Question of the Week #490

490. An 18-year-old male presents to the Emergency Department for evaluation of chest pressure for an hour. The pain is radiating to his jaw. On examination, he is diaphoretic, and he complains of nausea. Past medical history is unremarkable. Urine reveals positive benzolegonine. Below is his ECG. What is the most likely cause of the patient’s symptoms?

ekg

A. Early repolarization

B. Ischemia

C. Cocaine induced myocardial infarction

D. Atrial fibrillation

E. Wolf-Parkinson-White Syndrome

Question of the Week #489

A 35 Year old woman presents for evaluation of recurrent headaches for the past few months.  Lately, she has been waking up with a headache almost daily though it tends to improve in the latter half of the day. She is frustrated as she can not even get some sleep during the attack since lying down makes her feel worse . She has associated nausea. She has transient attacks of light flashes  that resolve spontaneously. Her menstrual history is unremarkable. On physical examination, she has no neurological deficits. Funduscopic examination shown below: QBANK INSTA AD

Which of the following information, if elicited in the patient history, would increase the clinical suspicion of the diagnosis?

A)     Constipation

B)     Family history

C)      Recent weight gain

D)      Galactorrhea

E)   Urinary Incontinence

Question of the week # 488

A 31 Year old woman diagnosed with suspected diagnosis of Idiopathic intracranial hypertension underwent a lumbar puncture for diagnostic purposes. An MRI of the brain that was obtained prior to lumbar puncture did not reveal any structural abnormalities or mass effect. Laboratory investigations including coagulation parameters were normal. About 12 hours after the procedure, the patient complains of moderate to severe headache. Headache is mainly in the occipital region which increases while sitting up and improves on lying flat. She has two episodes of vomiting in the last one hour. She also complains of dizziness and ringing sensation in her ears.  Physical examination does not reveal any papilledema or focal neurological deficits.

Most appropriate next step in managing this patient?

A) Blood cultures

B) MRI of the Lumbar Spine

C) Non-Contrast CT scan of brain

D) Observation

E) Acetazolamide

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