Uworld | Step 2ck

2022-05-11 22:04:01 Educational objective: Spinal cord compression is characterized by signs and symptoms of upper motor neuron dysfunction distal to the site of compression. These include weakness, hyperreflexia, and an extensor plantar response. Cord compression is a medical emergency requiring prompt diagnosis by spinal MRI. Open / Comment

2022-05-11 07:03:01 Open / Comment

2022-05-11 07:02:01 A 34-year-old man comes to the physician after several days of difficulty walking. He also describes some "funny" sensations in his feet He has no recent skin rash, diarrhea, or joint pain. He has had lower back pain for the last week due to a lifting injury while he was moving. He visited friends in Connecticut 1 month ago and while there developed an upper respiratory infection that lasted 4 days. He smokes 1 pack of cigarettes a day and admits to occasional IV drug use. He has not been sexually active for 3 months. His temperature is 36. 7° C (98° F), blood pressure is 120/80 mm Hg, pulse is 90/min, and respirations are 16/min. Chest examination is unremarkable. The abdomen is soft and nontender. The liver span is 8 cm and the spleen is not palpable. Cranial nerves II-XII are intact Muscle strength is reduced in the lower extremities but well preserved in the upper extremities. Lower-extremity sensation is decreased. Mild hyperreflexia is noted bilaterally in the lower extremities . Stroking the soles of the feet elicits extension of the great toe. Open / Comment

2022-05-10 22:02:01 Educational objective: Non-pupil-sparing oculomotor nerve (CN Ill) palsies are concerning for aneurysmal compression. MR or CT angiography should be performed immediately. Pupil-sparing CN Ill palsies are most commonly caused by microvascular ischemia associated with diabetes mellitus, hypertension, and hyperlipidemia. Open / Comment

2022-05-10 12:31:06 95% of the exam is repeated

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https://t.me/USMLERECALLS2021/573 Open / Comment

2022-05-10 07:01:57 A 54-year-old woman comes to the emergency department due to double vision and a droopy eyelid. The patient began seeing 2 side-by-side images while watching television last night She attributed the symptoms to tiredness and went to bed. The vision disturbance was persistent on wakinq up today, and the patient also found her right eyelid was drooping. The diplopia is worse when looking toward the left and is not associated with headache, nausea, dizziness, or focal weakness or numbness. Physical examination shows ptosis of the right eye. Adduction and upward gaze are impaired on the right side. Pupils are 2 mm on the left and 5 mm on the right, and both are reactive to light Examination of other cranial nerves is unremarkable. Upper and lower extremity strength, deep tendon reflexes, and sensation are normal. Noncontrast CT scan of the head is normal. Open / Comment

2022-05-04 00:28:00 https://t.me/studentdoctor Open / Comment

2022-04-30 21:07:01 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

2022-04-30 07:06:01 Open / Comment

2022-04-30 07:06:01 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