| Author | 19 Posts |
dr_jojo
|
5………………..A 27-year-old primigravid woman at 29 weeks' gestation
comes to the
emergency department because of a 24-hour history of
increasingly severe
right-sided abdominal pain and no appetite. She has
vomited twice over
the past 4 hours. She has not had vaginal bleeding.
Her temperature
is 38.2 C (100.8 F). Examination shows exquisite
tenderness of the
right lateral flank and the fundus. There are no
peritoneal signs. Bowel
sounds are absent. The fetal heart rate is 144/min.
Laboratory
studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3–5/hpf
Which of the following is the most likely diagnosis?
A
) Abruptio placentae
B
) Appendicitis
C
) Cholelithiasis
D
) Colitis
E
) Pyelonephritis
6…………….. A 28-year-old woman develops fatigue and
orthopnea 3 weeks after
the uncomplicated delivery of her first child. Her
blood pressure is
115/78 mm Hg, and pulse is 112/min. Crackles are
heard at both lung
bases. The point of maximal impulse is laterally
displaced and diffuse;
an S3 is present. There is 2+ pedal edema. An x-ray
film of the chest
shows vascular cephalization of pulmonary vasculature
and Kerley B lines.
Which of the following is the most appropriate next
step in management?
A
) Measurement of serum creatine kinase and lactate
dehydrogenase
activities
B
) Echocardiography
C
) Dipyridamole thallium scan
D
) Ventilation-perfusion lung scans
E
) Myocardial biopsy
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| Aashi
Forum Moderator
Topics: 113
Posts: 1,061
|
1) Appendicitis
2) Post partum Dilated cardiomyopathy---->CHF--->do ECHO
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| hanialkhadher
Forum Elite
Topics: 18
Posts: 260
|
A ) Abruptio placentae ,There are no
peritoneal signs.
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| damngood
Forum Newbie
Topics: 0
Posts: 79
|
its not abruption
the q says absent bowel sounds
soo most probable diagnosis is appendicitis
and the second one is echo for cardiomyopathy
aashi is right
|
| maiya
Forum Newbie
Topics: 3
Posts: 35
|
why couldn't the answer to the first question be (E) Pyelonephritis? she has the flank pain...and uti's are very common in preg...
wut y'all think?
|
| Justice
Forum Fanatic
Topics: 117
Posts: 2,324
|
(B)
(B)
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Don't live in a town where there are no doctors
|
| r_albayunen
Forum Senior
Topics: 0
Posts: 218
|
E , tenderness of the right lateral flank, fever, absence of localized peritoneal signs, and WBC in urine .. but then you have the anorexia and absence bowel sounds classic of appendicitis ... its vague unless is a retrocecal atypical presentation of the appendix; suggestions??
B
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| cookie909
Forum Newbie
Topics: 0
Posts: 18
|
B
B
if it was pyelonephritis...the urine wud have wbc CASTS...not wbcs
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| fongch
Forum Elite
Topics: 71
Posts: 316
|
All right, I go for appendicitis.
Edited by fongch on 05/14/07 - 07:50 PM
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| ashfaque
Forum Newbie
Topics: 0
Posts: 142
|
appendicitis
echo
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| usmle12
Forum Senior
Topics: 19
Posts: 194
|
E cz she has no peritoneal signs no garding rigidity so appendicitis ruled out plus she has flank pain not right lower quadrant pain
B
|
| ts97
Forum Senior
Topics: 13
Posts: 128
| | 08/06/07 - 11:51 AM
0 of 1 forum leaders found this post helpful
| #12 |
5. E, pyelonephtitis. I think only retroperitoneal organ can cause flank pain. But I am confused by absent bowel sounds... But there is pyuria though (Pyuria is defined as ≥ 8 WBCs/μL of uncentrifuged urine, which corresponds to 2 to 5 WBCs/high-power field in spun sediment.)
6.B
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| ts97
Forum Senior
Topics: 13
Posts: 128
|
And elevated LDH rather points to kidneys damage...
|
| ansalshah
Forum Newbie
Topics: 3
Posts: 15
|
Abswer is BBB appendicitis..dont be confused by flank pain..in pregnancy appendietis present as flank pain because of upward displacement of appendix by uterus,,
|
| ts97
Forum Senior
Topics: 13
Posts: 128
| | 08/09/07 - 12:54 PM
0 of 2 forum leaders found this post helpful
| #15 |
Still vote for pyelonephritis:
appendicitis: 0.05% to 0.1% of pregnancies
pyelonephritis: 1% to 2% of pregnancies
|
| liliaeliz
Forum Elite
Topics: 41
Posts: 373
|
b-b
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| SkiKidd
Forum Newbie
Topics: 0
Posts: 21
|
Pyelonephritis causes paralytic ileus, nausea, vomiting and anorexia.
Being as Pyelo is an infection most often starting in the renal pelvis and collecting system, casts are not always found initially. Besides, the information given is an incomplete UA at best, and while you might have casts + WBCs, finding WBCs definately does not rule out pyelo, it only rules out glomerulonephritis which is exclusively casts due to the location of the disease.
You could argue for abruptio placenta (Class 1 with no bleeding) but the basis would be fundal pain exclusively as none of the other symptoms match. Also the fundal pain could be from the fact that it is a 30 week pregnancy and the uterus would be touching the inflammed kidney causing confusion of referred pain in an already unreliable area.
If you say Appy then you have to argue for a concurrent UTI which is an unlikely test question.
I think I would have to say most of the signs point toward pyelo
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| limsianyik
Forum Newbie
Topics: 0
Posts: 1
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CMTD
The presence of more than five leukocytes per high-power field is considered significant pyuria. Leukocytes in the urine are indicative of injury to the urinary tract, which may or may not be due to infection. Other causes of pyuria include calculous disease, strictures, neoplasm, genitourinary tuberculosis, glomerulonephropathy, or interstitial cystitis. Leukocyte counts will vary by the state of hydration, method of collection, and degree of injury to the urinary tract.
elevation of WBCs is not significant, its less than 5
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| Tintin
Forum Junior
Topics: 7
Posts: 52
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SOURCE: http://www.uptodate.com/patients/content/topic.do...
"The differential diagnosis includes the causes of abdominal pain in nonpregnant individuals, as well as pregnancy-related causes of abdominal pain, such as round ligament syndrome, labor, abruption, ectopic pregnancy, and uterine rupture (see individual topic reviews). The latter three diagnoses, in contrast to appendicitis, are often accompanied by uterine bleeding. In addition, abruption and uterine rupture are commonly associated with fetal heart rate abnormalities."
"The physiologic changes of pregnancy can confound the diagnosis. In particular, the normal pregnant woman's white blood cell count ranges from 6000 to 16,000 cell/mm3 in the first and second trimesters, and may rise as high as 20,000 to 30,000 cells/mm3 during labor. Thus, leukocytosis can be a normal finding in pregnant women."
"Pregnant women with pyuria may be treated for urinary tract infection and forgo further investigation, in which case the actual diagnosis of appendicitis may be delayed. It is important to remember the inflamed appendix is often in close proximity to the bladder and ureter; as a result, microscopic hematuria and pyuria are found in up to one-third of patients with acute appendicitis."
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