Uworld | Step 1

2022-02-26 07:32:01 Open / Comment

2022-02-26 07:31:01 A 55-year-old man with poorly controlled hypertension and type 2 diabetes mellitus comes to the emergency department due to difficulty seeing. He has had blurry vision for the last 2 weeks, and 1 day ago he suddenly noticed a shadow develop across the visual field of his left eye. The patient has no recent headache, double vision, vertigo, light sensitivity, or nausea. On examination, pupils are equal and reactive to light. There is an area of reduced vision in the left eye. Funduscopic examination reveals a flameshaped hemorrhage in the left temporal hemiretina. Open / Comment

2022-02-25 21:30:34 Educational objective:
Infection of the medial face, sinuses (ethmoidal or sphenoidal), or teeth may spread through the valveless facial venous system into the cavernous sinus, resulting in cavernous sinus thrombosis. Patients typically present with headache, fever, proptosis, and ipsilateral deficits in cranial nerves Ill, IV, VI, and V (ophthalmic and maxillary branches). Open / Comment

2022-02-25 07:30:22 Open / Comment

2022-02-25 07:29:01 A 48-year-old man comes to the hospital after a day of high-grade fever, progressive headache, and double vision. The patient has been having purulent nasal drainage and frontal headache for the past several days. He has a history of type 2 diabetes mellitus. His temperature is 38.9 C (102 F), blood pressure is 110/70 mm Hg, and pulse is 94/min. Physical examination shows ptosis, mydriasis, mild proptosis, and loss of the corneal reflex of the right eye. Visual acuity is normal in both eyes, but the patient is unable to move the right eye in any direction. There is decreased sensation in the right upper face. Open / Comment

2022-02-24 21:29:01 Educational objective: Cryptococcus neoformans causes meningoencephalitis in patients with untreated AIDS. Diagnosis can be made by detecting the polysaccharide capsule in cerebrospinal fluid using the latex agglutination test. India ink staining of cerebrospinal fluid is also used for diagnosis and can demonstrate round or oval budding yeast. Open / Comment

2022-02-24 07:29:01 Open / Comment

2022-02-24 07:28:01 A 54-year-old man is brought to the emergency department due to a week of progressive headaches and confusion. He was treated for viral esophagitis 6 months ago and Pneumocystis pneumonia 2 months ago. Temperature is 38 C (100.4 F), blood pressure is 142/86 mm Hg, and pulse is 64/min. The patient is lethargic and oriented to person and place only. CT scan of the head shows a mildly increased ventricle size but no other abnormalities. Lumbar puncture reveals an elevated opening pressure, and cerebrospinal fluid analysis shows moderately increased protein concentration and pleocytosis. The latex agglutination test is positive for soluble polysaccharide antigen. Open / Comment

2022-02-23 21:28:01 Educational objective: Botulinum neurotoxin produced by C/ostridium botulinum prevents the release of acetylcholine from presynaptic nerve terminals. The toxin impairs peripheral muscarinic and nicotinic neurotransmission, causing both autonomic symptoms (eg, fixed pupillary dilation, dry mouth) and skeletal muscle weakness (eg, diplopia, dysphagia, respiratory depression).Its effects at the neuromuscular junction can be seen on electromyography as a decrease in muscle response following stimulation of a motor nerve. Open / Comment

2022-02-23 07:27:01 Open / Comment