PKG
Forum Senior
Topics: 25
Posts: 62
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1) 72 YEAR OLD MAN WITH CHRONIC ABDOMINAL PAINAND HEADACHE FOR 4 MONTHS. HE IS A SMOKER AND ALCOHOLIC. HE HAS BEEN FORGETFUL FOR 6 MONTHS ACCORDING TO HIS WIFE.
ON EXAM TEMP=98.3, BP = 168/98, P=79/MIN. THERE IS MILD SHORT TERM MEMORY LOSS, DECREASED SENSATION TO PINPRICK IN THE DISTAL EXTREMITIES. HE HAS ATAXIC GAIT . HE HAS GOUTY TOPHI I THE GREAT TOE OF THR RIGHT FOOT. WHAT IDS THE NEXT STEP IN THE MANAGEMENT? THERE WERE SOME LABS GIVRN...ALL WERE NORMAL..EXCEOT...SERUM URIC ACID WAS 14 MG/DL
CT SCAN OF THE ABDOMEN
MRI
MEASURE URINE PORPHOBILINOGEN
FOLKS...WHATS THE DIAGOSIS?
2) WHATS LIMBIC ENCEPHALLOPATHY?
3) 4 MONTH OLD CHILD COMES WITH A BIRTH MAR ON HER FOREARM WHICH HAS INCREASED IN SIZE OVER THE LAST SEVERAL WEEKS.IT MEASURES 3 X 2 CMS , BRIGHT RED, RAISED,SOFT , NONTENDER, COMPRESSIBLE. WHAT IS THE NEXT STEP IN THE MANAGEMENT
EXCISION
LASER
NO INTERVENTION NECESSARY
4) 52 YEAR OLD FEMALECOMES WITH H/O DECREASED LIBIDO . SHE HAS UNDERGONE TAH WITH BSO SOMETIME BACK FOR MENORRHAGIA AND IS CURRENTLY ON CONJUGATED ESTROGEN THERAPY.ON EXAM, ER VAGINA IS MOIST AND RUGATED. WHAT IS THE CAUSE OF HER CONDITION?....FOLKS THERE WERE MANY OPTIONS.....SEE IF YOU CAN ANSWER WITHOUT THE OPTIONS
5) what is eczema herpeticum?
6) a 6 month old comes with an enlarged head. on exam, the infant has retarded development. he was operated for myelomeningocoele as a neonate.what is the cos of the hydrocephalus?
increased production
decreased absorption of csf
obstruction to the flow of csf
7) 77 year old woman comes with 2 day h/o cramping abdominal pain with distension.she has nausea and vomitting. no history of previous operations. she has fever of 99.4, bp is normal, pulse rate is 112 per min. respiratory rate is 24 /min. cardio pulmonary exam is normal. examination of the abdomen shows distension with mild diffuse tenderness. bowel sounds are high pitched. x ray film of the abdomen shows air fluid levels throghout the small bowelwith air in the liver.no gas in the colon or free airwhats the diagnosis?
cecal cancer
adhesive bowel obstruction
gall stone ileus
mesenteric infaction
small bowel lymphoma
8) by what mechanism does beta blocker help post MI who still have angina symptoms?
decreasing mocardial contractions
decreasing diastolic relaxation
dilating coronary arteries
peripheral vasodilatation
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| babli
Forum Guru
Topics: 40
Posts: 425
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1) ct of abdomen.
3) no intervention necessary.will involute by 5 years of age.
5)dermatitis due to HSV.
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| marasmus
Forum Junior
Topics: 2
Posts: 42
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6)obstruction to flow
7)gall stone ileeus
8)dec. myocardial contractions
WHICH NBME WAS THIS...1,2 OR 3?
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| srf
Forum Guru
Topics: 73
Posts: 405
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1] idiopathic raised intracranial pressure
2] B1 encephllopathy
3] no intervention
4] decresed androgens
5] eczema plus herpes infection ,painful vesicles
6] outflow obstuction
7] mesentric infarction at 77 he will have lot atheroscerosis
8] decrease contraction
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| Rasul
Forum Guru
Topics: 56
Posts: 485
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To srf:
Agreed with everything except #7-Gallstone ileus.
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| marasmus
Forum Junior
Topics: 2
Posts: 42
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 air in the liver is pathognomic for gallstone ileus
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| PKG
Forum Senior
Topics: 25
Posts: 62
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thanks folks....can ayone explain the answer to question 1? why ct scan of the abdomen? are you thinking of abdominal aortic aneurysm? srf, why do you say, the diagnosis is benign intracranial HT? neuroimaging studies will be normal in this.
can anyone explain the answer to question 4?
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| Rasul
Forum Guru
Topics: 56
Posts: 485
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I'd say, the man is obviously an alcoholic. He's got alcoholic neuropathy, ataxic gait(like cerebellar ataxy), and forgetfulness. Plus, he has gout(because alcohol produces both overproduction and undersecretion of uric acid)
So, he's in pain because of his gout, and he takes medications to help him(Aspirin, NSAIDs). Due to his affected memory he can't keep the track of how many times he took those meds, so lately he's chronically abuses these pain meds. That's how he has the abdominal pain and probably the headache too.
Liver toxicity, possible site of GIT bleeding-those are pathologies I'd look for in the patient like this. MRI- won't give me anything, urine porphilinogen- so what if it's high, he's got gout. CT scan of abdomen sounds closer to reality.
Attention: I might be wrong!I'm sure ther are other opinions too. Let's share.
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| PKG
Forum Senior
Topics: 25
Posts: 62
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rasul....good explanation....but why does the man in question 1 have hypertension? can you correlate? i thought doing ct scan to look for abdominal aortic aneurysm. and the neurological features could be a sign of multi infarc dementia........anyone any opinions on this?
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| Rasul
Forum Guru
Topics: 56
Posts: 485
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Long years of alcohol abuse can create HTN. What I'm thinking about is how headache goes with this everything?Abdominal pain and headache started simultaneously-4 months ago. What created one, created another one?
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| Rasul
Forum Guru
Topics: 56
Posts: 485
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You know, PKG, I kept on thinkng about this problem. The headache doesn't add up with my explanation of possible gout treatment med overdose. Besides, liver toxicity or GIT bleeding would have affected the lab panel.Aneurism choice though seems to embrace everything.
Alcohol increases chances of silent aneurism rupturing. Let's say, he has Berry aneurisms, and aortic aneurism, and now they increase in size and go to rupture.
That would explain the headache.
I really don't know if it's the correct answer. Other opinions?
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| an
Forum Guru
Topics: 19
Posts: 437
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i think the qu has something missing...i vaguely remeber it...PKG was there something about this guy using lead vessels to brew alcohol at home?...coz i remeber fitting it all with lead toxicity...the headache,abdominal pain, neuropathy, gout and hypertension
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| marasmus
Forum Junior
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THATS RIGHT an..THIS QUESTION IS FROM NBME 2....IN THE QUESTION THE OLD MAN HOME BREWES ALCOHOL ...SO LEAD POISONING..AND EVERTHING MAKES SENSE..BUT FOR LEAD POISONING WHATS THE BEST FIRST TEST..LEAD LEVELS OR ZINC PHOSPHORYLASE?..AS FAR I KNOW ITS LEAD LEVELS..AREN'T THEY DONE WITH A FINGER STICK TEST AND GIVE INSTANT RESULTS?
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| Rasul
Forum Guru
Topics: 56
Posts: 485
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Thanks, an @ marasmus! It all makes sense now.
The best choice is probably lead level. According to some sources brain CT or MRI can be helpful to visualize the cerebellar or cerebral lesions in lead poisonog.
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