NBME Q-What do you think?

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NBME Q-What do you think?

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studentdoc
Forum Senior

Topics: 14
Posts: 33

10/20/06 - 05:22 AM

70 yo female w increased abdominal pain over the last 2 days. history of renal failure with dialysis over last 18 months and her last treatment was 2 hours ago. She appears toxic and her temp is 102.2. Her abdomen is diffuse tender to deep palpation with rebound tenderness. WBC cnt is 18,000. Next best step...

1- xray of the abdomen

2- comparison of abdominal fluid amylase with serum amylase

3- gram's stain of abdominal fluid

4- ultrasound of abdomen

5- CT scan of abdomen and pelvis

5yo girl with 104 fever and nonproductive cough x 12hrs. 4 days ago she was treated with antibiotics for pneumo pneumonia. decrease breath sounds over right lower field and dullness to percussion at right costophrenic angle. most likely diagnosis....

1- bronchopleural fistula

2- empyema

3- lung abscess

4- pleurodynia

5- pneumothorax

Please explain how you came up with your answer and not with copy and paste from internet. Thanks.

studentdoc
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Topics: 14
Posts: 33

10/20/06 - 07:24 AM

Anyone?????

foco
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Topics: 9
Posts: 66

10/21/06 - 01:43 PM

For the first one, If the patient is on peritoneal dialisis, may be answer 3, I'm not sure. But in a real situation I would ask first for a CT(answer 5) You have to diagnosis an abdominal proces. Maybe even apendicitis, old people especialy those in dialisis don't have typical findings.

The clinical findings in the second question correlates whit empyema(answer 2)

Guptashutosh
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Topics: 35
Posts: 354

10/23/06 - 06:20 AM

1> CT abd pelvis to look out for any e/o abcess, it will be the best choice , but usg may be the first choice..
2> empyema for the 2nd one

truedeam59
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Topics: 29
Posts: 145

11/09/06 - 04:41 PM

I Agree.
for the 1st one ,there is almost a smilar question somewhere in kaplan.

fongch
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04/19/07 - 09:31 AM

What about lung abscess for the 2nd question?

Justice
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Posts: 2,372

04/19/07 - 09:40 AM

1. CT scan
2. Empyema... I guess pneumococcus would not cause the abscess, it's more about St. aureus...

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fongch
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04/19/07 - 11:31 AM

I was thinking the question emphasize oral antibiotics, which make foreign body a possibility.

Justice
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04/19/07 - 11:48 AM

If this have happened in the US, the pediatric forms of antibiotic are given in syrup... grin

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webjeee
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Topics: 99
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05/02/07 - 05:00 AM

#10

why not gram's stain of abdominal fluid

Justice
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05/02/07 - 05:57 AM

#11

webjeee wrote:
why not gram's stain of abdominal fluid

Any abdominal fluid suggested in the Q?
I think this is spontaneous peritonitis that is frequently seen in dialysis Pts, and it is most likely caused by E. Coli, so the treatment can be started empirically... In addition, obtaining lavage fluids is another invasive procedure, and it may worsen the situation. I have an impression that USMLE wants us to start with the less invasive option.
Any comments from my distinguished colleagues?

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usmle12
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Topics: 19
Posts: 194

05/02/07 - 08:13 PM

#12

i think when i gave nbme it was peritoneal dialysis so in tht case ill go for gram stain...but any could any one recheck...

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