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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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  #1  
Old 04-17-2012
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Cool Let's Do Some Cases

how about solving few cases...I will give you the history and the examination findings and maybe some investigations...and you should:
1- give the diagnosis (or differential in some cases)
2- investigations (prefer findings too)
3- management

so, how about that?
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  #2  
Old 04-17-2012
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Post case 1(medicine)

A 32 yrs old woman presents with worsening lower back pain, difficulty in walking and weakness of both lower limbs for 6 months.
The pain was severe, exacerbated by activity and poorly responsive to analgesics. The lower limb weakness was pronounced when climbing stairs and getting up from chairs.
She also complains of dry mouth, constipation, and urinary frequency.

O/E:
vital signs: stable
heart, lungs, abdomen, breast: no abnormalities
no nystagmus or cerebellar signs
hoffman's reflex: negative
gait: trendelenburg
sensory: normal
motor: no muscle atrophy or tenderness
normal range of motion
power: grade 2/5 in both limbs hip extensors and abductors, grade 4/5 in other muscles in other muscles in both upper and lower limbs.
reflexes: both limbs knee and ankle jerks unelicitable
both limbs biceps jerk elicited after 4 seconds of isometric muscle contraction.
both limbs flexor plantars

good luck
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  #3  
Old 04-17-2012
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Default

Quote:
Originally Posted by lama166 View Post
A 32 yrs old woman presents with worsening lower back pain, difficulty in walking and weakness of both lower limbs for 6 months.
The pain was severe, exacerbated by activity and poorly responsive to analgesics. The lower limb weakness was pronounced when climbing stairs and getting up from chairs.
She also complains of dry mouth, constipation, and urinary frequency.

O/E:
vital signs: stable
heart, lungs, abdomen, breast: no abnormalities
no nystagmus or cerebellar signs
hoffman's reflex: negative
gait: trendelenburg
sensory: normal
motor: no muscle atrophy or tenderness
normal range of motion
power: grade 2/5 in both limbs hip extensors and abductors, grade 4/5 in other muscles in other muscles in both upper and lower limbs.
reflexes: both limbs knee and ankle jerks unelicitable
both limbs biceps jerk elicited after 4 seconds of isometric muscle contraction.
both limbs flexor plantars

good luck

Lambert eaton myasthenic syndrome.
chest xray
rx:guanidine hydrochloride
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  #4  
Old 04-18-2012
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Default answer to case 1

Lambert-Eaton Myasthinic Syndrome
diagnosis by:
electrodiagnostic testing: marked increment in actionpotentials following exercise
antibodies testing:voltage gated calcium channels antibodies
chest imaging:for small cell lung carcinoma
management:
3,4-diaminopyridine to relieve the symptoms
sometimes steroids can be used


facts about LEMS:
characteristic features are proximal myopathy, autonomic neuropathy and areflexia.
clinical features are usually benign, insidiously, and progress slowly, leading to diagnostic delay.
secondary to small cell lung carcinoma in almost 50% of patients, and may precede other clinical manifestations by months to years. chest imaging is mandatory in all patients.
diagnosis requires characterstic clinical findings, and either positive voltage gated calcium channels autoantibodies, typical repetitive nerve stimulation, or both.

thankx
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um aala (04-18-2012)



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