Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
A 45-year-old male warehouse worker is evaluated for a back injury he experienced 4 months ago when lifting a heavy box; he has been bedridden intermittently since then. Today he is asking for a disability form to be completed so that he can be reassigned to a desk job. His back pain does not radiate and he has no lower-extremity weakness; however, he reports that both legs are completely numb. He takes over-the-counter NSAIDs but no prescription medications. He has no history of injection drug use and is otherwise healthy.
On physical examination, the temperature is normal, pulse rate is 74/min, and blood pressure is 126/82 mm Hg. The patient has exquisite diffuse lumbar and paraspinal tenderness to light palpation, with no areas of erythema or warmth; his spinal range of motion is decreased. Pressing downward on his head elicits lower back pain. Although he is able to passively extend his legs without pain when sitting down, he has back pain radiating down his right leg with a supine straight-leg-raising test. Lower-extremity motor strength is intact, and patellar and ankle reflexes are symmetric.
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
The patient's examination findings, consisting of widespread superficial tenderness, pain on axial loading of the skull, and inconsistent straight-leg-raising tests (should be positive both when the patient is sitting and supine), suggest a nonorganic component to his back pain. These findings (Waddell's signs) are considered nonorganic because they do not correspond to anatomic distributions or make physiologic sense. The examination findings and the pending disability claim also suggest that the patient is at high risk for persistent symptoms. Psychologic evaluation is appropriate because Waddell's signs have been correlated with hypochondriasis and hysteria, and the patient may benefit from antidepressants or cognitive-behavioral therapy. There is no convincing evidence that epidural corticosteroids benefit patients with chronic low back pain resulting from herniated discs or spinal stenosis; no controlled trials have evaluated patients without neurologic deficits. A meta-analysis found no convincing evidence that the antispasmodic cyclobenzaprine is more effective than placebo for treating chronic low back pain. However, cyclobenzaprine does provide modest treatment benefits for patients with acute low back pain, although adverse effects are common. The patient does not have any red flags warranting plain radiography, such as trauma, age older than 50 years, history of malignancy, fever, immunosuppression, substance abuse, or neurologic deficits. An MRI is not indicated because there are no red flags necessitating early imaging and no reason for considering back surgery in this patient.
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
q2
A 76-year-old man is evaluated for a syncopal episode that occurred last night after a coughing paroxysm following a fit of laughter. The patient is accompanied by his wife, who found him unconscious and slumped against the wall in the bathroom but reported that he regained consciousness quickly when she laid him fully on the floor and raised his legs. On regaining consciousness, he was fully oriented, spoke clearly, and had no difficulty standing up or walking. He reports having felt lightheaded and faint several times recently while trying to urinate but had not passed out before. His history includes coronary artery disease, stable angina, hypertension, chronic obstructive pulmonary disease with paroxysmal coughing, and benign prostatic hyperplasia with increasing difficulty urinating. He also has a seizure disorder caused by a remote head injury, with seizures occurring every 1 to 2 months, and the most recent one occurring 2 months ago. Physical examination, including complete neurologic evaluation, is normal.
Which of the following is the most likely diagnosis?
A Vertebrobasilar transient ischemic accident
B Situational syncope
C Carotid sinus syncope
D Grand mal seizure
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
Answer and Critique (Correct Answer = B)
True syncope is an abrupt, transient loss of consciousness due to global cerebral hypoperfusion without focal neurologic deficit and with spontaneous recovery. This patient experienced situational syncope, in which syncope is associated with a particular situation. It includes syncope associated with vagal stimulation, such as straining at micturition, defecation, cough, and, occasionally, swallowing, especially very cold liquids. Vertebrobasilar transient ischemic attacks (TIAs) may cause transient loss of consciousness but usually involve focal neurologic deficits, such as hemianopsia or ataxia; carotid TIAs involve focal neurologic deficits without loss of consciousness. Carotid sinus syncope, also vagally mediated, is caused by pressure on the carotid sinus due to turning the head, a tight collar, shaving, a tumor, or vascular dissection. Prodromal aura, secondary incontinence, slowness in regaining full consciousness (>5 minutes), and postictal disorientation are characteristic of generalized seizure, although syncope may be associated with brief prodromal nausea or sweating.
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
mechanism of treatment of warts(or even skin tunours) by intralesional candida antigen injection?????
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
The present immunotherapy relates to a method of treating epithelial tumors and the pharmaceutical compositions and kits useful in treating such tumors. The immunotherapy comprises injecting an effective amount of a pharmaceutical composition containing at least one antigen into the tumor, wherein the antigen is selected for inducing or having the ability to induce a cutaneous delayed type hypersensitivity (DTH) response in the subject prior to the injection of the antigen into the tumors. This immunotherapy is particularly useful in treating epithelial tumors, such as warts or verrucae, that are induced by or related to papillomavirus. Antigens useful in the present immunotherapy are anergy panel antigens, such as killed mumps virus, candida extract, trichophyton extract or comparable antigenic extracts. Additionally, the method optionally includes the injection of an effective amount of at least one cytokine or colony stimulating factor into the tumor either simultaneously with or sequentially to the injection of the antigen. The subject treated by the present immunotherapy is preferably a mammal selected from a human, canine, bovine, feline, equine, ovine or rabbit subject.
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
thanx for the self assessment (answered too) facts. but I doubt if such things will be tested at step 2 level?? other MKSAP had somewhat more probability these ones are exceptional qs.. teasers as few would say....
Anyways I welcome any info.
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
Critically ill surgical patients who received insulin infusion to maintain blood glucose <110 mg/dL had significantly lower hospital and 1-year mortality, sepsis, acute renal failure, and critical-illness polyneuropathy, and fewer days of intensive care and ventilatory support compared with those who received conventional glucose control with an insulin infusion to maintain glucose at <215 mg/dL.
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
yeah u r right!!!!!!!!!!
actually i did half of the mksap git and hematology questions...and after completing it i felt very confident in git...and when i tried to do usmleworld it looked like a piece of cake.....but the general medicine questions doesnt seems to be good....except few..loks like a time waste ,maybe...i will stop now at question 45....stil hundred questions left...wont do it more...will pick up mksap for another topic later on ....
now will watch the match between liverpool and manu...its gonna be a cracker.....
Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
Reputation:
5
thanx for understanding and not getting unnecessarily offended by my blatant comments...
DO post in points you find might be suitable for CK... from MKSAP
Do you haveteh links to MKSAP other Qs??
teh earlier link posted dint work...or if possible you may send it as an attachment??
thanx
|
