Uworld | Step 1

2021-11-17 08:15:05 A 14-year-old boy is brought to the physician by his mother for seizures. His seizures are usually characterized as a blank stare and lip smacking, followed by generalized shaking. The patient occasionally bites his tongue during the episodes and feels confused afterwards. His seizures have been refractory to various antiepileptic medications, and he is started on lamotrigine. Open / Comment

2021-11-16 20:14:01 Open / Comment

2021-11-16 20:14:01 A 53-year-old man is evaluated for right hand discomfort. A month ago, he started to intermittently experience a "pins and needles" sensation in his right hand that is worse at night. He has no neck pain or history of trauma to the right upper extremity. The patient has smoked a pack of cigarettes daily for 20 years and has worked as an accountant for the past 30 years. On physical examination, there is loss of sensation over the right fifth digit. There is no swelling, redness, or warmth of the hand. Open / Comment

2021-11-11 08:01:01 A 61-year-old man comes to the office due to a painful rash on his face for the past 3 days. The patient has no other medical conditions and takes no medications. He is a retired schoolteacher and lives with his wife. Skin examination findings are shown in the exhibit. The remainder of the physical examination shows no abnormalities. Open / Comment

2021-11-10 19:01:01 Open / Comment

2021-11-10 19:00:28 A 75-year-old man is brought to the emergency department after a syncopal episode at his assisted living facility. The event occurred an hour ago, when he was eating lunch with other residents of the facility. The patient suddenly slumped over onto the table and awakened spontaneously after about 30 seconds. He appeared pale afterwards but was not confused, and fingerstick blood glucose was normal. Medical history includes hypertension, type 2 diabetes mellitus, benign prostatic hyperplasia, and Alzheimer disease. Temperature is 37 C (98.6 F), supine and standing blood pressure is 110/68 mm Hg, and pulse is 62/min. The oropharyngeal mucosa is moist and jugular venous pressure is normal. The lungs are clear on auscultation and heart sounds are normal. The patient is hospitalized for observation and is found to have an episodic bradyarrhythmia and atrioventricular block. If this patient's condition is due to a medication, Open / Comment

2021-11-10 08:59:01 Open / Comment

2021-11-10 08:59:01 A 40-year-old woman is evaluated for neck pain that has gradually worsened over the past several months. The patient reports a pulling sensation in her neck that causes difficulty in keeping her head straight. She has had no trauma and has no other medical conditions. Physical examination shows a spastic and thickened sternocleidomastoid muscle causing head tilt. The patient is diagnosed with idiopathic torticollis. She is treated with injections of a bacterial product into the affected muscle, with significant relief of her symptoms. Open / Comment

2021-11-09 19:58:01 Open / Comment

2021-11-09 19:57:01 A 58-year-old man comes to the emergency department due to sudden right-sided weakness. He has no sensory loss, problems speaking/swallowing, or difficulty with balance. The patient was previously told that he has elevated blood pressure, but he does not routinely follow up with his physician. He takes no medications. Examination shows intact cranial nerves and sensory function. The patient has 3/5 muscle strength on the right side. Initial CT scan without contrast reveals no abnormalities. Four weeks later, repeat brain imaging shows a 9-mm, fluid-filled cavitary lesion in the left internal capsule. Open / Comment