sunny2
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mazinger,
No. 6 -My answer is - A
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| mazinger
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sunny2 wrote:mazinger, No. 6 -My answer is - A
Could you please explain sunny2?
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original mazinger z
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| sunny2
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Mazinger, This is what i think, I may be wrong as this answer is an educated guess based on certain facts and exclusion of other wrong choices
Making changes and adjustments to the home environment such as night time lighting can help make activities easier and safer for the person with Alzheimer's and can reduce specific symptoms, such as wandering.
people who have Alzheimer's may eventually lose access to what has been called the "map room" of the brain, the systems that orient us in time and space. Wandering and losing one's way to or from destinations - even within one's own home (specially at night)- may result. so well lit hallways , staircases and galleries will help people with the disease overcome the loss of these internal mapping abilities and reduce risk of injuries.
What do you think !!
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| mazinger
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very clever response sunny2... I really liked your approach 
Thank U
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original mazinger z
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| mazinger
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Guys I wont be able to connect for a few days, my laptop computer just fell from a desk and now its broken  ... Eventhough it is still functional It will take a few days to fix, I am so sad because the MLE's are draining all my resources and I wont be able to get myself a new computer..
I want to cry and I am not kidding..
bye
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original mazinger z
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| npas
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About the nbme answers u guys r right about the answers..about the pseudo tumour cerebri answer...do any of u know why the obesity..ofcourse it is a hormonal imbalance..which hormone??
Sunny2's explanation is a good one...
Mazinger..look at the mail box..I have tried to put some suggestions..
Zainab..we r waiting for ur qs..Dr Pumpkin..how much more in surgery?
regs
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| npas
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ANS 7..is it fat embolism syndrome?my explanation..1)typical latency..12 to 72 hours after the injury..2)injury could have been trauma to adjascent organ liver(fatty organ) ...3)manifestations of pulmonary embolism..
npas
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| mazinger
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I can still post with my broken laptop, its just its broken  ... Well I am going to be able to connect until I send it for repairs..
About question 7, I would have thought of atelectasis this patient has many risk factors for this. The patient has gone through major surgery, she also has abdominal pain that will not let the right hemithorax expand adequately which in this case would lead to this pathology, note that the patient has a major shunt of blood which supports my atelectasis theory...
And the timing is also important note this is happening between the first 48 hours after abdominal surgery...
What keeps me confused is the linear markings thing in the CXR so if I have to choose I go for atelectasis...
Npas if you can comment on my thoughts would really be appreciated..
regards
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| sunny2
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npas
answer to Q.7 I think might be Atelectasis
as Atelectasis is a very common pulmonary complication in patients following thoracic and upper abdominal procedures. General anesthesia and surgical manipulation lead to atelectasis by causing diaphragmatic dysfunction and diminished surfactant activity and that atelectasis is typically basilar and segmental in distribution and migh present as linear markings
Fat embolism should indicate the History of:
Trauma to long bone or pelvis or orthopedic procedures
Parenteral lipid infusion or
Recent corticosteroid administration
and CXR indicates : diffuse bilateral pulmonary infiltrates within 24-48 hours and also clinically it should indicate some degree of hypotension,mental changes , thrombocytopenia and petechiaie with tachycardia and tachypnoea
mazinger...does this explanation make any sense !!!
I feel these USMLE -q's allways give 2-3 clues in the question so instead of assuming somethingh which might happen we should first focus on making sense from what is allready given in the question.
I may be wrong...it's just another guess
Edited by sunny2 on 11/21/06 - 07:06 PM. Reason: addition
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| mazinger
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sunny2 wrote:
mazinger...does this explanation make any sense !!!
It does a lot to me.. thanks about the pulmonary markings thing...
In addition to a diffuse fat embolism may look like increased eosinophils and eosinophiluria...
Sunny2, npas, dr pumpkin, zianab could you proceed with further questions please..?
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| mazinger
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8. No Xrays cannot really tell...
9.
A) Bipolar disorder
10.
C) Calcium, insulin, and glucose
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original mazinger z
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| npas
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 ..It turns out my way of thinking is absolute rubbish...don't know why I'am coming up with so many wrong answers..Atelectasis is right..esp I can't find linear Xray marking anywhere in fatty embolism!!But the Po2 and Pco2...and the latent period somehow made me think the embolism way..
but its ok to be wrong here..have to be better in exams..and I should not quit trying.
8)..in this one the presentation alone does not take us to a specific answer..if the abdo film was vague enough then we would go for the ct scan..if there was clear findings of pneumoperitonium or clear indication of perforation we may go for leparotomy..
9)yeah...I agree with mazinger's Bipolar disorder..but I would have given a thought to schizoaffective disorder..but it could be diagnosed only if the psychosis is present for atleast 2 wks..right?However Atypical episodes of mania may involve gross delusions, paranoid ideations, and auditory hallucinations..so bipolar disorder is perfect.
10)clear case of hyperkalemia..calcium to restore conductive activity of heart..insulin to take potasium into cells and glucose to prevent hypoglycemia..way to go Mazinger ..
where is Dr Pumpkin and Zainab!!!Hope we will have ur inputs soon..
regs..npas
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| mazinger
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npas wrote:
but its ok to be wrong here..have to be better in exams..and I should not quit trying.
