Uworld | Step 2ck

2023-03-21 08:49:01 A 63-year-old woman is brought to the office due to a change in behavior over the past year. The patient was a highly successful CEO of a large company but had to step down 3 months ago due to poor performance. She once excelled in organization and strategic planning, but 9 months ago, she began to have significant difficulty planning important meetinqs. Now the patient is unable to shop and cook for herself. She has had recent bouts of sadness and urinary frequency. Medical history is significant for hypertension and type 2 diabetes mellitus. Temperature is 37 .1 C (98.8 F), blood pressure is 132/79 mm Hg, pulse is 76fmin, and respirations are 14fmin. The patient scores 23130 (normal: ~26) on the Montreal Cognitive Assessment. Gait is slow and unsteady. Extraocular movements are intact Reflexes are 3+ in the left upper extremity and 2+ on the right Open / Comment

2023-03-20 18:38:01 Educational Objective: Torticollis is a common form of focal dystonia involving the sternocleidomastoid muscle. It can occur idiopathically but is very often medicationrelated. Discontinuation of the causative agent(s) may improve symptoms. Open / Comment

2023-03-19 23:07:22 Rock your USMLE exam

Don't let the stress of the exam impact your success any longer.

Our proven recall strategies will provide you with the tools you need to confidently and accurately ace the exam .

With our expert guidance and personalized approach, you can finally achieve the USMLE score you've been dreaming of .

Don't wait any longer to take control of your future. Sign up for our recalls  today!"


For details and membership

contact:
@usmle_recall

Join now.

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

2023-03-19 18:47:01 Educational objective: Surgical resection is recommended for solitary brain metastasis in patients with good performance status and stable extracranial disease. patients with multiple brain metastases, whole brain radiation therapy is typically used. Open / Comment

2023-03-19 08:46:01 A 65-year-old man is brought to the emergency department after having a seizure. Past medical history is significant for non-small cell lung carcinoma diagnosed 2 years ago and treated surgically. He continues to work as a college professor and usually walks 1-2 miles daily. MRI of the brain shows a solitary cortical mass (2 cm x 3.5 cm) in the right hemisphere at the grey-white matter junction that is most consistent with metastasis. CT scan of the chest and abdomen shows no evidence of recurrent malignancy. The patient is admitted for further management and started on phenytoin. Open / Comment

2023-03-19 06:45:16 Rock your USMLE exam

Don't let the stress of the exam impact your success any longer.

Our proven recall strategies will provide you with the tools you need to confidently and accurately ace the exam .

With our expert guidance and personalized approach, you can finally achieve the USMLE score you've been dreaming of .

Don't wait any longer to take control of your future. Sign up for our recalls  today!"


For details and membership

contact:
@usmle_recall

Join now.

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

2023-03-18 18:46:01 Educational objective: Phenytoin is an antiepileptic drug with known teratogenic effects (eg, fetal hydantoin syndrome). Women of childbearing age who have a low risk of seizure recurrence may safely discontinue phenytoin if considering becoming pregnant; however, the medication should be slowly tapered as rapid withdrawal may result in seizure recurrence. Open / Comment

2023-03-18 08:45:04 A 29-year-old woman comes to the clinic for routine follow-up. Five years ago, she experienced an unprovoked generalized tonic-clonic seizure. At that time, phenytoin was prescribed, and the patient has been on a stable dose since. She has not experienced seizure recurrence. MRI of the brain performed following the initial episode was normal. She has no other medical problems and is a lifetime nonsmoker. The patient's family history is negative for neurologic disease. She is in a stable relationship and is contemplating pregnancy. Blood pressure is 123/72 mm Hg and pulse is 75/min. Neurologic examination is unremarkable. Serum phenytoin level is 11 mcg/ml (therapeutic range, 10-20 mcg/ml}. Electroencephalogram is normal. Open / Comment

2023-03-17 20:44:09 Educational objective: Patients with an intracranial mass often have headache associated with nausea and vomiting andfor focal neurologic deficits. Symptoms are often worse at night and with body positioning that increases intracranial pressure. An MRI of the brain is usually diagnostic . Open / Comment

2023-03-17 08:43:01 A 65-year-old man comes to the ·office due to unsteady gait and frequent falls over the past 2 months. His left side feels "weak," which makes it difficult to maintain balance when walking or standing. He has also had headaches and nausea, which are worse in the mornings before he has had coffee. The patient has a history of hypertension and type 2 diabetes mellitus, and he had a myocardial infarction 5 years ago. He takes insulin for diabetes mellitus but does not routinely monitor his blood glucose. The patient is a former smoker and does not use alcohol or illicit drugs. Blood pressure is 130/80 mm Hg and pulse is 76/min. Ambulation results in the patient swaying to the left and using the wall to brace himself. There is increased resistance to passive flexion of the left upper and lower extremity. Open / Comment