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🔰♦️USMLE Step 2 resources to aid success.😍👌 👌 Save this list for a rainy day 😉

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Educational objective: Postherpetic neuralgia is characterized by burning pain and hyperesthesia lasting >4 months following acute zoster. The risk is greatest in those with advanced age, severe initial pain, or severe rash. First-line treatment includes anticonvulsants (eg, gabapentin) and tricyclic antidepressants (eg, amitriptyline).

A 68-year-old woman comes to the office due to persistent right-sided chest pain. The patient has had burning pain on the right chest wall and back for the past several months. She has had no associated cough, dyspnea, or trauma but had a transient rash in the same region prior to the onset of symptoms. Medical history is notable for breast cancer treated with surgery and chemotherapy, as well as hypertension and type 2 diabetes mellitus. Temperature is 37.1 C (98.8 F), blood pressure is 130/80 mm Hg, and pulse is 82/min. Chest examination shows no skin rash, but there is a band-like area of hyperesthesia on the right side. Lung auscultation reveals prolonged expiration with no wheezes. Heart sounds are normal. Back examination shows no deformity or focal tenderness.

Educational Objective: Hypokalemia is a common electrolyte abnormality that causes weakness, fatigue, and muscle cramps. When severe, it can lead to paralysis and arrhythmia. The ECG may show U waves, flat and broad T waves, and premature ventricular beats.

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A 54-year-old woman presents to your office complaining of difficulty walking. She describes severe weakness and occasional pain in her thigh muscles. She has stumbled and fallen several times over the last week. Her past medical history is significant for hypertension treated with hydrochlorothiazide and metoprolol. She consumes two to three cans of beer on weekends. Her younger brother died of a neurological disease when he was 20 years old. Her mother suffers from hypertension and diabetes mellitus. Her heart rate is 90/min and blood pressure is 170/100 mmHg. Chest examination is within normal limits. A bruit is heard over the left carotid artery. Neurologic examination reveals hyporeflexia and decreased strength in all muscle groups. Her ESR is 12 mm/hr. ECG shows flat and broad T waves with occasional premature ventricular contractions.

Educational objective: Descending (type B) aortic dissections can be associated with interruption of blood flow to the anterior spinal cord, leading to anterior spinal cord ischemia (particularly in the lower thoracic levels). Patients generally develop acute bladder paralysis, lower extremity paresis, crude touch/pain sensation loss, and diminished reflexes (initially). Vibrioception and deep touch sensation are generally preserved because these are carried in the posterior columns and receive some blood flow from the intact posterior spinal arteries.

A 56-year-old man with a prolonged history of hypertension and medication nonadherence comes to the emergency department with abrupt-onset, severe, tearing back pain. Blood pressure is 240/130 mm Hg, and CT angiography reveals descending aortic dissection originating at the left subclavian artery takeoff and extending to the iliac arteries. Intravenous infusion of labetalol and nitroprusside are initiated, and the patient is admitted for further management In the intensive care unit, the patient states that the pain has improved, but he is unable to move the lower extremities. Blood pressure is now 110/60 mm Hg, and pulse is 56/min. Physical examination shows normal heart and lung sounds and a distended urinary bladder. Neurological examination shows normal cranial nerves and upper extremity examination. There is weakness of bilateral lower extremities with decreased deep tendon reflexes. The patient is unable to sense crude touch and pain in the lower extremities, but vibration sensation is intact

Educational Objective: Riluzole is a glutan1ate inhibitor that is currently approved for use in patients with amyotrophic lateral sclerosis.

A 36-year-old Caucasian male is brought to the emergency department due to weakness of his upper and lower extremities. Neurological examination reveals weakness, atrophy, fasciculations, spasticity and hyperreflexia of the involved muscles. His sensory, bowel, bladder and cognitive functions are intact Serum creatine kinase is normal. Cerebrospinal fluid examination is within normal limits. Electromyography shows chronic partial denervation. The patient is subsequently diagnosed with amyotrophic lateral sclerosis.

Educational objective: The 3 cardinal signs of Parkinson disease are rest tremor, rigidity, and bradykinesia. The presence of at least 2 of these 3 on physical examination is grounds for a clinical diagnosis of this disease.