mazinger
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Thank u zianab, I really made final conclusions about two questions thanks to your posts... I was not sure about the scabies thing, but after you picked this one I knew I was on the right track.. The second I had my doubts on was the sleeping thing the fact that the pt quited his job made me think something associated with depression or even worse I started fantazising again.. At this moment of my life my only job is to perform surgery to my books, and my sleep wake cycle is all messed up.. So my own conclussions of my life, NOT HAVING A FORMAL JOB CAN SCREW UP YOUR SLEEP PATTERN... hahaha anyways we all agree its normal aging...
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original mazinger z
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| mazinger
Forum Guru
Topics: 46
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14. A 7-week-old boy is brought to the physician because of fever,
irritability, and lethargy for 3 days. He has had no vomiting, diarrhea, or symptoms of an upper respiratory tract infection. He always seems hungry to his mother despite being fed 3 ounces of formula every 3 hours. His mother also notes that he has many wet diapers throughout the day and night. He currently appears irritable. His
temperature is 37.8 C (100 F), blood pressure is 80/50 mm Hg, pulse is
150/min, and respirations are 25/min. Examination shows a sunken
anterior fontanelle. Mucous membranes are dry. There is tenting of the
skin. Examination shows no other abnormalities. Urinalysis is negative for glucose and
protein.
Edited by mazinger on 12/12/06 - 10:39 AM
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original mazinger z
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| anne06
Forum Elite
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and d uw qt says that pt is recevn 60% by o2 mask and pao2 is 55...from this how do we calculate fio2?i wud really appreciate it if sm1 can clear these doubts 4 me//
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| npas
Forum Senior
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Long time I posted..let me try the qs..
1)D]Captopril..upto 139 systolic is very well managed by diet and exercise alone..more than that requires medical intervention..ACE inhibitors to start with.
2)c]Neurogenic bladder..30 yr history of Diabetis..ruling out other options..
3)B]Fasting blood glucose and insulin..hyperinsulenemia
4)A]Evaluation at 14years required when breast development not present..can be delayed to 16 yeras if breast development is present..
5)Don't know
6)B]Abdominal ultrasonography
7)D]Slipped capitel femoral epiphysis..'examine the hip of an obese child presenting with knee pain'...internal rotation producing pain.
8)D]Postural reflex impairment..most disabling is bradykinesia..but making the parkinsonian patient prone to injury is postural reflex impairment.
regs..npas
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| npas
Forum Senior
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I missed the last discussion..reading ur explanations I think it was real good..but Mazinger..u took off the qs..real good to see u guys so regular..
take care all.. ..npas
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| zianab
Forum Elite
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answers to qs
1E) Hydrochlorothiazide therapy
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| zianab
Forum Elite
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no 2 C) Neurogenic bladder .
associated with this condition are elevated residual urine, decreased bladder sensation, impaired detrusor contractility, detrusor areflexia
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| zianab
Forum Elite
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3bB) Fasting insulin and glucose levels
insulinoma might be the cause
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| zianab
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4A) Reexamination in 1 year if the patient has not
had menarche
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| zianab
Forum Elite
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5A) Decreased gluconeogenesis
NOT SURE
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| zianab
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6B) Abdominal ultrasonography
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| zianab
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7D) Slipped capital femoral epiphysis
LOOK AT OBESE MALE,NO INJURY .
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| zianab
Forum Elite
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8D) Postural reflex impairment
Parkinson'd disease
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| zianab
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9B) Serum lipid studies
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| zianab
Forum Elite
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11B) Diverticulosis
age of patient also it presents as bleeding
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| dr.pumpkin
Forum Newbie
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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
Forum Newbie
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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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