zianab
Forum Elite
Topics: 17
Posts: 282
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hi,
mazinger can u please post the new qs as we are done with cardiology qs.please post atleast 12-13 so that we can do it fast.
I am going to post the qs 7 nobody is answering on the main forum so that we can know the answer.
keep posting dr .pumkin,npas and mazinger regarding your progress.
take care
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| mazinger
Forum Guru
Topics: 46
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Zianab sorry I didnt post any answer for that particular question..
I would defientely go for paroxysmal SVT.. why? the vignette explains itself, paroxysmal episodes of tachycardia, converted to sinus rythm by the use of an iv drug which is from my perspective adenosine....
new qs...
Ok Ill post new but I dont think there are much of cardio qs in form 2... I can post from other sources though... Just give me the green signal and Ill proceed to do so... 
BTW comments are accepted, as always I could have missed something...
But thats it...
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original mazinger z
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| dr.pumpkin
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Topics: 4
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yeahh mazinger , zianab is pretty right ,, ur posting questions helpl a lott ..
thnxx frnd ,, n it wuld be really nice if culd post frm other sources too n help us out wid answers  ..
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| dr.pumpkin
Forum Newbie
Topics: 4
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frns i have a doubt...can somone clear it up plzz ??
When to do fasciotomy in c/o compartment syndrome ??
- just as soon a the diagnosis is made of compartment syndrome or after the evidence of decreased blood flow shown in the doppler studies ??
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| dr.pumpkin
Forum Newbie
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haven`t covered much as yet...very l`l of studies till nw...
frns, wuld be posting after covering a bitt...
tk cr all..
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| dr.pumpkin
Forum Newbie
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hmm...i m finding these ques a bit hard  ...stiil give a try,, plzz do correct me frns..
QUES#1 - ( E )..the patient has mastitis..though letting the milk out via breast pump or feeding is imp , but i think the best step wuld be starting the Antibiotic early..
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| dr.pumpkin
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QUES#2 i am clueless... ..
the patient is having the complication of Epi. anesth leading to maternal hypotension and fetal bradycardia...also the patient is already in labour , cervix appreciably dilated..so it wuldn`t be good to give tocolytics ( nifedipine, MgSO4 )..
shuld we give ephedrine to make the mother a bit stable or give her oxytocin to fasten the delivery
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| dr.pumpkin
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me badly stuck up on surgery...still 1 chap left, lectures too, n questions also... ..
i have been studying since morning,, i donno wats going wrong ??  ..
zianab, npas wat abt u guys ??
hw much have u covered ?? Hw many questions have u done ??
gud luck frns...keep doing well..
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| dr.pumpkin
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| npas
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1)C__discontinue the breast feeding....coz when symptoms r systemic we should discontinue the breast feeding and do the surgical I and D..
2)This one was tough..confused me a bit..Is it A)Ephidrine..'coz the presentation is that of a shock..most probably due to epidural anasthesia induced sympathetic blockade..so we should give a vasopressor..but I read in one book that its contraindicated in pregnancy(category C)..but here we don't have a choice I think.
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| npas
Forum Senior
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hey Dr Pumpkin..u r online..I also thought about the oxytocin..but it is CI in the fetal distress..rt??I'am confused too..let the others contribute.
npas
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| npas
Forum Senior
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and we both r in the same boat Dr p..I have some pages here and there left,plus the lectures...and the qs..yesterday I didn't study..u know why!!
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| mazinger
Forum Guru
Topics: 46
Posts: 918
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The first one I would definetely go for penicillase resistant antibiotics... Note that antibiotics are not always necessary unless there are prominent signs of an active infection.. In this case the patient is having chills so antbiotics are indicated...
The second one ephedrine is the right option and npas is right... There is a sympathetic blockade when epidural anesthesia is applied and its best treated with ephedrine.. Unlike direct alpha 1 agonists such as etilephrine, ephedrine does not induce a vasoconstriction of uterine blood vessels...
Regards
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original mazinger z
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| dr.pumpkin
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zianab,, thanx fr the fasciotomy answer...
does it go for the burn thing also ??
plzz see this ques too...
there`s a guy presenting wid circumferential,third degree burns of wrist n elbow 3 days later..he now has numbness in the hand, motor function is intact...
wats the next best step ??
they mention doing doppler studies n then escharotomy if the flow is decreased...
i m soo sorry fr the confusion...but this is really unclear to me
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| mazinger
Forum Guru
Topics: 46
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about the fetal decelaritions are just a consequence of placental hypoperfusion, remember that the blood flow in an organ is mainly determined by its perfusion pressure and the resistance of the local vessels (arterioles).. In this case if one fails the other can compesate only to a level (compensation mechanisms are always incomplete), note that the baby is not only suffering but also the patient is having cerebral hypoperfusion...
