neuroblastoma
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Prep4usmle Ck members whosoever wanna join group chat on yahoo messenger is most welcome.
Just add this id asdvsd2003@yahoo.com
one session in day time ( 11 am-12 noon) US EASTERN TIME
second session in evening time. 11pm -12 pm US EASTERN TIME
Edited by neuroblastoma on 08/25/07 - 03:21 PM
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| actin
Forum Newbie
Topics: 2
Posts: 13
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neuroblastoma,
when do u plan to do chat.i left u couple of messages in ur yahoo messenger but got no reply.
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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chat starting from MONDAY ...
EVERYONE PLZ tell me ur preferable timings.
first 20 days questions from medicine ..
2 days infections --27,28 august
2 days Respi 29-30
4 days CVS 31-3 sep
2 days GIT 4-5 sep
3 days Renal + Electrolytes 6-7-8sep
2 days Rheumato 9-10 sep
2 days endocrine 11-12 sep
2 days hemato 13-14
1day neuro 15 sep
5 days OB/gyane
3 days Psyc
3 days paeds (first 12 chapters)
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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2 sessions ( TIMING will be adjust due to participants)
Its TEAM WORK.
one session in day time ( 11 am-12 noon) US EASTERN TIME
second session in evening time. 11pm -12 pm US EASTERN TIME
most of u have already added to yahoo messenger.. almost everyone is most welcome to join this questions chat.
this chat will help to motivate eachother and i bet its best way to do lotsa questions.
guys..leave ur email id. who wanna be part of this team
Edited by neuroblastoma on 08/25/07 - 03:20 PM
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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ACTIN, u have been added and all other guys who contacted me.. we are team now.and will start by monday.Good luck everyone.
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| actin
Forum Newbie
Topics: 2
Posts: 13
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pls invite me to both sessions.
thanks for arranging these step 2 chats.we 'll certaily do as u wish.
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| h212
Forum Newbie
Topics: 1
Posts: 33
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Thanks neuroblastoma for organizing such sessions.... Loking forward to it....
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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h212.. sure!! u have been added to our team
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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INFECTIOUS DISEASES TOPIC FOR TODAY 'S QUESTIONS
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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asdvsd2003 (08/27/2007 11:01:07 AM): ok guys... welcome here
asdvsd2003 (08/27/2007 11:01:16 AM): 11 am US eastern time
asdvsd2003 (08/27/2007 11:01:29 AM): i will post INfectious ds QUESTIONS TODAY
asdvsd2003 (08/27/2007 11:01:37 AM): here u go....first one
asdvsd2003 (08/27/2007 11:01:42 AM): A 54-year-old male comes to you with complaints of fever, exertional dyspnea and a non-productive cough for one week. He was diagnosed with HIV infection three years ago; however he has been asymptomatic. His vitals are, T: 38.9C(102F), RR: 28/min, PR: 100/min, and BP: 120/80 mm Hg. He is hypoxic at 80% saturation on room air; using a 100% non-rebreather mask, his oxygen saturations increased to 92%. Lab results are: Hb: 11.5 g/dL WBC: 7,000/cmm; no band forms Platelets: 130,000/cmm ABG on room air: pH: 7.46 PO2: 60 mm Hg PCO2: 32 mm Hg The chest-x ray shows a diffuse bilateral interstitial infiltration. His CD4 count is 190/µL and the LDH is 400 U/L. What is the most appropriate next step in this patient?
asdvsd2003 (08/27/2007 11:01:57 AM): A. Initiation of antiretroviral (HAART) treatment B. Intravenous ceftriaxone C. Intravenous pentamidine and steroids D. Trimethoprim-sulfamethoxazole and steroids E. Trimethoprim-sulfamethoxazole alone
asdvsd2003 (08/27/2007 11:02:29 AM): i dont have mic to speak right now.. i will arrange that soon
prep step2ck (08/27/2007 11:03:34 AM): d ,,,
prep step2ck (08/27/2007 11:03:40 AM): is ans
Ramy Azzam (08/27/2007 11:03:48 AM): E?
usteps (08/27/2007 11:03:59 AM): D
Ramy Azzam (08/27/2007 11:04:11 AM): asd I think u're the one who should invite coz u're the host of this conference
asdvsd2003 (08/27/2007 11:04:12 AM): yes..D
asdvsd2003 (08/27/2007 11:04:28 AM): PCP (pneumocystis carinii pneumonia) is a hallmark manifestation of AIDS. It is one of the most common opportunistic infection seen in AIDS, mostly associated with CD4 count < 200/µL. The diagnosis should be considered in any HIV patient who presents with dry cough, exertional dyspnea and fever. Chest x- ray usually shows bilateral interstitial infiltrates. PCP is also indicated by the symptom of hypoxia, which may be more severe than expected from radiographic findings. Serum LDH levels are frequently elevated and diagnosis is confirmed by demonstration of organism in sputum or BAL aspirate
asdvsd2003 (08/27/2007 11:05:06 AM): Trimethoprim-sulfamethoxazole is the initial drug of choice in PCP irrespective of the severity of the pneumonia. Steroids have been shown to decrease mortality in cases of severe PCP. Indication of steroid use in PCP includes: 1. PaO2 < 70mm Hg. 2. A-a gradient > 35. This patient has a PaO2 < 70 mm Hg, and thus steroid use is indicated in this patient.
prep step2ck (08/27/2007 11:05:15 AM): wat if patient is resistant to sulf drugs ,?
asdvsd2003 (08/27/2007 11:05:20 AM): The diagnosis of PCP is likely if a HIV patient has a non-productive cough, exertional dyspnea, fever, severe hypoxia, bilateral interstitial infiltrates on chest-x ray, and a normal white count. TMP-SMX is the drug of choice. Steroids have been shown to decrease the mortality in patients with severe PCP infection. Indication of steroid use in PCP includes: 1. PaO2 < 70mm Hg. 2. A-a gradient > 35; [A-a gradient = [(150 – {1.25 X pCO2}) - PO2] *Extremely high yield question for USMLE!!!
prep step2ck (08/27/2007 11:05:40 AM): drug of choice ,in case of resistance to sulfa drug ,,is ?
asdvsd2003 (08/27/2007 11:05:47 AM): PENTAMIDINE
asdvsd2003 (08/27/2007 11:05:57 AM): ?
prep step2ck (08/27/2007 11:06:02 AM): correct
asdvsd2003 (08/27/2007 11:06:17 AM): Whts the prophylaxix of PCP?
prep step2ck (08/27/2007 11:06:33 AM): wat if u r giving it for prophylaxis ,,and the person is allergic to sulfa?
usteps (08/27/2007 11:06:47 AM): TMP. Sulfamethaxozla
asdvsd2003 (08/27/2007 11:06:49 AM): dapsone is sulfa?
prep step2ck (08/27/2007 11:06:55 AM): nope
asdvsd2003 (08/27/2007 11:06:58 AM): dapsone in prophylaxix
usteps (08/27/2007 11:07:10 AM): dapsone
prep step2ck (08/27/2007 11:07:15 AM): dapsone isnot sulfa
asdvsd2003 (08/27/2007 11:07:19 AM): ok
asdvsd2003 (08/27/2007 11:07:33 AM): good job guys!!!
prep step2ck (08/27/2007 11:07:37 AM): for prophylaxis ,firs choice is ,,tmp.-smx
asdvsd2003 (08/27/2007 11:07:41 AM): yes
prep step2ck (08/27/2007 11:07:43 AM): if allegy ,dapsone
asdvsd2003 (08/27/2007 11:07:50 AM): correct
usteps (08/27/2007 11:07:52 AM): ok.. now i got it
asdvsd2003 (08/27/2007 11:08:11 AM): A 25-year-old African-American woman comes to your office with complaints of generalized malaise, headaches, mild fever and anorexia. She is sexually active and her medical history is positive for pelvic inflammatory disease 8 months ago, adequately treated with a combination of cephalosporin and doxycycline. On examination, you note a painless shallow ulcer on the vulva. The rest of the examination is without anomalies. Initial evaluation reveals a positive Frei test for Chlamydia serotype L2. Which of the following will the patient most likely develop if her present condition goes untreated? A. Granuloma inguinale B. Proctocolitis C. Septic arthritis D. Dendritic corneal ulcer E. Aortitis F. Tabes dorsalis
Yahoo! Messenger (08/27/2007 11:08:50 AM): Swagata Datta has joined the conference.
prep step2ck (08/27/2007 11:08:52 AM): a
asdvsd2003 (08/27/2007 11:08:54 AM): A 25-year-old African-American woman comes to your office with complaints of generalized malaise, headaches, mild fever and anorexia. She is sexually active and her medical history is positive for pelvic inflammatory disease 8 months ago, adequately treated with a combination of cephalosporin and doxycycline. On examination, you note a painless shallow ulcer on the vulva. The rest of the examination is without anomalies. Initial evaluation reveals a positive Frei test for Chlamydia serotype L2. Which of the following will the patient most likely develop if her present condition goes untreated? A. Granuloma inguinale B. Proctocolitis C. Septic arthritis D. Dendritic corneal ulcer E. Aortitis F. Tabes dorsalis
prep step2ck (08/27/2007 11:08:55 AM): is ans
prep step2ck (08/27/2007 11:08:58 AM): a
prep step2ck (08/27/2007 11:09:22 AM): sorry proctocolitis
prep step2ck (08/27/2007 11:09:25 AM): that is b
asdvsd2003 (08/27/2007 11:09:49 AM): whts diagnosis?
prep step2ck (08/27/2007 11:09:55 AM): lgv
prep step2ck (08/27/2007 11:10:05 AM): lymphograumoma venerum
usteps (08/27/2007 11:10:15 AM): lymphogranuloma vneverium
asdvsd2003 (08/27/2007 11:10:17 AM): clue points?
prep step2ck (08/27/2007 11:10:27 AM): is right ans?
usteps (08/27/2007 11:10:29 AM): shallow painless ulcer
asdvsd2003 (08/27/2007 11:10:30 AM): yes
asdvsd2003 (08/27/2007 11:10:33 AM): B
asdvsd2003 (08/27/2007 11:10:35 AM): LGV
usteps (08/27/2007 11:10:48 AM): sexaually active.. pid
asdvsd2003 (08/27/2007 11:10:51 AM): This patient most likely has Lymphogranuloma venereum (LGV). LGV is a sexually transmitted disease caused by Chlamydia trachomatis serotypes L1, L2 and L3. The disease starts 1 to 4 weeks after initial contact and manifests with generalized malaise, headaches and fever. A papule appears and subsequently transforms into an ulcer, typically located in the vulvovaginal region. The ulcer is painless and the disease may go unnoticed until inguinal adenitis develops about a month later. In women, however, the lymphadenopathy involves more commonly the deep nodes around the rectum and anus. If untreated at this stage, LGV progresses into a severe and chronic disease causing ulceration, proctocolitis, rectal stricture, rectovaginal fistulas and elephantiasis.
asdvsd2003 (08/27/2007 11:11:31 AM): Option A: Granuloma inguinale (GI) is a distinct condition that presents similarly but is due to Donovania granulomatis. Unlike LGV, the ulcer and lymphadenopathy of granuloma inguinale present at the same time. Moreover, the ulcer of Granuloma inguinale has irregular borders and is characterized by a beefy red granular base. Option C: Septic arthritis is more likely to develop in disseminated gonococcemia when gonococcal urethritis is untreated. Arthritis may also be part of Reiter’s syndrome (arthritis, urethritis, conjunctivitis), but it is a reactive condition to chlamydia infection rather than septic arthritis. Option D: Dendritic corneal ulcer is seen with Herpes infections. Option E: Aortitis usually occurs in tertiary syphilis, not in LGV.
prep step2ck (08/27/2007 11:11:47 AM): it gives a pain less ulcer first ,that goes unnoticed ,,and then ,,,lymphadenitis ocurs ,thats painfull ,eventulaay involves deep lypm nodes in ingulinal area ,,and ,,can cause fistulea ,proctitis ,etc
asdvsd2003 (08/27/2007 11:12:08 AM): CORRECT!!
asdvsd2003 (08/27/2007 11:12:59 AM): An 8-year-old boy is brought by his parents to the emergency room with fever, headache, nausea and vomiting, for the last 3 days. The parents explain the delay in seeking help by saying, “we both need to work long hours to support our family". On examination, the child is conscious, cooperative and well oriented. His vitals are, Temperature: 39.4C(103F); PR: 103/min; BP: 80/50 mm Hg with no orthostasis. Neck is supple to palpation with no jugulovenous distension or lymphadenopathy. Chest examination demonstrated bilateral rales in an apical distribution. While examining the child, the mother interrupts by saying that she remembers removing a tick from the child’s shirt when he returned from a school camping trip 2weeks ago. On further examination, there is a diffuse maculopapular rash on t
asdvsd2003 (08/27/2007 11:13:12 AM): maculopapular rash on the trunk with numerous petechiae. Which of the following is the most appropriate next step in the management of this child?
asdvsd2003 (08/27/2007 11:13:21 AM): A. Rickettsial group specific indirect fluorescent antibody (IFA) test B. Chest X-ray AP and lateral views C. Immediate oral treatment with chloramphenicol D. Immediate intravenous treatment with doxycycline E. Intravenous fluid administration
prep step2ck (08/27/2007 11:14:19 AM): E
prep step2ck (08/27/2007 11:14:26 AM): IS ans
asdvsd2003 (08/27/2007 11:14:34 AM): CHECK OUT BP...yes!!!!!!!
asdvsd2003 (08/27/2007 11:14:47 AM): diagnosis??
prep step2ck (08/27/2007 11:14:54 AM): this is rockymountain spotted fever
asdvsd2003 (08/27/2007 11:15:15 AM): clue points?
prep step2ck (08/27/2007 11:15:30 AM): starts with vague headache ,,,n a cebtripetal rash ,,,can caue asulties ,hypotension ,,n gangrene
asdvsd2003 (08/27/2007 11:15:32 AM): different from other RASH
asdvsd2003 (08/27/2007 11:15:34 AM): ?
usteps (08/27/2007 11:15:34 AM): Camping.. tick,.. fever
prep step2ck (08/27/2007 11:15:46 AM): so ,,the man isseue is hypotension ,here ,,give iv fluids
prep step2ck (08/27/2007 11:15:57 AM): drug o choice is doxycycline
asdvsd2003 (08/27/2007 11:16:00 AM): Rocky mountain spotted fever (RMSF) is characterized by fever, myalgias, headache and a petechial rash. It is the most common and fatal tick-borne disease in the United States. The diagnosis of RMSF requires a high index of clinical suspicion, as delay in recognition can lead to systemic toxicity causing shock-like state characterized by hypotension (as noted in this child). Serology (indirect fluorescent antibody) is the usual confirmative diagnostic method. However, these tests are only useful after acute infection because serum antibodies become detectable during convalescence. Hence, the treatment of RMSF needs to be initiated on clinical suspicion. The treatment of choice for Rocky Mountain spotted fever is doxycycline (oral or intravenous) for adults and children. Some physicians use
asdvsd2003 (08/27/2007 11:16:33 AM): Some physicians use chloramphenicol in young children (less than 9 years) to avoid permanent stinging of the teeth; however, this risk is low and
usteps (08/27/2007 11:16:39 AM): He is 8 yrs old you can't give doxycycline
asdvsd2003 (08/27/2007 11:16:43 AM): many physicians prefer doxycycline because of the more serious risk of bone marrow suppression with chloramphenicol. Chest radiograph needs to be done in patients like this who appears significantly ill or who have abnormal lung findings on physical exam. However, the most acute problem requiring immediate attention in this child is hypotension, which needs to be corrected with intravenous fluid resuscitation (Choice E). If untreated, hypotension can lead to prerenal azotemia. Always remember ABC (Airway, Breathing, and Circulation) in the management of every patien
asdvsd2003 (08/27/2007 11:17:36 AM): less than 8 we can use AMOXICILLIN
asdvsd2003 (08/27/2007 11:17:42 AM): 8 IS OKAY
prep step2ck (08/27/2007 11:17:51 AM): rocky mountain spotted fever needs only one dose of doxycycline ,,the sideeefects r dose dependent ,,so its not goona harm the kid,
asdvsd2003 (08/27/2007 11:18:05 AM): yes..one dose
usteps (08/27/2007 11:18:15 AM): ok..
