Surgery collections Videos and quizez 2021

2023-03-25 18:13:02 Educational objective: Embolic strokes usually have sudden onset with maximal symptoms at the beginning. They occur more commonly in patients with a history of structural cardiac disease (eg, atrial fibrillation, endocarditis). Patients with atrial fibrillation PLUS existing structural heart disease have an increased risk of cardioembolic strokes. Open / Comment

2023-03-25 08:12:02 A 58-year-old right-handed man is brought to the emergency department with sudden onset of severe difficulty speaking and weakness that developed over a few seconds while he was at work. His other medical problems include hypertension, hyperlipidemia, severe left atrial enlargement (seen on previous echocardiogram), mild bilateral carotid disease with recent carotid ultrasound showing <30% stenosis, type 2 diabetes mellitus, and autosomal dominant polycystic kidney disease. He is not compliant with his medication regimen. The patient smokes a pack of cigarettes a day and drinks alcohol occasionally. His blood pressure is 156196 mm Hg and pulse is 124/min and irregularly irregular. His body mass index is 35 kgfm2. There are no carotid bruits. The patient speaks in very short sentences and has difficulty finding words while trying to speak. He is awake and alert but has difficulty following simple commands. There is a forced conjugate gaze preference to the left, neglect of the right visual field, and severe right lower facial droop. He has marked weakness and sensory loss in the right anm and mild weakness and sensory loss in the right leg. His fingerstick glucose value is 345 mgfdl. Open / Comment

2023-03-24 18:12:02 Educational objective: Spontaneous deep intracerebral hemorrhage is typically caused by hypertensive vasculopathy involving the penetrating branches of the major cerebral arteries. Common locations include the basal ganglia (putamen), cerebellar nuclei, thalamus, and pons. Putaminal hemorrhage often produces contralateral hemiparesis and contralateral sensory loss due to injury of the adjacent internal capsule. Open / Comment

2023-03-24 08:11:03 Open / Comment

2023-03-23 18:10:05 Educational objective: Diabetic neuropathy is a distal, symmetric polyneuropathy that can cause a "stocking and glove" pattern of sensory loss, impaired proprioception and vibratory sense, and diminished ankle reflexes; motor findings may be a late manifestation in severe disease. Hyperactive reflexes and an upgoing plantar reflex are inconsistent with diabetic neuropathy and are suggestive of an upper motor neuron process. Open / Comment

2023-03-23 08:08:02 A 60-year-old woman comes to the office due to "balance problems while walking." The patient has had 2 falls over the last 2 months associated with tingling in her feet and dull pains in her back and legs. Medical history is notable for type 2 diabetes mellitus; her most recent hemoglobin A1c was 7.6%. Neurological examination reveals decreased muscle strength in both legs, diminished proprioception peripherally in the feet, decreased pain sensation in the feet and ankles, a hyperactive right knee jerk, and an upgoing plantar reflex on the right side. Open / Comment

2023-03-22 18:08:02 Educational objective: Nontraumatic subarachnoid hemorrhage is most commonly due to ruptured saccular (berry) aneurysm and typically presents with thunderclap headache and symptoms of meningeal irritation (eg, nuchal rigidity, photophobia, nausea). Noncontrast CT scan usually reveals acute bleeding around the brainstem and basal cisterns. Open / Comment

2023-03-22 08:07:02 Open / Comment

2023-03-21 18:06:02 Educational objective: Huntington disease (HD) presents with psychiatric symptoms, cognitive impairment, and chorea. HD is an autosomal dominant CAG trinucleotide repeat expansion disease that is associated with preferential atrophy of the caudate nucleus and putamen. Open / Comment

2023-03-21 08:05:04 A 45-year-old man comes to the ·office due to increased irritability and problems at work. The patient, who is usually outgoing and friendly, began to experience significant irritability 2 months ago and has since gotten in trouble at work for inappropriate and rude behavior on several occasions. His performance as a bank loan officer has also suffered and he has made numerous mathematical errors. The patient is in danger of being fired and is very distressed. He has no medical history, but his father experienced a similar change in behavior around the same age and died 15 years later in a nursing home. Temperature is 36.7 C (98.1 F}, blood pressure is 125/79 mm Hg, pulse is 74/min, and respirations are 14/min. The patient cannot sit still during the examination and makes repeated involuntary writhing movements that are most prominent in the upper extremities. Deep tendon reflexes are 3+ bilaterally in the upper and lower extremities. He scores 22130 on the Montreal Cognitive Assessment (normal: ;::26}. An MRI is ordered. Open / Comment