Welcome to episode 528 of the Divine Intervention Podcasts. My name is Divine.

In this episode, we're going to be continue a series on the USMali Step 2C, Free 120.

This is the most recent one on the USMLA website. And this is going to be part 9. This is going to be to be part nine again I'm trying to give a

fairly detailed discussion of every single question in this series we've done 65 questions so

far so we're on question 66 so let's go ahead and power up here a little bit okay so question

66 let's just again if you've missed any part of the series I promise promise you, this is a lot of very useful learning. But anyway, okay. A 75-year-old man is admitted to the hospital because of a 3-D history of fever. He has type 2 diabetes, mellitus, hypertension, and chronic obstructive coronary disease. One year ago, he had a stroke with residual right lower extremity hemiparysis.

Medications are low dipine, tyotropium, metformin, gliparide, lycinopril and aspirin.

He does not drink alcoholic beverages and has smoked one pack of cigarettes daily for 50 years.

The patient is widowed, leaves alone and has three adult children. He is not in acute distress.

He is 178 centimeters, that's 5 foot 10 inches tall, and weighs 82 kilograms. That's 180 pounds.

His BMI is 26 kilogram per meter squared. Temperatures 39.2 degrees Celsius. That's 102.6 degrees

Fahrenheit. Pulse is 110 per minute. respiration is 22 per minute, and blood pressure

is 150 over 90 millimeters of mercury. Pulse oxymetry in room air shows an oxygen saturation of 96%.

Scattered end expiratory whizzes are heard. There is dense hemiparysis of the right lower

extremity. Appropriate therapy is initiated and three days later, the patient's

condition has improved. He's a weak, alert, and conversing with one of his sons about current events.

Temperature is 37.2 degrees Celsius, that's 99.0 degrees Fahrenheit. Pulse is 72 per minute,

and blood pressure is 130 over 82 millimeters of mercury. Discharge plans are discussed with the patient,

his son, the physician,

and a physical therapist. The physical therapy says the patient will be best cared for in a nursing

care facility. The patient acknowledges that a nursing facility would provide better care for him,

but says he will prefer to remain at home with a visiting nurse. Once outside the patient's room, his son says, I have his power of attorney.

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