prep step2ck (08/27/2007 11:18:23 AM): amoxicillin does not cover richettsia
asdvsd2003 (08/27/2007 11:18:24 AM): thanks prepstep
asdvsd2003 (08/27/2007 11:18:42 AM): ok. correct..ya,,now i am recalling this thing
prep step2ck (08/27/2007 11:18:56 AM): its intercelluar organsim ,,,,penicillin can t help ,as penicillin works on cell wall
asdvsd2003 (08/27/2007 11:18:57 AM): A 46-year-old Caucasian male who presented to emergency room with diabetic ketoacidosis 3 days ago develops low-grade fever, dull facial pain, and bloody nasal discharge. He also complains of diplopia and headache. On examination, his right nasal turbinates are necrotic, and his right eye has chemosis and proptosis. KOH staining of the scrapings from nasal turbinates shows hyphae. A preliminary diagnosis of mucormycosis is made. Which of the following is the most effective therapy for this patient? A. IV Amphotericin B B. Oral fluconazole C. Surgical debridement D. Surgical debridement plus IV amphotericin E. Surgical debridement plus oral fluconazole F. IV itraconazole alone
Yahoo! Messenger (08/27/2007 11:19:24 AM): Ramy Azzam has left the conference.
prep step2ck (08/27/2007 11:19:50 AM): d
prep step2ck (08/27/2007 11:20:12 AM): both debridement n antifungal
usteps (08/27/2007 11:20:21 AM): d
prep step2ck (08/27/2007 11:20:25 AM): rhizopus ,,mucormycosis
asdvsd2003 (08/27/2007 11:20:37 AM): yes D
asdvsd2003 (08/27/2007 11:20:40 AM): Mucormycosis is a serious disease and it requires aggressive surgical debridement plus early systemic chemotherapy with amphotericin B, which is the only effective drug against this fungus. Surgical debridement or IV amphotericin alone are ineffective to treat mucormycosis. Oral fluconazole or itraconazole are not effective against Rhizopus infection.
asdvsd2003 (08/27/2007 11:21:27 AM): ANY OTHER COMMENT?
asdvsd2003 (08/27/2007 11:21:34 AM): related
prep step2ck (08/27/2007 11:21:46 AM): ur explanation is perfect ,,asd
asdvsd2003 (08/27/2007 11:21:50 AM): ok
asdvsd2003 (08/27/2007 11:21:58 AM): An 18-year-old white male presents after he is bitten on his right leg by a dog on the street outside his house. The dog bite was unprovoked and the dog was not captured. His leg shows deep bite marks. His wound was cleaned with soap and water. Which of the following is the most appropriate next step in the management of this patient? A. Reassurance B. Passive immunization C. Active immunization D. Active and passive immunization
Swagata Datta (08/27/2007 11:22:42 AM): d
prep step2ck (08/27/2007 11:22:47 AM): apatient with osteomyelitis has methicillin resistant staph aureus infection ,,drug of choice is ?
usteps (08/27/2007 11:23:05 AM): yyu have to watch the dog for signs if rabies if found then immunization, passive
asdvsd2003 (08/27/2007 11:23:07 AM): vancomycin?
Swagata Datta (08/27/2007 11:23:17 AM): vanco
prep step2ck (08/27/2007 11:23:18 AM): yes asd
prep step2ck (08/27/2007 11:23:32 AM): and to ur q ,is d
asdvsd2003 (08/27/2007 11:23:33 AM): yes..D
asdvsd2003 (08/27/2007 11:23:37 AM): Dog bite may result in rabies, which is a fatal disease. Post exposure prophylaxis consists of both active and passive immunization. An attempt is made to capture the dog and if it fails, then the dog is assumed rabid and post exposure prophylaxis is indicated. If the dog is available and it does not show any features of rabies, it is observed for the development of rabies. If it shows features of rabies within 10 days, it is killed and its brain is examined to confirm the presence of rabies and post exposure prophylaxis is given when rabies in dog is confirmed by FA (fluorescent antibody) examination on its brain. If the dog seems to be rabid at the time of dog bite, it is killed immediately and its head is sent for examination and if FA testing on its brain confirms the presence of rabie
asdvsd2003 (08/27/2007 11:24:23 AM): A 29-year-old college student presents with the complaint of yellow discoloration of his eyes. He has been suffering from sore throat for the past week. He tried several over-the-counter products to relieve the symptoms, but all were in vain. He also complains of fatigue, and malaise. His examination reveals, BP: 130/70mm Hg; Temperature: 38.8C(102F); RR: 18/min; PR: 110/min. Examination of throat reveals palatal petechiae with streaky hemorrhage and blotchy red macules. Tonsils are enlarged and covered with whitish exudates. Lymph nodes are palpable deep to the sternocleidomastoid muscle. Abdominal examination shows normal bowel sounds, no tenderness, no hepatosplenomegaly and no shifting dullness. His labs show: ESR: 45 mm/hr Leukocyte count: 14,000/c
asdvsd2003 (08/27/2007 11:24:33 AM): A 29-year-old college student presents with the complaint of yellow discoloration of his eyes. He has been suffering from sore throat for the past week. He tried several over-the-counter products to relieve the symptoms, but all were in vain. He also complains of fatigue, and malaise. His examination reveals, BP: 130/70mm Hg; Temperature: 38.8C(102F); RR: 18/min; PR: 110/min. Examination of throat reveals palatal petechiae with streaky hemorrhage and blotchy red macules. Tonsils are enlarged and covered with whitish exudates. Lymph nodes are palpable deep to the sternocleidomastoid muscle. Abdominal examination shows normal bowel sounds, no tenderness, no hepatosplenomegaly and no shifting dullness. His labs show: ESR: 45 mm/hr Leukocyte count: 14,000/c
asdvsd2003 (08/27/2007 11:24:48 AM): Erythrocyte: 5 millions/cmm Hemoglobin: 12 g/dL Hematocrit: 46 % Platelet: 137,000/cmm WBC differential: Segmented Neutrophils:26 Band Neutrophils: 4 Lymphocytes: 60 Atypical lymphocytes: 30 Monocytes: 5 Eosinophils: 3 Basophils: 2
asdvsd2003 (08/27/2007 11:24:59 AM): Which of the following is commonly associated with this condition?
asdvsd2003 (08/27/2007 11:25:11 AM): A. Pneumonia B. Autoimmune hemolytic anemia C. Splenic infarction D. Hepatoma E. Empyema F. CNS lymphoma
usteps (08/27/2007 11:25:45 AM): no clue
prep step2ck (08/27/2007 11:26:05 AM): b
asdvsd2003 (08/27/2007 11:26:13 AM): DIAGNOSIS?
prep step2ck (08/27/2007 11:26:22 AM): this is infectious mononucleiosis
asdvsd2003 (08/27/2007 11:26:26 AM): good job
asdvsd2003 (08/27/2007 11:26:44 AM): The patient is suffering from Infectious mononucleosis (IM). It is characterized by the fever, sore throat, toxic symptoms and lymphadenopathy. Physical examination usually reveals pharyngitis, tonsillitis, uvular edema and gingivitis along with tonsillar exudates. Mild palatal petechiae may be found. However, this finding is non-specific and frequently found in patients suffering from streptococcal pharyngitis. There is a characteristic distribution of lymph node involvement in infectious mononucleosis; it is typically symmetric and involves the posterior cervical chain of lymph nodes more than the anterior chain. Other findings may include: severe fatigue, myalgias, nausea, anorexia & splenomegaly. Other rare manifestations include jaundice, hepatomegaly, myocarditis, airway obstruction
asdvsd2003 (08/27/2007 11:27:21 AM): Hematological abnormalities seen in infectious mononucleosis include hemolytic anemia, thrombocytopenia, disseminated intravascular coagulation. (DIC) and thrombotic thrombocytopenic purpura / hemolytic uremic syndrome (TTP/HUS). Hemolytic anemia results from anti-I antibodies against red blood cells. Thrombocytopenia is not a common finding in heterophil positive Infectious mononucleosis. Hepatoma and CNS lymphoma is not associated with the infectious mononucleosis. There are no known pulmonary complications such as pneumonia or empyema in infectious mononucleosis. Splenic rupture is one of feared complication and trauma precedes half of the cases. Contact sports like soccer should be avoided. Splenic infarction does not occur in Infectious mononucleosis.
asdvsd2003 (08/27/2007 11:27:59 AM): Always suspect infectious mononucleosis in young patients presenting with sore throat and nonspecific symptoms. Many diseases have similar manifestations so know the clinical presentation, physical findings and complications of infectious mononucleosis.
asdvsd2003 (08/27/2007 11:28:26 AM): hemolytic anemia, thrombocytopenia, disseminated intravascular coagulation. (DIC) and thrombotic thrombocytopenic purpura / hemolytic uremic syndrome (TTP/HUS
asdvsd2003 (08/27/2007 11:28:50 AM): A 37-year-old homosexual white male comes to his primary care physician for the evaluation of skin lesions around his anus, which are slightly pruritic. He does not have fever, malaise or anorexia. He has never been tested for HIV or other sexually transmitted diseases. He denies drug or food allergy. Examination shows skin colored, verrucous, papilliform lesions around his anus. Which of the following is the most appropriate treatment for this patient? A. Podophyllin B. Penicillin C. Erythromycin D. Doxycycline E. Tetracycline
usteps (08/27/2007 11:28:57 AM): thabkx asd... could not relate the H. anemia ti IM
usteps (08/27/2007 11:29:22 AM): a
usteps (08/27/2007 11:29:28 AM): anal warts
prep step2ck (08/27/2007 11:29:31 AM): a
prep step2ck (08/27/2007 11:29:46 AM): condyloma acuminata
asdvsd2003 (08/27/2007 11:29:48 AM): yes A
asdvsd2003 (08/27/2007 11:29:50 AM): he above patient is most likely suffering from condylomata acuminata (anogenital warts), which are caused by human papilloma virus. The lesions of condylomata acuminata are skin colored or pink, verrucous and papilliform in contrast to the lesions of condyloma lata, which are flat or velvety. Such patients usually don’t have systemic features. Podophyllin is one of the available treatment options for condylomata acuminata. It is an antimitotic agent and leads to cell death. It is teratogenic and is contraindicated in pregnancy. Its adverse effects are local irritation and ulceration. There are three treatment options for condyloma acuminata, which are chemical or physical agents, immune therapy and surgery. The choice of treatment depends upon the number and extent of lesions. Chemical age
asdvsd2003 (08/27/2007 11:30:34 AM): A 65-year-old female had open cholecystectomy 10 days ago. She now presents to you with a painful rash, which is just above the scapula and is distributed all the way to her right nipple. She says the pain is severe and the rash is very itchy. She denies taking any medications. She has tried several over the counter medications without success. On examination, the skin is red and excoriated. There are some intact vesicles distributed from underneath the scapula extending all the way to the right breast. The most effective treatment is: A. Acetaminophen B. Topical steroids C. Lidocaine D. Acyclovir E. Tricyclics
usteps (08/27/2007 11:31:06 AM): d
asdvsd2003 (08/27/2007 11:31:24 AM): CORRECT.
prep step2ck (08/27/2007 11:31:25 AM): herpes zoster ,,,d\
asdvsd2003 (08/27/2007 11:31:28 AM): D
asdvsd2003 (08/27/2007 11:31:31 AM): Postherpetic neuralgia is pain that sometimes follows resolution of acute herpes zoster infection. It can be accompanied by itching and can be extremely painful. Herpes zoster infects the sensory ganglia and is characterized by pain along the distribution of the affected nerve and crops of clustered vesicles over the area. The virus usually gets reactivated in the dorsal root ganglia. The best treatment for this condition is acyclovir given for 5-10 days. In immunocompromised patients, varicella zoster immunoglobulin can be administered.
asdvsd2003 (08/27/2007 11:32:11 AM): A 45-year-old female presents to emergency room complaining of urinary frequency, burning during urination, and weakness. Her last menstrual period was one year ago, and she is not sexually active. She is not taking any medications. Her temperature is 37.8 C (100 F), blood pressure is 120/76 mmHg, pulse is 80/min, and respirations are 14/min. Very mild costovertebral angle tenderness is present. IV ceftriaxone is started. Two days later, the patient feels much better. Antibiotic susceptibility testing returned with an uropathogen (E.coli) highly sensitive to ceftriaxone, gentamycin, ciprofloxacin and trimethoprim/sulfamethoxazole (TMP/SMX). Which of the following is the most reasonable next step in the management of this patient? A. Add ciprofloxacin to the regimen B. Switch to TM
asdvsd2003 (08/27/2007 11:32:23 AM): B. Switch to TMP/SMX C. Switch to gentamycin D. Continue ceftriaxone E. Discontinue antibiotic therapy
usteps (08/27/2007 11:33:23 AM): d
prep step2ck (08/27/2007 11:33:41 AM): d
asdvsd2003 (08/27/2007 11:33:49 AM): NO
asdvsd2003 (08/27/2007 11:33:52 AM): This patient has signs and symptoms suggestive of uncomplicated pyelonephritis. It seems that the condition responded to parenteral antibiotic therapy. The patients with uncomplicated pyelonephritis can be usually switched to an oral antibiotic after 48-72 hours of parenteral therapy (Choice D). At this point, the most reasonable step is to switch to an oral antibiotic chosen according to the antibiotic susceptibility testing. TMP/SMX is a good choice, because it is relatively cheap. The average duration of antibiotic therapy during uncomplicated pyelonephritis is two weeks (Choice E). There is no reason to add another antibiotic (Choice A) or switch to another parenteral agent (Choice C).
usteps (08/27/2007 11:33:55 AM): than b
asdvsd2003 (08/27/2007 11:33:58 AM): Ans B
prep step2ck (08/27/2007 11:34:46 AM): right ,,,i got it
asdvsd2003 (08/27/2007 11:34:52 AM): After 48-72 hours of parenteral therapy for uncomplicated pyelonephritis, the patient can be usually switched to an oral agent. Oral therapy is more convenient and less expensive; if the results of antibiotic susceptibility testing are known, the appropriate antibiotic can be easily chosen. *Extremely high yield question for USMLE!!!
usteps (08/27/2007 11:35:17 AM): when can i continue ceftriaxone
usteps (08/27/2007 11:35:28 AM): if it was complicated???
