Uworld | Step 2ck

2023-03-16 18:43:01 Educational objective: The management of myasthenic crisis with respiratory failure consists of endotracheal intubation followed by treatment with plasmapheresis (or intravenous immunoglobulins) and corticosteroids. Open / Comment

2023-03-16 08:40:11 A 68-year-old man with myasthenia gravis is evaluated for progressive weakness while hospitalized. The patient was admitted 2 days prior due to fever, productive cough, and pleuritic chest pain. Chest x-ray demonstrated a right lower lobe consolidation for which the patient has been receiving intravenous ceftriaxone and azithromycin. He also has been receiving his outpatient dose of pyridostigmine.
In the past several hours,
he has experienced progressive generalized weakness and an inability to cough out sputum. His temperature is 37.6 C (99.8 F), blood pressure is 130170 mm Hg, pulse is 11 Of min, and respiratory rate is 25fmin. Oxygen saturation is 89°/o on 4 Umin oxygen by nasal cannula. The patient appears to be in distress, and his breathing pattern is rapid and shallow with occasional gurgling sounds. Lung auscultation reveals coarse crackles throughout There is mild weakness of the extremities, but deep tendon reflexes are normal. His vital capacity is now 1.0 L compared to 1.5 Lat the time of admission, and arterial blood gas shows pH 7.27, pC02 55 mrn Hg, and p02 60 mm Hg. The patient is intubated and moved to the intensive care unit Open / Comment

2023-03-15 18:41:01 Educational objective: Dementia with Lewy bodies causes cognitive fluctuations, visual hallucinations, and parkinsonism. Cognitive symptoms may precede, or appear along with, parkinsonian features. Open / Comment

2023-03-15 08:40:05 A 67-year-old woman is brought to the office by her son. He reports that his mother has had periodic confusion, memory loss, and poor sleep and seems "kind of out of it sometimes." These symptoms have gradually worsened over the past 1-2 years. The patient occasionally sees "strangers in the backyard," who are not there when her son looks for them. More recently, she has begun walking more slowly and has fallen twice in the past month without any significant injuries. The patient has a history of hypertension and depression. She does not drink alcohol or use illicit drugs. On physical examination, she walks slowly and has mild bilateral hand tremors and mild bilateral lower limb rigidity. On cognitive examination, the patient appears to be oriented to person and place, and can recall 1 of 3 items in 5 minutes; she can state the days of the week forward but does not cooperate with stating them backward. Chemistries, complete blood count, vitamin B12, and thyroid function tests are normal. Serun1 treponemal test is nonreactive. MRI of the brain shows mild generalized cortical atrophy. Open / Comment

2023-03-14 22:40:08 Educational objective: Alzheimer disease is the most common cause of dementia in the western world.
It is characterized initially by gradual memory loss, language
difficulties, and apraxia, followed by impaired judgment and personality and behavioral changes. Brain imaging often reveals generalized cortical atrophy. Open / Comment

2023-03-14 17:35:57 An 80-year-old retired engineer is brought to the office by his son for a routine check-up. The patient believes that his son is too greedy and wants all of his money. He accuses his son of "kicking him out of the house to get all of his property." The patient has been more forgetful over the last few years. He cannot recall recent events but occasionally recounts stories about being in the navy and his escapades while on shore leave. He has no significant medical history except smoking for 6 years when he was young. On exam, his temperature is 37.0 C (98.6 F), blood pressure is 138/88 mm Hg, pulse is 86/min, and respirations are 14/min. He is oriented to person and place only and is unable to cooperate with much of the cognitive examination. He has very poor short-term recall. He is unable to name the current American president and states, "I don't care to follow politics anymore." The neurological examination is nonfocaL Brain MRI reveals mild, generalized cortical atrophy and slightly reduced hippocampal volume. His rapid plasma reagin is negative; the result of a fluorescent treponemal antibody absorption test is nonreactive. Serum electrolytes and thyroid function tests are normal Open / Comment

2023-03-12 16:59:50 Usmle recalls step 1, 2 and 3
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https://t.me/USMLERECALLS2021/872 Open / Comment

2023-02-25 22:02:02 Usmle recalls step 1, 2 and 3
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2023-02-23 11:57:23 https://t.me/studentdoctor Open / Comment

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