Author Topic: Medical Board Vignettes (Read 6281 times)

Lorenzo · « **on:** March 10, 2011, 02:34:26 AM »

Soccer player who was kicked in the leg suffered a damaged medial meniscus.

What else is likely to have been damaged?

A: Anterior cruciate ligament ("unhappy triad")

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Lorenzo · « **Reply #1 on:** March 10, 2011, 02:35:47 AM »

X-RAY show bilateral hilar lymphadenopathy. What is diagnosis?

A: Sarcoidosis

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Lorenzo · « **Reply #2 on:** March 10, 2011, 02:37:12 AM »

25 year old woman presents with a low grade fever, a rash across her nose that gets worse when she is out in the sun, and widespread edema.

You are concerned about what disease?

A: SLE (systemic lups erythermatosus)

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Lorenzo · « **Reply #3 on:** March 10, 2011, 02:38:35 AM »

A 60 year old asian man presents with acute knee pain and swelling. X-RAY shows joint space without erosion.

What is the diagnosis and what would you find on aspiration?

A: Pseudogout; rhomboid calcium pyrophosphate crystals in aspirate.

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Lorenzo · « **Reply #4 on:** March 10, 2011, 02:39:34 AM »

A 60 year old asian man presents with acute knee pain and swelling. X-RAY shows joint space without erosion.

What is the diagnosis and what would you find on aspiration?

A: Pseudogout; rhomboid calcium pyrophosphate crystals in aspirate.

Treatment?

A: Long-term NSAID treatment, colchicine, allopurinol.

A2: Advise patient to stay away from high cholesterol intake

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Lorenzo · « **Reply #5 on:** March 10, 2011, 02:42:33 AM »

Man presents with 1 wild, flailing arm. Where is the lesion?

A: Contralateral subthalamic nucleus (Hemiballismus)

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Lorenzo · « **Reply #6 on:** March 10, 2011, 02:43:28 AM »

Patient's tongue protrudes toward the left side, and patient exhibits a right-sided spastic paralysis.

Where is the lesion?

A: Left medulla, CN XII

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Lorenzo · « **Reply #7 on:** March 10, 2011, 02:44:30 AM »

43 year old man experiences dizziness and tinnitus. CT shows an enlarged internal acoustic meatus.

What is diagnosis?

A: Schwannoma

Treatment: Surgical removal

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Lorenzo · « **Reply #8 on:** March 10, 2011, 02:45:22 AM »

25 year old woman presents with sudden monocular vision loss and slightly slurred speech. She has a history of weakness and parethesias that have resolved.

What is the diagnosis?

A: Multiple Sclerosis

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Lorenzo · « **Reply #9 on:** March 10, 2011, 02:47:47 AM »

25 year old woman presents with sudden monocular vision loss and slightly slurred speech. She has a history of weakness and parethesias that have resolved.

What is the diagnosis?

A: Multiple Sclerosis

Treatment: Steroids, Interferon

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Lorenzo · « **Reply #10 on:** March 10, 2011, 02:53:13 AM »

10 year old child "spaces out" in class. During spells, the child has a slight quivering of the lips.

Diagnosis?

A: Absence Seizures

Treatment: Ethosuximide

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Lorenzo · « **Reply #11 on:** March 10, 2011, 02:57:04 AM »

65 year old man presents with paranoia, obsessive compulsion, delusion of neighbours following him, presents with introverted lifestyle.

What is diagnosis?

A: Cluster A personality disorder with possible schizoid tendency

Treatment: Neuroleptics (Thioridazine, fluphenazine, chlorpromazine ) + adjutant psychoanalytic psychotherapy

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Lorenzo · « **Reply #12 on:** March 10, 2011, 03:03:42 AM »

** very popular board question

Military Veteran becomes paralyzed upon hearing airplane engines.

What is the diagnosis?

A: PTSD (post traumatic stress disorder)

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Lorenzo · « **Reply #13 on:** March 12, 2011, 01:08:08 AM »

child has been anemic since birth.

splenectomy would result in increased hematocrit in what disease?

A: spherocytosis

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Lorenzo · « **Reply #14 on:** March 12, 2011, 01:08:52 AM »

patient presents with fatigue and blood tests show a macrocytic , megaloblastic anemia.

what is the danger of giving folate alone?

A: corrects anemia, but neural damage progresses if the patient is B12 deficient.

