Kamsi
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20. A patient complains to a physician of chronic pain and tingling of the buttocks. The pain is exacerbated when the buttocks are compressed by sitting on a toilet seat or chair for long periods. No lumbar pain is noted. Pain is elicited when the physician performs Freiberg's maneuver, in which there is a forceful internal rotation of the extended thigh. Which of the following is the most likely diagnosis?
a)Disk compression of the sciatic nerve
b)Fibromyalgia
c)Piriformis syndrome
d)Popliteus tendinitis
e)Posterior femoral muscle strain
45.A 22-year-old man comes to the emergency department with a 3-day history of fever, chills, a cough, pleuritic chest pain, and low-back pain. He says that the symptoms came on "out of the blue". He is the son of a wealthy local businesswoman and still lives at home, which he says "is cool because my parents are never around". His temperature is 39 C (102.2 F), blood pressure is 120/80 mm Hg, pulse is 70/min, and respirations are 16/min. Physical examination shows oval, retinal hemorrhages with a clear, pale center and pinpoint lesions between his toes. Blood cultures are drawn. A chest x-ray film shows multiple patchy infiltrates. Laboratory studies show:
Hemoglobin...................................11 g/dL
Hematocrit....................................39%
Erythrocyte sedimentation rate.......39 mm/hr
Which of the following is the most likely pathogen?
a)Candida albicans
b)Pseudomonas aeruginosa
c)Serratia marcescens
d)Staphylococcus aureus
e)Streptococcus viridans
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| kpmle2
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20) A
45) e
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| neuroblastoma
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20) C
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| kpmle2
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20) Is C
Pain with forceful internal rotation of the flexed thigh (Freiberg's maneuver),
abduction of the affected leg while sitting (Pace's maneuver),
raising of the knee several centimeters off the table while lying on a table on the side of the unaffected leg (Beatty's maneuver), or
pressure into the buttocks where the sciatic nerve crosses the piriformis muscle while the patient slowly bends to the floor (Mirkin test) is diagnostic.
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| dr in trouble
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45---Isnt it shud be D---staph aureus is the most common cause of IE.
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| kpmle2
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Roth spots more common with streptococcus. And there is no IV drug use in the stem of the Q (which will be a major risk factor for staph aureus).
Kamsi what is the answer ?
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| doc_clotaire
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20 ) C
45 ) D
He is the son of a wealthy local businesswoman and still lives at home, which he says " is cool because my parents are never around".
You have to assume that this dude is probably using drug .... That is USMLE buddy
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| aaroho
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Yeap agree with doc_clotaire
c
d
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| Kamsi
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The correct answer is
C. This is piriformis syndrome. As you may recall from your anatomy, the piriformis is the small muscle that crosses the greater sciatic foramen, cutting it into two spaces as the muscle passes from the edge of the sacrum to the greater trochanter. The sciatic nerve comes out of the greater sciatic foramen below the piriformis, and is liable to compression by the muscle. Symptoms are as described above; bicycle riding and running may also set off the symptoms, which may take the form of chronic nagging ache, pain, tingling, or numbness. Treatment is usually to teach the patient to avoid maneuvers that set off the symptoms. Some patients have been helped by corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve; this therapy is thought to work by reducing the fat around the muscle and thereby increasing the available space in the area.
D. This patient has acute bacterial endocarditis, most likely due to Staphylococcus aureus, the most common organism causing endocarditis in intravenous drug abusers. The "pinpoint lesions" between his toes are signs of injection drug abuse. Acute endocarditis in drug abusers typically presents with a high fever, pleuritic chest pain, and a cough. The tricuspid valve is commonly affected in these patients. A murmur may not be present in early acute endocarditis or in injection drug abusers with tricuspid valve disease. The retinal lesions are called Roth spots. Other findings include anemia and an elevated erythrocyte sedimentation rate. Diagnosis is with blood cultures, which are typically positive for S. aureus, and with echocardiography. Treatment is with antibiotics.
Streptococcus viridans(choice E) is a common cause of endocarditis in individuals who are not injection drug abusers. The onset of symptoms is usually more gradual, patients present with a low-grade fever, new cardiac murmur, splenomegaly, hematuria, proteinuria, and an elevated erythrocyte sedimentation rate
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| kpmle2
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thanks for the answers.
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