Uworld | Step 2ck

2022-04-26 21:01:01 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, totlowed by impaired judgment and personality and behavioral changes. Brain imaging often reveals generalized cortical atrophy. Open / Comment

2022-04-26 07:01:29 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. Open / Comment

2022-04-26 07:01:01 Open / Comment

2022-04-26 01:19:28 https://t.me/studentdoctor Open / Comment

2022-04-25 21:59:01 Educational objective: Medications used in the treatment of Parkinson disease may cause hallucinations. Dopamine agonists and, to a lesser extent, levodopa are associated with this adverse effect Open / Comment

2022-04-25 07:59:01 Open / Comment

2022-04-25 07:58:01 A 63-year-old man is brought to the office by his daughter due to recurrent falls. According to his daughter, the patient has lost his balance and fallen several times over the past 6 months. He has not sustained serious injuries. She has also noticed some "shaking" of his right hand that is most apparent at rest The patient has lived alone since his wife died 5 years ago and still shops, cooks, and cleans independently. Blood pressure is 141/68 mm Hg and pulse is 72/min. Neurologic examination shows mild rigidity of the limb muscles that is most prominent on the right side with a slow, shuffling gait The patient is prescribed medication for his symptoms but returns to the office 4 weeks later reporting "disturbing visions of strangers creeping around corners of his apartment" On examination, he is alert and scores 27 /30 on the Montreal Cognitive Assessment (normal: ;::26). Open / Comment

2022-04-24 20:58:01 Educational objective: Elderly patients with depression often present with cognitive impairment that can mimic other causes of dementia. The impairment is usually reversible with treatment of the underlying depressive disorder. Open / Comment

2022-04-24 07:58:01 Open / Comment

2022-04-24 07:57:01 A 67-year-old man comes to the clinic for the first time. He speaks and walks very slowly. The patient's chief symptom is "extreme forgetfulness" for the past 6 months and he fears he is developing "dementia like my father." He says, "I used to be a very bright and sharp person, but now I can't even concentrate to work or read a book or newspaper. I feel extremely low and useless." The patient tearfully shares that he has been losing sleep, has little energy, and recently took a leave of absence from work as he could no longer concentrate on details and complete his paperwork. Medical history is significant for hypertension, hypercholesterolemia, diabetes, benign prostatic hyperplasia, and transient ischemic attack. Family history is significant for hypertension and diabetes in his mother and Alzheimer disease in his father. He does not smoke and drinks wine only occasionally. The patient has lived alone for the last 6 months since his son moved out Physical examination is normal except for markedly slow movements. CT scan of the head is normal. Open / Comment