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Lorenzo · « **Reply #15 on:** March 12, 2011, 01:10:21 AM »

Patient presents with anemia, hypercalcemia, and bone pain on palpation; bone marrow biopsy shows a slide packed with cells that have a large, round, off-center nucleus.

what is the diagnosis and what may be found on urinalysis?

A: multiple myeloma (plasma cell neoplasm); Bence Jones protein (Ig Light Chains)

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Lorenzo · « **Reply #16 on:** March 12, 2011, 01:11:15 AM »

AIDS patient has just been diagnosed with cancer.

What neoplasms are associated with AIDS?

A: B-cell lymphoma, kaposi's sarcoma

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Lorenzo · « **Reply #17 on:** March 12, 2011, 03:13:40 AM »

A 16 year old gymnast presents to the emergency department after landing awkwardly on her ankle. She is diagnosed with a sprained ankle. Which of the following ligaments is most commonly injured in an ankle sprain?

A: Anterior talofibular ligament

Reason: The lateral ligaments are most commonly injured , and the most common of these ligaments is the Anterior Talofibular Ligament.

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Lorenzo · « **Reply #18 on:** March 12, 2011, 03:23:40 AM »

An 8 year old boy is brought to his pediatrician by his parents with complaints of swelling
and pain over his right femur for the past 2-3 weeks. The child and parents deny any history
of trauma to the region. The patient reports that the pain is often worse at night, and his
mother states that he has been having low grade fevers of 37.8 degs C. On physical exam,
there is no erythema of the region, but a firm immobile tender mass is palpable. Fine needle
aspiration cytology of the region reveals anaplastic small blue cells. Genetic evaluation of this
patient is most likely to reveal which of the following?

A: t (11; 22) chromosomal translocation

Reasoning: the patient's presentation and histology is most consistent with Ewing's Sarcoma and is associated with t(11;22) translocations.

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Deepwater · « **Reply #19 on:** March 18, 2011, 03:13:11 PM »

thanks for these, doc... nice ireview

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Lorenzo · « **Reply #20 on:** March 18, 2011, 03:14:33 PM »

yw, hehehe!

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Lorenzo · « **Reply #21 on:** March 18, 2011, 03:16:50 PM »

do you remember the pneumonic for BRACHIAL PLEXUS damage?

DR. MACU

------

Damage to Radial Nerve = Drop Wrist

Damage to Median Nerve = Ape Hand

Damage to Ulnar Nerve = Claw Hand

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Deepwater · « **Reply #22 on:** March 18, 2011, 03:19:02 PM »

put some more. nalingaw ko. hehehe

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Lorenzo · « **Reply #23 on:** March 18, 2011, 03:20:31 PM »

haha. nalingaw ka sa anatomy ? oy, you are indeed a geek eh?

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Deepwater · « **Reply #24 on:** March 18, 2011, 03:25:39 PM »

buing... nice man ireview nga naay mkarelate gud... lahi sad ako remembering tool sa brachial plexus... Radial.n---wRist drop (R=R), Ulnar n.--Claw hand (itakilid ang u= c) median n.---ape hand or waiters tip (balihon ang M=W)

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Lorenzo · « **Reply #25 on:** March 18, 2011, 03:26:55 PM »

Warning: This is sexual, but highly useful and well remembered by many, many male medics. bwahahaha

THE 12 CRANIAL NERVES

Mnemonic : Oh Oh Oh To Touch And Feel Virgin Girl's Vagina Ah Heaven!

O = Ocular
O = Optic
O = Oculomotor
T = Trochlear
T = Trigeminal
A = Abducens
F = Facial
V = Vestibulococchlear
G = Glossopharyngeal
A = Accessory
H = Hypoglossal

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Lorenzo · « **Reply #26 on:** March 18, 2011, 03:27:28 PM »

buing... nice man ireview nga naay mkarelate gud... lahi sad ako remembering tool sa brachial plexus... Radial.n---wRist drop (R=R), Ulnar n.--Claw hand (itakilid ang u= c) median n.---ape hand or waiters tip (balihon ang M=W)

hehehe. cute. salamat, Doctora.

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Deepwater · « **Reply #27 on:** March 18, 2011, 03:29:44 PM »

Warning: This is sexual, but highly useful and well remembered by many, many male medics. bwahahaha

THE 12 CRANIAL NERVES

the ever famous.

Mnemonic : Oh Oh Oh To Touch And Feel Virgin Girl's Vagina Ah Heaven!

