thndvall
Forum Newbie
Topics: 2
Posts: 18
|
Tough q's
Attached Files:
NBME111.jpg (123 KB, 68 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
33
Attached Files:
nbme1133.jpg (130 KB, 52 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
34
Attached Files:
nbme1134.jpg (102 KB, 37 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
35
Attached Files:
nbme1135.jpg (132 KB, 35 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
38
Attached Files:
nbme1138.jpg (134 KB, 35 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
40
Attached Files:
nbme1140.jpg (107 KB, 32 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
44
Attached Files:
nbme1144.jpg (138 KB, 34 downloads)
|
| peter90036
Forum Elite
Topics: 28
Posts: 315
|
?intussussssseption--enema
?myocarditis*pick or mvp
?B
pallor = iron & there's no hyper/hypothyroid si/sx
medication sideffect? not sure ...
valve - endocarditis - brain abcess
young resp infxn finland = cystic fibrosis
Edited by peter90036 on 04/02/08 - 07:30 PM
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
#1 A volvulus-->upper GI with contrast
Over the past 7 decades, controversy has emerged over the use of the upper GI versus the contrasted enema. Physicians have been reluctant to administer a barium meal to infants suspected of obstruction, hence the popularity of the contrasted enema. The upper GI series provides more information regarding the degree of obstruction and actual location of proximal GI anatomy.
BE findings are more likely to be inconclusive, and, furthermore, BE impedes reading of any subsequent upper GI study.
In 1992, Ford et al found that a limited upper GI study using 5 milliliters of barium was well tolerated and allowed visualization of anatomy and subsequent BE if needed, such as in the case of complete obstruction with necessary observation of lower anatomy.
--emedicine topic 1205
|
| peter90036
Forum Elite
Topics: 28
Posts: 315
|
sorry i meant intus... intus.. intussusception
|
| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
Post #1: Intussusception----------->water soluble contrast enema
Post#2: Myocarditis---------------->coxsackie virus----------->C
Edited by Markus2009 on 04/02/08 - 07:44 PM
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
#1 B recent upper resp. tract infection, nonbilious vomiting, bloody stool--->intussuseption. If intussusception is strongly suspected, perform a contrast enema without delay. emedicine topic 385
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
"Cold" one month ago=Coxsackie-virus induced myocarditis--->echo will show diffuse diskinesia
Answer: C
|
| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
#3 B Gastric outlet obstruction syndrome------------>Metabolic alkalosis----->loss of HCL during vomiting.
#4 B Complete blood count-------->rule out iron deficiency anemia in a patient with pallor and fibromyoma LOL
#5 B
Edited by Markus2009 on 04/02/08 - 10:57 PM
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,967
|
thndvall wrote:
Tough q's
OK, despite the fact that there is NO rebound/guarding, the child is already toxic... Her body temp (38 oC) is unlikely due to recent infection... If the child would not be toxic, I would go with enema (indeed, classic solution), but in this febrile kid I go with
(E) - Immediate laparotomy...
Edited by Justice on 04/03/08 - 12:22 PM
___________________
Don't live in a town where there are no doctors
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,967
|
thndvall wrote:
33
C
___________________
Don't live in a town where there are no doctors
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,967
|
thndvall wrote:
35
B - iron-deficient anemia due to blood loss from leyomiomas + pica
___________________
Don't live in a town where there are no doctors
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,967
|
thndvall wrote:
38
B - sulfa drug allergy
___________________
Don't live in a town where there are no doctors
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,967
|
thndvall wrote:
40
(A)
___________________
Don't live in a town where there are no doctors
|
| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
Justice wrote:
OK, despite the fact that there is NO rebound/guarding, the child is already toxic... Her body temp (38 oC) is unlikely due to recent infection... If the child would not be toxic, I would go with enema (indeed, classic solution), but in this febrile kid I go with
(E) - Immediate laparotomy...
I would go for surgery if it would be signs of perforation. AXR is not showing free-air. Enema is diagnostic and therapeutic in this particular case.
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,967
|
thndvall wrote:
44
This is (A) - Alpha1-antitrypsin deficiency: grandma is from Finland (recall that AAT is most common in individuals of Northern European and Iberian descent); child is developing emphysema...
___________________
Don't live in a town where there are no doctors
|
| aspire
Forum Senior
Topics: 24
Posts: 158
|
Intusussception-Water soluble contrast enema, helps in diagnosis and treatment.
33. Diffuse hypokinesia with dilated ventricles..Dilated cardiomyopathy-Myocarditis due to infection (cause) presenting with features of left heart failure.
34.Na-140,CL-80,K-2.5,HCO3-40, B,Vomiting causes loss of gastric acid-->alkalosis.
35.---
38. Medication adverse effect-Sulpha allergy-->maculopapular rash.
40.Brain abscess.
41.Pulmonary alveolar proteinosis.
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
#1) B, knees to the chest, bloody stool, vomiting nonbilious fluid, and recent upper rti is predisposing factor for intussusception. Contrast enema is diagnostic and therapeutic, xray is normal with no free gas so perf less likely
#2) C, myocarditis from Coxsackie virus "bad cold" and it shows diffuse hypokinesia on echo
#3) B, vomiting results in hypochloremic alkalosis with increased bicarb due to loss of H+ and disocciation of H2CO3
#4) B, pallor and sinus tach suggest anemia in otherwise healthy, check CBC
#5) A, eosinophilia and itchy rash suggest eczema, a common problem; med adverse affect from sulfa drug presenting as Stevens Johnson syndrome is non-itchy rash and is very rare (1/1,000,000)...she has been on TMP-SMX for one year, why now?
#6) A, brain abscess from vegetation embolus from infective endocarditis, explains the neuro findings of headache and hemiparesis
#7)B, white race, hyperinflation, recurring at young age, wheeze, cough, poor growth argue for CF; in alpha1 AT def., by the time dyspnea becomes the dominant manifestation and a diagnosis is established, most patients will have seen several physicians over several years, A1AT usu. presents in fourth decade
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
see answer choices next post
Attached Files:
NBME1143a.jpg (158 KB, 22 downloads)
|
| thndvall
Forum Newbie
Topics: 2
Posts: 18
|
answer choices
Attached Files:
NBME1143b.jpg (116 KB, 22 downloads)
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | | | | |
