Uworld | Step 2ck

2023-01-19 08:01:01 A 56-year-old man is brought to the emergency department due to difficulty speaking and paralysis of the right side of his body since he awoke this morning. The patient has not seen a primary care physician for many years and takes no medications. Two years ago, he was told that his blood pressure was elevated during a visit to the dentist He has a 30-pack-year smoking history and drinks 1 or 2 cans of beer daily. The patient has a sedentary lifestyle and a diet consisting mostly of fast food. His father had a stroke at age 60. Blood pressure is 170/95 mm Hg and pulse is 94/min. BMI is 34 kg/m2. The patient's speech is dysarthric. Weakness of the right lower face and right upper and lower extremities is present There is decreased pinprick sensation on the right side of the lower face and body. Right-sided deep tendon reflexes are brisk, and Babinski sign is present on the right Noncontrast CT scan of the head reveals no hemorrhage. Serum LDL is 190 mg/dl and HbA 1 c is 8%. Open / Comment

2023-01-18 22:01:10
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https://t.me/USMLERECALLS2021/817 Open / Comment

2023-01-18 20:00:15 Educational objective: Subclavian steal syndrome occurs due to stenosis or occlusion of the proximal subclavian artery, leading to reversal of blood flow in the ipsilateral vertebral artery. Patients are often asymptomatic but may have symptoms of upper extremity ischemia (eg, pain, fatigue, paresthesias) or vertebrobasilar insufficiency (eg, dizziness, ataxia, dysequilibrium) that are worsened by upper extremity exercise. Open / Comment

2023-01-18 07:59:01 A 68-year-old man comes to the emergency department due to severe dizziness while playing tennis an hour ago. He says that he had a spinning sensation accompanied by nausea and vomiting; the symptoms have now subsided. The patient has had brief episodes of dizziness in the past, especially when performing vigorous work with his arms. He has also experienced heaviness and fatigue of the left arm with exertion. The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. Blood pressure is 140/90 mm Hg on the right arm and 100/74 mm Hg on the left, and pulse is 82/min and regular. A systolic bruit is present at the base of the neck just above the clavicle on the left side. Cardiac auscultation discloses a fourth heart sound. There is no extremity weakness or sensory loss. Open / Comment

2023-01-17 20:59:01 Educational objective: Papilledema is caused by increased intracranial pressure and presents with transient vision loss lasting a few seconds with changes in head position.
It requires urgent diagnostic evaluation (eg, ophthalmologic examination, neuroimaging, and/or lumbar puncture) as persistent papilledema can lead to vision loss. Open / Comment

2023-01-17 08:57:01 A 34-year-old woman comes to the physician with complaints of periodic visual obscurations. She has episodes during which she goes blind for several seconds when standing up or stooping forward abruptly. She also describes frequent morning headaches over the last 2 months for which she takes ibuprofen or aspirin almost every morning. The patient takes no other medications. Her past medical history is insignificant except for an uncomplicated vaginal delivery. She does not use tobacco, alcohol, or illicit drugs. Her temperature is 36.4 C (97.6 F), blood pressure is 138/88 mm Hg, and pulse is 93/min. Her body mass index is 35 kg/m2. Visual field testing shows enlarged blind spots. Open / Comment

2023-01-16 20:57:01 Educational objective: Because the facialfophthalmic venous system is valveless, uncontrolled infection of the skin can result in cavernous sinus thrombosis. Red-flag symptoms include severe headache; bilateral periorbital edema; and cranial nerve 111, IV, V, and VI deficits . Open / Comment

2023-01-16 08:56:01 A 23-year-old man comes to the physician complaining of worsening headache over the past week. He is "under a lot of stress at school" and having trouble sleeping because the headache is constant Two weeks ago, he had an insect bite on his right cheek and now both of his eyes are swollen. He also has lost his appetite and vomited twice today. His temperature is 38.3° C (101° F), blood pressure is 130/90 mm Hg, pulse is 104/min, and respirations are 20/min. Examination shows erythema and swelling of the right cheek and bilateral eyelid edema, right greater than left Bilateral extraocular movements are restricted. The bilateral forehead and mid-face are extremely tender to light palpation. Open / Comment

2023-01-15 20:56:01 Educational objective: Patients with advanced AIDS are at increased risk for malignancy. Primary CNS lymphoma is an AIDS-defining malignancy associated with the expression of Epstein-Barr virus oncogenes, which can often be identified in the cerebrospinal fluid. MRI of the brain generally shows a solitary, irregular, nonhomogenous ring-enhancing mass. Open / Comment

2023-01-15 08:55:09 A 25-year-old man is brought to the emergency department due to a generalized tonic-clonic seizure. According to his roommate, the patient has had worsening confusion and lethargy for the last 2 weeks. Today, he had a seizure lasting approximately 3 minutes. The patient has a history of HIV and is not adherent with antiretroviral therapy or other HIV-related medications. He is an active injection drug user. Temperature is 37.7 C (99.9 F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 16/min. On physical examination,
the patient is somnolent but
arousable. There is no focal extremity weakness or sensory loss. CD4 count is 26/mm3 and viral load is 86,000 copies/ml. MRI of the brain with contrast shows a solitary, irregular, nonhomogenous ring-enhancing lesion in the periventricular area. Cerebrospinal fluid PCR is positive for Epstein-Barr virus DNA. Open / Comment