O = Ocular
O = Optic
O = Oculomotor
T = Trochlear
T = Trigeminal
A = Abducens
F = Facial
V = Vestibulococchlear
G = Glossopharyngeal
A = Accessory
H = Hypoglossal

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Lorenzo · « **Reply #28 on:** March 18, 2011, 03:29:49 PM »

buing... nice man ireview nga naay mkarelate gud... lahi sad ako remembering tool sa brachial plexus... Radial.n---wRist drop (R=R), Ulnar n.--Claw hand (itakilid ang u= c) median n.---ape hand or waiters tip (balihon ang M=W)

dra, what do we call waiter's tip ?

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Lorenzo · « **Reply #29 on:** March 18, 2011, 03:31:21 PM »

hahaha @ 'the ever famous'.

i remember during my 1st Medical Anatomy Exam.

We had to locate all the 12 nerves and then name them.

I started to name the nerves (but i said the mnemonic first!). My proctor's eyes got wide after hearing me. Bwahahahaha!

good times. good times.

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Deepwater · « **Reply #30 on:** March 18, 2011, 03:43:28 PM »

dra, what do we call waiter's tip ?

they have the same nerve involvement sa ape hand. so as with claw hand, also known as pope hand

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Lorenzo · « **Reply #31 on:** March 18, 2011, 03:45:51 PM »

I'd like to add something that i saw today (and was saddened by):

21 year old african american female comes in to the ER after failing to meet her dialysis appointment. Patient's history indicates that she has CHF (chronic heart failure), CRF (chronic renal failure) , both of which are secondary to her untreated hypertension. The patient came in because she was suffering from asthma. What drug would she be given if she suffered an acute asthma attack?

A: Albuterol

OT: I was really saddened today to see such a young person who has yet to live life already dying. Only 21 years old and already CHF and CRF. $:-\$

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Lorenzo · « **Reply #32 on:** March 18, 2011, 03:46:38 PM »

they have the same nerve involvement sa ape hand. so as with claw hand, also known as pope hand

very good! high yield ra ba ni sa USMLE. very high yield.

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Lorenzo · « **Reply #33 on:** March 18, 2011, 03:51:01 PM »

I'd like to add something that i saw today (and was saddened by):

21 year old african american female comes in to the ER after failing to meet her dialysis appointment. Patient's history indicates that she has CHF (chronic heart failure), CRF (chronic renal failure) , both of which are secondary to her untreated hypertension. The patient came in because she was suffering from asthma. What drug would she be given if she suffered an acute asthma attack?

A: Albuterol

OT: I was really saddened today to see such a young person who has yet to live life already dying. Only 21 years old and already CHF and CRF. $:-\$

for the first 5 minutes, this patient did not talk to me. i came to her bed to take her H&P pero she would not talk. luoy kaayo. i told her that her failure to take her anti-hypertension pills and chf pills are hurting her. she is so young. she looked at me today after i said to her, "you are still very young, so very young. you can still enjoy your life , but you have to protect your life..."

ingon sija nako, "i dont want to die...i just dont want to die.."

luoy kaayo. its kind of hard sometimes when dealing with cases like this. after finishing her history, i let the nurse continue the dialysis.

luoy kaayo. $:-\$

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Deepwater · « **Reply #34 on:** March 18, 2011, 03:53:59 PM »

I'd like to add something that i saw today (and was saddened by):

21 year old african american female comes in to the ER after failing to meet her dialysis appointment. Patient's history indicates that she has CHF (chronic heart failure), CRF (chronic renal failure) , both of which are secondary to her untreated hypertension. The patient came in because she was suffering from asthma. What drug would she be given if she suffered an acute asthma attack?

A: Albuterol

OT: I was really saddened today to see such a young person who has yet to live life already dying. Only 21 years old and already CHF and CRF. $:-\$

this is really unfortunate. how did she get CHF? tambok ni sya? african americans have the highest risk of cardiovascular problem and hardest to treat depending on their inherited genes. ambot lng sad pero so far mao ako nabantayan. have to update myself more with US statistics.

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Deepwater · « **Reply #35 on:** March 18, 2011, 03:56:49 PM »

sure mo asthma to basin nagcongestive heart failure sya. wla pajud dialysis, basin ni.inom daghan fluids mao na nagdyspnea. mao pud na ka-paet kay non-compliant mga patients also because mahal sad tambal.

