Eating Clay - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 07-30-2011
podebrad's Avatar
USMLE Forums Addict
 
Steps History: CK+CS
Posts: 138
Threads: 28
Thanked 77 Times in 36 Posts
Reputation: 87
Default Eating Clay

A 34-year-old pregnant woman presents to the emergency room with her husband. Her husband claims that she needs to talk to a psychiatrist immediately because he often catches her eating their child's clay. She admits to eating clay occasionally but cannot explain why she does it. She claims that she has been tired for the past 7 months but has attributed it to the pregnancy. She denies any past medical history and does not take any medications. She claims she was given a prescription for vitamins by her obstetrician but was unable to fill it because her husband lost his job and his health benefits. She was trying to improve her nutrition, but often finds herself desiring to eat clay, lettuce, or ice chips. Her blood pressure is 110/70 mm Hg, and pulse is 72/min. Her stool is guaiac-negative, and her skin is pale. Laboratory studies reveal: hemoglobin 9 g/dL; hematocrit 27%; MCV 80 Ám3; platelet 280,000/mm3. Her red-cell distribution width is 18%. What is the best management for this patient's anemia?

(A) Prenatal vitamins with iron supplementation
(B) Transfusion
(C) Intramuscular iron injection
(D) Upper endoscopy
(E) Erythropoietin
Reply With Quote Quick reply to this message
The above post was thanked by:
1TA2B (07-31-2011)



  #2  
Old 07-30-2011
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 239
Threads: 3
Thanked 48 Times in 37 Posts
Reputation: 58
Default

(B) Transfusion
__________________
I'm Predictable In The Unpredictable Future !
Reply With Quote Quick reply to this message
  #3  
Old 07-30-2011
busterbee's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 218
Threads: 16
Thanked 110 Times in 59 Posts
Reputation: 120
Default

A vit + iron
Reply With Quote Quick reply to this message
  #4  
Old 07-30-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 285 Times in 191 Posts
Reputation: 297
Default

B.Transfusion
Reply With Quote Quick reply to this message
  #5  
Old 07-30-2011
podebrad's Avatar
USMLE Forums Addict
 
Steps History: CK+CS
Posts: 138
Threads: 28
Thanked 77 Times in 36 Posts
Reputation: 87
Default Please give the explanations too..

The whole point is to have a discussion....so that we all can learn something from the way we think...thanks...
Reply With Quote Quick reply to this message
  #6  
Old 07-30-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 175
Threads: 13
Thanked 239 Times in 59 Posts
Reputation: 249
Default

She has Pica due to iron deficinecy ( the pica and the high RDW points to it) Now according to my knowledge transfusion is only if a symptomatic anemia which besides the pica this pateint isnt showing. So that leads me towards choosing
A) Prenatal vitamins with iron supplementation

other answers

c) IM is rarely used
d)endoscopy isnt really needed as from history we can see cause is nutritional deficiency also her stool guiac test as negative ruling out a blood loss.
e)erythropoetien is used usually in patients of RF who cant produce RBCs her problem isnt that she cant produce its the fact that she needs iron to produce the necessary hemoglobin

EDIT furthur info on IM iron as i was wondering when we would use it -Parenteral iron therapy (intravenously or intramuscular) is only given when oral therapy has failed or oral absorption is seriously compromised (by illnesses, or when the patient cannot swallow) and benefit from oral therapy cannot be expected

Last edited by docnas; 07-30-2011 at 01:44 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
podebrad (07-31-2011)
  #7  
Old 07-30-2011
busterbee's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 218
Threads: 16
Thanked 110 Times in 59 Posts
Reputation: 120
Default

transfusion!!isn't it too agressive managment....she has no major symptoms

vit n iron..it'l take a month for response
Reply With Quote Quick reply to this message
  #8  
Old 07-30-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 175
Threads: 13
Thanked 239 Times in 59 Posts
Reputation: 249
Default

