Dr.Conard Fischer Videos

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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.

Which of the following is the most likely diagnosis?

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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This patient's condition is most likely due to which of the following etiologies?

A 59-year-old man comes to the emergency department with diplopia that started several hours ago. His past medical history is significant for long-standing diabetes with poor glycemic control, right-knee osteoarthritis, and peptic ulcer disease. Physical examination shows right-sided ptosis with the right pupil in the inferolateral position. Pupils are equal in size and reactive to light bilaterally.

Educational objective: The suprachiasmatic nucleus regulates circadian rhythms by processing light information from the retina and modulating body temperature and the production of hormones (eg, cortisol, melatonin). Dyssynchrony between the local environment (eg, daylight hours, sleep schedules) and internal circadian rhythms can cause insomnia and daytime sleepiness (ie, jet lag). Melatonin supplementation is recommended for the treatment of insomnia associated with jet lag.

Which of the following hypothalamic nuclei is most likely responsible for this delayed improvement in his symptoms?

A 37-year-old man comes to the office due to difficulty sleeping. He says that his new job as a business executive is very stressful and requires considerable travel. During the past 3 months, the patient has made numerous trips between the United States and France. He experiences insomnia and daytime sleepiness for several days after these trips, but his sleep then improves significantly.

Educational objective: The middle meningeal artery is a branch of the maxillary artery, which enters the skull at the foramen spinosum and courses intracranially deep to the pterion (where the frontal, parietal, temporal, and sphenoid bones meet). Skull fractures at this site may cause laceration of this vessel, leading to an epidural hematoma.

A branch of which of the following arteries is most likely severed in this patient?

A 23-year-old woman is brought to the emergency department unconscious after a motor vehicle accident. The patient was texting on her cell phone and was not wearing a seatbelt during the incident. She has no known medical problems and takes no medications. Her temperature is 36. 7 C (98 F), blood pressure is 155/90 mm Hg, pulse is 62/min, and respirations are 1 O/min. A linear skull fracture at the junction of the frontal, parietal, temporal, and sphenoid bones is seen on head CT scan.