I am going to answer the sample USMLE Step 1 Questions with Explanation. These questions are available at USMLE.org
Q- A 20-year-old woman is brought to the urgent care center because of a 2-month history of progressive weakness of her arms. She also has a 1-week history of moderate back pain and headache. Her only medication is ibuprofen as needed for pain. Muscle strength is 3/5 in the upper extremities. Sensation to pinprick is decreased over the upper extremities. MRI of the spine shows a central syrinx in the cervical spinal cord. It is most appropriate to obtain specific additional history regarding which of the following in this patient?
(A) Diet
(B) Family illness
(C) Recent travel
(D) Trauma
(E) Unintended weight loss
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Answer
This patient’s presentation, including progressive upper extremity weakness, decreased pinprick sensation in the upper extremities, and an MRI showing a central syrinx in the cervical spinal cord, is consistent with syringomyelia. Syringomyelia often arises from conditions that disrupt the normal flow of cerebrospinal fluid (CSF) in the spinal cord.
Trauma is a common cause of syringomyelia, especially if there has been a prior spinal cord injury or whiplash-like events that could disrupt CSF dynamics. Post-traumatic syringomyelia typically develops months to years after an injury but can present progressively, as seen in this patient.
The correct answer is D
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