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 - 02:49 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
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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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| 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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