the pregnancy fact though is throwing me off since she is pregnant the chronic anemia can be bad for the baby so thats making me wonder do we have to be more aggressive in our treatment? like i know in elderly of in patients of heard disease we transfuse them at hematocrit lvls ov 25-30 even , so is pregnancy ( which does produce a heart overload like problem) included in this category ?
Reply With Quote Quick reply to this message
  #9  
Old 07-30-2011
busterbee's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 218
Threads: 16
Thanked 110 Times in 59 Posts
Reputation: 120
Default

same dilemma..i too remember that young person transfuse if hct less than 20-25 and in elderly if hct below 30
Reply With Quote Quick reply to this message
  #10  
Old 07-30-2011
cool_atomic's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 472
Threads: 29
Thanked 224 Times in 135 Posts
Reputation: 247
Default

young healthy people need not be transfused till Hct<20, if pregnant, consider 25, but still, we have to take the whole picture into consideration. She is not acutely symptomatic and has only pica, and transfusion has its own risks including infection, so i'd go for Oral iron supplementation.
Reply With Quote Quick reply to this message
  #11  
Old 07-31-2011
1TA2B's Avatar
USMLE Forums Guru
 
Steps History: CK Only
Posts: 475
Threads: 39
Thanked 351 Times in 169 Posts
Reputation: 374
Default A. Oral

Quote:
Originally Posted by podebrad View Post
A 34-year-old pregnant woman presents to the emergency room with her husband. Her husband claims that she needs to talk to a psychiatrist immediately because he often catches her eating their child's clay. She admits to eating clay occasionally but cannot explain why she does it. She claims that she has been tired for the past 7 months but has attributed it to the pregnancy. She denies any past medical history and does not take any medications. She claims she was given a prescription for vitamins by her obstetrician but was unable to fill it because her husband lost his job and his health benefits. She was trying to improve her nutrition, but often finds herself desiring to eat clay, lettuce, or ice chips. Her blood pressure is 110/70 mm Hg, and pulse is 72/min. Her stool is guaiac-negative, and her skin is pale. Laboratory studies reveal: hemoglobin 9 g/dL; hematocrit 27%; MCV 80 Ám3; platelet 280,000/mm3. Her red-cell distribution width is 18%. What is the best management for this patient's anemia?

(A) Prenatal vitamins with iron supplementation
(B) Transfusion
(C) Intramuscular iron injection
(D) Upper endoscopy
(E) Erythropoietin
I would go with A. Oral supplement

She's hemodynamically stable without sign of complications like heart failure.

Good question!

Let us know the correct answer.

Thanks
__________________
Skill+Hardwork+Preparation=Success
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
The above post was thanked by:
podebrad (07-31-2011)
  #12  
Old 07-31-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,251 Times in 441 Posts
Reputation: 1265
Default

Quote:
Originally Posted by podebrad View Post
A 34-year-old pregnant woman presents to the emergency room with her husband. Her husband claims that she needs to talk to a psychiatrist immediately because he often catches her eating their child's clay. She admits to eating clay occasionally but cannot explain why she does it. She claims that she has been tired for the past 7 months but has attributed it to the pregnancy. She denies any past medical history and does not take any medications. She claims she was given a prescription for vitamins by her obstetrician but was unable to fill it because her husband lost his job and his health benefits. She was trying to improve her nutrition, but often finds herself desiring to eat clay, lettuce, or ice chips. Her blood pressure is 110/70 mm Hg, and pulse is 72/min. Her stool is guaiac-negative, and her skin is pale. Laboratory studies reveal: hemoglobin 9 g/dL; hematocrit 27%; MCV 80 Ám3; platelet 280,000/mm3. Her red-cell distribution width is 18%. What is the best management for this patient's anemia?

