By failing to prepare, you are preparing to fail.–Benjamin Franklin
Now onto this week’s podcast
A 21-year-old man presents after he was bitten by a spider. He has a picture of the spider on his phone (shown above). Which of the following is a potential complication of a bite by this spider?
A. Abdominal rigidity
B. Autonomic instability
C. Coagulation abnormalities
A 66-year-old man with hypertension and hyperlipidemia presents after an episode of severe chest pain while walking to work. He is currently asymptomatic. His vitals are T 36.27°C, HR 76/min, BP 143/85 mm Hg, RR 18/min, and oxygen saturation 99%. A 12-lead ECG is performed as seen above. Which of the following is the most appropriate next step in management?
A. Give 325 mg of aspirin, and activate the cardiac catheterization lab
B. Give 325 mg of aspirin, and admit for serial troponin testing and stress test
C. Give 325 mg of aspirin, and discharge home with cardiology follow-up in 24–48 hours
D. Send d-dimer, and consider CT pulmonary angiogram if elevated
A 17-year-old boy from New Jersey presents with a 3-day history of rash and a 1-day history of facial droop. He also complains of a headache. The images above represent the physical examination findings. In addition you note mild nuchal rigidity. A noncontrast head CT is performed and is normal. Which of the following is the next best step for this patient?
A. Acyclovir and corticosteroids
B. Lumbar puncture
C. MRI brain
D. Serologic testing for Lyme disease
A 52-year-old man presents with decreased sensation in the upper extremities and chronic neck pain. He states that the loss of sensation has been progressive for months. On physical examination, he has decreased sensation to pain over the upper back, shoulders, and arms with intact proprioception and light touch. What disorder does this patient exhibit?
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
What is the most frequently seen oculomotor sign in patients with Wernicke encephalopathy?
A. Lateral nystagmus
B. Lateral rectus palsy
A patient with metastatic breast cancer presents with weakness and nausea. An ECG is shown above. What electrolyte abnormality is likely in this patient?
That wraps up RoshCast Episode 44! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast and @RoshReview. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions.
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Megha and Nachi