dr.pumpkin
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ooops !!! these are the hardest ones mazinger  ....
i ll try them though ...cos we have u as our saviour ..hehe ....
1. i m not sure ..confused between exercise and weight reduction and hydrochlorthiazide..
2. neurogenic bladder...
3. fasting insulin and glucose levels,,suspected insulinoma..
4. re examination in one year...
5 ? don`t know
6 abdominal US for abd . aortic aneurysm
7 slipped capital epiphysis.........
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| dr.pumpkin
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8. postural reflex impairment leads to falls which may cause injury to patient..
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| mazinger
Forum Guru
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1st question, from my perspective what this question is really asking is wether you should start treating or investigating a very young patient with hypertension.. And that is something I dont know, I think we should start treating first and then investigate for secondary causes... HCT is always first line treatment for almost all types of hypertension, ACE are first line for diabetics plus hypertension..
Dear Zianab I have been noticing that we all have different perspectives and disagreements in all questions regards about hypertension, I think we should do a Q&A about this subject as we were doing in the past...
2nd C) Neurogenic bladder
3rd. B) Fasting insulin and glucose levels
4. A) Reexamination in 1 year if the patient has not
had menarche.
5. A) Decreased gluconeogenesis
This patient has a glycogen storage dzs, its a Von Gierke's glucose 6 phosphatase deficiency enzyme required to remove the phosphate at the 6 position so glucose can get out of the liver to the circulation..
Reducing substances in the urine are found in VG and galactosemia...
This patients have severe fasting hypoglycemia and hepatic damage...
6. B) Abdominal ultrasonography, this question is asked in UW, but it makes you decide bet/ abdominal echo vs CT, ECHO is the TEST OF CHOICE...
7. D) Slipped capital femoral epiphysis, chubby boy with referred knee pain, pain production with internal rotation is classic..
8. D) Postural reflex impairment
9. B) Serum lipid studies
10. E) Severe volume depletion notice that the patient urinary sediment is normal, high BUN creatinine ratio and physical signs are all compatible with this..
11. B) Diverticulosis
12. D) Calcium-channel blocking agent this was discussed in the Q&A we did in cardio, Diltiazem DOC, aspirin and beta blocker are contraindicated...
MATCHING SET
Na+ Cl K HCO3 pH Specific gravity
A)132 89 2.8 39 5.0 1.025
B)133 110 3.9 16 6.0 1.015
C)163 117 4.3 22 5.5 1.003
D)165 115 4.5 19 5.0 1.030
13. Between the options the only one that has low Cl levels and met alkalosis (high bicarbonate levels) is A
14. My diagnosis is some sort of diabetes insipidus, and between the options the only one that has high Na levels and low urinary specific gravity is C..
15. E this patient needs urgent reintubation and mechanical ventilation no matter what! Or he may die....
Dr P thank uu for the compliments buddy.... I am glad I can be of help..
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original mazinger z
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| zianab
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mazinger could you please explain why you choose this option in qs 14 thanks.any body elase please also comment on this too.
thankyou
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| mazinger
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Dear Zianab this is my explanation for Q14
Ok lets see.. Q14 is about a 7 week old boy who is constantly fed and constantly peeing, so the patient from my perspective is losing lots of fluids through the urine (and nowhere else), note that the physical exam is also compatible with dehydration..
So which hormone is the main determinant of the volume of urine, ADH... High ADH conditions are asociated with low serum Na and concentrated urine, Low ADH conditions are asociated with high serum Na and very dilute urine (low specific gravity)..
So the specific gravity of the urine tends to remain low in this patient eventhough the patient is dehydrated...
And this is all because this baby is losing lots of free water in the urine...
So the only option that gives High Na+ and dilute urine (low specific gravity) is C...
And that's it, hope it helps...
Edited by mazinger on 12/12/06 - 03:49 PM
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original mazinger z
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| zianab
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thankyou mazinger for your explanation.
good to see you npas and dr pumkin on forum.keep up the good work friends!!!
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| zianab
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answers to new qs
1E) Malingering
patient seems to be normal otherwise in between episodes,and the seizures appeared after knowing that she has to move to another state ,which she doesnot want to..
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| zianab
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2G) Syringomyelia
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| zianab
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3cC) Intravenous antibiotic therapy
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| zianab
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4C) Antibiotic therapy for recurrent urinary tract
infections
the urine shows increased wbc
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| zianab
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5E) Resection of the colon tumor
not sure
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| zianab
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7D) 23-Valent pneumococcal
Pneumococcal disease remains the leading cause of serious bacterial infection among children high risk ppoulation.
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| zianab
Forum Elite
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8C) Brief psychotic disorder
please research about this as I am not sure
9B) Cervical incompetence
10
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| dr.pumpkin
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sorry frns to interrupt in b/w...i have a question :
a 36 y/o G1P0 at 35 wks gestation presents c/o a several day h/o generalised malaise, anorexia, nausea and emesis. She has also been experiencing abdominal discomfort which she attributes to indigestion.she has apoor apetite and has lost several pounds since her last visit 1 week ago. She denies any headache or visual changes. Her fetal movements have been good. and denies any regular uterine contractions, vaginal bleeding or rupture of membranes . N o other medical history is there.
On Physical exam you notice that she is mildly jaundiced , appears to be a little l confused. vita signs :
temp : 100 ` F , Bp : 100/62 , Pulse 70. She has no edema and is hydrated.She is sent to labor for delivery and is hooked to a external fetal monitor. It indicates FHR 160, that is non reactive, but with good variablility.