asdvsd2003 (08/27/2007 11:35:42 AM): IF ITS NOT GETTING BETTER
asdvsd2003 (08/27/2007 11:35:57 AM): CONTINUE WITH I/V drugs
prep step2ck (08/27/2007 11:35:57 AM): yes ,,,for complicated urinary tract infection u need iv dose
asdvsd2003 (08/27/2007 11:36:08 AM): A 27-year-old, HIV-positive, male comes to his physician with a 2-day history of fever, profuse watery diarrhea and abdominal cramps. His current medications include zidovudine, didanosine, indinavir, trimethoprim-sulfamethoxazole and clarithromycin. His CD4 count is 45/cubic mm of blood. His vitals are, PR: 102/min; RR: 14/min; Temperature: 37.9C(100.2F); BP: 105/70mm Hg. He is started on fluid and electrolyte support. What will be the most appropriate next step in his management? A. Stop antibiotics and send stool for clostridium difficle toxin assay B. Colonoscopy and biopsy of the ulcers C. Stool examination D. Start empirical antibiotic for gram negative organisms E. Loperamide and lactose-free diet until diarrhea subsides
usteps (08/27/2007 11:36:21 AM): u men after i switch to Septrin... thani he is not getting better then back to ceftriaxone
usteps (08/27/2007 11:37:02 AM): Sorry guys, the previous question
usteps (08/27/2007 11:37:18 AM): i still didn't get it 100%
prep step2ck (08/27/2007 11:37:19 AM): d
prep step2ck (08/27/2007 11:37:57 AM): nope ,,the q scenerio ,tell u its uncoplicated infection ,so u ll use oral antibiotic
prep step2ck (08/27/2007 11:38:44 AM): lets sai ,its a patient who has some stone ,or sometumour ,cauing obstruction,this is complicated ,,,u need iv drug
usteps (08/27/2007 11:38:59 AM): ok thanks prep
asdvsd2003 (08/27/2007 11:39:08 AM): Chronic pyelonephritis may require high doses of antibiotics for as long as six months to clear the infection
Yahoo! Messenger (08/27/2007 11:39:57 AM): SARDA OKRAM has joined the conference.
asdvsd2003 (08/27/2007 11:39:59 AM): answer
asdvsd2003 (08/27/2007 11:40:01 AM): Diarrhea, in HIV-infected patients, can be due to multiple etiological agents like Salmonella, Shigella, Campylobacter, Clostridium difficile, Giardia, Cryptosporidium, Mycobacterium avium complex and Cytomegalovirus. Therefore, an etiologic diagnosis must be made before starting antibiotic therapy. Stool examination (Choice C) should be done first in all HIV-infected patients with diarrhea for bacterial culture, ova and parasites. Colonoscopy and biopsy of the ulcers (Choice B) is reserved for those with persistent diarrhea and negative stool examination. Antibiotic therapy (Choice D) is begun once a diagnosis is established. Lactose free diet and loperamide (Choice E) are used when diarrhea is persistent and no cause is found. It is more likely that an infective organism-causing diarrhea
asdvsd2003 (08/27/2007 11:40:09 AM): ans C
prep step2ck (08/27/2007 11:40:10 AM): one more imp thing..is that once u r sure with history n urinalysis that this is uncomlicated uTI , u don t even do culturs ,go to treatment right away [oral ]
asdvsd2003 (08/27/2007 11:40:27 AM): OK
usteps (08/27/2007 11:40:33 AM): ok
usteps (08/27/2007 11:40:43 AM): thanks guys
asdvsd2003 (08/27/2007 11:41:14 AM): A 27-year-old, HIV-positive, male comes to his physician with a 2-day history of fever, profuse watery diarrhea and abdominal cramps. His current medications include zidovudine, didanosine, indinavir, trimethoprim-sulfamethoxazole and clarithromycin. His CD4 count is 45/cubic mm of blood. His vitals are, PR: 102/min; RR: 14/min; Temperature: 37.9C(100.2F); BP: 105/70mm Hg. He is started on fluid and electrolyte support. What will be the most appropriate next step in his management? A. Stop antibiotics and send stool for clostridium difficle toxin assay B. Colonoscopy and biopsy of the ulcers C. Stool examination D. Start empirical antibiotic for gram negative organisms E. Loperamide and lactose-free diet until diarrhea subsides
asdvsd2003 (08/27/2007 11:41:17 AM): this ques??
prep step2ck (08/27/2007 11:41:23 AM): that was d ,stool exam
prep step2ck (08/27/2007 11:41:33 AM): i thought d is stool exam
asdvsd2003 (08/27/2007 11:41:44 AM): ans C..
asdvsd2003 (08/27/2007 11:41:48 AM): Oh ok
asdvsd2003 (08/27/2007 11:41:55 AM): Diarrhea, in HIV-infected patients, can be due to multiple etiological agents like Salmonella, Shigella, Campylobacter, Clostridium difficile, Giardia, Cryptosporidium, Mycobacterium avium complex and Cytomegalovirus. Therefore, an etiologic diagnosis must be made before starting antibiotic therapy. Stool examination (Choice C) should be done first in all HIV-infected patients with diarrhea for bacterial culture, ova and parasites. Colonoscopy and biopsy of the ulcers (Choice B) is reserved for those with persistent diarrhea and negative stool examination. Antibiotic therapy (Choice D) is begun once a diagnosis is established. Lactose free diet and loperamide (Choice E) are used when diarrhea is persistent and no cause is found. It is more likely that an infective organism-causing diarrhea
prep step2ck (08/27/2007 11:42:17 AM): so it goes in an orde ,,with hiv ,u start with stool exam ,,n continue with colonoscopy n biopsy ,if n clue with stool exam
SARDA OKRAM (08/27/2007 11:42:37 AM): k
asdvsd2003 (08/27/2007 11:42:37 AM): correct!!!
asdvsd2003 (08/27/2007 11:43:04 AM): A 23-year-old white male presents with abrupt onset of fever, myalgia, and gustatory hallucinations. He is reported to be having bizarre behavior. His vitals are, PR: 95/min; Temperature: 40C(104F); BP: 120/80 mm Hg. He is confused and disoriented. Neurological examination is non-focal and signs of meningeal irritation are negative. There is no papilledema on fundoscopy. CT scan without contrast is normal. Lumbar puncture is done which shows that: Cerebrospinal
asdvsd2003 (08/27/2007 11:43:24 AM): A 23-year-old white male presents with abrupt onset of fever, myalgia, and gustatory hallucinations. He is reported to be having bizarre behavior. His vitals are, PR: 95/min; Temperature: 40C(104F); BP: 120/80 mm Hg. He is confused and disoriented. Neurological examination is non-focal and signs of meningeal irritation are negative. There is no papilledema on fundoscopy. CT scan without contrast is normal. Lumbar puncture is done which shows that: Cerebrospinal fluid protein: 80mg/dL, Glucose: 35 mg/dl, Cell count: 150/mm3. Result of Polymerase Chain Reaction (PCR) is awaited. What is the most appropriate next step in the management of this patient? A. IV Acyclovir B. Brain biopsy C. IV ceftriaxone and vancomycin D. Wait the result of PCR E. IV dexamethasone
prep step2ck (08/27/2007 11:43:59 AM): a acyclovior
usteps (08/27/2007 11:44:04 AM): a
usteps (08/27/2007 11:44:09 AM): encephalitis
prep step2ck (08/27/2007 11:44:10 AM): encephlitis ,temporal lobe
asdvsd2003 (08/27/2007 11:44:18 AM): yes A.
asd22 22 (08/27/2007 11:44:22 AM): No, thank you.
asdvsd2003 (08/27/2007 11:44:29 AM): A 23-year-old white male presents with abrupt onset of fever, myalgia, and gustatory hallucinations. He is reported to be having bizarre behavior. His vitals are, PR: 95/min; Temperature: 40C(104F); BP: 120/80 mm Hg. He is confused and disoriented. Neurological examination is non-focal and signs of meningeal irritation are negative. There is no papilledema on fundoscopy. CT scan without contrast is normal. Lumbar puncture is done which shows that: Cerebrospinal fluid protein: 80mg/dL, Glucose: 35 mg/dl, Cell count: 150/mm3. Result of Polymerase Chain Reaction (PCR) is awaited. What is the most appropriate next step in the management of this patient? A. IV Acyclovir B. Brain biopsy C. IV ceftriaxone and vancomycin D. Wait the result of PCR E. IV dexamethasone This
prep step2ck (08/27/2007 11:44:40 AM): herpes simplex is mcc .with temporal lobe encephlitis
asdvsd2003 (08/27/2007 11:44:42 AM): SORYYYYYY
asdvsd2003 (08/27/2007 11:44:43 AM): This patient is most likely suffering from Herpes simplex virus (HSV) encephalitis. HSV most frequently affects temporal area of brain and as a result, features like bizarre behavior and gustatory hallucinations may be present. Disease is usually abrupt in onset and fever is present along with impaired mental status. Meningeal signs are frequently absent and cerebrospinal fluid (CSF) findings are nonspecific with low glucose and pleocytosis. CSF tested by PCR for herpes simplex virus DNA is now the diagnostic test of choice. Brain biopsy used to be the diagnostic test of choice but now it is largely replaced by PCR. Whenever there is suspicion of HSV encephalitis, IV acyclovir should be started without delay. This patient’s clinical picture is typical of HSV encephalitis, therefore waitin
asdvsd2003 (08/27/2007 11:45:11 AM): SUDDEN ONSET
asdvsd2003 (08/27/2007 11:45:40 AM): do we do CT first or LP in this case??
prep step2ck (08/27/2007 11:46:10 AM): ct ,,first if neurological deficit is there
usteps (08/27/2007 11:46:13 AM): fundoscopy before the LP
usteps (08/27/2007 11:46:21 AM): than Ct
usteps (08/27/2007 11:46:32 AM): then last is ct
usteps (08/27/2007 11:46:46 AM): to exclude any brain path
asdvsd2003 (08/27/2007 11:46:47 AM): he is confused and disoriented---i guess CT first
prep step2ck (08/27/2007 11:46:56 AM): risk of herniation is there if u do lp without CT
asdvsd2003 (08/27/2007 11:47:05 AM): obvious after checking papilledema
usteps (08/27/2007 11:47:11 AM): ok
SARDA OKRAM (08/27/2007 11:47:19 AM): k got
SARDA OKRAM (08/27/2007 11:47:24 AM): it
asdvsd2003 (08/27/2007 11:47:42 AM): in this case i would go for CT first then LP
asd22 22 (08/27/2007 11:47:58 AM): No, thank you.
prep step2ck (08/27/2007 11:48:03 AM): COZ when inntracranial pressure is high ,,,,csf formation dec ,,absortion inc for compnsation ,,that causes brain to exapand [herniation]
asdvsd2003 (08/27/2007 11:48:23 AM): COrrect
asdvsd2003 (08/27/2007 11:48:37 AM): papliedema--High ICP---RISK OF HERNIATION
asdvsd2003 (08/27/2007 11:48:43 AM): A 34-year-old recently migrated African American male presents with severe headache and high-grade fever with chills for the last two days. He also complains of severe malaise, myalgia and vomiting. He adds that the present episode started with feeling of intense cold and chills with shivering followed by high-grade fever. He had two similar episodes in the past, when he was in Africa. His vitals are, T: 38.9C(102F), RR: 20/min, PR: 110/min and BP: 100/60 mm Hg. He has pallor with mild splenomegaly but rest of his physical examination is normal. What is the most likely diagnosis in this patient?
asdvsd2003 (08/27/2007 11:48:55 AM): A. Sickle cell crisis B. Babesiosis C. Falciparum malaria D. Meningitis E. Typhoid fever
usteps (08/27/2007 11:49:23 AM): c
SARDA OKRAM (08/27/2007 11:49:26 AM): c
asdvsd2003 (08/27/2007 11:49:44 AM): 10 MINUTES MORE.... HOPE TO SEE U IN SESSION TONIGHT
asdvsd2003 (08/27/2007 11:50:06 AM): yes C
asdvsd2003 (08/27/2007 11:50:08 AM): Malaria is a protozoal disease caused by genus plasmodium, which is a RBC parasite and is transmitted by the bite of infected Anopheles mosquitoes. It is the most important parasitic disease and is endemic in most of the developing countries of Asia and Africa. Four species of Plasmodium, viz, P. falciparum, P. vivax, P. ovale, and P. malariae can cause malaria. Most of the deaths are due to falciparum malaria whereas vivax and ovale are responsible for several relapses.
SARDA OKRAM (08/27/2007 11:50:10 AM): typical presentation of malaria
prep step2ck (08/27/2007 11:50:28 AM): falciparu m
SARDA OKRAM (08/27/2007 11:50:42 AM): oval vivex fever every 72 hrs
asdvsd2003 (08/27/2007 11:51:02 AM): Babesiosis is a protozoal disease caused by Babesia microti, which is also a RBC parasite and is transmitted by tick. Clinical features can range from asymptomatic infection to severe hemolytic anemia with jaundice and renal failure. It is more commonly seen in patients with functional asplenia or splenectomy
SARDA OKRAM (08/27/2007 11:51:35 AM): yep
asdvsd2003 (08/27/2007 11:51:56 AM): A 25-year-old female comes to you with the complaint of a painful rash over the right hand for 4 days, and a tender swelling in the right axilla for 2 days. The patient is a bank accountant, and has been in good health in the past. When asked about pets, she says that she has two cats. On examination, she has multiple vesicular and erythematous papules over the site that itches, and a tender suppurative right epitrochlear and axillary lymphadenopathy. What is the most appropriate management of this patient? A. Watchful observation B. Oral azithromycin C. Oral penicillin D. Topical corticosteroids E. Oral cephalexin F. Lymph node biopsy
prep step2ck (08/27/2007 11:52:26 AM): b azithro
usteps (08/27/2007 11:52:27 AM): b
SARDA OKRAM (08/27/2007 11:52:29 AM): b
asdvsd2003 (08/27/2007 11:52:30 AM): 8 MINUTES LEFT
usteps (08/27/2007 11:52:34 AM): cat scratch disease
SARDA OKRAM (08/27/2007 11:52:37 AM): cats stratch
asdvsd2003 (08/27/2007 11:52:50 AM): YES
asdvsd2003 (08/27/2007 11:52:51 AM): B
asdvsd2003 (08/27/2007 11:52:52 AM): This patient has a classic presentation of cat-scratch disease. Cat-scratch disease is an infectious disease caused by B. henselae, transmitted by a cat scratch or bite, or from a fleabite. It is commonly seen in young, immunocompetent individuals. It most commonly presents as a localized cutaneous and lymph node disorder near the site of inoculum, with a very rare involvement of the liver, spleen, eye or central nervous system. A local skin lesion evolves through vesicular, erythematous and papular phases, but can be pustular or nodular. Localized, regional lymphadenopathy, the hallmark of CSD, is tender and may be suppurative. The
SARDA OKRAM (08/27/2007 11:53:11 AM): wats rx for cat bite?
asdvsd2003 (08/27/2007 11:53:25 AM): erythematous papules over the site that itches
asdvsd2003 (08/27/2007 11:55:28 AM): Most patients with CSD have a gradual resolution of symptoms, even without specific antibiotic therapy. However, a tender regional lymphadenopathy and systemic symptoms may be debilitating. A short course of antibiotic is recommended for all patients with CSD. Five days of azithromycin has been found to be particularly effective. Other options include a seven- to ten-day course of clarithromycin, rifampin, trimethoprim-sulfamethoxazole, or ciprofloxacin. Doxycycline has also been found to be effective
SARDA OKRAM (08/27/2007 11:56:16 AM): k
asdvsd2003 (08/27/2007 11:56:44 AM): so
asdvsd2003 (08/27/2007 11:56:49 AM): AZITHROMYCIN..
prep step2ck (08/27/2007 11:56:54 AM): a 16 weeks preganant woman comes with UTI ,,,drug o choice is?
asdvsd2003 (08/27/2007 11:56:55 AM): -5 DAYS
asdvsd2003 (08/27/2007 11:57:10 AM): AMOXICILLIN?
prep step2ck (08/27/2007 11:57:15 AM): right
asdvsd2003 (08/27/2007 11:57:36 AM): everyone!!! i want you to bring questions.. even if single line
asdvsd2003 (08/27/2007 11:57:46 AM): or full scnerio question
SARDA OKRAM (08/27/2007 11:57:49 AM): nitrofurintion too
prep step2ck (08/27/2007 11:57:56 AM): a person wih copd comes with recurrent attacks of bronchiectais ..u next step ?
asdvsd2003 (08/27/2007 11:58:04 AM): hope u all read post on prep4usmle about the schedule
asdvsd2003 (08/27/2007 11:58:19 AM): hmm
asdvsd2003 (08/27/2007 11:58:28 AM): O2+steroids??