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Lorenzo · « **Reply #36 on:** March 18, 2011, 03:59:30 PM »

this is really unfortunate. how did she get CHF? tambok ni sya? african americans have the highest risk of cardiovascular problem and hardest to treat depending on their inherited genes. ambot lng sad pero so far mao ako nabantayan. have to update myself more with US statistics.

not morbidly obese, her weight was normal for her age and height. long term untreated hypertension. non-compliant history of not taking her medication led to chf, with chf, ning manifest ijang CRF.

Edematous kaajo.

~~~

Very sensitive kaayo ning african american population, because they react differently to chf / hypertension medication.

normally i would prescribe my patients (hypertensive patients) : Ace inhibs (Lisinipril, Captopril), ARBS (losartan).

however, for African americans, they do not do well with Aceinhibs. They do really well with : CCBs, and Diuretics (Hydrocholorthiazide).

Note: importante jud i monitor ilang uric acid levels when they're on HCT; kai mag hyperuricemic cases; gouty attack.

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Deepwater · « **Reply #37 on:** March 18, 2011, 04:00:32 PM »

lisod kaayo asthmatic pajud. ang pagkahypertensive ani cguro wlay check-up check-up. taas cguro cholesterol sad ani bataa.

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Lorenzo · « **Reply #38 on:** March 18, 2011, 04:01:20 PM »

sure mo asthma to basin nagcongestive heart failure sya. wla pajud dialysis, basin ni.inom daghan fluids mao na nagdyspnea. mao pud na ka-paet kay non-compliant mga patients also because mahal sad tambal.

oo asthma kai gi tagaan ug albut, na wa ijang symptom. asthmatic man pood to sija sa ijang history.

pero yes, you are right, dra, one has to be cautious in seeing all possibilities. thanks.

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Lorenzo · « **Reply #39 on:** March 18, 2011, 04:03:23 PM »

lisod kaayo asthmatic pajud. ang pagkahypertensive ani cguro wlay check-up check-up. taas cguro cholesterol sad ani bataa.

oo. ang problema kai non-compliant kaajo. preventable man jud ni ijang crf . unta ning take to sija sa ijang CHF medication sa una. sus ijang lab values...hyperprotenemia ...beyond high levels.

gi admit nako, gi order jud nako ang dialysis kai she missed her dialysis kono 2 days ago.

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Lorenzo · « **Reply #40 on:** March 24, 2011, 12:44:11 PM »

Unilateral DNR Orders

If the physician has concluded that CPR would be physiologically futile, resuscitation need not be offered as a treatment option. For example, if the patient is exsanguinated upon arrival to the ER and has been pulse-less with a flat electrocardiogram for 20 minutes, CPR may be withheld without surrogate consent. When the patient is terminal but not moribund, we recommend that consent include the following four mandatory provisions:

1) the physician must obtain a second opinion

2) the hospital ethics committee must be consulted

3) an atmosphere for negotiation between parties must be created

4) the patient's right to be transferred to another provider must be preserved

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Lorenzo · « **Reply #41 on:** March 24, 2011, 12:56:06 PM »

Decisions to forgo interventions for children

With infants and children, as with adults, recommendations sometimes must be made about what forms of care are indicated when death is likely.
Although it often is psychologically and emotionally difficult to accept the death of an infant or child, physicians sometimes must recommend that certain interventions are not medically indicated because they are futile, providing no, or at best minimal, benefits. All of the cautions about the concept of futility should be observed.

Case 1:

A fetus is delivered by spontaneous abortion at 21 weeks of gestation, weighing 350 g, and is hypoxic at birth.

Case II:

Jason, a 4 year ol boy , who was absent from his home for approximately 2 hours, is found at the bottom of a heated swimming pool. When drawn from the water, he is limp, has a grayish pallor and is cold. His father initiates mouth to mouth resuscitation, with no response. The Emergency Medical Services (EMS) arrives 8 minutes later. During the ambulance trip to the ER, CPR is given for 26 minutes and two doses of Epinephrine fail to stimulate any physiologic response. Rectal temperature is 35 degs C.

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Lorenzo · « **Reply #42 on:** March 24, 2011, 01:02:45 PM »

Decisions to forgo interventions for children

With infants and children, as with adults, recommendations sometimes must be made about what forms of care are indicated when death is likely.
Although it often is psychologically and emotionally difficult to accept the death of an infant or child, physicians sometimes must recommend that certain interventions are not medically indicated because they are futile, providing no, or at best minimal, benefits. All of the cautions about the concept of futility should be observed.

