dr_jojo
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39. A previously healthy 6-month-old boy is brought
to the emergency
department because of a 12-hour history of
intermittent episodes of
inconsolable crying associated with drawing up of the
legs. Over the past
6 hours, he has had intermittent diarrhea that is
reddish and mucoid,
and for the past 3 hours he has been somnolent. On
examination, he is
sleepy but arousable. His temperature is 38.1 C
(100.6 F), blood
pressure is 90/55 mm Hg, pulse is 140/min, and
respirations are 38/min. He
cries when his abdomen is palpated; a mass is felt in
the right lower
quadrant. His leukocyte count is 12,400/mm3 (50%
segmented neutrophils,
8% bands, 1% eosinophils, 40% lymphocytes, and 1%
monocytes). Serum
electrolyte levels are within normal limits. An x-ray
film of the
abdomen shows no free air.
A
) Administration of parenteral antibiotics
B
) Admission to the hospital for medical management
C
) Admission to the hospital for operative
management
D
) Colon contrast studies
E
) Discharge for follow-up by personal physician
F
) Endoscopy
G
) MRI of the abdomen
H
) Observation in the emergency department
40. A previously healthy 14-year-old girl is
brought to the
emergency department because of abdominal pain for 12
hours. She has a 1-week
history of brownish vaginal discharge. Menarche was
at the age of 12
years, and her periods have occurred at regular 28-day
intervals over
the past year. Her last menstrual period was 7 weeks
ago. Her
temperature is 37 C (98.6 F), blood pressure is 85/55
mm Hg, pulse is 145/min,
and respirations are 24/min. Abdominal examination
shows generalized
tenderness, and there is guarding with rebound in the
right lower
quadrant. Her hematocrit is 24%, and leukocyte count
is 9400/mm3 (60%
segmented neutrophils, 3% bands, 1% eosinophils, 35%
lymphocytes, and 1%
monocytes). Serum electrolyte levels are within
normal limits.
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| eckimazuro
Forum Newbie
Topics: 2
Posts: 15
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39 D
40 has no answers
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| CINIII
Forum Senior
Topics: 34
Posts: 64
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39-d
40-looks like a ruptured ectopic pregnancy-C.
we would need laprotomy
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| dermatology
Forum Elite
Topics: 30
Posts: 293
|
39 ) intusucception ?????? c or h
40 ) ?????
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
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39 - D (barium studies for diagnosis and treatment of intussusception), although he may be having gram-negative sepsis, so if the question is "best next step", A would be a good option, too...
40 - Ruptured ectopic pregnancy - start venous fluids, then, surgery
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When men make the rules, God decides the exceptions.
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| fudoc_20
Forum Newbie
Topics: 3
Posts: 45
|
39 
40 :i guess we should think in other things in addition to ectopic ..like .complicated corpous luteum cyst .i think it is more reasnable here as functional cyst is soo common in that period ..after puberty .and it is soo simlar to ectopic with no risk factor mentioned for ectopic and no history of any previous sexual intercourse .so i prefer thinking in corpous 1st then ectopic any way .nned to do laproscopy to confirm and manage .
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| coolmavs
Forum Elite
Topics: 21
Posts: 327
|
yes, intusussception and ruptured ectopic
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