SARDA OKRAM (08/27/2007 11:58:35 AM): broncoscopy?
asdvsd2003 (08/27/2007 11:58:38 AM): yes
asdvsd2003 (08/27/2007 11:58:51 AM): bronchoscopy can be done before therapy
asdvsd2003 (08/27/2007 11:59:14 AM): whts ur idea..prepck?
prep step2ck (08/27/2007 11:59:33 AM): the sequence will be ct ,,,then brochoscpy
prep step2ck (08/27/2007 11:59:38 AM): nn invasive test first
prep step2ck (08/27/2007 12:00:12 PM): we r going to find out wats cauusing recurrent attack ,that can be a tumour..or lung abcess
usteps (08/27/2007 12:00:12 PM): ct to confirm the bronchiectasis???
usteps (08/27/2007 12:00:21 PM): ok
prep step2ck (08/27/2007 12:00:23 PM): yes ct ,for confirmation
usteps (08/27/2007 12:00:26 PM): got it
asdvsd2003 (08/27/2007 12:00:44 PM): thank you very much guys!! hope to see you in evening session at 11 pm usa eastern time.. we will continue ID. topic. hope you all will participate regularly and bring questions.. thanks all once again.
asdvsd2003 (08/27/2007 12:00:51 PM): thanks prepck
asdvsd2003 (08/27/2007 12:00:58 PM): ya..right no invasive first
usteps (08/27/2007 12:01:03 PM): thanks you all
prep step2ck (08/27/2007 12:01:22 PM): thanx everybody esp asd for ur effor s
prep step2ck (08/27/2007 12:01:37 PM): bye
asdvsd2003 (08/27/2007 12:01:39 PM): whtever question u have in mind right now,,, note it down we will do in evevning session
SARDA OKRAM (08/27/2007 12:01:39 PM): thank u
asdvsd2003 (08/27/2007 12:01:44 PM): bye thanks... study hard now
SARDA OKRAM (08/27/2007 12:01:49 PM): k
usteps (08/27/2007 12:01:55 PM): bye 4 now
SARDA OKRAM (08/27/2007 12:01:55 PM): bye
Yahoo! Messenger (08/27/2007 12:01:57 PM): prep step2ck has left the conference.
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
|
BRING questions on infectious diseases.
all of you bring infectious ds questions.
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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tonight again--Infectious ds.
|
| lakshya_0_7
Forum Elite
Topics: 27
Posts: 350
|
thanx a lots neuro for posting the chat..if u could do that everytime it would be great
___________________
IM-99/99/pass,no uslors,research(3 mo just started), 2008 grad,need visa,applied on 5 sept,ivs-1,rej-1!
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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asdvsd2003 (08/28/2007 11:02:43 AM): A 35-year-old Caucasian male presents to your office with a two week history of low-grade fever and progressive weakness. His past medical history is significant for ‘a heart murmur detected a long time ago.’ He denies any illicit drug use. Physical examination reveals splinter hemorrhages and small petechiae on the palatal mucosa. ESR is 60/min. Urinalysis reveals microscopic hematuria and proteinuria 1+. You order echocardiography after hearing murmurs on heart auscultation. Which of the following valvular dysfunction is most likely to be detected? A. Aortal regurgitation B. Mitral regurgitation C. Tricuspid regurgitation D. Pulmonic stenosis E. Mitral stenosis
Yahoo! Messenger (08/28/2007 11:02:45 AM): usmleckprep has joined the conference.
Actin Myocin (08/28/2007 11:02:46 AM): good mrning guys
usmleckprep (08/28/2007 11:02:53 AM): good morning gals
SARDA OKRAM (08/28/2007 11:03:25 AM): gm
Yahoo! Messenger (08/28/2007 11:03:32 AM): usmleckprep has joined the conference.
Yahoo! Messenger (08/28/2007 11:03:32 AM): Actin Myocin has joined the conference.
Actin Myocin (08/28/2007 11:03:46 AM): B
asdvsd2003 (08/28/2007 11:03:58 AM): B
usmleckprep (08/28/2007 11:03:59 AM): B?
asdvsd2003 (08/28/2007 11:04:08 AM): YES
asdvsd2003 (08/28/2007 11:04:10 AM): B
usmleckprep (08/28/2007 11:04:19 AM): wheres the question...lolz
asd22 22 (08/28/2007 11:04:22 AM): I am working at the moment...maybe another time?
asdvsd2003 (08/28/2007 11:04:27 AM): This patient presents with signs and symptoms suggestive of subacute infective endocarditis. This condition usually involves previously damaged heart valves (‘a heart murmur detected a long time ago’ in this scenario). Currently, the most common predisposing factor to native valve endocarditis is mitral valve prolapse (MVP). Rheumatic valvular damage was the leading predisposing factor 20-30 years ago, but now it is not so common. Mitral valve is most commonly affected in endocarditis patients who are not IV drug abusers, and mitral regurgitation is the most common valvular abnormality observed in these patients.
andre besso (08/28/2007 11:05:28 AM): rocky mount spot fever.....................all BUT fulminant disease death in 5 days vasculitis of small art/veins severe abd pain rash when disease starts patients recovering are resistent to reinfection
usmleckprep (08/28/2007 11:06:06 AM): e?...... justa guess
Actin Myocin (08/28/2007 11:06:09 AM): last one
Actin Myocin (08/28/2007 11:06:26 AM): hey can u poat some useful Qs.....
andre besso (08/28/2007 11:06:30 AM): a=4 ticks...MC riketsia....rash appears between 3d/5th day of illness....
andre besso (08/28/2007 11:06:42 AM): 3d/5th day of illness....
asdvsd2003 (08/28/2007 11:06:59 AM): OK
Actin Myocin (08/28/2007 11:07:00 AM): hmmm.tx
usmleckprep (08/28/2007 11:07:04 AM): kool
andre besso (08/28/2007 11:07:06 AM): w
andre besso (08/28/2007 11:07:14 AM): w....
Actin Myocin (08/28/2007 11:07:20 AM): gimme 2 min ....am taking out my treasure of Qs
usmleckprep (08/28/2007 11:07:25 AM): lolz
usmleckprep (08/28/2007 11:07:28 AM): alibaba
asdvsd2003 (08/28/2007 11:07:33 AM): Anndre whts the resource of ur questions
usmleckprep (08/28/2007 11:07:37 AM): and we the 40 thieves
Actin Myocin (08/28/2007 11:07:48 AM): andre make his own Qs,....yaar....
andre besso (08/28/2007 11:07:50 AM): pretest
andre besso (08/28/2007 11:08:09 AM): Mc Graw
asdvsd2003 (08/28/2007 11:08:09 AM): well, pretest medicine has better than these
asdvsd2003 (08/28/2007 11:08:27 AM): actually the questions u post-- format aint good
asdvsd2003 (08/28/2007 11:08:40 AM): A 45-year-old Caucasian male is admitted for dyspnea and high-grade fever of 2 days duration. His past medical history is significant for bone marrow transplantation for AML, 3 months ago. His vital signs are, BP: 122/80 mm Hg, PR: 90/min, RR: 20/min and Temperature: 39C(102.2F). You order a chest radiograph which shows multifocal diffuse patchy infiltrates. A high-resolution chest CT is ordered, which shows ground glass attenuation and innumerable small nodules. Which of the following is the most likely cause of his fever? A. Bacterial pneumonia. B. Pneumocystis carinii pneumonia. C. Toxic pneumonitis due to chemotherapy. D. CMV pneumonitis. E. Fungal pneumonitis.
andre besso (08/28/2007 11:08:45 AM): k sorr folks..
asdvsd2003 (08/28/2007 11:09:06 AM): hey,dont be sorry.. bring some 2-3 line stemmed questions
usmleckprep (08/28/2007 11:09:06 AM): ? d
Actin Myocin (08/28/2007 11:09:08 AM): d
Actin Myocin (08/28/2007 11:09:11 AM): d for sure
andre besso (08/28/2007 11:09:13 AM): d
Actin Myocin (08/28/2007 11:09:16 AM): dueto immunosuppre
asdvsd2003 (08/28/2007 11:09:30 AM): usmlepreck ur turn now?
Actin Myocin (08/28/2007 11:09:35 AM): common in BM transplant
asdvsd2003 (08/28/2007 11:09:37 AM): put ur ques
usmleckprep (08/28/2007 11:09:45 AM): hmmm
asdvsd2003 (08/28/2007 11:09:51 AM): yes D CORRECT
usmleckprep (08/28/2007 11:10:03 AM): 40 yo male
usmleckprep (08/28/2007 11:10:11 AM): came to a new city
Actin Myocin (08/28/2007 11:10:13 AM): A 28-year-old man comes to see you for treatment of recurrent blisters on his lower lip. For the past 5 years he has suffered from intermittent episodes of blistering, the most recent starting yesterday afternoon. The lesions are moderately painful and the pain usually precedes the appearance of blisters by approximately a day. The lesions only occur on his lip and are not associated with any constitutional symptoms. They usually resolve in a week to 10 days. Review of symptoms and past medical history are unremarkable. Vital signs are: temperature 37.0 C (98.6 F), blood pressure 128/69 mm Hg, pulse 68/min, and respirations 20/min. Examination reveals grouped vesicles with an erythematous rim and base on the patient’s lower lip. The rest of the examination is normal. Which of the following
usmleckprep (08/28/2007 11:10:19 AM): has yellowish discoloration of sclera
Actin Myocin (08/28/2007 11:10:42 AM): A. Prescribe foscarnet B. Prescribe ganciclovir C. Prescribe prednisone D. Prescribe valacyclovir E. Take a skin biopsy
Actin Myocin (08/28/2007 11:11:50 AM): sory mleccs..
usmleckprep (08/28/2007 11:11:51 AM): d
usmleckprep (08/28/2007 11:11:55 AM): D is the answer
andre besso (08/28/2007 11:11:57 AM): d?
usmleckprep (08/28/2007 11:12:05 AM): herpes labialis
andre besso (08/28/2007 11:12:13 AM): y..
Actin Myocin (08/28/2007 11:12:26 AM): sure D...
usmleckprep (08/28/2007 11:12:29 AM): valacyclovir is used
Actin Myocin (08/28/2007 11:12:32 AM): The correct answer is D. This patient has herpes labialis, a mild and self-limiting infection caused by reactivation of latent herpes simplex type 1. The virus usually is acquired in childhood and remains dormant in the trigeminal ganglion. Common triggers for reactivation include fatigue, stress, and sunburn. If oral acyclovir or valacyclovir is started early, during prodromal pain or within the first 1 to 2 days of skin lesions, it can shorten the duration of symptoms. Patients should be advised to wear sun block and can be given a prescription to be filled at the earliest sign of a recurrence. If recurrences are frequent, acyclovir can be used prophylactically
asdvsd2003 (08/28/2007 11:12:59 AM): PASTE UR QUES PREPCK
usmleckprep (08/28/2007 11:13:24 AM): 40 yr old male , moved to a new town, has yellowish discoloration of skin , urine positive fr bilirubin
usmleckprep (08/28/2007 11:13:27 AM): wats teh diagnosis
Actin Myocin (08/28/2007 11:13:39 AM): hep a
usmleckprep (08/28/2007 11:13:45 AM): hepatitis a, hep B, gilberts
usmleckprep (08/28/2007 11:13:47 AM): rotors
usmleckprep (08/28/2007 11:13:52 AM): crijjler najjar
andre besso (08/28/2007 11:13:53 AM): b?
Actin Myocin (08/28/2007 11:14:16 AM): wel....in gilbert pt shud be dner stree....ur Q din say
asdvsd2003 (08/28/2007 11:14:25 AM): ROTOrs
Actin Myocin (08/28/2007 11:14:27 AM): under stress
usmleckprep (08/28/2007 11:14:33 AM): asd is right
andre besso (08/28/2007 11:14:47 AM): rotor aut recess
Actin Myocin (08/28/2007 11:14:50 AM): man i am out.
usmleckprep (08/28/2007 11:14:54 AM): also conjugated bilirubinemia..... is seen in rotors
andre besso (08/28/2007 11:16:19 AM): A recent outbreak of diarrhea is investigated,several developed bloody dirrhea and one eve RF,... THEY ATE AT THE SAME RESTAURANT food consumed was: pork chops hamburger fish sushi boliled eggs
Actin Myocin (08/28/2007 11:16:39 AM): wats RF
andre besso (08/28/2007 11:16:45 AM): renal failure
SARDA OKRAM (08/28/2007 11:16:53 AM): ham
asdvsd2003 (08/28/2007 11:16:54 AM): hamburger
asdvsd2003 (08/28/2007 11:16:58 AM): e coli
asdvsd2003 (08/28/2007 11:17:07 AM): enterohemoragic
andre besso (08/28/2007 11:17:07 AM):
Actin Myocin (08/28/2007 11:17:09 AM): ham
andre besso (08/28/2007 11:17:10 AM): a=2...........................E cholii 0157:H7...........from mild diarrea to rf even death.. beef raw milk (fecal-oral)....prev=handwah &milk pasto
usmleckprep (08/28/2007 11:17:17 AM): e coli
andre besso (08/28/2007 11:17:21 AM): yep
usmleckprep (08/28/2007 11:17:23 AM): hemolytiv uremnic syndrome
usmleckprep (08/28/2007 11:17:31 AM): o7 h 157
Actin Myocin (08/28/2007 11:17:34 AM): 24-year-old woman comes to the emergency department with a 4-day history of a progressive sore throat. She reports that she is now having difficulty swallowing solids and liquids because of the pain. She has had episodes of tonsillitis in the past, but none associated with symptoms this severe. She is otherwise healthy and has been on no medications and has no known drug allergies. She denies any history of smoking or alcohol abuse. On review of symptoms, she admits to some changes in her voice that now sounds somewhat muffled. In addition, she has had some low-grade fevers. She denies respiratory distress or drooling. Her temperature is 38.8 C (101.8 F), but otherwise her vital signs are stable. Her leukocyte count is 16,000/mm3. On physical examination, she is in mild distress with a mu
Actin Myocin (08/28/2007 11:17:47 AM): A. Acute tonsillitis B. Benign neoplasm C. Chronic tonsillitis D. Peritonsillar abscess E. Squamous cell carcinoma
asdvsd2003 (08/28/2007 11:18:20 AM): complete ques?