Case 1:

A fetus is delivered by spontaneous abortion at 21 weeks of gestation, weighing 350 g, and is hypoxic at birth.

Case II:

Jason, a 4 year ol boy , who was absent from his home for approximately 2 hours, is found at the bottom of a heated swimming pool. When drawn from the water, he is limp, has a grayish pallor and is cold. His father initiates mouth to mouth resuscitation, with no response. The Emergency Medical Services (EMS) arrives 8 minutes later. During the ambulance trip to the ER, CPR is given for 26 minutes and two doses of Epinephrine fail to stimulate any physiologic response. Rectal temperature is 35 degs C.

In case 1, no infant of that birth weight and gestational age is known to have survived under current medical regimens. Although this may constitute probablistic futility, it more likely reflects the physiological incapacity of immature lungs to perform their essential work and thus would constitute physiologic futility.

In case 2, resuscitative efforts can be discontinued on the grounds of probabilistic futility. Current data suggests that failure to obtain a physiologic response after more than 20 minutes of good resuscitative efforts and two doses of epinephrine in the presence of normal body temperature justifies termination of intervention.

In the likelihood that Jason survives, Jason probably has sustained brain damage that would severely compromise his quality of life.

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Deepwater · « **Reply #43 on:** March 24, 2011, 03:25:02 PM »

this is so true. unfortunately, esp in the phils. if dli ipaundang sa family sa patient, dli sad paundangun sa doctor. i remember as an intern, we resuscitated a patient for two hours before declared dead. he had 24 epinephrines given na cguro with no response. kapoi intawn cge og pump.

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Lorenzo · « **Reply #44 on:** March 24, 2011, 08:53:31 PM »

this is so true. unfortunately, esp in the phils. if dli ipaundang sa family sa patient, dli sad paundangun sa doctor. i remember as an intern, we resuscitated a patient for two hours before declared dead. he had 24 epinephrines given na cguro with no response. kapoi intawn cge og pump.

24 epinephrines ? Ka grabeh pood sa Pilipinas. Dili diay sila kahibalo that after 2 high doses of epi, mag saturate ang receptors sa pericardium?

By Medical Law, a brain that is deprived of oxygenated air for 5 minutes will be neurologically impaired. The situation that you personally had to endure was considered physiologically futile as well as fell in the realm of probabilistic futility. But it was noble, nonetheless.

One question, Dra, were you guys physically pumping the patient via manual cardiopulmonary resuscitation or where you guys using an defibrillator? In America, when dealing with patients who are suffering from acute Supraventricular Tachycardia, we usually give a dose (or two) of epinephrine and then cardioeversion to correct the abormal dysrythmia, which if left uncorrected for too long, becomes fatal.

Dra, I will nonetheless give you a standing ovation for that dedicated 2 hours of physical cardioeversion when all seemed lost. Daghan ko kaayo respect para nimo!!

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Deepwater · « **Reply #45 on:** March 25, 2011, 07:32:49 AM »

24 epinephrines ? Ka grabeh pood sa Pilipinas. Dili diay sila kahibalo that after 2 high doses of epi, mag saturate ang receptors sa pericardium?

Dra, I will nonetheless give you a standing ovation for that dedicated 2 hours of physical cardioeversion when all seemed lost. Daghan ko kaayo respect para nimo!!

we manually resuscitate especially at the ER and wards (and its not only me sad nagpump oi, puli puli mi sa mga co-interns) but i noticed we only used the defibrillator when the patient had insurance or good financial background (thats the sad part) and these are the family of patients who asks the doctors to not stop resuscitating... we usually alternate sa defibrillator then manual. with regards to the epi, thanks, new learning for me. Its not always all the time sad that we give more than 3 epis... most really is three epi's and we give 15mins for response if wla na, we appraise the family but like i said some family's in their verge of emotional insatbility cguro moask man ipadayun sa doc, especially if the patient is young so ambot nganu tagaan man sad epi nasad sa amo resident.

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Lorenzo · « **Reply #46 on:** March 25, 2011, 09:42:31 AM »

