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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 4/Question#13 (reveal difficulty score)
A 67-year-old man is brought to the emergency ...
Brain abscess ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: infectious_disease Neuro Cardio

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submitted by โˆ—saffronshawty(30)
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can someone please explain this answer :D

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szsnikaa  Brain abscesses are secondary to septic emboli via hematogenous spread. Edema often forms around these abscesses leading to a mass effect (+ Babinski & Mild Hemiparesis on the left). +10
kingfriday  Guy has a valve replacement -> he then has a new murmur, fever, and FND - he probably has endocarditis due to staph epidermidis. Carotid artery occlusion wouldn't cause more issues (i think vision in particular would be included) in addition to more severe deficits. There would also be no fever. Venous sinus thrombosis would also not present with fever and also probably include vision problems Encephalitis would probably present with AMS and seizures - may or may not be nuchal rigidity Hydrocephalus: wet wacky wobbly- not seen here +5
tinylilron  So the brain abscess would be due to staph epidermis rather than strep pyogenes, right? +
notyasupreme  ^^ yeah, pretty sure I read on Anki that it's usually S aureus initially that commonly causes it, then becomes epidermitis +



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submitted by โˆ—step_prep7(71)
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  • Elderly patient with a history of aortic valve replacement presents with fever, new systolic murmur and signs of septic emboli to the brain, most consistent with infective endocarditis
  • Although brain abscess is a rare complication of endocarditis (1-7%), it is a feared complication of septic emboli to the brain and is more likely to occur than the other options listed
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submitted by satanicdo(7)
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endocarditis from Staph aureus (prosthetic valve put in 5 years ago) that spread to the brain (and can/will lead to brain abscess)

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