USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 66-year-old woman comes to the Emergency Department because of a decelerating motor vehicle accident that resulted in injury to her neck. Her temperature is 37.1°C (98.8°F), pulse is 90/min, respirations are 20/min, and blood pressure is 130/85 mm Hg. Physical examination shows bilateral loss of pain and temperature sensation in her upper extremities with triceps and biceps reflexes are weak bilaterally and strength 2/5. Lower extremity reflexes are present, with 4/5 muscle strength. Which of the following is a risk factor for the most likely diagnosis?