Actin Myocin (08/28/2007 11:18:27 AM): 24-year-old woman comes to the emergency department with a 4-day history of a progressive sore throat. She reports that she is now having difficulty swallowing solids and liquids because of the pain. She has had episodes of tonsillitis in the past, but none associated with symptoms this severe. She is otherwise healthy and has been on no medications and has no known drug allergies. She denies any history of smoking or alcohol abuse. On review of symptoms, she admits to some changes in her voice that now sounds somewhat muffled. In addition, she has had some low-grade fevers. She denies respiratory distress or drooling. Her temperature is 38.8 C (101.8 F), but otherwise her vital signs are stable. Her leukocyte count is 16,000/mm3. On physical examination, she is in mild distress with a mu
Actin Myocin (08/28/2007 11:18:39 AM): On physical examination, she is in mild distress with a muffled voice but no stridor. Her neck is tender along the upper cervical lymph node chain, particularly on the left, but there is no palpable mass or fluctuance. Intraoral examination reveals significant erythema, edema, and palpable tenderness of the left soft palate area with secondary deviation of the uvula to the right. This presentation is most consistent with which of the following conditions? A. Acute tonsillitis B. Benign neoplasm C. Chronic tonsillitis D. Peritonsillar abscess E. Squamous cell carcinoma
SARDA OKRAM (08/28/2007 11:19:07 AM): d
usmleckprep (08/28/2007 11:19:10 AM): d
asdvsd2003 (08/28/2007 11:19:13 AM): D
usmleckprep (08/28/2007 11:19:13 AM): right
andre besso (08/28/2007 11:19:14 AM): d
Actin Myocin (08/28/2007 11:19:30 AM): yesssssssssssssssssssssss
Actin Myocin (08/28/2007 11:19:34 AM): The correct answer is D. Common causes of sore throat include pharyngitis, tonsillitis, and peritonsillar abscess (PTA). A PTA can develop from an acute tonsillitis in which purulent fluid collects in the peritonsillar space between the tonsil and pharyngeal constrictor muscles. The classic findings include deviation of the uvula to the contralateral side and a “hot potato” voice. Treatment is with incision and drainage, usually under topical and local anesthesia. The presentation of acute tonsillitis (choice A) is very similar. The key to distinguishing between acute tonsillitis and a peritonsillar abscess is the physical examination. Acute tonsillitis often is associated with inflamed tonsils with an overlying whitish exudate. Generally, however, the tonsils appear symmetric and ther
usmleckprep (08/28/2007 11:19:39 AM): deviation of uvula , left sided localization
Actin Myocin (08/28/2007 11:19:59 AM): Acute tonsillitis often is associated with inflamed tonsils with an overlying whitish exudate. Generally, however, the tonsils appear symmetric and there is no deviation of the uvula. This presentation would be uncommon for a neoplastic disease (choice B), which would be expected to develop progressively over a longer period of time and with less significant acute pain. An elevated white blood cell count and fever indicate a likely infectious etiology. Patients with chronic tonsillitis (choice C) have tonsils that appear scarred or “cryptic” from past acute infections and chronic low-level infection. Patients often complain of bad breath. The fever, pain, and leukocytosis in this case indicate a more acute process. A squamous cell carcinoma (choice E) of the oral cavity or tons
Actin Myocin (08/28/2007 11:20:13 AM): of the oral cavity or tonsil would be expected to present following a more indolent course. Physical examination would be characterized by an indurated or ulcerative lesion. Malignancies of the oral cavity and oropharynx are often associated with progressive discomfort, dysphagia, and weight loss, and are not as commonly associated with fever and elevated white blood cell count. Finally, tobacco and alcohol abuse are common risk factors for squamous cell carcinoma of the head and neck, which, in this case, the patient denies
asdvsd2003 (08/28/2007 11:20:51 AM): A 40-year-old Caucasian male who had undergone renal transplant six months ago comes to you because of fever, chills, and cough with expectoration. His temperature is 39.4C (103 F), blood pressure is 110/65 mmHg, pulse is 110/min, and respirations are 22/min. An x-ray film of the chest shows a right lower lobe nodule with cavity. The gram stain of the sputum is shown below. What is the most appropriate treatment of this condition? A. Penicillin B. Trimethoprim-sulfamethoxazole C. Vancomycin D. Gentamycin E. Metronidazole F. Doxycycline G. Amphotericin H. Itraconazole I. Acyclovir J. Voriconazole K. Clindamycin
Actin Myocin (08/28/2007 11:21:50 AM): pcp?
Actin Myocin (08/28/2007 11:21:53 AM): f?
usmleckprep (08/28/2007 11:21:53 AM): no
andre besso (08/28/2007 11:22:26 AM): renal transplant .....
asdvsd2003 (08/28/2007 11:22:36 AM): gram stain shows---the presence of crooked, branching, beaded, gram-positive filaments, which are weakly acid-fast positive.
Actin Myocin (08/28/2007 11:22:43 AM): hmm
liliaeliz (08/28/2007 11:22:47 AM): b
Actin Myocin (08/28/2007 11:22:48 AM): actimyces
asdvsd2003 (08/28/2007 11:22:53 AM): yes
Actin Myocin (08/28/2007 11:23:03 AM): b
Actin Myocin (08/28/2007 11:23:04 AM): ?
andre besso (08/28/2007 11:23:07 AM): b
asdvsd2003 (08/28/2007 11:23:08 AM): B
Actin Myocin (08/28/2007 11:23:09 AM): b?
asdvsd2003 (08/28/2007 11:23:10 AM): YES
asdvsd2003 (08/28/2007 11:23:12 AM): CORRECT
asdvsd2003 (08/28/2007 11:23:14 AM): The clinical presentation of this patient is suggestive of pulmonary nocardiosis. Nocardiosis is an invasive disease associated with an organism belonging to genus Nocardia, which are saprophytic aerobic actinomycetes that are present worldwide in soil. Patients with deficient-cell mediated immunity (e.g., lymphoma, an AIDS patient with CD4 < 250, transplanted organs, etc.) are at increased risk of pulmonary or disseminated disease.
asdvsd2003 (08/28/2007 11:23:36 AM): Sulfonamides are the drugs of choice for nocardiosis.
Actin Myocin (08/28/2007 11:23:39 AM): v nice q
usmleckprep (08/28/2007 11:23:43 AM): excellent
Actin Myocin (08/28/2007 11:23:45 AM): ok...tx
Actin Myocin (08/28/2007 11:24:08 AM): A 37-year-old man comes to the physician for the first time because he had a 12-mm PPD that was performed at work before starting a new job as a high school teacher. He is a recent immigrant from India; he arrived in the United States 1 year ago. He has no known medical history and takes no medications. He has never had active tuberculosis (TB). He has no family members or other close contacts with active TB. He denies any fever, cough, weight changes, night sweats, or chills. He had a Bacille Calmette-Guerin (BCG) vaccination during childhood. Vital signs are normal and physical examination is unremarkable. Chest x-ray is normal. Which of the following is the most appropriate next step in management? A. No treatment; explain that because he is older than 35 years of age, latent TB wo
Actin Myocin (08/28/2007 11:24:24 AM): A. No treatment; explain that because he is older than 35 years of age, latent TB would not be treated because of possible drug toxicity B. No treatment; explain that he is a low risk patient and a PPD less than 15 mm is considered negative C. No treatment; explain that his PPD result is meaningless because of prior BCG vaccination D. Treat with INH, rifampin, pyrazinamide, and ethambutol for 6 month; explain that a high risk patient with a PPD of >10 mm needs aggressive TB treatment E. Treat with 9 months of isoniazid (INH); explain that treatment decreases the risk for developing active TB
usmleckprep (08/28/2007 11:25:18 AM): b
asdvsd2003 (08/28/2007 11:25:21 AM): B
andre besso (08/28/2007 11:25:29 AM): b
asdvsd2003 (08/28/2007 11:25:40 AM): NORMAL person > 15 considered positive PPD?
Actin Myocin (08/28/2007 11:25:59 AM): The correct answer is E. This patient is a high risk patient because he is a recent immigrant. A PPD greater than 10 mm in a recent immigrant is considered a positive test. His absence of symptoms and a normal chest x-ray makes active TB unlikely. The most appropriate course of action at this time, therefore, is to treat with 9 months of INH alone. In the recent past, age greater than 35 years was considered a cutoff for the treatment of latent TB (choice A). This age cutoff no longer exists. Patients with latent TB should be treated regardless of their age. This patient is considered a high risk patient and therefore a positive PPD is anything greater than 10 mm. Low risk patients (choice B) are considered to have a positive PPD if they have greater than 15 mm of induration.
liliaeliz (08/28/2007 11:26:03 AM): e
asdvsd2003 (08/28/2007 11:26:13 AM): IMMIGRANT..HMM
Actin Myocin (08/28/2007 11:26:13 AM): Prior history of receiving a BCG vaccination (choice C) is no longer considered significant. You should interpret the results of a PPD test the same regardless of past BCG vaccination. Four-drug treatment (choice D) is reserved for patients with active TB. It is unlikely that this patient has active TB because he has a clear chest x-ray and no symptoms.
asdvsd2003 (08/28/2007 11:26:17 AM): RIGHTTTTTTT
usmleckprep (08/28/2007 11:26:18 AM): good one tehre
Actin Myocin (08/28/2007 11:26:27 AM): he need tx...take a look at palan notes
Actin Myocin (08/28/2007 11:26:32 AM): he need sit
asdvsd2003 (08/28/2007 11:26:35 AM): yes
Actin Myocin (08/28/2007 11:26:45 AM): tx us
asdvsd2003 (08/28/2007 11:27:03 AM): he comes the category of risk
usmleckprep (08/28/2007 11:27:05 AM): welcom ACTINNNNNNNNNNNNNNNNNN
asdvsd2003 (08/28/2007 11:27:07 AM): under the
Actin Myocin (08/28/2007 11:27:08 AM): yes
Actin Myocin (08/28/2007 11:27:16 AM): txxxx...us
asdvsd2003 (08/28/2007 11:27:18 AM): thank you
andre besso (08/28/2007 11:29:41 AM): A patient with immune disfunction typically get all BUT---: cytomegalo Haemo flu Myco TBC Pneumo carinii Histoplasma capsu.
usmleckprep (08/28/2007 11:29:54 AM): b
asdvsd2003 (08/28/2007 11:30:06 AM): b
andre besso (08/28/2007 11:30:40 AM): a=2...........eg Hodkin/AIDS or cortico/cytotoxic receivers get Listeria Legion. Nocardia Salmonella......VZV HSV Toxo g. , Strongylo .Patients with humoral disfunction on the other hand lack opsinisation Abs so cant defend against encapsulated bugs like Haemo flu, Strep p. . Granulocytopenics ,moreover,get C andida Asperg. Pseudo auro
asdvsd2003 (08/28/2007 11:30:49 AM): A 34-year-old male from SE Asia (Southeast Asia) presents to you with a lesion on his left forearm. He denies any symptoms except to say that he has no sensation in that part of the arm. He says that about a month ago he had developed general malaise, headache and a dry cough. On examination, you find a 4 x 4 cm hypopigmented plaque. He has no sensation to pin prick over that area. You also notice that the left upper arm has significant muscle atrophy. The best method to make a diagnosis of this disorder is: A. Obtain a chest x-ray B. Obtain blood cultures C. Do a skin biopsy D. Obtain a CT of head E. EMG studies
Actin Myocin (08/28/2007 11:31:17 AM): e
usmleckprep (08/28/2007 11:31:22 AM): c
andre besso (08/28/2007 11:31:25 AM): e
usmleckprep (08/28/2007 11:31:27 AM): C
Actin Myocin (08/28/2007 11:32:03 AM): ans? c or e
asdvsd2003 (08/28/2007 11:32:03 AM): correct C
andre besso (08/28/2007 11:32:04 AM): mm ...lesion..
Actin Myocin (08/28/2007 11:32:08 AM): good
andre besso (08/28/2007 11:32:09 AM): y c
asdvsd2003 (08/28/2007 11:32:20 AM): leprosy caused by mycobatereum
asdvsd2003 (08/28/2007 11:32:22 AM): lapre
usmleckprep (08/28/2007 11:32:24 AM): a preterm infant at 32 weeks birth is in NICU, develops lethargy, poor suckling, irritability, Ct was done and dilated entire ventricular system is seen
Actin Myocin (08/28/2007 11:32:28 AM): biopsy is more invasive done only in MG
asdvsd2003 (08/28/2007 11:32:41 AM): in leprosy, the nerve involvement is patchy and segmental and no strict pattern of nerve involvement is identified.
usmleckprep (08/28/2007 11:32:42 AM): with prominent subarachnoid areas
Actin Myocin (08/28/2007 11:33:05 AM): wats NICU
asdvsd2003 (08/28/2007 11:33:14 AM): neonatal ICU
usmleckprep (08/28/2007 11:33:14 AM): a preterm infant at 32 weeks birth is in NICU, develops lethargy, poor suckling, irritability, Ct was done and dilated entire ventricular system is seen with prominent subarachnoid areas. The patient was diagnosed with?
Actin Myocin (08/28/2007 11:33:19 AM): ok
usmleckprep (08/28/2007 11:33:25 AM): a. dandy walker
usmleckprep (08/28/2007 11:33:30 AM): b arnold chiari
Actin Myocin (08/28/2007 11:33:48 AM): is that all choices u have
usmleckprep (08/28/2007 11:33:57 AM): wait
Actin Myocin (08/28/2007 11:33:58 AM): if yes then B
usmleckprep (08/28/2007 11:34:02 AM): intraventriculat=r hhge
usmleckprep (08/28/2007 11:34:07 AM): intrauterine infectuions
andre besso (08/28/2007 11:34:09 AM): b
asdvsd2003 (08/28/2007 11:34:18 AM): b
Actin Myocin (08/28/2007 11:34:20 AM): hahahalol.....
usmleckprep (08/28/2007 11:34:27 AM): a. dandy walker usmle us: b arnold chiari
Actin Myocin (08/28/2007 11:34:29 AM): lol......us ....u r so funny
usmleckprep (08/28/2007 11:34:29 AM): intraventriculat=r hhge usmle us: intrauterine infectuions
Actin Myocin (08/28/2007 11:34:31 AM): lol
usmleckprep (08/28/2007 11:34:40 AM): no........
