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🔰♦️USMLE Step 1 resources to aid success.😍👌
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Educational objective: Mild to moderate cancer-related pain can usually be managed with nonopioid analgesics. However, if initial interventions are not effective, intermittent doses of short-acting opioids should be offered. If the pain requires frequent dosing or if bedtime dosing does not provide relief through the night, a long-acting opioid may be added.
Which of the following is the most appropriate immediate next step in this patient's pain management?
A 71-year-old man comes to the ·office due to worsening low back pain. The patient is having significant pain with movement that is limiting his activity, as well as nocturnal pain that is disrupting his sleep. He has had no lower extremity weakness or numbness and no bladder or bowel dysfunction. He is taking ibuprofen 3-4 times a day, and it is not controlling his pain. The patient has a history of prostate cancer and takes leuprolide. He also received palliative radiotherapy for multiple lumbar spine metastases several months ago. Temperature is 37 C (98.6 F), blood pressure is 140/86 mm Hg, and pulse is 88/min. Lower extremity motor strength, deep tendon reflexes, and sensation are normal.
Educational objective: Chemotherapy-induced peripheral neuropathy typically presents as a symmetric, distal, sensory neuropathy that spreads in a stocking-glove pattern. Common causative agents include platinum-based medications (eg, cisplatin}, taxanes (eg, paclitaxel), and Vinca alkaloids (eg, vincristine }.
Educational objective: Chemotherapy-induced peripheral neuropathy typically presents as a symmetric, distal, sensory neuropathy that spreads in a stocking-glove pattern. Common causative agents include platinum-based medications (eg, cisplatin}, taxanes (eg, paclitaxel), and Vinca alkaloids (eg, vincristine }.
A 58-year-old woman comes to the physician due to difficulty walking. Over the last several weeks she has also experienced bilateral foot numbness and tingling. She was diagnosed with advanced Hodgkin lymphoma 2 months ago and is currently undergoing chemotherapy containing bleomycin, doxorubicin, and vincristine. Her other medical problems include type 2 diabetes and hypertension. Physical examination shows bilateral weakness on dorsiflexion of the feet and loss of pain and temperature sensation affecting both toes. Knee jerk reflexes are 2+ bilaterally but ankle jerk reflexes are absent
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🔰♦️USMLE Step 2 resources to aid success.😍👌
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Repost from Kaplan Step 2 CK 2026
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Educational objective: Wernicke encephalopathy is a neurologic complication of thiamine deficiency; it classically manifests as the triad of ataxia, encephalopathy, and oculomotor dysfunction.It is usually associated with long-standing alcohol abuse; however, it may be caused by any disorder that causes chronic malnourishment (eg, short-gut syndrome). Treatment is with intravenous thiamine.
Which of the following is the most likely cause of this patient's neurologic symptoms?
38-year-old hospitalized woman is evaluated for new-onset confusion. The patient has a prolonged history of Crohn disease and was admitted 2 days ago due to worsening abdominal pain, nausea, and watery diarrhea. She tested positive for Clostridioides (formerly C/ostridium) difficile infection and is receiving oral vancomycin and intravenous fluids. Her gastrointestinal symptoms have been improving, but since yesterday the patient has been incoherent, disoriented, and unsteady. She has no other medical conditions but has had small bowel resections due to stricture and fistula in the past and has lost 10 kg (22 lbs) over the past 6 months. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 36.6 C (98 F), blood pressure is 120/70 mm Hg, and pulse is 92/min with no orthostatic changes. BMI is 19.5 kg/m2. On examination, she is not oriented to time or place. Pupils are equal and reactive to light Abduction of the right eye is limited and elicits bilateral horizontal nystagmus . Motor strength and deep tendon reflexes are normal throughout Finger-to-nose and heel-to-shin testing are normal, but the gait is wide based.
