Isther
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78 yo F. Presenting with tonic-clonic convulsions. At ER relatives refer she had abdominal pain and distention for 3 days. Have history of HTN, CAD, and hyperlipidemia for several years. BP 100/70, HR 65, T 37.5 C., RR 16. Meds are nitro, atenolol, amlodipin. What is the best next management step:
- Rectal exam Electrolytes CT abdomen CT head US abdomen
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| Isther
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- Rectal exam
- Electrolytes
- CT abdomen
- CT head
- US abdomen
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| study_ing
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electrolytes..im thinking abdominal ileus and seizures can both be explained by that..also less exoensive.
but next management step---rectal exam may be? need to complete p/e b4 moving on ...and in a 78 yr old, prostatic ca (mets for the convulsions) cud be apossibility
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| cerebral
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female with prostatic ca?
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| study_ing
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hehehe
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| frank100
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this is an emergency, so ABC must be used. the differential here is huge, so start with the most simple and cheapest of all the options (rectal exam), then sample her. because electrolites won´t be ready now, but you can see your own finger STAT!!!
Airway, Breathing, and Circulation have been addressed (I hope), but physical exam is always first so put the finger goes first. you´re goin to sample her at the same time, but electrolites won´t be ready in this moment.
maybe you will need 4 and 5, but this is not the priority of the question ("best next management step")
my answer is (a)
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| tolito
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good thinking frank.
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| shumaila
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electrolytes is the next best management step
however recctal exam is the next step not next best step
corrrect me ifI am wrong what is answer isther
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| Isther
Forum Guru
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What frank says is true... the answer is 1... Besides the patient is old, has CAD and abd distention, if the rectal exam shows occult or gross blood then mesenteric ischemia has to be addressed quick.
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