docnikki
Forum Guru
Topics: 93
Posts: 680
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1) A previously healthy 62-year-old man comes to the emergency department because of abdominal pain for 48 hours. His temperature is 38.6 C (101.5 F), blood pressure is 130/80 mm Hg, pulse is 110/min, and respirations are 15/min. Abdominal examination shows diffuse left lower quadrant tenderness with no peritoneal signs. Rectal examination shows no abnormalities; test of the stool for occult blood is negative. His leukocyte count is 14,700/mm3. Which of the following is the most appropriate next step in diagnosis?
A) Barium enema
B) CT scan of the abdomen
C) Colonoscopy
D) Cystoscopy
E) Exploratory laparotomy
2.A 4-year-old boy is brought to the emergency department 20 minutes after being involved in a motor vehicle collision. He was an unrestrained passenger. On arrival, his blood pressure is 110/70 mm Hg, pulse is 100/min, and respirations are 32/min with grunting and retractions. Examination shows multiple bruises over the chest. Arterial blood gas analysis while breathing 40% oxygen shows:
pH 7.38
PCO2 34 mm Hg
PO2 66 mm Hg
An x-ray film of the chest obtained 4 hours later shows diffuse infiltrates on the right side. Which of the following is the most likely diagnosis?
A) Acute respiratory distress syndrome
B) Aspiration pneumonia
C) Fat embolism
D) Hemothorax
E) Pulmonary contusion
3.A 3-year-old girl is brought to the physician after her mother noted blood on her underpants. Examination shows genital condylomata acuminata in the perineal, peri-introital, labial, and anal areas. Some of the pedunculated condylomata appear to have caused the bleeding. She has no visible intravaginal condylomata or vaginal or anal tears. Her mother has a palmar wart on her hand but no history of condylomata acuminata. Her mother has a boyfriend who does not live with them and who has never been left alone with the girl. They live with the mother's 27-year-old brother who only baby-sits the children when they are asleep. Which of the following is the most appropriate next step in management?
A) Psychiatric assessment of the mother
B) DNA typing of the mother's palmar wart for papillomavirus
C) Treatment of the mother's palmar wart
D) Vaginal, anal, and throat cultures for Chlamydia trachomatis and Neisseria gonorrhoeae in the child
E) Laser therapy of the condylomata acuminata in the child
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| robin082006
Forum Hero
Topics: 471
Posts: 5,125
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1. B
2. E
3. D
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| nadiabarati
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agree with robin
nowadays they use CT scan for diagnosing diverticulitis
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| eaguin
Forum Senior
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Please can you explain me why did you choose pulmonary contusion over ARDS?
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| Aashi
Forum Moderator
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Simple eaguin--->just conc on the time interval..ARDS develops typically b/w 24 -48 hrs, and the criteria for ARDS is fleeting infiltrates BILATERALLLY, and PaO2 less than 50 mm Hg with an FIO2 more than 0.6--->In the absense of any heart condition* that is r/o cardiogenic pul.edema)
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| vanshita
Forum Guru
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diagnosis of diverculitis why we cannot use barium enema?
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| ALS
Forum Senior
Topics: 4
Posts: 190
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avoid colonscopy and barium enemas in the initial stage of acute diverculitis because there is a risk of perforation.
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| damngood
Forum Newbie
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yea agree with als
barium enema causes perforation in diverticulosis
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| maiya
Forum Newbie
Topics: 3
Posts: 35
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with regards to the second question - why couldn't it be aspiration?
and on the third question - i know that checking for STDs is probably the best bet, but there aren't any vaginal or anal tears. (but what are the chances of a little girl getting the nasties down there from mommy's wart on the finger...?) any thoughts?
besides that tho - what is the preferred treatment for a child with the c. acuminata? do we that laser? or pharmacotherapy?
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| r_albayunen
Forum Senior
Topics: 0
Posts: 218
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B
E
D
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| rezaaa
Forum Senior
Topics: 8
Posts: 180
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who is the child being abused by, mother or her uncle?
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| zeloc
Forum Junior
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Posts: 53
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I am assuming it is the uncle because otherwise they would not have mentioned him in the question.
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| liliaeliz
Forum Elite
Topics: 40
Posts: 371
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1b
2 pulmonar contusion on C-XR WHITE OUT no difuse infiltrate
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| liliaeliz
Forum Elite
Topics: 40
Posts: 371
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why you pick up pulmonar contusion can you explain me ?thanks
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| kochs
Forum Senior
Topics: 13
Posts: 141
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The main point being tested in q 3 of the little girl is that palmar wart and genital warts are caused by different HPV TYPES, so mom has not transmitted it thru her palmar warts , SO assumption is that the uncle is having genital warts and has comitted child sexual abuse....sad !
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