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Physical examination reveals upper extremity tremors, mild dystonia of the upper extremities and mild incoordination involving his hands. Which of the following is the best initial management of this patient’s condition?A 33-year-old man is brought to the emergency department by his partner for 24 hours of fever, severe headache, and neck stiffness. His companion also comments that he has been vomiting several times in the past 8 hours and looks confused. His personal medical history is unremarkable. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing. He says his memory is now poor, and he has trouble focusing on tasks. His behavior has changed in the past 6 months in that he has frequent episodes of depression, separated by episodes of bizarre behavior, including excessive alcohol drinking and shoplifting. His parents have begun to suspect him of using street drugs, which he denies. A pulsatile abdominal mass is felt in the lower umbilical region. Patient’s feet have the following appearance seen in the picture. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the umbilical region. Past medical history is significant for 2 transient ischemic attacks 6 months prior, characterized by a sudden right-sided weakness and trouble speaking but recovered fully within 30 minutes. Current medications are sildenafil 100 mg orally as needed. Patient reports a 30-pack-year smoking history and heavy alcohol use on the weekends. The patient’s weight is 63.5 kg (140 lb), height is 185 cm (6 ft 1 in), and he has a BMI of 18.5 kg/m 2. Which of the following is the most appropriate further management of this patient? After an hour of supplemental oxygen, rest, and careful monitoring his dyspnea improves and chest pain resolves without medication. Lorazepam and follow-up with psychiatryA 69-year-old male with a longstanding history of hypertension and high cholesterol presents with abdominal pain and ‘bruising on his feet’. He reports that the pain is worse with inspiration and does not radiate. He says he has anxiety and takes alprazolam as needed. His paternal uncle died of an aortic dissection at age 42. He smokes half a pack of cigarettes a day and drinks alcohol socially. Temperature is 36.7☌ (98.0☏), blood pressure is 130/80 mm Hg, pulse is 82/min, and respiration rate is 14/min. The rest of the examination is within normal limits. A computed tomography (CT) scan of his head is shown in the exhibit. Which of the following additional clinical findings would you expect to be present?A 23-year-old man comes to the emergency department presenting with sudden-onset dyspnea and right-sided chest pain over the last hour.
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Students: Educators’ Pro Tips for Tough TopicsThe United States Medical Licensing Examination (USMLE) assesses a physicians ability to apply knowledge, concepts, and principles, and to demonstrate.A 10-year-old boy is brought to a family physician by his mother with a history of recurrent headaches. The headaches are moderate-to-severe in intensity, unilateral, mostly affecting the left side, and pulsatile in nature. Past medical history is significant for mild mental retardation and complex partial seizures sometimes leading to secondary generalized seizures. Start Your USMLE Step 2 CK Prep With UWorld Since 2003, nearly all medical students in the United States have trusted UWorld to prepare for their licensing exams.His birth history and family history are not available. Being at the forefront of medical education gives us an obligation to provide students with only the best practice questions and explanations.Details: Start Your USMLE Prep with the UWorld Step 2 CK QBank Since 2003, nearly all medical students in the United States have trusted UWorld to prepare.
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