Uworld | Step 2ck

2022-07-20 08:24:01 Open / Comment

2022-07-20 08:24:01 A 68-year-old woman comes to the emergency department for evaluation of stroke-like symptoms. The patient says her face appeared "twisted" this morning but was normal when she went to bed last night Her brother recently had a stroke, and the patient was worried that she may also be having a stroke. The patient has a history of hypertension, hypertipidemia, and type 2 diabetes mellitus. Vital signs are within normal limits. Physical examination shows facial asymmetry with drooping of the left corner of the mouth and loss of the left nasolabial fold. Open / Comment

2022-07-19 21:23:01 Educational objective: lvlyasthenic crisis is a life-threatening complication of myasthenia gravis that is characterized by severe respiratory muscle weakness leading to respiratory failure. Symptoms are often preceded by increasing generalized or bulbar muscle weakness. The condition may be precipitated by infection, surgery, and certain medications (eg, fluoroquinolones). Open / Comment

2022-07-19 08:23:03 Open / Comment

2022-07-19 08:22:01 A 34-year-old woman is brought to the emergency department due to a 2-day history of progressive dyspnea and drowsiness. According to her husband, she had difficulty swallowing food and almost choked while having dinner yesterday. One week ago, she was treated with ciprofloxacin for a urinary tract infection. The patient volunteers in a local library and for the past several months has had to reduce her work hours due to difficulty lifting books and placing them on shelves. She drinks alcohol socially and does not smoke. Her blood pressure is 142/90 mm Hg, pulse is 92/min, and respirations are 20/min and shallow. Pulse oximetry shows 93o/o on room air. The patient's BMI is 32 kgfm2. Her speech sounds nasal. Physical examination demonstrates clear lung fields with the use of accessory muscles of respiration and paradoxical abdominal wall motion with inspiration. Heart sounds are normal without a murmur. Muscle strength is bilaterally decreased with normal deep tendon reflexes . Babinski reflex is absent bilaterally. Arterial blood gas shows pH 7.2, pC02 65 mm Hg, and p02 90 mm Hg. Open / Comment

2022-07-18 21:22:01 Educational objective: Medication overuse headache is characterized by chronic, near-daily headache in the setting of regular use of acute headache medications in patients with a preexisting headache disorder. Common features include headache that is present upon awakening and brief symptom relief followed by rebound pain. Management involves cessation of the culprit medication. Open / Comment

2022-07-18 08:21:01 A 36-year-old woman comes to the office due to headaches. Over the past 3 months the patient has had constant, bilateral headaches almost every day shortly after awakening. She has had intermittent episodes of migraines since adolescence, but her current headaches are more frequent though milder. The patient has been taking over-the-counter analgesics several times a day. She has had no focal weakness, numbness, or vision changes. The patient has no other medical conditions and does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits. BMI is 24 kg/m2. Physical examination, including funduscopy and neurological examination, shows no abnormalities. Blood cell counts and serum chemistry studies are within normal limits. Open / Comment

2022-07-17 21:21:01 Educational objective: Guillain-Barre syndrome (GBS) is characterized by ascending weakness, bulbar symptoms (eg, dysarthria) and respiratory compromise after antecedent illness such as respiratory or gastrointestinal infection (especially Campylobacter jejun1). Cerebrospinal fluid analysis shows albuminocytologic dissociation. Treatment of GBS includes intravenous immunoglobulin or plasmapheresis. Open / Comment

2022-07-17 09:20:21 Open / Comment

2022-07-17 08:20:24 Open / Comment