A 19-year-old man goes swimming in an inland pond in Puerto Rico. Within a few days, he notices itching of his skin over several surfaces of his body. He is unconcerned until several weeks later when he develops lancinating pains extending down his legs and all of his toes. Over the course of just a few days, he develops paraparesis and problems with bladder and bowel control. Within one week, he is unable to stand and has severe urinary retention. Which of the following is the most appropriate plan of action on an emergency basis?
a. Initiate anticoagulation
b. Perform sensory-evoked potential testing
c. Order an MRI scan
d. Place a cervical collar
e. Perform spinal angiography
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Order an MRI scan.
A number of spinal cord processes could have produced this evolving paraplegia. Rapid investigation is essential to maximize the likelihood that this young man will recover cord function once the lesion has been treated. Even a reversible lesion left untreated for days or weeks will lead to permanent disability. Magnetic resonance imaging scanning is the best emergent test when available, as it will show compressive lesions as well as processes, such as tumors, inflammation, or infection, that may affect the parenchyma of the spinal cord itself. Vascular lesions, such as spinal cord AVMs, may also be seen on MRI, although spinal angiography is often required to confirm the lesion and guide therapy. Anticoagulation is ill advised, because any one of several processes, such as tumors, vascular malformations, or infections, may have already led to bleeding into the spinal cord or be susceptible to bleeding.