npas
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5)I think there is seeding into the abdo(the distention) and metasteasis to liver..this is stage 4 where we may have to resort into palliative measures like chemotherapy..but resection is to be done anyway,right?I'am confused
7)agree with Zainab
8)A]Adjustment disorder with depression..In brief psychotic disorder the stressor is bigger and symptoms r more bizarre..
npas
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| npas
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I'am trying the 10th one..though not sure..
Bacterial infection'coz glucose and protein value indicates the same..the explanation for rbcs may be a traumatic lumbar puncture!!!what do u say???
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| npas
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11)E..streptococcus pneumonae
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| dr.pumpkin
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okee...nw here i come the snail pace ...
1, malingering ( u covered it all zianab  ..)
2. syringomyelia
3..IV antibiotics right now. but we will treat the leukopenia occuring due to the chemotherapeutic agents with G-CSF and GM-CSF subsequently.
4.discontinue the drug. The patient has developed chronic tubulointerstitial nephritis d/t anlgesics. ( presents wid polyuria, mild proteinuria..hyperkalemia would be an additional finding )
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| dr.pumpkin
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5. chemotherapy. the tumor has reached the unresectable stage ( it has metastasised to the liver ) , so the treatment then is chemotherapy...
npas, i m not sure but the reason for only giving chemotherapy may be is that if surgery will be futile as it will not eradicate the disease and further ,this old pateint ( wid low hemoglobin levels which im sure he must be having d/t CA) would be apoor surgical risk...esp when there are no benefits to offer...
guys,,please don`t get angry over this crappy n creepy stuff!!
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| dr.pumpkin
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agree wid u guys for..
8. brief psychotic disorder
9. cervical incompetence.
.
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| dr.pumpkin
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10. ? herpes simplex encephalitis
11 E : streptococcus penumoniae.. ( multiple myelome pts very much prone to develop infection from encapsulated organisms : H.I nfluenzae, Strep Pneumoniae )
12 Hydatiform mole (patient had a profuse vaginal bleeding , had a uterus larger than dates, a h/o hyperemesis as well )...
13 . Sub arachnoid hemmorhage ( sudden onset of severe headache, has neck stiffness ...)
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| dr.pumpkin
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npas...correct answer  ! for the ques i posted...!! good work...u have covered it all...
zianab , here`s the explanation: ( as in the book..)
acute fatty liver is a rare complication of pregnancy. It may be fatal for both baby and the mother.
It usually manifests during late in pregnancyand is common in nulliparous women.Typically the pateint has a h/o general malaise , nausea , emesis, apetite loss. Liver enzymes usu <500. Elevated PT/PTT , bilirubin and ammonia levels. Marked hypoglycemia present
Low platelet and fibrinogen secondary to cosumptive coagulopathy.
MANAGEMENT IS immidiate delivery as this condition spontaneously resolves after delivery.
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| dr.pumpkin
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dear npas...
for the HELLP sydrome management consits of both MgS04 and prompt delivery...But if u asking the next best step, better u give the patient MgSo4 to prevent seizures from occuring and meanwhile prepare the patient for delivery .
If its the definitive treatment , then it surely is prompt delivery...
hope i have not confused u more... ...
gud luck alll....
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| mazinger
Forum Guru
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Agree a 100% with Dr Pumpkin.. I didnt know the cervical incompetence thing and I wasnt sure with the strep pneumonia, but of course I would have picked this option over anything else...
There is something I would have picked in the asthmatic patient question and the veccine, I would have gone for the influenza vaccine over anything... From my perspective asthma, or inhaled steroids are not a risk factor for aquiring strep peunomia infection, but asthma worsens with influenza infection.... I forgot to mention regarding the colon ca question, I read my kaplan notes and noticed that anything above Duke C chemo is the mainstay of therapy...
Edited by mazinger on 12/14/06 - 09:39 AM
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| zianab
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mazinger what is your answer for qs 10 and please can you also explain it
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| mazinger
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Herpes simplex encephalitis produces the same disturbances in CSF as all viral encephalitis, but it also gives high RBCs because it produces rapid destruction of the brain parenchyma at the temporal lobes... And that's basically it, I found a very similar question in UW...
Today Ill post new mcqs...
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| npas
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Herpes simplex encephalitis produces the same disturbances in CSF as all viral encephalitis, but it also gives high RBCs because it produces rapid destruction of the brain parenchyma at the temporal lobes... mazinger
I didn't know that..new info for me..thanx..what about the lower glucose and high protein?I will also check the book..
hope i have not confused u more...... Dr Pumpkin
No Dr P..perfect..thanx
npas
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| npas
Forum Senior
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One last doubt..can u guys tell me the criteria u used to seperate Brief psychotic disorder from adjustment disorder with depression in Q 8..I mean AD is also out of normal reaction to a stressor..
npas
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| mazinger
Forum Guru
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dear npas psych is my worst subject... 
BTW my friends I am glad we all have participated in these open discussions, I have learned lots of things from you and I also have learned quite a few things about myself.. I feel I am more ready to the test than I was be4..
I hope this whole experience results useful for you as as it was for me...
Thanks for everything....
jj
Edited by mazinger on 12/18/06 - 12:13 PM
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| zianab
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1D) Begin ganciclovir therapy
CMV infection results in large atypical cells with intranuclear and intracytoplasmic inclusion bodies commom in immunocompromised , AIDS, neonates, and transplant recipients.
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| mazinger
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agree cmv virus can reactivate in transplanted patients... Between the drugs that work on cmv are gancyclovir and foscarnet, other nucleoside analogues do not work on cmv since it doesnt have thymidine kinase...
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| zianab
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2D) Respiratory syncytial virus
I am not sure about the adenopathy findings.please research this qs
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| zianab
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3C) Acyclovir therapy
if picture was there then it would be easy to identify. herpes zoster/post herpetic neuralgia
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| zianab
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4C) ACTH stimulation test
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| zianab
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F) Radiation of the pain into the posterior lower extremity
herniated disc/disc rupture
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| zianab
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6C) Cigarettes
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| zianab
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7C) Tell the daughter it is a legal requirement to tell the patient any and all results of medical testing
8F) Vitamin B6
PYRIDOXINE DEF DUE TO ISONIAZID
9E) ,,,,,,,Urinary supersaturation with uric acid ??????????
10D) Switching from warfarin to heparin before pregnancy
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| zianab
Forum Elite
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11 E) Nortriptyline
CHRONIC PAIN SYNDROME?????PLEASE RESEARCH ABOUT THE OTHER DRUGS USED
12E) Treponema pallidum
Tabes dorsalis cause damage to the sensory nerves in dorsal roots, producing ataxia and loss of pain sensation, proprioception, and deep tendon reflexes in joints
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| zianab
Forum Elite
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13D) Dysthymic disorder
14B) Methacholine challenge test
15A) Measurement of serum a1-antitrypsin level ?????
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