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Chronic urticaria — USMLE Step 3 MCQ

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HardInternal Medicine (Chronic Management)Chronic urticariaUSMLE Step 3

Six hours after intramedullary fixation of a tibial fracture, an awake patient has escalating pain despite opioids, pain with passive toe extension, a tense anterior compartment, and new paresthesias. Pedal pulses remain palpable. Which next step is most appropriate?

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Correct answer: D — Obtain immediate orthopedic evaluation for emergent compartment fasciotomy without delaying for MRI

The best answer is “Obtain immediate orthopedic evaluation for emergent compartment fasciotomy without delaying for MRI”. Acute compartment syndrome is diagnosed clinically in a cooperative patient with evolving pain, passive-stretch pain, tenseness, and neurologic symptoms. Pulses are commonly preserved until late. Immediate complete decompression is limb-saving; MRI, biomarkers, or waiting for pulselessness causes irreversible injury. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: NCBI Bookshelf, Acute Compartment Syndrome: https://www.ncbi.nlm.nih.gov/books/NBK448124/