we manually resuscitate especially at the ER and wards (and its not only me sad nagpump oi, puli puli mi sa mga co-interns) but i noticed we only used the defibrillator when the patient had insurance or good financial background (thats the sad part) and these are the family of patients who asks the doctors to not stop resuscitating... we usually alternate sa defibrillator then manual. with regards to the epi, thanks, new learning for me. Its not always all the time sad that we give more than 3 epis... most really is three epi's and we give 15mins for response if wla na, we appraise the family but like i said some family's in their verge of emotional insatbility cguro moask man ipadayun sa doc, especially if the patient is young so ambot nganu tagaan man sad epi nasad sa amo resident.

i relayed your story today , dra, with members of my surgical group and we had a discussion about this. our lead surgeon, Dr. Bautisto, who is a product of UST (he is also head of the surgical wing here) gave all of us an interesting lesson: the difference between american and philippine hospital setting. the lecture gave all of us an eye opening awareness of the situation in the philippines. the story that he shared with us, bares similarity with that of your personal experience. and i appreciate them both.

it is saddening to hear that in the philippines, a defibrillator is held off if a patient shows no financial competence. So you mean to tell me that if a person from say Inabanga (suffering from chest pain that radiates to her back and jaw) is rushed to Ramiro Hospital and if she has no health insurance, in case she suffers an acute heart attack / or hypothetical SVT, she will not be given a defibrillator?

Here in the United States, even if one has no health insurance or not, if it is a medical Emergency, the patient must be given emergency care. Mao na ang differense sa setting.

Professionalism aside, I can sympathize with why you guys didn't give up, at the request of the patient's family. How old was the patient diay? And what was the cause of death? Hypertrophic cardiomyopathy or acute MI?

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Lorenzo · « **Reply #47 on:** March 25, 2011, 10:05:38 AM »

A 69 year old man is hospitalized for an exacerbation of asthma. He is placed on albuterol and an inhaled corticosteroid , but due to low oxygen saturation, he is intubated. After 3 days in the hospital, he has a temperature of 39.4 degs C, a blood pressure of 104/ 63 mm Hg, a pulse of 108/ min, and a respiratory rate of 35/ min. On physical examination, the patient is found to have coarse rhonchi at the base of the lung fields bilaterally. The patient is producing purulent , foul-smelling sputum that shows Pseudomonas aeruginosa on culture analysis. Which of the following agents could be used to treat Pseudomonas aeruginosa infection?

A. Cefoperazone
B. Cefotaxime
C. Cefotetan
D. Ceftriaxone
E. Cefuroxime

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Deepwater · « **Reply #48 on:** March 26, 2011, 04:03:42 AM »

This was a hospital in Cebu. as in Ramiro however, I don't really know if they do use or not because I have never worked there but I know they make use of everything that they have. The patient's family just go home with a lot of bills to pay. In the setting in internship/clerkship cguro, hospitals like CDUH and the like make most of their many interns or PGI's in a code. Also the lasck of knowledge with the use of a defibrillator also comes to mind as well.

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Deepwater · « **Reply #49 on:** March 26, 2011, 04:25:02 AM »

A 69 year old man is hospitalized for an exacerbation of asthma. He is placed on albuterol and an inhaled corticosteroid , but due to low oxygen saturation, he is intubated. After 3 days in the hospital, he has a temperature of 39.4 degs C, a blood pressure of 104/ 63 mm Hg, a pulse of 108/ min, and a respiratory rate of 35/ min. On physical examination, the patient is found to have coarse rhonchi at the base of the lung fields bilaterally. The patient is producing purulent , foul-smelling sputum that shows Pseudomonas aeruginosa on culture analysis. Which of the following agents could be used to treat Pseudomonas aeruginosa infection?

A. Cefoperazone
B. Cefotaxime
C. Cefotetan
D. Ceftriaxone
E. Cefuroxime

4th generation cephalosporins has the highest bactericidal effect on Psuedomonas, but 3rd generation are also useful for serious gram neg infections, however, among the 3rd generation ceftazidime and cefoperazone are the ones most active against psedomonas aeroginosa so answer is A

A. Cefoperazone- 3rd gen

B. Cefotaxime-3rd gen
C. Cefotetan-2nd gen
D. Ceftriaxone- 3rd gen
E. Cefuroxime-2nd gen

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Lorenzo · « **Reply #50 on:** March 26, 2011, 08:26:47 PM »

Excellent!!

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Lorenzo · « **Reply #51 on:** March 26, 2011, 08:28:44 PM »

This was a hospital in Cebu. as in Ramiro however, I don't really know if they do use or not because I have never worked there but I know they make use of everything that they have. The patient's family just go home with a lot of bills to pay. In the setting in internship/clerkship cguro, hospitals like CDUH and the like make most of their many interns or PGI's in a code. Also the lasck of knowledge with the use of a defibrillator also comes to mind as well.