(A) Prenatal vitamins with iron supplementation
(B) Transfusion
(C) Intramuscular iron injection
(D) Upper endoscopy
(E) Erythropoietin
(A) Prenatal vitamins with iron supplementatio the answer IDA case
Reply With Quote Quick reply to this message
  #13  
Old 07-31-2011
podebrad's Avatar
USMLE Forums Addict
 
Steps History: CK+CS
Posts: 138
Threads: 28
Thanked 77 Times in 36 Posts
Reputation: 87
Default That was an awesome discussion

(A) Prenatal vitamins with iron supplementation

Explanation:

This patient presents with anemia that is most likely secondary to iron-deficiency anemia from pregnancy. A normal nonmenstruating, nonpregnant person only requires one milligram per day of iron. When pregnant, this requirement can raise to 4 to 5 mg per day. The intestinal system usually cannot absorb more than 3 to 4 mg per day; therefore, pregnant women are routinely anemic. Although the mean corpuscular volume (MCV) is at the low end of normal, she can still be iron deficient. The older cells will be normal, and the newer cells will be iron deficient. Therefore, the RDW shows the difference in the size of the cells. The average cell size (MCV) may still be normal because it is an average of both the older and the newer cells. Although she is tired, she is not severely symptomatic enough to need a transfusion or intramuscular iron injections. Upper endoscopy would not be useful unless she had hematemesis or some other indication of upper gastrointestinal tract bleeding. Erythropoietin will not be helpful in anemia related to pregnancy because this problem is based on a deficiency of iron. The pica described in the question of eating clay, lettuce, and ice chips is a manifestation of the iron deficiency.
Reply With Quote Quick reply to this message
The above post was thanked by:
busterbee (07-31-2011)
  #14  
Old 07-31-2011
busterbee's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 218
Threads: 16
Thanked 110 Times in 59 Posts
Reputation: 120
Default

Quote:
Originally Posted by podebrad View Post
(A) Prenatal vitamins with iron supplementation

Explanation:

This patient presents with anemia that is most likely secondary to iron-deficiency anemia from pregnancy. A normal nonmenstruating, nonpregnant person only requires one milligram per day of iron. When pregnant, this requirement can raise to 4 to 5 mg per day. The intestinal system usually cannot absorb more than 3 to 4 mg per day; therefore, pregnant women are routinely anemic. Although the mean corpuscular volume (MCV) is at the low end of normal, she can still be iron deficient. The older cells will be normal, and the newer cells will be iron deficient. Therefore, the RDW shows the difference in the size of the cells. The average cell size (MCV) may still be normal because it is an average of both the older and the newer cells. Although she is tired, she is not severely symptomatic enough to need a transfusion or intramuscular iron injections. Upper endoscopy would not be useful unless she had hematemesis or some other indication of upper gastrointestinal tract bleeding. Erythropoietin will not be helpful in anemia related to pregnancy because this problem is based on a deficiency of iron. The pica described in the question of eating clay, lettuce, and ice chips is a manifestation of the iron deficiency.
if you people can discuss a little about when to transfuse in different conditions it'l be of great help.... i know in elderly if hct below 30 transfuse n in young it can be delayed even till hct is 20
Reply With Quote Quick reply to this message
  #15  
Old 07-31-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 14
Threads: 1
Thanked 10 Times in 5 Posts
Reputation: 20
Default clay

A. is the correct answer

(B) Transfusion- TRansfusion is carried if Hb <7 or it's an acute hemorrhage.
(C) Intramuscular iron injection - Done if there is problem w/Fe absorption
(D) Upper endoscopy- Stool is guiac negative it's unlikely that she is bleeding from eso varices, besides she'd likely to vomit blood in that case
(E) Erythropoietin- If kidneys are failing then yes-that would be an option. However, I am not sure if it's approved for pregnant
Reply With Quote Quick reply to this message
The above post was thanked by:
USMLE-Syndrome (07-31-2011)



  #16  
Old 08-01-2011
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 200
Threads: 101
Thanked 194 Times in 64 Posts
Reputation: 217
Default

in iron deficiency what value of RDW
i chosse A
Reply With Quote Quick reply to this message



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
One hour after eating baked potatoes! kemoo USMLE Step 1 Forum 5 01-11-2011 10:44 AM
Abdomina Pain After Eating, DDx Sabio USMLE Step 2 CK Bits & Pieces 2 07-22-2010 06:53 AM
Eating raw meat Sarah-cali USMLE Step 1 Forum 11 03-24-2010 08:08 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)