Kamsi
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37) A 59-year-old man is referred for evaluation because he has been fainting at his job, where he operates heavy machinery. He is pale and gaunt, but otherwise his physical examination is remarkable only for 4+ occult blood in the stool. Laboratory studies show a hemoglobin of 5 gm/dL with microcytosis, as well as decreased levels of serum iron and increased iron binding capacity. Which of the following will most likely establish the diagnosis?
A. Upper gastrointestinal series (swallowed barium studies)
B. Colonoscopy
C. Flexible sigmoidoscopy to 45 cm
D. Upper gastrointestinal endoscopy
E. Visceral angiogram
41) On the 7th postoperative day after the pinning of a broken hip, a 76-year-old man suddenly develops severe pleuritic chest pain and shortness of breath. When examined, he is found to be anxious, diaphoretic, and tachycardic, with a blood pressure of 140/85 mm Hg. He has prominent distended veins in his neck and forehead. Blood gases show hypoxemia and hypocapnia. His chest x-ray film is unremarkable. The nurses have placed him on supplemental oxygen by face mask. Which of the following is the most appropriate next step in management?
A. Aortogram and emergency surgical repair
B. ECG and cardiac enzymes
C. Intubation and respirator, with hyperventilation and PEEP
D. Retinal examination looking for fat droplets
E. Ventilation-perfusion lung scan, or spiral CT scan of the chest
42) A young man sustains a gunshot wound to the base of his neck. He was shot point blank with a .38 caliber revolver. The entrance wound is above the left clavicle, below the level of the cricoid cartilage, and just lateral to the sternomastoid muscle. The exit wound is just above the spinous process of the right scapula. He has normal breath sounds on both sides, is awake and alert, is talking with a normal tone of voice, is neurologically intact, and is hemodynamically stable. Portable x-ray films of the neck and chest taken in the emergency department show some air in the tissues of the lower neck, but are otherwise non-diagnostic. Which of the following is the most appropriate next step in management?
A. Observation for several hours
B. CT scan of the lower neck and upper chest
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
D. Immediate surgical exploration of the lower neck through a collar incision
E. Immediate surgical exploration of the upper chest through a median sternotomy
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| Doc750
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D, E, C
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| nyimalay
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D
E
C
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| madoo
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37) i think it is classic case for cancer colon so maybe
B. Colonoscopy
41)sure it is Pulmonary embolism and for it , with such classic presentation i think the next step for a PE is anticoagulant treatment even before any spiral CT or V\Q scan as we can't delay the treatment in this classic presentation but first any chest pain should have EKG as 1st choice "looking for ischemic heart and not for looking for any ecg changes with PE"
so i think it is
B. ECG and cardiac enzymes
42) A. Observation for several hours
i don't know why i feel my answers are wrong so plz kamsi tell us the answers and explanation
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| hanialkhadher
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B. Colonoscopy
B. ECG and cardiac enzymes
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
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| Kamsi
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B
E Pt has PE
C
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| madoo
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are u sure that 41) is E
as i had read > ECG should be the first study in patients suspected of having a PE because it may help rule out other causes of chest pain "blueprints emergency medicine"
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| Doc750
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pleuritic chest pain, hypoxia, JVD on 7th day post op .. suspect PE as #1 differential. Treat with heparin first (if no c/i) and then confirm dx.
if your doing emergency mgmt, on a new admit pt, without history of recent flight or other risk factors for PE, then ECG is on your #1 test to run list.
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| MAGY17
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B ...... COLON CANCER
E PULMONAR EMBOLISM ( tipically happens day 7 in elderly, immobilized pcte )
C for gunshot wounds to the UPPER ZONE........arteriographic dx and management is preferred
BASE OF THE NECT.....ARTERIOGRAPHY, ESOPHAGOGRAM, ESOPHAGOSCOPT AND BRONCHOSCOPY BEFRORE SURGERY HELP DECIDE THE SPECIFIC SURGICAL APPROACH
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| doyoudig
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B. Colonoscopy
B. ECG and cardiac enzymes - should come 1st, to r/o heart related prob's
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
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