This is good information , particularly the work setting information. Thank You very much for sharing this with me.

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Deepwater · « **Reply #52 on:** March 27, 2011, 03:01:04 AM »

Professionalism aside, I can sympathize with why you guys didn't give up, at the request of the patient's family. How old was the patient diay? And what was the cause of death? Hypertrophic cardiomyopathy or acute MI?

patients less than 50-60 years old, usually of patients with MI.

Doc, keep those cases coming... and thank you.

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Lorenzo · « **Reply #53 on:** March 27, 2011, 10:04:10 AM »

Way Sapayan, Doctora! We have to motivate each other and help each other.

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Lorenzo · « **Reply #54 on:** March 27, 2011, 10:06:21 AM »

A patient comes in to the ER complaining of chest pain and radiating pain to her back , left arm and jaw. You are the senior resident MD on the floor that night. You diagnose her as having Myocardial Infarct. As the resident MD, what is your treatment plan?

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Lorenzo · « **Reply #55 on:** March 28, 2011, 12:18:18 PM »

4th generation cephalosporins has the highest bactericidal effect on Psuedomonas, but 3rd generation are also useful for serious gram neg infections, however, among the 3rd generation ceftazidime and cefoperazone are the ones most active against psedomonas aeroginosa so answer is A

A. Cefoperazone- 3rd gen

B. Cefotaxime-3rd gen
C. Cefotetan-2nd gen
D. Ceftriaxone- 3rd gen
E. Cefuroxime-2nd gen

additionally.

one of the reasons why cefoperazone is preferred is due to the fact that it does not cross the blood brain barrier and thus does not cause neural side effects.

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Lorenzo · « **Reply #56 on:** March 28, 2011, 12:21:03 PM »

A patient comes in to the ER complaining of chest pain and radiating pain to her back , left arm and jaw. You are the senior resident MD on the floor that night. You diagnose her as having Myocardial Infarct. As the resident MD, what is your treatment plan?

Treatment of Myocardial Infarction:

MONAB

M- Morphine
O- 100% oxygen
N- Nitrates
A-Aspirin
B-Beta Blocker

+

It is also good to give a patient tPA or Streptokinase (so long as he/she was not given this before, for allergenicity's sake)

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Lorenzo · « **Reply #57 on:** March 28, 2011, 12:26:11 PM »

A 50 year old woman was diagnosed by her oncologist for a benign thyroid adenoma. She opted for surgical resection of the thyroid adenoma. After the surgery, the patient woke up and had a hoarse voice. This most likely was a result of a damage to which nerve during the surgical procedure?

A: Recurrent Laryngeal Nerve

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Lorenzo · « **Reply #58 on:** March 28, 2011, 12:30:38 PM »

A 28 year old law student came to her family doctor's office complaining of vaginal iching. The patient reported to the doctor that the itching has been present for the past week now. Upon physical examination, the family doctor observes a milky gray colored exudate coming out of the patient's vagina and labial fold. Upon use of KOH, there is also an observable malodorous smell. After lab exams, you observe clue cells. What bacterial pathogen is responsible for this patient? And what is the name of the condition?

A: Gardnerella Vaginalis ; condition is known as: Bacterial Vaginosis

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Lorenzo · « **Reply #59 on:** March 28, 2011, 12:34:57 PM »

A 3rd year Resident MD comes to your office complaining of excruciating pain when walking. Upon requesting him to walk , you observe an affected gait. He complains of pain on the lateral aspect of his ankle. Using your knowledge of Medical Anatomy, what ligament is most probably affected?

A: Talofibular Ligment; the reason why is because most common injured area in the foot is the lateral aspect, and the most common lateral ligament affected during an injury is the talofibular ligament.

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Lorenzo · « **Reply #60 on:** March 28, 2011, 12:38:46 PM »

A 28 year old law student came to her family doctor's office complaining of vaginal iching. The patient reported to the doctor that the itching has been present for the past week now. Upon physical examination, the family doctor observes a milky gray colored exudate coming out of the patient's vagina and labial fold. Upon use of KOH, there is also an observable malodorous smell. After lab exams, you observe clue cells. What bacterial pathogen is responsible for this patient? And what is the name of the condition?

A: Gardnerella Vaginalis ; condition is known as: Bacterial Vaginosis

