Uworld | Step 1

2022-06-02 08:35:18 A 67-year-old woman with a known history of lung cancer comes to the office due to hoarseness and
difficulty swallowing. She has no disturbances in vision or hearing. On examination, there is loss of the gag reflex on the left side; when the patient is prompted to say "ah," the uvula deviates to the right side.
a right lower lobe lung mass and several osteolytic rib lesions. MRI of the head also demonstrates multiple Her left shoulder is drooped and strength is reduced during left shoulder shrug testing. Chest x-ray shows
lesions consistent with metastasis. Open / Comment

2022-06-01 20:35:24 Educational objective: Germinomas are the most common pineal gland tumor and present with obstructive hydrocephalus and dorsal midbrain (Parinaud) syndrome. Germinomas in the suprasellar region cause endocrinopathies due to pituitary/hypothalamic dysfunction. Open / Comment

2022-06-01 08:31:01 Open / Comment

2022-06-01 08:29:01 A 4-year-old boy is brought to the office due to headaches that have worsened progressively over the past month and are most severe when lying down. He also has had nonbloody, nonbilious emesis for 2 weeks that typically occurs early in the morning. In addition, the child has intermittent blurry vision, particularly when looking up at the mirror while brushing his teeth. Physical examination shows bilateral papilledema, inability to gaze upwards, and bilateral eyelid retraction. Laboratory testing of sodium, growth hormone, luteinizing hormone (LH}, and follicle-stimulating hormone (FSH} is normal. Given the early morning emesis and papilledema, a brain mass is suspected and a brain MRI is ordered. Open / Comment

2022-05-31 22:01:47 Educational objective: The oculomotor nerve (CN Ill) is most susceptible to injury from ipsilateral posterior communicating artery aneurysms. Aneurysmal compression of CN Ill produces mydriasis (due to superficial parasympathetic fiber damage) with diplopia, ptosis, and down and out deviation of the ipsilateral eye (due to somatic efferent fiber injury). Open / Comment

2022-05-31 08:57:01 Open / Comment

2022-05-31 08:56:01 Open / Comment

2022-05-31 08:54:01 A 55-year-old, right-handed man comes to the emergency department due to recent onset of severe, throbbing, right-sided headache and double vision. His medical history includes poorly controlled hypertension and chronic tobacco use. Neurologic examination shows that he is awake, alert, and oriented and can follow commands. Visual fields and optic fundi are normal. The position of the right eye is down and out with ipsilateral ptosis, and the right pupil is dilated and nonreactive to both light and accommodation. Left eye examination is normal. Based on this patient's neurologic deficits, CT angiography of the head is most likely to reveal an aneurysm arising Open / Comment

2022-05-30 21:53:01 Educational objective: Primary varicella-zoster virus infection (chickenpox) occurs most commonly in childhood. Subsequently, the virus migrates to the sensory ganglia, where it lies dormant for decades. Over time, waning cellmediated immunity allows reactivation of the virus, which spreads down a single nerve to cause a painful, erythematous, vesicular rash in a dermatomal distribution. Open / Comment

2022-05-30 08:52:01 Open / Comment