Gyrus Daily Questions; Internal Medicine #57 - 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 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Arrow Gyrus Daily Questions; Internal Medicine #57

A man comes to the emergency department with weakness in his leg that has been getting markedly worse over the last few days. He has weakness and loss of deep tendon reflexes the legs.He recalls an upper respiratory illness about 2 - 4 weeks prior that resolved.What is the most urgent steps?
A.Steroids
B. intravenous Immunoglobulins.
C. Peak inspiratory pressure.
D. Intubation .
E. Lumbar puncture

Q from Condroid Fissure.
Reply With Quote Quick reply to this message
The above post was thanked by:
Rani Kumar (11-07-2012)



  #2  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,088 Times in 1,047 Posts
Reputation: 2108
Default

C. Peak inspiratory pressure.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (10-26-2012)
  #3  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

Quote:
Originally Posted by Novobiocin View Post
C. Peak inspiratory pressure.
Why this patient has weakness of lower limb ?
Reply With Quote Quick reply to this message
  #4  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,088 Times in 1,047 Posts
Reputation: 2108
Default

Quote:
Originally Posted by cingulate.gyrus View Post
Why this patient has weakness of lower limb ?
GBS: demyelination of peripheral nerves due to autoantibodies.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (10-26-2012)
  #5  
Old 10-26-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Quote:
Originally Posted by cingulate.gyrus View Post
A man comes to the emergency department with weakness in his leg that has been getting markedly worse over the last few days. He has weakness and loss of deep tendon reflexes the legs.He recalls an upper respiratory illness about 2 - 4 weeks prior that resolved.What is the most urgent steps?
A.Steroids
B. intravenous Immunoglobulins.
C. Peak inspiratory pressure.
D. Intubation .
E. Lumbar puncture

Q from Condroid Fissure.
Its letter C (in fact the measure of Vital Capacity on the bedside is the accurate answer)

This is because respiratory function tests will tell you who will need to be closely monitored and who doesnt, this in case they require an endotracheal intubation (which a lot will)
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (10-26-2012)
  #6  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

Quote:
Originally Posted by Novobiocin View Post
GBS: demyelination of peripheral nerves due to autoantibodies.
I mean this patient has weakness of lower limb only.There is nothing in the question to sugeest for a respiratory failure except for a respiratory infection 2 - 4 weeks back possibley viral infection which predispose to GBS.
Reply With Quote Quick reply to this message
  #7  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,088 Times in 1,047 Posts
Reputation: 2108
Default

Quote:
Originally Posted by cingulate.gyrus View Post
I mean this patient has weakness of lower limb only.There is nothing in the question to sugeest for a respiratory failure except for a respiratory infection 2 - 4 weeks back possibley viral infection which predispose to GBS.
Yes, there is nothing in the question stem to suggest respiratory failure except that "weakness in his leg that has been getting markedly worse over the last few days". Anyway, you want to rule out an impending respiratory failure i.e. before it happens to compromise his respiration which can be done by doing serial measurements of his Peak inspiratory pressure or VC. I believe measuring Peak inspiratory pressure is easier than measuring VC.

Besides, this is the best option to choose among the choices since:

A.Steroids -don't help in GBS
B. intravenous Immunoglobulins-only given once respiratory failure sets in or other life threatening complications.
C. Peak inspiratory pressure.
D. Intubation - no indication
E. Lumbar puncture-no indication

Quote:
Peak inspiratory pressure (PIP) is the highest level of pressure applied to the lungs during inhalation[1]. In mechanical ventilation the number reflects a positive pressure in centimeters of water pressure (cmH2O). In normal breathing, it may sometimes be referred to as the maximal inspiratory pressure (MIPO), which is a negative value[2].

Maximum inspiratory pressure (MIP) is the value representing the highest level of negative pressure a person can generate on their own during an inhalation.[1] Represented by centimeters of water pressure (cmH2O) and measured with a manometer. Maximum inspiratory pressure is an important and noninvasive index of diaphragm strength and an independent tool for diagnosing many illnesses[2] .
Quote:
A person's vital capacity can be measured by a spirometer which can be a wet or regular spirometer. In combination with other physiological measurements, the vital capacity can help make a diagnosis of underlying lung disease.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”

Last edited by Novobiocin; 10-26-2012 at 09:18 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
anomali (10-26-2012), cingulate.gyrus (10-27-2012), dipika (10-26-2012), Rani Kumar (11-07-2012)
  #8  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 790
Threads: 76
Thanked 672 Times in 316 Posts
Reputation: 690
Default

C is the answer............we have to keep checking for the respiratory function to detect impending failure...most imp step to consider in GBS......

we love your explanations Novobiocin........ Thank you for taking the pain
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Matched!!!
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (10-27-2012), Novobiocin (10-26-2012)
  #9  
Old 10-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,088 Times in 1,047 Posts
Reputation: 2108
Default

Quote:
Originally Posted by anomali View Post
C is the answer............we have to keep checking for the respiratory function to detect impending failure...most imp step to consider in GBS......

we love your explanations Novobiocin........ Thank you for taking the pain
No pain, no gain...........

Quote:
NO PAINS, NO GAINS.
If little labour, little are our gains:
Man's fate is according to his pains.
Hesperides 752.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
anomali (10-26-2012), cingulate.gyrus (10-27-2012)
  #10  
Old 10-27-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 551 Times in 308 Posts
Reputation: 561
Default

You all are correct
Anser is C Peak inspiratory pressure.

This case is Guillian Barre .Ascending weakness with loss of deep tendon reflex is charecteristic. Peak inspiratory pressure is the correct answer.
The peak inspiratory pressure diminishes as the diaphragm is weakened.peak inspiratory pressure predicts who will have respiratory failure before it happens .

It is more important than to start therapy with either intravenous immunoglobulins or plasmapheresis. Combinations of these medications are not effective.
Steroids are not effective.Lumbar puncture ill show an elevated protien levesl with no cells.
Reply With Quote Quick reply to this message
The above post was thanked by:
Rani Kumar (11-07-2012)



Reply

Tags
Internal-Medicine-, Pulmonology-, Step-2-Questions

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
Gyrus Daily Questions; Internal Medicine #54 cingulate.gyrus USMLE Step 2 CK Forum 7 10-13-2012 10:21 AM
Gyrus Daily Questions; Internal Medicine #38 cingulate.gyrus USMLE Step 2 CK Forum 2 09-29-2012 10:47 PM
Gyrus Daily Questions; Internal Medicine #35 cingulate.gyrus USMLE Step 2 CK Forum 3 09-29-2012 03:33 AM
Gyrus Daily Questions; Internal Medicine #33 cingulate.gyrus USMLE Step 2 CK Forum 11 09-29-2012 03:17 AM
Gyrus Daily Questions; Internal Medicine #32 cingulate.gyrus USMLE Step 2 CK Forum 4 09-28-2012 11:37 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)