How do we treat this:

Metronidazole (highly preferred) or any other antibiotics + probenicid

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Lorenzo · « **Reply #61 on:** March 28, 2011, 12:49:14 PM »

You are a 1st year Psychiatry Resident MD at a local hospital. You are seeing a 65 year old man who is diagnosed for clinical depression and hypermania. You look into his patient file and realize that he is recently now taking Fluoxetine , an SSRI (serotonin selective receptor inhibitor), to treat his bouts of depression. For his mania, you notice that the attending MD has prescribed him Carbomezapine. While taking the patient's history, you observe that while he talks, he has quick uncontrollable movements that involves his lips, and his tongue.

What is the cause of this ?

A: The patient clearly has the signs and symptoms of long-term anti-psychotic medication: Tarditive Dyskinesia (uncontrollable jerky movements that invovles the lips and the tongue). The cause of this was long term intake of Typical Anti-depressant --> HALOPERIDOL (HALDOL). Since the patient is recently prescribed Fluoxetine, we can surmise that the patient was taking HALDOL or any other type of Typical Anti-Psychotics, which have extrapyramidal side effects (Tarditive dyskinesia being one of them...)

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Lorenzo · « **Reply #62 on:** March 28, 2011, 12:58:25 PM »

A 28 week old fetus is delivered prematurely. As one of the OB/GYNEs on the floor , you observe that the patient has breathing difficulty. You and the neonatologist diagnose the child as having FRDS (fetal respiratory distress syndrome).

What is deficient in this child? What cell is responsible for producing this deficient material?

A: Surfactant is deficient; Alveolar Pneumocyte Type II are responsible for producing Surfactant.

PATHOPHYSIOLOGY: Surfactant is synthesized after week 35 of gestation. If there is premature delivery prior to week 35, ALWAYS expect the infant to have FRDS.

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Lorenzo · « **Reply #63 on:** March 28, 2011, 12:59:36 PM »

A 28 week old fetus is delivered prematurely. As one of the OB/GYNEs on the floor , you observe that the patient has breathing difficulty. You and the neonatologist diagnose the child as having FRDS (fetal respiratory distress syndrome).

What is deficient in this child? What cell is responsible for producing this deficient material?

A: Surfactant is deficient; Alveolar Pneumocyte Type II are responsible for producing Surfactant.

PATHOPHYSIOLOGY: Surfactant is synthesized after week 35 of gestation. If there is premature delivery prior to week 35, ALWAYS expect the infant to have FRDS.

As the OB/GYNE , how will you treat Fetal Respiratory Distress Syndrome?

A: Corticosteroids.

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Lorenzo · « **Reply #64 on:** March 28, 2011, 01:03:20 PM »

As the OB/GYNE , how will you treat Fetal Respiratory Distress Syndrome?

A: Corticosteroids.

What is the complication of diabetes and corticosteroid deficiency and Respiratory Distress Syndrome?

A: High insulin levels in diabetic mothers antagonize the effects of corticosteroids. Infants of diabetic mothers have a
higher incidence of respiratory distress syndrome.

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Lorenzo · « **Reply #65 on:** September 14, 2011, 02:28:15 AM »

Pulmonary Shunt:

A pulmonary shunt is also known as a right-to-left shunt. By definition, systemic venous blood is delivered to the left side of the heart w/o exchanging oxygen and carbon dioxide with the alveoli. A good example is blood passing through a region of atelectasis.

When a significant pulmonary shunt exists, breathing pure O2 will elevate systemic arterial PO2 a small amount , but it will never produce enough full saturation of the hemoglobin.

Failure to obtain a significant increase in arterial PO2 following administration of supplemental oxygen in hypoxemias strong evidence of the presence of a pulmonary shunt.

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Lorenzo · « **Reply #66 on:** September 14, 2011, 02:29:30 AM »

Pulmonary Shunt:

A pulmonary shunt is also known as a right-to-left shunt. By definition, systemic venous blood is delivered to the left side of the heart w/o exchanging oxygen and carbon dioxide with the alveoli. A good example is blood passing through a region of atelectasis.

When a significant pulmonary shunt exists, breathing pure O2 will elevate systemic arterial PO2 a small amount , but it will never produce enough full saturation of the hemoglobin.

Failure to obtain a significant increase in arterial PO2 following administration of supplemental oxygen in hypoxemias strong evidence of the presence of a pulmonary shunt.

There is increase in A-a oxygen gradient

Supplemental O2 ineffective at returning arterial PO2 to normal

End-tidal air does not reflect the arterial values

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