Actin Myocin (08/28/2007 11:34:48 AM): wat a Q....with an awesome choices
usmleckprep (08/28/2007 11:34:48 AM): the answer is intraventricular hhge
usmleckprep (08/28/2007 11:34:52 AM): preterm, infant
asdvsd2003 (08/28/2007 11:34:53 AM): intaravent he
usmleckprep (08/28/2007 11:35:01 AM): typical finding in cerebral palsy
Actin Myocin (08/28/2007 11:35:02 AM): wats I/V huge
usmleckprep (08/28/2007 11:35:11 AM): hhge
usmleckprep (08/28/2007 11:35:12 AM): is haemorrhage
usmleckprep (08/28/2007 11:35:14 AM): sowie
Actin Myocin (08/28/2007 11:35:16 AM): u meat I/V heorage
usmleckprep (08/28/2007 11:35:17 AM): sorry
Actin Myocin (08/28/2007 11:35:27 AM): ok....lol.....tx ....awesome Q
asdvsd2003 (08/28/2007 11:35:43 AM): well, arnold chiari type 2?>
asdvsd2003 (08/28/2007 11:35:46 AM): type 2
Actin Myocin (08/28/2007 11:35:48 AM): no prob yaar.....keep up the good work of at least POSTING qS
andre besso (08/28/2007 11:35:49 AM): y u rt
usmleckprep (08/28/2007 11:35:57 AM): lolz yeah
Actin Myocin (08/28/2007 11:36:00 AM): LOL
Actin Myocin (08/28/2007 11:36:03 AM): lol
usmleckprep (08/28/2007 11:36:07 AM): laziness personified]
Actin Myocin (08/28/2007 11:36:28 AM): so ans is I/V hemo
usmleckprep (08/28/2007 11:36:43 AM): yes
asdvsd2003 (08/28/2007 11:36:43 AM): thank you
usmleckprep (08/28/2007 11:36:46 AM): The cerebellar tonsils are elongated and pushed down through the opening of the base of the skull (see foramen magnum), blocking the flow of cerebrospinal fluid (CSF
Actin Myocin (08/28/2007 11:36:49 AM): ok,....tx....v nice q
usmleckprep (08/28/2007 11:36:52 AM): this is arnold chiari
Actin Myocin (08/28/2007 11:37:15 AM): rite....hydrocephalus.....non communicating
usmleckprep (08/28/2007 11:37:16 AM): and is almost seen in all patients presenting with spina bifida and hydrocephalus
asdvsd2003 (08/28/2007 11:37:31 AM): u mean no subacrachnoid fluid will increase in ARNOLD CHIARI
Actin Myocin (08/28/2007 11:37:34 AM): yes .....tx
andre besso (08/28/2007 11:37:39 AM): meningomylocele..
Actin Myocin (08/28/2007 11:37:51 AM): no asd fluid will defi inc in arnold......
Actin Myocin (08/28/2007 11:38:10 AM): arnold is acause of non comm hydro
asdvsd2003 (08/28/2007 11:38:19 AM): Ct was done and dilated entire ventricular system is seen with prominent subarachnoid areas
Actin Myocin (08/28/2007 11:38:45 AM): well.....thats y i thot ...was arnold...but i think I/V makes more sense
asdvsd2003 (08/28/2007 11:38:46 AM): VENTRICULAR SYTEM will be dilated in both
Actin Myocin (08/28/2007 11:38:53 AM): yes thats rite
usmleckprep (08/28/2007 11:38:54 AM): Dandy-Walker syndrome (DWS), or Dandy-Walker complex, is a congenital brain malformation involving the cerebellum and the fluid filled spaces around it.
usmleckprep (08/28/2007 11:39:00 AM): guys preterm.....
usmleckprep (08/28/2007 11:39:02 AM): child...
asdvsd2003 (08/28/2007 11:39:08 AM): yes,,thats righttt
usmleckprep (08/28/2007 11:39:09 AM): with intraventricular hhge
asdvsd2003 (08/28/2007 11:39:12 AM): premature
usmleckprep (08/28/2007 11:39:15 AM): plus cns symptoms
usmleckprep (08/28/2007 11:39:19 AM): keep ur eyes closed
usmleckprep (08/28/2007 11:39:28 AM): and mark cerebral palsy
Actin Myocin (08/28/2007 11:39:45 AM): so if it wasn preterm...can our asn be arnold then...
usmleckprep (08/28/2007 11:39:59 AM): yes the answer can change
usmleckprep (08/28/2007 11:40:12 AM): depends onmany things
asdvsd2003 (08/28/2007 11:40:14 AM): hmm.. so on CT arnold look differen
Actin Myocin (08/28/2007 11:40:18 AM): hmmm....wat specific abt pretern as far as being preterm is concerned
usmleckprep (08/28/2007 11:40:22 AM): and ppl are around me
Actin Myocin (08/28/2007 11:40:33 AM): oook
Actin Myocin (08/28/2007 11:40:40 AM): tx...sory for bothering u....
usmleckprep (08/28/2007 11:40:40 AM): so i can just play HIDE and SEEK
Actin Myocin (08/28/2007 11:40:45 AM): sure
asdvsd2003 (08/28/2007 11:41:07 AM): next
Actin Myocin (08/28/2007 11:41:14 AM): 60-year-old woman comes to the emergency department complaining of a cough that is nonproductive of sputum, low-grade fever, chills, and shortness of breath for the past 10 days. She has a history of rheumatoid arthritis and recently completed a course of steroids. Her past medical history is notable for chronic obstructive pulmonary disease as well. Her medications include albuterol and ipratropium inhalers. She denies allergies. She has a significant smoking and alcohol history that is ongoing. On physical exam, she is tachypneic and febrile and appears ill. Her blood pressure is 120/80 mm Hg, respirations are 28/min, and oxygen saturation is 92% on room air. Her lungs are clear. The remaining examination is unremarkable. Chest radiography reveals minimal lymphadenopathy and a diffuse i
Actin Myocin (08/28/2007 11:41:29 AM): Chest radiography reveals minimal lymphadenopathy and a diffuse interstitial pattern. The arterial blood gas reveals a normal alveolar gradient. Which of the following pathogens is the most likely cause of this patient’s condition? A. Legionella pneumophila B. Mycobacterium avium complex C. Mycoplasma pneumoniae D. Pneumocystis carinii E. Streptococcus pneumoniae
Actin Myocin (08/28/2007 11:42:26 AM): c,omon easy guys
asdvsd2003 (08/28/2007 11:42:39 AM): D
Actin Myocin (08/28/2007 11:42:47 AM): never mind not that easy guys
Actin Myocin (08/28/2007 11:42:51 AM): lol
usmleckprep (08/28/2007 11:42:51 AM): lolz
usmleckprep (08/28/2007 11:42:58 AM): u r funny actinnnnnnnnnnnnnnnnnnnnnn
Actin Myocin (08/28/2007 11:43:13 AM): its cuz i marked it wrong...so not easy anymore after having seen the asn
usmleckprep (08/28/2007 11:43:13 AM): ? c
asdvsd2003 (08/28/2007 11:43:17 AM): C
asdvsd2003 (08/28/2007 11:43:19 AM): C OR D
Actin Myocin (08/28/2007 11:43:23 AM): lol
andre besso (08/28/2007 11:43:23 AM): c
Actin Myocin (08/28/2007 11:43:37 AM): The correct answer is B. Given this patient’s age and smoking and alcohol history, she is at risk for infection with Mycobacterium avium complex. Symptoms include cough, low-grade fever, shortness of breath, and malaise. The radiography is fairly typical for this presentation as well. The patient’s sputum should be cultured for acid-fast bacilli, and she may need treatment with agents such as clarithromycin, ethambutol, and rifampin. She should be tested for HIV as well. Legionella pneumophila (choice A) often affects middle-aged smokers, often with underlying chronic lung disease. Patients often present with a high-grade fever as well that is abrupt in onset. Cigarette smokers and patients on steroids are susceptible
Actin Myocin (08/28/2007 11:43:41 AM): lol
asdvsd2003 (08/28/2007 11:43:44 AM): OH
Actin Myocin (08/28/2007 11:43:54 AM): thTS Y I SAID NOT THAT EASY GUYS
usmleckprep (08/28/2007 11:44:07 AM): non productive huh
usmleckprep (08/28/2007 11:44:09 AM): wht the hell
Actin Myocin (08/28/2007 11:44:14 AM): Mycoplasma pneumoniae (choice C) is a common cause of atypical pneumonia. Symptoms develop over several days and include malaise, fever, cough, and headache. It is generally a disease of the young, and its incidence declines after 30 to 35 years of age. Patients on steroids are susceptible to Pneumocystis carinii (choice D). This patient is thus functionally immunocompromised. Laboratory diagnosis would require culturing induced sputum. To prevent such an infection, daily use of trimethoprim-sulfamethoxazole would be the ideal prophylaxis. Patients typically have a high A-a gradient. Streptococcus pneumoniae (choice E) is a common cause of community-acquired pneumonia. The onset of bacterial pneumonia is usually sudden, and the patient becomes toxic rapidly. Cough is notable for ru
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
|
bring respiration questions for todays chat..
Goodluck all
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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CVS questions for today's chat
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| vaibhavbora
Topics: 14
Posts: 246
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plz add me also vaibhav4u_2003@yahoo.com
___________________
VB
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| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
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git chat tonighttt
|
| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
|
GIT questions from kapan notes, UW bank, kaplan qbank..
its going greattt, thanks guys whosoever participating there
|
| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,036
|
Yahoo! Messenger (09/06/2007 11:01:16 AM): Actin Myocin has joined the conference.
Yahoo! Messenger (09/06/2007 11:01:45 AM): usteps has joined the conference.
asdvsd2003 (09/06/2007 11:02:16 AM): Hi guys... bring NEPHRO questions
asd22 22 (09/06/2007 11:02:41 AM): No, thank you.
Yahoo! Messenger (09/06/2007 11:02:57 AM): prep step2ck has joined the conference.
Yahoo! Messenger (09/06/2007 11:03:26 AM): shabie begum has joined the conference.
asdvsd2003 (09/06/2007 11:04:21 AM): hiiii everyone
shabie begum (09/06/2007 11:04:27 AM): hi
usteps (09/06/2007 11:04:31 AM): Hi
asdvsd2003 (09/06/2007 11:04:38 AM): todays topic RENAL +ELECTROLYTES
shabie begum (09/06/2007 11:04:49 AM): ok
prep step2ck (09/06/2007 11:05:18 AM): hi everyone
asdvsd2003 (09/06/2007 11:05:32 AM): A 56-year-old male, with chronic renal insufficiency (CRF), comes with the complaints of lethargy and dizziness. His EKG shows tall T waves and increased PR interval. His serum K+ is 6.4 meq/L. A bolus of calcium gluconate is given and the patient is started on hemodialysis. As the patient is suffering from active peptic ulcer disease, you decide to go for citrate hemodialysis, instead of heparin hemodialysis. Which of the following acid base imbalance is likely to occur in this patient because of this type of hemodialysis? A. Anion gap metabolic acidosis. B. Non-anion gap metabolic acidosis. C. Metabolic alkalosis. D. Respiratory acidosis. E. Respiratory alkalosis.
prep step2ck (09/06/2007 11:06:03 AM): met alk
usteps (09/06/2007 11:06:26 AM): no idea
shabie begum (09/06/2007 11:06:38 AM): met alk
asdvsd2003 (09/06/2007 11:06:50 AM): YES C
asdvsd2003 (09/06/2007 11:06:53 AM): This patient is having dialysis for his resistant hyperkalemia. However, because active peptic ulcer disease is a contraindication for heparin use, this patient is given citrate instead of heparin hemodialysis. Citrate is an alkaline compound and high doses of citrate in a patient with CRF can lead to citrate intoxication and metabolic alkalosis secondary to citrate accumulation. In this patient, as citrate is used for hemodialysis and he already has severe CRF, he runs a high risk of developing metabolic alkalosis secondary to citrate intoxication. Infusion of more than eight units of bank blood (anticoagulated with acid-citrate-dextran) is also associated with citrate intoxication.
asdvsd2003 (09/06/2007 11:07:35 AM):
asdvsd2003 (09/06/2007 11:07:40 AM): NEXT PLZZ
prep step2ck (09/06/2007 11:07:56 AM): 5 yr old in er
prep step2ck (09/06/2007 11:08:05 AM): with severe rt flank pain ,
prep step2ck (09/06/2007 11:08:11 AM): kub ,,normal
prep step2ck (09/06/2007 11:08:21 AM): usg shows 5 mm stone
prep step2ck (09/06/2007 11:08:33 AM): urine ph=.5
prep step2ck (09/06/2007 11:08:37 AM): wab absent
prep step2ck (09/06/2007 11:08:45 AM): rbc 2-3 /hpf
shabie begum (09/06/2007 11:08:49 AM): what is wab
prep step2ck (09/06/2007 11:08:58 AM): nitrates esterase negative
prep step2ck (09/06/2007 11:09:03 AM): wbc ,,
shabie begum (09/06/2007 11:09:06 AM): ok
prep step2ck (09/06/2007 11:09:06 AM): absent
prep step2ck (09/06/2007 11:09:19 AM): whats ur management?
shabie begum (09/06/2007 11:09:42 AM): what is the loaction of stone
prep step2ck (09/06/2007 11:10:01 AM): in rt ureter
asdvsd2003 (09/06/2007 11:10:22 AM): bicarb
prep step2ck (09/06/2007 11:10:26 AM): rt asd
prep step2ck (09/06/2007 11:10:37 AM): this is probably uric acid stone
asdvsd2003 (09/06/2007 11:10:37 AM): ph is 5
asdvsd2003 (09/06/2007 11:10:42 AM): yes
prep step2ck (09/06/2007 11:10:44 AM): aakinzation ,is needed
asdvsd2003 (09/06/2007 11:10:48 AM): rightt
asdvsd2003 (09/06/2007 11:11:45 AM): nexttttt plzz
asdvsd2003 (09/06/2007 11:12:00 AM): ok
asdvsd2003 (09/06/2007 11:12:02 AM): An 18-year-old college-going male is brought to the Emergency Room by his friends. They mention that he appeared unusually withdrawn and aloof a few hours after a football game, unlike his normal happy and good-natured self. He complains of dry mouth. Physical exam reveals injected conjunctivae and tachycardia. This patient is demonstrating clinical features of: A. Opioid overdose B. Adrenal crisis C. Alcohol intoxication D. Cocaine withdrawal E. Cannabis abuse
prep step2ck (09/06/2007 11:12:12 AM): a pateint comes to u with renal stone ,,wat will u say low ditrry ca ..low fluid intake ,high soduim intake dec protein
prep step2ck (09/06/2007 11:12:14 AM): ?
asdvsd2003 (09/06/2007 11:12:43 AM): dec preotein
usteps (09/06/2007 11:12:50 AM): E
prep step2ck (09/06/2007 11:13:06 AM): cannabis
asdvsd2003 (09/06/2007 11:13:09 AM): yes E
asdvsd2003 (09/06/2007 11:13:22 AM): MARIJUANA
prep step2ck (09/06/2007 11:13:22 AM): ur ans is rt asd
asdvsd2003 (09/06/2007 11:13:30 AM): thanx
asdvsd2003 (09/06/2007 11:13:42 AM): nexttt plz
asdvsd2003 (09/06/2007 11:13:57 AM): usteps??? shabie?
prep step2ck (09/06/2007 11:13:58 AM): most ;ethal complication of polycystic kidney ds?
prep step2ck (09/06/2007 11:14:07 AM): lethal complication
asdvsd2003 (09/06/2007 11:14:44 AM): hypertension related cerebral hemorahge?
usteps (09/06/2007 11:14:48 AM): SAH subarachoid hemmorrahge
asdvsd2003 (09/06/2007 11:14:54 AM): or beryy aneurysm rupture--SAH
prep step2ck (09/06/2007 11:15:03 AM): rt
prep step2ck (09/06/2007 11:15:20 AM): aneurysm ,,,sah
asdvsd2003 (09/06/2007 11:15:23 AM): ok
asdvsd2003 (09/06/2007 11:15:31 AM): not hypertension
prep step2ck (09/06/2007 11:15:46 AM): mot lethal one is aneurysm
Yahoo! Messenger (09/06/2007 11:15:48 AM): Afsaneh has joined the conference.
