Surgery collections Videos and quizez 2021

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https://t.me/USMLERECALLS2021/916 Open / Comment

2023-03-30 08:21:03 A 56-year-old right-handed man comes to the physician with right-sided weakness and speech difficulty. He speaks in short sentences with considerable effort He fully follows written and verbal commands but has difficulty writinq and repeating. Open / Comment

2023-03-29 18:21:02 Educational objective: lvlyasthenia gravis is caused by autoantibody-mediated degradation of acetylcholine receptors at the neuromuscular junction, which often leads to fatigable ocular and bulbar muscle weakness. Most patients with acetylcholine receptor antibodies have thymic abnormalities (eg, thymoma, thymic hyperplasia), which appear as an anterior mediastinal mass on chest imaging. Open / Comment

2023-03-29 08:19:02 A 38-year-old woman is evaluated in the clinic due to swallowinq problems that began 1 month ago while eating dinner. Halfway through the meal, she had difficulty chewing her steak and was unable to swallow it Since then, the patient has had 2 similar episodes associated with food and water regurgitation through her nose. She has a history of gastroesophageal reflux disease and a meningioma that was resected 4 years ago. The patient uses omeprazole and over-the-counter eye drops as needed. She has smoked a half pack of cigarettes daily for 16 years and drinks 1 to 2 glasses of wine daily. Her blood pressure is 138/76 mm Hg and pulse is 82/min. Oropharyngeal examination is unremarkable. Lung auscultation is normal. Heart sounds are normal with no murmurs. The abdomen is soft and nontender with no organomegaly. She has no focal weakness or sensory loss, and reflexes are normal. Upper gastrointestinal endoscopy and esophageal manometry are normal. CT scan of the chest is shown below. Open / Comment

2023-03-28 18:18:02 Educational objective: Myasthenia gravis is characterized by fluctuating, fatigable muscle weakness that worsens with repetitive motions and improves with rest Common symptoms include weakness of the proximal (eg, difficulty rising from sitting), ocular (eg, diplopia, ptosis), and bulbar (eg, dysarthria, dysphagia) muscles. Pregnant and postpartum patients are at increased risk for developing the disease. Open / Comment

2023-03-28 08:17:02 A 28-year-old woman comes to the office due to weakness. The patient, who is 8 weeks postpartum, reports intermittent weakness of the upper and lower extremities. She says, "11/ly arms feel weak after carrying the baby for a few minutes, and I can't lift him until I rest for some time. Yesterday evening, I couldn't even get off of the toilet, but today, I feel fine." The patient has also had episodes of blurry vision. Her pregnancy was complicated by gestational diabetes, but she has no chronic medical conditions. The patient's only medication is a daily multivitamin. She does not use tobacco, alcohol, or illicit drugs. Blood pressure is 120/68 mm Hg and pulse is 74/min. Physical examination shows normal pupils and extraocular movements. Jugular venous pressure is not elevated, and chest auscultation reveals no abnormalities. There is no extremity edema. Deep tendon reflexes and muscle strength of the bilateral upper and lower extremities are normal. Open / Comment

2023-03-27 18:16:02 Educational objective: Benign paroxysmal positional vertigo causes brief (<1 min) episodes of vertigo triggered by changes in head position. Triggering an episode by using provocative head positioning maneuvers (eg, Dix-Hallpike) is diagnostic. Open / Comment

2023-03-27 08:15:03 A 62-year-old woman comes to the emergency department feeling "dizzy." While at a grocery store today, the patient was looking up at a high shelf when she suddenly experienced a spinning sensation accompanied by nausea. She closed her eyes and sat down in the aisle, and the symptoms resolved after about a minute. The patient has had no headache, earache, tinnitus, or hearing impairment The symptoms recurred 30 minutes later when she bent down to get into her car. Currently, she feels well and has no symptoms. Medical history is significant for hypertension, hyperlipidemia, and type 2 diabetes mellitus. She previously smoked a pack of cigarettes a day but quit 10 years ago. Open / Comment

2023-03-26 18:15:04 Educational objective: Neurological deficits related to an acute demyelinating plaque of multiple sclerosis usually last for days to weeks whereas transient ischemic attack (TIA) symptoms usually last for <24 hours. The initial treatment of TIA is modifying risk factors, starting aspirin and statin, and improving blood pressure control. Open / Comment

2023-03-26 08:14:02 A 52-year-old right-handed woman comes to the emergency department due to speech arrest and right arm weakness. The symptoms began suddenly at breakfast but resolved after about 30 minutes. The patient has a history of relapsing-remitting multiple sclerosis. Three months ago, she was hospitalized due to blurry vision in the left eye, which was treated with corticosteroids and improved after several weeks. The patient's other medical issues include hypertension and hyperlipidemia. She is currently not taking any disease-modifying therapy for her multiple sclerosis. She has a 40-pack-year history of tobacco use. Blood pressure is 170/96 mm Hg, and pulse is 92/min. BMI is 35 kg/m2. There is a mild afferent pupillary defect in the left eye with diminished visual acuity. Noncontrast CT scan of the head is unremarkable. Open / Comment