gilbert
Forum Junior
Topics: 16
Posts: 45
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43. An 82-year-old man is brought to the emergency department because of the sudden onset of confusion 48 hours ago. His family says that he previously had been functional and independent. His temperature is 37.5°C (99.5°F), blood pressure is 110/70 mm Hg, pulse is 90/min, and respirations are 12/min. The skin is warm and clammy. Bowel sounds are hypoactive, and there is guarding and tenderness in the right lower quadrant of the abdomen. Examination of the heart, lungs, and extremities shows no abnormalities. He is drowsy but arousable and oriented to person but not place or time. There are no focal deficits. Which of the following is the most likely diagnosis?
A ) Appendicitis
B ) Colon cancer
C ) Meningitis
D ) Pneumonia
E ) Urinary tract infection
A?
40. A previously healthy 27-year-old woman comes to the physician because of a 3-month history of moderate abdominal pain that improves for a short time after she eats. She has not had any rectal bleeding. Her temperature is 36.4°C (97.5°F), blood pressure is 110/70 mm Hg, and pulse is 80/min. Abdominal examination shows midepigastric tenderness. Her hemoglobin level is 12 g/dL, and leukocyte count is 8000/mm3. Serum Helicobacter pylori antibody assay is positive. Which of the following is the most appropriate next step in management?
A ) HIDA scan
B ) Amoxicillin, clarithromycin, and omeprazole therapy
C ) Ciprofloxacin therapy
D ) Omeprazole, magnesium hydroxide, and metoclopramide therapy
E ) Ranitidine therapy
B
42. A 47-year-old man comes to the physician because of a 3-week history of increasing facial swelling and a 1-week history of morning headaches and mild shortness of breath. He had previously felt well. He completed a course of chemotherapy 4 months ago for small cell carcinoma of the lung. His temperature is 37.2°C (98.9°F), blood pressure is 142/80 mm Hg with an 8-mm Hg paradoxical pulse, pulse is 84/min, and respirations are 18/min. Examination shows significant diffuse facial and periorbital edema. The optic discs are sharp, and ocular movements are intact. The lungs are hyperresonant bilaterally with a moderately prolonged expiratory phase. Mild rhonchi are heard on inspiration and expiration. An x-ray film of the chest shows a 10-cm mass in the right upper lobe and apex. Which of the following is the most likely explanation for these findings?
A ) Chemotherapy-induced bone marrow toxicity
B ) Chemotherapy-related cardiac toxicity
C ) Hypercoagulable state secondary to malignancy
D ) Interstitial metastatic pulmonary disease
E ) Intracranial metastases
F ) Lymphatic obstruction
G ) Malignant pericarditis
H ) Paraneoplastic syndrome
I ) Pleural metastases
J ) Soft tissue metastases
K ) Vascular obstruction
K?
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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I agree with your answers.
1.Most likely appendicitis leading to sepsis since other choices doesn't fit at all.
2.This is the eradication rx for H.pylori
3.I am thinking of SVC obstruction -can occur in small cell CA(Centrally located)
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| nadiabarati
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B??? Does appendicitis occur in such an age? 82?
B
K? so how about resonance bilaterally?
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| Akeen
Forum Newbie
Topics: 1
Posts: 37
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1. E. UTI. Nothing in the question supports malignancy while appendicitis seems unlikely at that age???
2. Triple therapy
3. B. Chemotherapy induced cardiac toxicity resulting in constrictive peicarditis - facial puffiness and exagerated pulsus paradoxus.
___________________
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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But how to explain the periorbital edema and htper-resonant lungs?
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| prasannakumar
Forum Senior
Topics: 24
Posts: 55
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3. paraneoplastic syn
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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you dont see diffuse periorbital and facial edema in constructive pericarditis and 8mm hg pulsus in not significant, it will be significant only when its more than 10.
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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I agree with gilberts answers.
Mr Prasanna kumar, why do you think that its due to paraneoplastic syndrome.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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The asnwer for the first wuestion-->Is it UTI/Appendicitis or colon cancer??we have 3 different answers!!
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