asdvsd2003 (09/06/2007 11:16:12 AM): A 52-year-old female, with known rheumatoid arthritis (RA) comes to the ER with confusion and tinnitus. She has been taking aspirin for the past 10 years for RA. On examination she has RR: 22/min, BP: 132/80 mmHg, PR: 86/min. A clinical diagnosis of aspirin toxicity is made. Which of the following would best describe the acid base status of this patient? pH, PaCO2(mmHg), HCO3(meq/L) A. 7.36, 22, 12 B. 7.29, 50, 23 C. 7.22, 35, 14 D. 7.40, 40, 24 E. 7.45, 30, 20
asdvsd2003 (09/06/2007 11:16:57 AM): In adults in the acute stage of toxicity, it stimulates the respiratory center and thus leads to respiratory alkalosis.
prep step2ck (09/06/2007 11:17:16 AM): a
shabie begum (09/06/2007 11:17:35 AM): B
usteps (09/06/2007 11:17:46 AM): c
Afsaneh (09/06/2007 11:17:54 AM): C
asdvsd2003 (09/06/2007 11:18:08 AM): ans is A
asdvsd2003 (09/06/2007 11:18:11 AM): Choice (A) has a near normal pH but a marked decrease in bicarbonate and PaCO2. If it were a primary metabolic acidosis with respiratory compensation then the expected PaCO2 as given by Winter’s formula should be 1.5(12) +8 = 26. However, the observed PaCO2 is less than 26, indicating a coexisting respiratory alkalosis. Thus, Choice (A) is suggestive of mixed metabolic acidosis and respiratory alkalosis.
asdvsd2003 (09/06/2007 11:18:29 AM): I DIDNT KNOW IT
asdvsd2003 (09/06/2007 11:19:44 AM): Choice (B) is suggestive of acute respiratory acidosis without compensation. Choice (C) is suggestive of primary metabolic acidosis without compensation. Choice (D) shows a normal acid base status. Choice (E) is suggestive of respiratory alkalosis with metabolic compensation.
asdvsd2003 (09/06/2007 11:22:19 AM): NEXTTTTTTTTTT
asdvsd2003 (09/06/2007 11:22:21 AM): NEXTTTTTTTTTT
asdvsd2003 (09/06/2007 11:22:31 AM): PLZ
prep step2ck (09/06/2007 11:22:38 AM): a55 yrold chronic smoker undergoes cystectomy
shabie begum (09/06/2007 11:22:49 AM): since she is taking aspirin for 10 yeras won't there be compensation.
prep step2ck (09/06/2007 11:22:56 AM): a illeal conduit is formed ..for urinary diversion
prep step2ck (09/06/2007 11:23:17 AM): 3 months later he becomes confused .tachypneac
prep step2ck (09/06/2007 11:23:22 AM): ph=7.3
prep step2ck (09/06/2007 11:23:34 AM): watacid basr dosorderis this?
prep step2ck (09/06/2007 11:24:05 AM): see shabie ,,this a mixed typeacid base disorder ........
usteps (09/06/2007 11:24:13 AM): metabolic acidosis.... absirption of acid fom GI
prep step2ck (09/06/2007 11:24:14 AM): so first look at ph ..
prep step2ck (09/06/2007 11:24:20 AM): this is acidic ph ,,,
prep step2ck (09/06/2007 11:24:27 AM): hco3 is low
asdvsd2003 (09/06/2007 11:24:37 AM): metabloc acidosis fr prepck ques
prep step2ck (09/06/2007 11:25:04 AM): so apply formula to calculate co2 ,that does nt match c02 in q
shabie begum (09/06/2007 11:25:09 AM): i got it . tx
prep step2ck (09/06/2007 11:25:27 AM): so coz ph is near normal this is mixed ,,metabolic acidosis res alakalosis
shabie begum (09/06/2007 11:25:35 AM): thanks
prep step2ck (09/06/2007 11:25:59 AM): right ,,usmle steps
prep step2ck (09/06/2007 11:26:09 AM): this is met acidosis in my q
asdvsd2003 (09/06/2007 11:26:34 AM): ok
prep step2ck (09/06/2007 11:26:51 AM): cl /hco3 exchange ,oses hco3 ,,aidosis [met]
asdvsd2003 (09/06/2007 11:27:02 AM): A 34-year-old white female goes to the funeral of her dear friend and suddenly develops chest pain, sweating and palpitations. She is rushed to an ER and an EKG is taken which is normal. On examination, she is tachycardiac and tachypneic. Her ABG shows pH of 7.48, PaCO2 of 33 mmHg, and HCO3- of 24 meq/L. Which of the following would be the most appropriate treatment of her alkalosis? A. IV Ringer lactate. B. IV Ammonium chloride. C. IV Sodium bicarbonate. D. IV Hydrochloric acid. E. Ask the patient to breathe in a small paper bag. F. Sedation with diazepam.
shabie begum (09/06/2007 11:27:33 AM): E
usteps (09/06/2007 11:27:37 AM): E
asdvsd2003 (09/06/2007 11:27:51 AM):
Afsaneh (09/06/2007 11:28:00 AM): E
prep step2ck (09/06/2007 11:28:17 AM): paper bag breathing
prep step2ck (09/06/2007 11:28:22 AM): is it ok ,,asd?
asdvsd2003 (09/06/2007 11:28:44 AM): yessssssss
prep step2ck (09/06/2007 11:28:47 AM): ok
asdvsd2003 (09/06/2007 11:28:48 AM): E
asdvsd2003 (09/06/2007 11:29:05 AM): RESPI ALKA
asdvsd2003 (09/06/2007 11:29:09 AM): NEXT PLZZ
asdvsd2003 (09/06/2007 11:29:39 AM):
prep step2ck (09/06/2007 11:29:40 AM): an obese man will hav wat type of metabolic disorder ?
asdvsd2003 (09/06/2007 11:30:18 AM): obstr sleep apnea
asdvsd2003 (09/06/2007 11:30:21 AM): well
prep step2ck (09/06/2007 11:30:35 AM): acid base disorder ?
usteps (09/06/2007 11:30:37 AM): Resp acidosis
prep step2ck (09/06/2007 11:30:54 AM): yes ,,hypovebtilation ..res acidosis
asdvsd2003 (09/06/2007 11:31:02 AM): respi acidosis
asdvsd2003 (09/06/2007 11:31:04 AM): yes
asdvsd2003 (09/06/2007 11:31:17 AM):
asdvsd2003 (09/06/2007 11:31:23 AM): late comer
prep step2ck (09/06/2007 11:31:24 AM): pt with iolated systolic htmn ,,treatment ?
prep step2ck (09/06/2007 11:31:41 AM): isolated systolic HTN ?
usteps (09/06/2007 11:31:43 AM): Thiazide diuretics
prep step2ck (09/06/2007 11:31:45 AM): RT
prep step2ck (09/06/2007 11:31:58 AM): RAYNAUDS DS +HTN ..TREATMENT ?
usteps (09/06/2007 11:32:12 AM): calcium Channel blockers
asdvsd2003 (09/06/2007 11:32:13 AM): ca cha b
Afsaneh (09/06/2007 11:32:19 AM): what is pt?
asdvsd2003 (09/06/2007 11:32:40 AM): diameteic+hT TREATMENT?
prep step2ck (09/06/2007 11:32:41 AM): RT UMLE STEPS ,,CA BLOCKER
usteps (09/06/2007 11:32:49 AM): pt is patient
shabie begum (09/06/2007 11:32:50 AM): yes, cc blockers
asdvsd2003 (09/06/2007 11:32:58 AM): DM+ht t/t?
prep step2ck (09/06/2007 11:33:01 AM): HEART FAILURE +ATRIAL FIB ..TREATMENT ?
Afsaneh (09/06/2007 11:33:02 AM): ok
shabie begum (09/06/2007 11:33:05 AM): ACE
prep step2ck (09/06/2007 11:33:07 AM): ACE ,INH
shabie begum (09/06/2007 11:33:09 AM): ACI
asdvsd2003 (09/06/2007 11:33:12 AM): rightt
prep step2ck (09/06/2007 11:34:15 AM): HEART FAILURE +atrial fib...............digxin
asdvsd2003 (09/06/2007 11:34:20 AM): yes
usteps (09/06/2007 11:34:22 AM): For heart failure and A fib. beta Blockers
asdvsd2003 (09/06/2007 11:34:34 AM): no digoxicin
prep step2ck (09/06/2007 11:34:36 AM): wat life style change helps u dec bp ,,most ?
usteps (09/06/2007 11:34:43 AM): ok
asdvsd2003 (09/06/2007 11:34:45 AM): stop smoking
prep step2ck (09/06/2007 11:34:53 AM): rt ,,asd
prep step2ck (09/06/2007 11:35:14 AM): drug of choice in hypertensive emergency ?
asdvsd2003 (09/06/2007 11:35:26 AM): nitropruside
prep step2ck (09/06/2007 11:35:42 AM): hypertensive emergency +mi ..treatment ?
prep step2ck (09/06/2007 11:35:59 AM): u r right asd
asdvsd2003 (09/06/2007 11:36:16 AM): nitrates
asdvsd2003 (09/06/2007 11:36:22 AM): nitroglycerin
shabie begum (09/06/2007 11:36:26 AM): beta blockers
prep step2ck (09/06/2007 11:36:27 AM): rt asd
prep step2ck (09/06/2007 11:36:48 AM): nitroglycerin i preferable
asdvsd2003 (09/06/2007 11:36:52 AM): yeah
prep step2ck (09/06/2007 11:37:18 AM): caused of renal artery stenosis in kids ?
shabie begum (09/06/2007 11:37:34 AM): fibromuscular dsysplasia
prep step2ck (09/06/2007 11:37:37 AM): rt
asdvsd2003 (09/06/2007 11:37:40 AM): yep
asdvsd2003 (09/06/2007 11:37:47 AM): even in females
asdvsd2003 (09/06/2007 11:38:09 AM): A 20-year-old white male presents with complaints of polyuria, polydypsia, vomiting, abdominal pain, and constipation. His vitals are as follows: PR: 102/min; BP: 100/70 mm of Hg; Temperature: 37.0C(99F); RR: 14/min. Lab studies shows serum sodium of 140 meq/L, serum potassium 4.0 meq/L, serum bicarbonate 25 meq/L, serum chloride 101 meq/L, serum calcium 13 mg/dL, serum phosphorus 2.0 mg/dL, blood glucose 120 mg/dL, serum creatinine 1 mg/dL. ECG shows a shortened QT interval. IMRA assay reveals high PTH levels. 24 hours urinary calcium excretion is 40 mg/dL (lower than normal) and the creatinine clearance is 115 ml/min. Which of the following is most consistent with this patient’s findings? A. Primary hyperparathyroidism B. Vitamin D intoxication C. Multiple myeloma D. Sar
asdvsd2003 (09/06/2007 11:38:18 AM): D. Sarcoidosis E. Familial hypocalciuric hypercalcemia
prep step2ck (09/06/2007 11:38:34 AM): 28 yr old with hyperventiation ,,,,gets confused chest pain n has paresthesia
usteps (09/06/2007 11:38:44 AM): A
Yahoo! Messenger (09/06/2007 11:39:10 AM): Ankur Gupta has joined the conference.
usteps (09/06/2007 11:39:17 AM): Sorry E
prep step2ck (09/06/2007 11:39:57 AM): primary hyperpara thy
asdvsd2003 (09/06/2007 11:40:01 AM): yes E
asdvsd2003 (09/06/2007 11:40:05 AM): E
asdvsd2003 (09/06/2007 11:40:07 AM): Increased serum calcium, decreased serum phosphorus, and increased PTH levels can only be explained by primary hyperparathyroidism and familial hypocalciuric hypercalcemia (FHH). Measurements of 24hr urinary calcium excretion and creatinine clearance can confirm the diagnosis of FHH and distinguish it from primary hyperparathyroidism. In primary hyperparathyroidism urinary calcium excretion is normal or elevated (24 hour calcium excretion above 250 mg [6.2 mmol] in women and 300 mg [7.5 mmol] in men) while in familial hypocalciuric hypercalcemia urinary calcium excretion typically is below 200 mg/day (5 mmol/day) when creatinine clearance is normal. Vitamin D intoxication, multiple myeloma, and sarcoidosis all cause hypercalcemia but PTH level is low in all these cases.
asdvsd2003 (09/06/2007 11:41:27 AM): prep step2ck: 28 yr old with hyperventiation ,,,,gets confused chest pain n has paresthesia
asdvsd2003 (09/06/2007 11:41:52 AM): PANIC ATTACK so far
prep step2ck (09/06/2007 11:41:54 AM): pr=98
prep step2ck (09/06/2007 11:41:59 AM): rr=23
asdvsd2003 (09/06/2007 11:42:02 AM): ok
prep step2ck (09/06/2007 11:42:07 AM): ph=7.5
prep step2ck (09/06/2007 11:42:20 AM): pao290
prep step2ck (09/06/2007 11:42:20 AM): pao2=90
prep step2ck (09/06/2007 11:42:26 AM): paco2 =22'
prep step2ck (09/06/2007 11:42:32 AM): hco3 =18
prep step2ck (09/06/2007 11:42:41 AM): hco3 =18?
prep step2ck (09/06/2007 11:42:55 AM): wats cause for paresthesia?
usteps (09/06/2007 11:43:15 AM): Hypocalcemia due to alkalosis
asdvsd2003 (09/06/2007 11:43:29 AM): yes
asdvsd2003 (09/06/2007 11:43:36 AM): ALKALOSIS
prep step2ck (09/06/2007 11:43:47 AM): rt
prep step2ck (09/06/2007 11:44:01 AM): res alk ,,,,hypocalcemia
asdvsd2003 (09/06/2007 11:44:23 AM): goood one
prep step2ck (09/06/2007 11:44:40 AM): d/d for papillary necrosis ?
asdvsd2003 (09/06/2007 11:45:08 AM): acetamniophen toxicity
asdvsd2003 (09/06/2007 11:45:20 AM): phencyclididine
asdvsd2003 (09/06/2007 11:45:28 AM): NSAIDS
shabie begum (09/06/2007 11:45:29 AM): sickle cell anemia
prep step2ck (09/06/2007 11:46:09 AM): analgesics,,sickle cel ,,urinary obs,ch pyeloneph diabetes
asdvsd2003 (09/06/2007 11:47:00 AM): ok
prep step2ck (09/06/2007 11:47:00 AM): renal failure with systemic eoinophila ,,,d/d?
usteps (09/06/2007 11:47:27 AM): Acute interstitial nephritis.. due to drugs
asdvsd2003 (09/06/2007 11:47:39 AM): yep
prep step2ck (09/06/2007 11:47:47 AM): inter ,neph ,,cholestrol emb ,,pAN
asdvsd2003 (09/06/2007 11:47:58 AM): ok
shabie begum (09/06/2007 11:48:17 AM): cholesterol embolism too!!
prep step2ck (09/06/2007 11:48:28 AM): FULL BROWNISH PIGMENTED CAST ..TELL U WAT?
prep step2ck (09/06/2007 11:48:44 AM): GRANULAR CAST.
shabie begum (09/06/2007 11:48:57 AM): pyelonephritis
prep step2ck (09/06/2007 11:49:00 AM): ATN
asdvsd2003 (09/06/2007 11:49:07 AM): atn
prep step2ck (09/06/2007 11:49:11 AM): RT ASD
prep step2ck (09/06/2007 11:49:24 AM): TREATMENT FOR HUS?
