docnikki
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1) A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after an episode of left arm shaking that lasted approximately 3 minutes. Over the past 2 days, he has had fever and emotional lability. On arrival, his temperature is 38.9 C (102 F). He is somnolent and disoriented to person, place, and time. He responds poorly to pain. Neurologic examination shows no other abnormalities. Laboratory studies show:
Hematocrit 34%
Leukocyte count 6000/mm3
Segmented neutrophils 50%
Lymphocytes 50%
Platelet count 280,000/mm3 Analysis of cerebrospinal fluid shows:
Leukocyte count 120/mm3
Segmented neutrophils 20%
Lymphocytes 80%
Erythrocyte count 300/mm3
Glucose 60 mg/dL
Protein 400 mg/dL Which of the following is the most likely cause of this patient's neurologic findings? A) Bacterial infection B) Congenital malformation C) Fungal infection D) Hemorrhage E) Immune-mediated demyelination F) Parasitic infection G) Viral infection
2. A 64-year-old woman has moderately severe postoperative pain 1 day after a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Which of the following is the most appropriate analgesic pharmacotherapy?
A
) Oral aspirin-codeine compound
B
) Oral diazepam
C
) Oral ibuprofen
D
) Intermittent intravenous naloxone
E
) Patient-controlled intravenous morphine
F
) Transcutaneous administration of fentanyl
3.. A 42-year-old woman comes to the physician for an annual pelvic examination and Pap smear. Over the past year, she has had increasing fatigue and difficulty sleeping. She has two children who both attend college. She is currently looking for part-time work outside the home. Her husband has been busy in a new start-up business. Examination shows no abnormalities. Laboratory studies show:
Hemoglobin 15 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 6000/mm3 with a normal differential
Serum
Na+ 145 mEq/L
Cl– 102 mEq/L
K+ 4.5 mEq/L
HCO3– 25 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.0 mg/dL
Alkaline phosphatase 70 U/L
Aspartate aminotransferase
(AST, GOT) 22 U/L
Alanine aminotransferase
(ALT, GPT) 19 U/L
γ-Glutamyltransferase
(GGT) 83 U/L
(N=5–50 U/L)
Which of the following is the most likely explanation for this patient's laboratory abnormalities?
A
) Acetaminophen
B
) Alcohol
C
) Diphenhydramine
D
) Estrogen effect
E
) Ibuprofen
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| Aashi
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G) Viral infection
E) Patient-controlled intravenous morphine
B) Alcohol
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| vanshita
Forum Guru
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Posts: 933
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1 imunne mediated demyelination beause of albumino cytologcal dissociation
2 c
3 d
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| nadiabarati
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G it's HSV encephalitis
E modern way for postoperative patients in severe pain
A maybe she's on chronic use of acetaminophen for her fatigue and pain
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| yasmeen
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VIRAL INFECTION
TRANSCUTANEOUS
ALCOHOL
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| eaguin
Forum Senior
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Viral
Patient control
Alcohol
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| docnikki
Forum Guru
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yasmeen why do u think its transcutaneos and not pt controlled.
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| yasmeen
Forum Guru
Topics: 72
Posts: 950
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THIS IS,NT THE TERMINAL CARE PT THERE R MANY OTHER REASONS FOR THIS OPERATION LIKE ATYPICAL HYPERPLASIA OF ENDOMETIUM,
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| webjeee
Forum Guru
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Posts: 354
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1) E) Immune-mediated demyelination
it's kind of limbic encephalopathy, isn't it?
I am wrong, its virus
Edited by webjeee on 03/24/07 - 08:55 AM
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| robin082006
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Posts: 5,123
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G) Viral infection
E--> Patient-controlled intravenous morphine
B Alcohol
isolated increased GGT: alcohol, Barbiturate, Phenytoin (Conrad F)
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| damngood
Forum Newbie
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viral infection
(clearly gives fever) raised protein and low glucose
pt controlled morphine (post op pain morphine is indicated )
alcohol (raised ggt)
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| maiya
Forum Newbie
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on the first question - does the RBC count mean anything?
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| Rasul
Forum Guru
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Transdermal Fentanyl is not admeinistered in postoperative period.
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| eckimazuro
Forum Newbie
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Regarding the first question: Yes, the RBC does mean something. In about 80% of cases, herpes simplex meningitis presents with a moderate (i.e. 100's) elevation of the RBC's and does not indicate a traumatic cause. Rather, all indications of the symptoms, e.g., quick and rapid onset, seizures, moderate CSF lymphocytosis and presence of RBC's (assuming a non-traumatic tap) strongly points to a viral meningitis, specifically an HSV meningitis. Immediate therapy needed (acyclovir).
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| usmle12
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G E B
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