Blood is drawn and shows:
WBC : 25,000 , pLATELETS : 51,000 , Hct : 42.0 , SGOT/PT : 287 / 350, GLUCOSE : 43, CREATININE : 2, FIBRINOGEN : 135 PT/PTT : 16/50 s, Serum ammonia : 90 mocromol/ml. Urinanlysis 3+ protien and large ketones.
What is the recommended treatment of thei s patient :
a. immidiate delivery
b.cholecystectomy.
c.intravenous diphenhydramine
d. MgSo4 Therapy.
e. Bed rest and supportive measures since this condition is self limited.
please anybody who answers this kindly explain the diagnosis too.
thnx...
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| mazinger
Forum Guru
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I havent studied ob gyn yet so I cannot make detailed comments on this subject, but it seems a HELLP Syndrome and isnt its treatment immediate delivery? And thats how far my knowledge goes Dr P...
GL
Npas, Dr P and Zianab keep on posting...
Regards
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| npas
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1)Malingeering..she has all the reason to malingeer..leaving a sick mother..I would have malingeered too
2)Syringomyelia..typical..
3)IV antibiotics..low wbc with signs of sepsis..
4)Discontinue current medication...the analgesic combination she is on is causing or worsening her peptic ulcer and it seems to be initiating the nephropathy..
Zainab..please explain ur 4th choice..
npas
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| npas
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Mazinger..On the first look Dr P's Q seems to be HELLP..but doesn't acute fatty liver of pregnancy appear to be more likely..Reasons..
__transaminase levels are lower (< 500 U/mL) in acute fatty liver of pregnancy..that is there is just a moderate rise
__Prothrombin time and bilirubin are elevated
__ Leukocytosis with thrombocytopenia
__ Hypoglycemia may be extreme
morover inhellp PT/PTT is mostly normal and there r signs of hemolysis..
Diagnosis mandates immediate delivery, preferably vaginally..
I have a doubt..in HELLP what is the next best step..MgSO4 or immediate delivary?
Dr Pumpkin..nice Q..
stay warm
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| zianab
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sorry for answering this one out of our sequence
12C) Hydatidiform mole
Symptoms similiar to preeclampsia that occur in the 1st trimester or early in the 2nd trimester. (This is nearly diagnostic of a hydatiform mole, because preeclampsia is extremely rare this early in normal pregnancy
also utersu larger for dates.
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| mazinger
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npas wrote:Mazinger..On the first look Dr P's Q seems to be HELLP..but doesn't acute fatty liver of pregnancy appear to be more likely..Reasons.. __transaminase levels are lower (< 500 U/mL) in acute fatty liver of pregnancy..that is there is just a moderate rise __Prothrombin time and bilirubin are elevated __ Leukocytosis with thrombocytopenia __ Hypoglycemia may be extreme morover inhellp PT/PTT is mostly normal and there r signs of hemolysis.. Diagnosis mandates immediate delivery, preferably vaginally.. I have a doubt..in HELLP what is the next best step..MgSO4 or immediate delivary? Dr Pumpkin..nice Q.. stay warm
I know nothing...
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original mazinger z
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| zianab
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13D) Subarachnoid hemorrhage
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| zianab
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14G) Pericardiocentesis
Many cancer drugs cause pericardial disease and the canser itself cause pericardial effusions.
.Symptoms of tamponade include shortness of breath, rapid pulse, cough, and chest discomfort. As it progresses, low blood pressure and shock develop and cardiac arrest can occur
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| zianab
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15E) Seborrheic dermatitis
Rosacea affects the middle third of the face, causing persistent redness over the areas of the face and nose that normally blush -- mainly the forehead, the chin and the lower half of the nose. The tiny blood vessels in these areas enlarge (dilate) and become more visible through the skin, appearing like tiny red lines (called telangiectasias
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| zianab
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2 qs still unanswered please anybody explain in detail!!!
10. A previously healthy 45-year-old woman has had fever and progressive confusion over the past 2 days. She is now unable to perform activities of daily living. Her temperature is 38 C (100.4 F). She is oriented only to person. There is no rash, and the neck is supple. A CT scan of the head shows normal findings. Cerebrospinal fluid analysis
shows:
Leukocyte count 20/mm3
Glucose 45 mg/dL
Protein 110 mg/dL
Erythrocyte count 1000/mm3
Which of the following is the most likely diagnosis?
A) Bacterial meningitis
B) Acute alcohol intoxication
C) Brain stem infarction
D) Cerebral infarction
E) Cryptococcal meningitis
F) Enterovirus infection
G) Hepatic encephalopathy
H) Herpes simplex encephalitis
I) Huntington's disease
J) Hypoglycemia
K) Lyme disease
11. A 57-year-old man with multiple myeloma comes to the physician
because of a 12-hour history of fever, sharp chest pain with deep inspiration, and cough productive of blood-tinged sputum. His temperature is 38.3 C (101 F), blood pressure is 120/78 mm Hg, pulse is 112/min, and respirations are 28/min. Crackles are heard at the
right lung base. His hemoglobin level is 9.2 g/dL, leukocyte count is 2600/mm3, and
platelet count is 96,000/mm3. Empiric antibiotics should be directed against
which of the following organisms?
A) Listeria monocytogenes
B) Neisseria meningitidis
C) Pseudomonas aeruginosa
D) Streptococcus bovis
E) Streptococcus pneumoniae
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| zianab
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DR PUMKIN CAN YOU PLEASE ANSWER THE QS YOU POSTED FROM PRETEST SO THAT WE CAN KNOW WHAT IS WRITTEN IN EXPLANATION????
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