shabie begum (09/06/2007 11:50:11 AM): nothing specific
asdvsd2003 (09/06/2007 11:50:11 AM):
usteps (09/06/2007 11:50:38 AM): supportive
asdvsd2003 (09/06/2007 11:50:47 AM):
asdvsd2003 (09/06/2007 11:51:00 AM): self limited
prep step2ck (09/06/2007 11:51:01 AM): syptomatic treatment +PERITONAL DIALYIS
prep step2ck (09/06/2007 11:51:16 AM): U NEED TO TREAT HEMATOLOGICAL N RENAL PROBLEM
asdvsd2003 (09/06/2007 11:51:21 AM): steroids sometimes used
prep step2ck (09/06/2007 11:51:26 AM): NEVER GIVE K
asdvsd2003 (09/06/2007 11:51:34 AM): okkkkkkkkkkk
prep step2ck (09/06/2007 11:51:36 AM): FEW BOOKS SAY ,NEVER USE STEROIDS
prep step2ck (09/06/2007 11:51:42 AM): SO STEROID IS CONTROVERSIAL
asdvsd2003 (09/06/2007 11:51:47 AM): okkk ,kaplan said sometimes
asdvsd2003 (09/06/2007 11:52:02 AM): so,, better not to give
prep step2ck (09/06/2007 11:52:06 AM): TREATMENT FOT TTP?
asdvsd2003 (09/06/2007 11:52:14 AM): plasmaphereiss
shabie begum (09/06/2007 11:52:17 AM): plasmapheresis
prep step2ck (09/06/2007 11:52:19 AM): RT ASD
prep step2ck (09/06/2007 11:52:54 AM): RENAL VEIN THROMBOSIS HAS STRONGEST RELATION WITH WHICH GLOMERULONEPHRITIS ?
usteps (09/06/2007 11:53:30 AM): Minimal change ( nephrotic syn)
shabie begum (09/06/2007 11:53:37 AM): membranous
prep step2ck (09/06/2007 11:53:41 AM): MEMBRANOUS...RT
asdvsd2003 (09/06/2007 11:53:44 AM): membranus
asdvsd2003 (09/06/2007 11:54:00 AM): late
asdvsd2003 (09/06/2007 11:54:17 AM): ok...
prep step2ck (09/06/2007 11:54:40 AM): A 27 YR OLD WITH POSTSTREPTOCOCCAL FEVER .DEV..RBC CAST ..MILD PROTEINURA ,,AFTER 3 DYS ,,COMPLIMENT NORMAL
prep step2ck (09/06/2007 11:54:48 AM): BUN =25
prep step2ck (09/06/2007 11:54:53 AM): CREATININE 2.1
prep step2ck (09/06/2007 11:55:02 AM): 15/90 BP
prep step2ck (09/06/2007 11:55:09 AM): DIAGNOSIS
prep step2ck (09/06/2007 11:55:11 AM): ?
asdvsd2003 (09/06/2007 11:55:26 AM): POST STREP glomerulonephrritis
usteps (09/06/2007 11:55:45 AM): Ig A nephropathy.... Complement is normal
prep step2ck (09/06/2007 11:55:47 AM): THIS IS IGA ..
prep step2ck (09/06/2007 11:55:59 AM): COMPLIMENT IS LOW IN POST STREP
usteps (09/06/2007 11:56:00 AM): and it is only after 3 days...
asdvsd2003 (09/06/2007 11:56:00 AM): ohhhhhhhhhhhh
asdvsd2003 (09/06/2007 11:56:06 AM): yess
prep step2ck (09/06/2007 11:56:07 AM): IGA ,IN 1-3 DAYZ
asdvsd2003 (09/06/2007 11:56:19 AM): thanks...good one
prep step2ck (09/06/2007 11:56:43 AM): POSSTEPTOCOCCAL,THROAT INF ,,10 DAYS,IMPEIGO 21 DAYS
asdvsd2003 (09/06/2007 11:56:55 AM): ok
prep step2ck (09/06/2007 11:57:19 AM): IV DRUG ABUSER ,GLOMERULONEPHITIS TYPE?
usteps (09/06/2007 11:57:43 AM): focall segmental
shabie begum (09/06/2007 11:57:56 AM): F S glomerulosclerosis
prep step2ck (09/06/2007 11:57:57 AM): RT ,,,FOCAL SEG
prep step2ck (09/06/2007 11:58:29 AM):
asdvsd2003 (09/06/2007 11:58:45 AM): 12;00 noon
asdvsd2003 (09/06/2007 11:58:57 AM): thanks prepstep ck
prep step2ck (09/06/2007 11:59:07 AM): U R WELCOME
asdvsd2003 (09/06/2007 11:59:14 AM): continue if u want
shabie begum (09/06/2007 11:59:15 AM): thanks to all
prep step2ck (09/06/2007 11:59:36 AM): WE LL CONTINUE TOMORROW .
prep step2ck (09/06/2007 11:59:39 AM): OK?
shabie begum (09/06/2007 11:59:42 AM): ok
asdvsd2003 (09/06/2007 11:59:45 AM): well, tonightt
asdvsd2003 (09/06/2007 11:59:51 AM): again same topic
shabie begum (09/06/2007 11:59:58 AM): what time tonight
asdvsd2003 (09/06/2007 12:00:03 PM): 11 pm
prep step2ck (09/06/2007 12:00:03 PM): THANX EVERYONE ,,,BYE
shabie begum (09/06/2007 12:00:15 PM): EST /CST
asdvsd2003 (09/06/2007 12:00:19 PM): est
shabie begum (09/06/2007 12:00:23 PM): ok . thanks
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Actin Myocin has joined the conference.
prep step2ck has joined the conference.
vaibhav BORA has joined the conference.
vaibhav BORA: hii
asd22 22: hi
asd22 22: NEPHRO
vaibhav BORA: ye
Cláudia has joined the conference.
Cláudia: Hello
asd22 22: Vaibhav post ur ques
prep step2ck: hi everyone
asd22 22: hi
vaibhav BORA: okk just a sec.
prep step2ck has left the conference.
prep step2ck has joined the conference.
asd22 22: helllo
Cláudia: what is the theme for today?
asd22 22: nephrology
asd22 22: renal system
prep step2ck has left the conference.
asd22 22: prepck....sign out//in
asd22 22: if u have yahoo prob
Afsaneh has joined the conference.
Cláudia: ok
Afsaneh: hi
asd22 22: hi
vaibhav BORA: A 76-year-old male presents to the emergency room. He had influenza
and now presents with diffuse muscle pain and weakness. His past medical
history is remarkable for osteoarthritis, for which he takes ibuprofen.
Physical examination reveals a blood pressure of 130/90 with no orthostatic
change. The only other finding is diffuse muscle tenderness. Laboratory
data includes:
BUN: 30 mg/dL
Creatinine: 6 mg/dL
K: 6.0 meq/L
Uric acid: 18 mg/dL
Ca: 6.5 mg/dL
PO4: 7.5 mg/dL
CPK: 28,000 IU/L
Urine output: 40 mL/h
Which is the most likely diagnosis?
a. Nonsteroidal anti-inflammatory drug吠nduced acute renal failure (ARF)
b. Volume depletion
c. Rhabdomyolysis-induced ARF
d. Urinary tract obstruction
Cláudia: hi
prep step2ck has joined the conference.
prep step2ck has left the conference.
asd22 22: C
asd22 22: c. Rhabdomyolysis-induced ARF
Afsaneh: c
asd22 22: CUZ diffuse muscle tenderness
vaibhav BORA: why not nsaid induces?
asd22 22: CUZ CPK is high
vaibhav BORA: ye and also coz of electrolye anomalies
asd22 22: yeah
asd22 22: Nsaid wont cause acute...prob
asd22 22: may be chronic.. with nasaids
vaibhav BORA: remarkable for osteoarthritis, for which he takes ibuprofen.
asd22 22: ok
vaibhav BORA: basically its electrolyte anomalies typical for rhabdo
vaibhav BORA: okk which test u run in this pt.?
asd22 22: no idea
Cláudia: mioglobin in urine?
vaibhav BORA: urinanalysis
Cláudia: yup
asd22 22: yes
vaibhav BORA: what casts?
asd22 22: myoglobin casts
asd22 22: ?
prep step2ck has joined the conference.
vaibhav BORA: muddy brown casts
andre besso has joined the conference.
vaibhav BORA: hi andre
andre besso: hi
asd22 22: hi
Cláudia: hi
asd22 22: ok..thanks vaibhav
Afsaneh: what is muddy brown cast?
vaibhav BORA: muddy brown granular casts is diagnostic of acute tubular necrosis and
consistent with rhabdomyolysis-induced
Afsaneh: myoglobin?
asd22 22: ok
Afsaneh: ok thank
vaibhav BORA: also suspect if + for heme and without rbc i think.........
prep step2ck: 32 yr old with recurrent abdominal pain ,,,,small bowel study shows stricture ,,,,he s diagnosed with crohn ds ,presents with colicky falank pain ,,,,, ivp shows kidney stone ...wat type of stone i there
prep step2ck: caciul po
prep step2ck: ca po4
prep step2ck: ocalate
prep step2ck: struvite
prep step2ck: urate
asd22 22: oxalate
prep step2ck: cystine
prep step2ck: rt asd
asd22 22: oxalate
prep step2ck: muddy brown cast =atn
asd22 22: ok
Afsaneh: oxalate
Afsaneh: ?
asd22 22: yesssss oxalate
asd22 22: correct
vaibhav BORA: why ?
prep step2ck: a 50 yr old comes with colicky abd pain ,,,in rt flank ,,exam of all system unrevealing ,,,cT ,,SHOWS ,,,, 4 mm radioopaque stone in rt ureter ,,ca=9.8 s creatinine 0.9 ..bun =15
Afsaneh: no uric acid stone
prep step2ck: wat s most appropriate step in management ?
vaibhav BORA: hydration and analgesics///
prep step2ck: oxalate stone ,,coz fat malaborption ,,leads to ca binding with fat ,,oxalate absorption inc in gut ,,leads to oxalate stones ,,,
vaibhav BORA: management hydration and analgesics.........
prep step2ck: yes ,,,first time renal stone ,,,,hydratuion n analgeisia ,,,no work up
asd22 22: ok
vaibhav BORA: whatz most common renal stone ?
prep step2ck: ca oxalate
Afsaneh: calciu oxalate
asd22 22: ca oxalate
prep step2ck: ca oxalate/po
vaibhav BORA: ok which one associated with infection ?
prep step2ck: struvite
asd22 22: yes
vaibhav BORA: which infection ?
asd22 22: struvite staghorn -- proteus
prep step2ck: a patient has uti ,,and urine is alkaline ,wat org is inv?
Afsaneh: protus
asd22 22: proteus
prep step2ck: rt
vaibhav BORA: proteus
vaibhav BORA: okk whats intial DX TEST/
asd22 22: fr wht? UTI
prep step2ck: mcc of primary hperaldosteronism ,,,,,,,,,leading to htn ?
vaibhav BORA: whatz most specific dx test?
asd22 22: UA, unrine culture
vaibhav BORA: for renal stones
asd22 22: lolzz
asd22 22: ok
prep step2ck: most specific ,urine culture
asd22 22: for stones--
vaibhav BORA: for YES FOR STONES
prep step2ck: initial test ,,urinalysis
Afsaneh:
asd22 22: UA
vaibhav BORA: okk ua shows hematuria what next?
asd22 22: u/s
asd22 22: U/S
vaibhav BORA: no
prep step2ck: if urineialysis is positive ,do urine culture
asd22 22: Xray
vaibhav BORA: ABD X RAY for stones
asd22 22: yes
prep step2ck: for hematuria irst test ,,,dipstick
vaibhav BORA: yes
prep step2ck: followd by micsroscopic exam
asd22 22: yes
prep step2ck: followed by testing for myoglobin ,,hemoglobin
vaibhav BORA: okkwhen will u do lithotripsy
prep step2ck: tone more than 2.5 cm
asd22 22: when stone is bigger size
asd22 22:
asd22 22: >2.5
prep step2ck: wat sized stone can eaily pass with hydration and analssis?
asd22 22: 3-4 mm
Afsaneh: 5mm
vaibhav BORA: well i have confusion on this kaplan notes have litho tripsy when < 2 cm
vaibhav BORA:
vaibhav BORA: well i have confusion on this kaplan notes have litho tripsy when < 2 cm
Cláudia: yes
Afsaneh: <5mm
asd22 22: centimeters
vaibhav BORA: why litho for small ones ?????????
vaibhav BORA: yeee
prep step2ck: 2.5 cm is big stone ,,, lithotripsy works
vaibhav BORA: read kaplan pg 257
asd22 22: yeah... 2 cm stone is big
vaibhav BORA: okkk
Afsaneh: >2.5cm
vaibhav BORA: what for >2cm
asd22 22: 1.5 cm is small?????????????????????
Afsaneh: litho
vaibhav BORA:
prep step2ck: 2--2.5 ,u can do litho tripsy ,if bigger than that u need some other procedure ,,like basket rmoval ,,or some surgery
Afsaneh: < 2
vaibhav BORA: okk thnx
Afsaneh: sorry
asd22 22: ok
prep step2ck: but if its struvite stone[staghorn calculi] ,,thats always big ,,go for surgery
prep step2ck: one more than ,,thats imp ,,is location of stone
asd22 22: ok
Afsaneh: A 58-year-old woman undergoes a radical hysterectomy for endometrial cancer. The intraoperative time is 5 hours and the blood loss is estimated at 1.8 liters. She is extubated and transferred to the recovery room where she slowly wakes up. She is then brought to the surgical floor where her urine output is documented by the nurse to be decreasing. Over the last 4 hours she has made 30, 22, 14, and 6 ml, respectively. Her blood pressure is also noted to be decreasing; the last reading was 89/63 mm Hg. Her pulse is 104/min. Which of the following is the most appropriate next step in management?
Afsaneh: A. Draw a complete blood count
B. Give a fluid challenge of 500 ml of intravenous fluid over 10 minutes
C. Insert a central line to measure central venous pressure
D. Irrigate her Foley catheter
E. Push 20 mg of furosemide intravenously
Cláudia: coraliphorm calculus
prep step2ck: b
vaibhav BORA: C. Insert a central line to measure central venous pressure
asd22 22: b
Afsaneh: yes b
Afsaneh: B. This is the cheapest and easiest way to determine and treat the patient's hypotension and decreased urinary output. Low urinary output after an extensive surgical procedure with a large amount of blood loss is usually caused by hypovolemia. These patients will "third-space" their fluids during the immediate postoperative period and therefore require increased intravenous fluids to maintain their blood pressure and urinary output. The other possibility is that the patient is developing acute renal failure. A low-tech diagnostic test to determine the etiology is a fluid challenge. Dehydrated patients will respond with an improved blood pressure and urinary output; those patients in renal failure will not do so. Measuring urinary sodium is a more elegant way to determine the patient's flui
prep step2ck: 56 yr old comes with acid base imbalance wat 2 parameters u would like to know?
vaibhav BORA: anion gap
prep step2ck: options r
prep step2ck: ph ,co2
vaibhav BORA: pco2 and phco3
prep step2ck: ph hco3
prep step2ck: ph po2
prep step2ck: pco2 p o2
prep step2ck: ?
Afsaneh: ph co2
vaibhav BORA: ph co2
asd22 22: ph, co2
prep step2ck: rt
vaibhav BORA: A 68-year-old female with stable c | | | | | | | | | | | | | | | | | | | | |