You are sooo right.. I would also rather to get wrong answers here in the forum and not in the real test.. Npas dont be discouraged by a wrong answer remember that each time we get a question wrong it opens up a path showing us what we should strength and reinforce prior to the test day...
Thank u for the compliments, and you know you can count on me in question discussions..
The whole point of this is to improve our techniques, knowledge, perspectives towards question solving....
Regards...
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| npas
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yes Mazinger..I agree with u..word to word..thanx for the boost up..
Lemme try out the next one..I'am creting confusion..once more ..
11. Six months after the delivery of her fourth
child, a 37-year-old ......
i'am picking up an unlikely answer..but will give the explanation..I will go for E)No treatment indicated...
My explanation..If the patient does not desire future childbearing and has severe disease or symptoms, definitive surgery is appropriate and often curative.But this patient is having no symtoms at all..and she is just 37..why does she have to bear the problems of early menopause!!
Why not a medical therapy...'coz "In asymptomatic patients, those with mild discomfort, or infertile women with minimal or mild endometriosis, expectant management may be appropriate. Although endometriosis is generally believed to be a progressive disease, no evidence indicates that treating an asymptomatic patient will prevent or ameliorate the onset of symptoms later"..
npas
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| mazinger
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eventhough I havent studied ob gyn yet.. You have convinced me... cool rationale, I am going to keep on my mind what you have posted
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| dr.pumpkin
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hiii frns...sorry fr a l`l hibernation  , had been busy wid a `not so important` stuff in my life ..
i ll answer the questions nw,
8 #E ..i think the pateint is presenting with acute mechanical intestinal obstruction...( m/b d/t adhesions) , though leukocytosis present but she`s afebrile..Also, the absolute signs of peritonitis ( rebound tenderness and involuntary gurading ) are absent , so we can wait and watch fr a few hrs n not rush for laparotomy.
thus, i `ll go for nasogastric intubation..
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| dr.pumpkin
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9# E.. ..
the patient is having hallucinations, which may pertain to ingestion of some subs to stay awake..the diagnosis of schizophrenia needs the symp. for atleast 6 mths ..
although the patient had a his of depression ( but 10 yrs back with no recent depressive symp), also these symptoms aren`t a manic episode..
person doesn`t seem have a personality disorder..
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| dr.pumpkin
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10# C ... calcium, insulin, glucose.
11# B.. gonadotropin releasing hormone therapy...
the patient is not symptomatic of the disease, thus we will not try a aggresive approach of total abdominal hysterectomy with b/l salpingo oopherectomy..( although the patient has completed her family )..we culd give her gonadotropin relasing hormones for the usual 3-6 mths...treating her wid them culd make the ectopic endometrium dormant..e Giving danazol wuld expose her to many more side effects like hirsuitism..
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| dr.pumpkin
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guys,,don`t u think we culd give her a therapy for a little while,,cos even though the patient is undergoing tubal ligation,, but she `s still exposed to the hormones...she culd have the endometrium growing..
so y not lets regress it ??
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| dr.pumpkin
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frns ,, wat abt the ques 9 ..
can we have such a long symptom free period in c/s of bipolar disorder...
yeah ..she was awake for three nights can point towards hyperexcitabilty ( as in mania )
but she is having clear hallucinations...she culd have taken a substance to stay awake ....
i don`t know...
plzzz frns can u clear this u fr me ???
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| dr.pumpkin
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okk...i got it,,,
it can`t be a mood disorder d/t substance ...
soo sorry frns ,, shuld have looked at the question more sincerely......
we have to choose the best anwer among the given options....
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| sunny2
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Hello mazinger, npas, dr pumpkin, zianab
I was a little hesitent answering questions while you guys were discussing in a group, so I was waiting for you all to answer those first
you all are doin a great job....motivating and supporting each other, no doubt that each of you will come out with GREAT scores.....surely.
my answers are:
8-A ; 9-A; 10-C; 11-B ;12-C ; 13- D
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| mazinger
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agree with U sunny2.. all the way, but I dont know about treating or not the patient with endometriosis.. Thats something I must find out while I review ob gyn, which I havent yet...
And cannot say much about the question that is missing the xrays...
what do you say guys new set? ready to go?
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| npas
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Hey Dr Pumpkin..u were a little puzzled with the 9th one..I was too..then I read this line in a bipolar disorder.."Atypical episodes of mania may involve gross delusions, paranoid ideations, and auditory hallucinations."..That is why bipolar disorder is more likely I think..
About ur endometriosis answer..what i had explained is a quote from 'current obs'..but what u r saying also sounds reasonable..Lemme see if I can do more reading into that..
Sunny2..U don't have to wait for our discussion to be over..anyone can plunge any time into our group..only thing is we all have to gain knowledge via this..
keep warm
npas
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| sunny2
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npas
Thank you for a very vital viewpoint....for Q.11
you are correct ,for mild to moderate asymptomatic endometriosis there is no need for treatent and above all sterilization by tubal ligation is somehow protective against endometriosis
dr.pumpkin...you are also right when you say u wld like to regress the condition, that is what i also thought .....but here in this question after reading it carefully ....I feel they want us to have an understanding of management of a asymptomatic mild / moderate endometriosis after tubal ligation
mazinger, let the new set roll in
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