A 26-year-old violinist comes to your clinic, complaining of anxiety. He is a first chair violinist in the local symphony orchestra and has started having symptoms during performances, such as sweating, shaking, and hyperventilating. It has gotten so bad that he has thought about giving up his first chair status so he does not have to play the solo during one of the movements. He says that he never has these symptoms during rehearsals or when he is practicing. He denies having any of these symptoms at any other time. His past medical history is unremarkable. He denies any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On examination you see a young man who appears worried. His vital signs and physical examination are unremarkable. What type of anxiety disorder best describes his situation?

Correct Answer: C

Rationale: The correct answer is C: Social phobia. The patient's symptoms of anxiety specifically occur in performance situations, such as playing solos with the orchestra, but not during rehearsals or practice sessions. This is characteristic of social phobia, also known as social anxiety disorder. Social phobia involves intense fear or anxiety about social situations where the individual may be scrutinized or judged, leading to avoidance of those situations. In this case, the patient's fear and anxiety are triggered by performing in front of an audience, which aligns with the diagnosis of social phobia. Choice A, Panic disorder, is incorrect because the patient's symptoms are specifically related to performance situations and not sudden, unexpected panic attacks. Choice B, Specific phobia, is incorrect because the fear is not related to a specific object or situation but rather to performing in front of others. Choice D, Generalized anxiety disorder, is incorrect because the patient's anxiety is not pervasive across various aspects of his life but is focused on

Correct Answer: B

Rationale: The correct answer is B: Negative. Tapping a pen rhythmically on the table can be distracting to others and disrupt the communication process. It can convey impatience, nervousness, or lack of focus. Nonverbal behaviors should support and enhance verbal communication, not detract from it. Other choices are not applicable as the behavior described is clearly negative.

Correct Answer: B

Rationale: The correct answer is B: Eccentric muscle contraction. During eccentric contractions, the muscle lengthens while generating force, placing greater stress on the muscle fibers and making them more susceptible to injury. In the case of the hamstring, which is commonly injured during activities involving sudden deceleration or slowing down, such as running downhill or stopping abruptly, the eccentric contraction plays a significant role. Choice A (Concentric muscle contraction) involves muscle shortening and is less likely to cause injury in the hamstring. Choice C (Isometric contractions) involve static muscle contractions with no change in muscle length, making them less likely to lead to hamstring injury. Choice D (Isotonic contractions) refers to muscle contractions with a constant load, which may or may not lead to hamstring injury depending on the specific exercise and load applied.

Correct Answer: D

Rationale: Kienböck's disease is osteonecrosis of the lunate bone. This occurs due to disrupted blood supply, leading to lunate collapse and wrist pain. Option D is correct as it directly relates to the pathology of Kienböck's disease. Options A, B, and C are incorrect as they do not describe the specific feature associated with Kienböck's disease. Osteonecrosis of the scaphoid (Option A) is more commonly seen in Preiser's disease, while Pencil-in-cup deformities (Option B) are typically associated with psoriatic arthritis. Heberden's and Bouchard's nodules (Option C) are seen in osteoarthritis of the fingers, not in Kienböck's disease.

Correct Answer: C

Rationale: The correct answer is C: MRI. MRI is the 'gold standard' for evaluating the rotator cuff due to its high sensitivity and specificity in detecting rotator cuff tears and other pathologies. It provides detailed imaging of soft tissues, allowing for better visualization of the rotator cuff structures. Plain x-rays are not ideal for evaluating soft tissues like the rotator cuff. Physical exam of the shoulder can provide valuable information, but it may not be as accurate as imaging tests. Ultrasound can be useful, but it is not as sensitive or specific as MRI for detecting rotator cuff tears. In summary, MRI is the preferred diagnostic test for evaluating the rotator cuff due to its superior imaging capabilities and accuracy in detecting pathologies.