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elitoki
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09/07/07 - 09:38 PM       #1

1. A 67 y.o man is brought to the ED because of a 3 day history of fever and headache. Five years ago, he underwent placement of a mechanical aortic valve for treatment of sequelae of rheumatic fever. He appears ill. His temperature is 40, 110/65mmHg pulse is 110 and res are 22. Agrade 3/6 systolic ejection murmur is heard. Neurologic examination shows mild left hemiparesis. Babinski’s sign is present on the left. There is no nuchal rigidity. This pt is a greatest risk for which of the following complication.

a) brain abscess
b) carotid artery occlusion
c) encephalitis
d) hydrocephalus
e) venous sinus thrombosis

2. A37 y.o. woman comes to the physician because of an itchy rash over ther trunk for 2wks. She has not had fever, chills, shortness of breath, chest pain, or gastrointestinal symptoms. She has a history of recurrent UTI and has been taking TMPSMZ prophylaxis for the past year. She is in mild distress. Her temperature is 37.5, blood pressure is 9/62mmHg, pulse is 78, resp 14min. examination shows a maculopapular erythematous rash over the trunk. Lab studies show:
Leukocyte count 10,500/mm3
Seg neutrophils 72%
Bands 1%
Eosinophils 15%
Lymphocytes 4%
Monocytes 8%
Serum
BUN 12 mg/dL
Creatinine 0.9 mg/dL
Urine : normal
Which of the following is most likely cause of these findings?
a) eczema
b) med adverse effect
c) Staphylococcal skin infection
d) Streptococcal Skin infection
e) UTI




Justice
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09/08/07 - 06:26 AM       #2

A
B

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gr8doc
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09/08/07 - 08:39 AM       #3

A
B Though I'm not very sure about the this one as normally allergic interstitial nephritis have eosinophiluria while here the urinalysis is normal.



Justice
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09/08/07 - 10:25 AM       #4

gr8doc wrote:
A
B Though I'm not very sure about the this one as normally allergic interstitial nephritis have eosinophiluria while here the urinalysis is normal.


It's a Steven-Johnson's, man

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elitoki
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09/09/07 - 01:01 PM       #5

Justice, where comes from Steven Johnson in second Q??? Could you explain pls. confused

numita
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09/12/07 - 05:41 PM       #6

its the toxicity of medicine tmp sulfmethoxazole

dermatology
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09/12/07 - 07:25 PM       #7

steven johnson have erosions ... this patient has maculo papular rash .... drug rash

tamerbashir
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12/03/07 - 12:07 PM       #8

A

B

steven johnson ? !


chemamr
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12/04/07 - 05:23 AM       #9

a, b

it's not stevens johnson (at least at this moment)


sherry39
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02/29/08 - 04:17 AM       #10

b/e....coz infective endocarditis can cause thromboembolism
a...lymphocytes are only 4%....it is immuno defecient disorder probably wiskott aldrich synd









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