulses beyond the injury, and the integrity of his arterial tree needs to be assessed. The limb should be immobilized in a long leg splint and immediately evaluated for vascular injury, a sequela of femoral fractures, posterior knee dislocation, or fracture of the proximal tibia and fibula. Noninvasive CT angiography would be a good way to start the evaluation, however angiography is the gold standard to diagnose arterial disruption or dissection.
Option B is incorrect
Emergent fasciotomy should be used in acute compartment syndrome; the compartment pressure should be no greater than 30-40 mm Hg.
Option C is incorrect
Reduction and repair of the fracture can be performed if necessary after vascular integrity has been assessed. Fixation of the fracture should be done first, along with fluid resuscitation and blood transfusion if the bleeding goes into the tissues sufficiently to cause hypovolemic shock. If the arterial supply is compromised and open reduction is necessary, a shunt can be used to reperfuse the limb while bony occurs followed by primary arterial repair.
Option D is incorrect
Right-leg amputation is unnecessary at this time, as the leg may be salvaged with an intervention after the vascular damage has been assessed.
Option E is incorrect
Intravenous resuscitation would be necessary in the case of hypovolemia, which is not the case here.
Glaspy JN, Steele MT. Chapter 271. Knee Injuries. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011.