Regards
Edited by mazinger on 11/20/06 - 08:29 AM
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| npas
Forum Senior
Topics: 8
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the 3rd q..answer I think is D)defect in phagocytic oxidative mechanism..recurrent respi infections plus positive NBT test..
npas
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| dr.pumpkin
Forum Newbie
Topics: 4
Posts: 168
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hey npas,, i guess surgery isn`t that l`l... ..hope we ll finish it soon...yeah frnd,,u wuld definitely be missin ur frns n family here...i wonder somtimes hw u n zianab manage it ?? ..
neways,,the gud thing is we shuld n we do get back to our main work n goal
 ...hope we are able to get it...
take care all...
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| npas
Forum Senior
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Mazinger
about the 1st one..I had the feeling that it was antibiotics..but when I checked the books I found --"if the presentation is localised give antibiotics..oxacillin etc..but if there is any sign of systemic infection(fever and chills in this case) immediately discontinue the breast feed and do the surgical incision and drainage.."
there is also an another line which supports ur answer that "if there is no suppuration then antibiotics can control it with in 24 hours..but if abcess has been formed incision and drainage is indicated"
do let me know ur explanation.
regs
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| mazinger
Forum Guru
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Dear Npas you are right about the surgical drainage, but its not listed in the options and by stopping breast feeding by itself wont make the infection go away... the patient has an acute infection and we have to give antibiotics for staff aureus, even in the case we perform a surgical drainage we have to give antibiotics still...
One last thought... In the absence of an abcess lactation should continue, why? one of the causes of infectious mastitis is milk retention in the breasts causing a massive congestion which predisposes to infections... By breast feeding the patient can relieve this congestion favoring to a decrease of the inflammation and less infections...
so thats basically it..
For the third one I agree its a chronic granulomatous dzs, NADPH Oxidase deficit.. Leukocites need this enzyme in order to have a normal respiratory burst and nitroblue tetratrozolium is a test that measures exactly this.. These patients are suceptible to catalase + microorganisms such as staff, candida, aspergillus and others... But they have immunity for catalase - microorganisms such as strep (microaerophyllic bacteria) because the minimal O2 radicals these bacteria produce can "feed up" the myeloperoxidase system in order to form BLEACH...
Comments are welcome...
Edited by mazinger on 11/19/06 - 02:02 PM
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| zianab
Forum Elite
Topics: 17
Posts: 282
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hello guys,
how are u all.I will post answers to the qs at night.
take care u all
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| USMLEGladiator
ck, CS Finish by Feb09
Topics: 128
Posts: 465
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for ac. mastitis, treatment of choice is dicloxacillin. breast feeding should continue. -source CMDT(current med diagnosis & treatment)
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Be confident,do hard work,forget past failures and success is yours.......
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| npas
Forum Senior
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ok guys..the first one is antibiotics..mazinger's explanations r convincing..and usmle gladiator also think so..I think I should accept it now..thanku for the explanations.
regs
npas
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| mazinger
Forum Guru
Topics: 46
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USMLEGladiator wrote:
for ac. mastitis, treatment of choice is dicloxacillin. breast feeding should continue. -source CMDT(current med diagnosis & treatment)
Good to see you around buddy...
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| mazinger
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npas wrote:
thanku for the explanations.
regs
npas
you are welcome, anytime...
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| mazinger
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Now its my turn to break the ice...
number 4 its a MI
In some cases it is difficult to clinically differentiate MI vs Unstable angina.. In this case the only way to be 100% sure is the ekg.. Since there is no ekg and no unstable angina option then I definetely pick MI.. Patient has ischemic heart dzs plus many risk factors and pain doesnt subside to 3 nitro tabs this patient has something serious going on...
number 5 is idiopathic cerebral hypertension.. The description fits well to the diagnosis..
number 6 I dont know the answer but perhaps night time constraints is a good option for a good night time sleep (of course if you are the caregiver), but this option is too sadistic to be considered... I am clueless
Edited by mazinger on 11/20/06 - 03:51 PM
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